e-Patient Dave

Power to the Patient!

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We the old(er) are getting REALLY old. And numerous. Think about it.

Forbes.com logoEight weeks ago on Forbes I noted an article I’d found that said half of all humans who’ve ever been 65 are alive today. (Actually the source said 60-75% of all 65+ people ever. But I’ll settle for half.) In less than two years that demographic bomb will include me.

Think about that.  There are 3x more people alive today (7 billion) than at the start of the baby boom (2.3 billion, 1946).  Combine it with the reality that because medicine is awesome, people who in those days would have died (e.g. me) are living much longer. Lots of old people coming. Zombie fields of old people. (We’re not “getting old” until much later, but there are a lot of us.)

Case in point: here are  the 34 obituaries in today’s New York Times.

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Forbes post on a fascinating TED idea: put capability in untrained hands??

Forbes screen grab (click to visit on Forbes)
Click to visit the post on Forbes

Update 5/10: fixed the link to the Forbes post. Thanks to Flora for reporting the mistake!

My new post on Forbes has generated the most activity I’ve had there, in terms of views, Tweets, links and comments. Its topic is an amazing new thought that’s come to light just this year, thanks to a TED Prize talk that was given this winter by a guy name Sugata Mitra. His thing is “SOLE”: Self Organized Learning Environments.

(I know some of you already saw this on Forbes, but a lot of my readers don’t go there.)

Click the image (or here) to visit the post and watch his 2013 TED Prize talk.

He’s clearly crazy.  In 1999, in the slums of New Delhi, he put an internet-connected computer through a hole in the wall that’s the boundary of the slum region, so little kids could get at it. He gave them no instruction, and came back months later. What he found, as you’ll see, is that the kinds had figured out all kinds of stuff, just by poking and exploring. Without mature supervision.

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The Big Ugly continues: “Hospital charges bring a backlash”

Here’s the next episode in what I’m starting to call “The Big Ugly” – a wave of suffering that will happen as the medical industry contracts, and everyone tries to find ways to maintain their income. Unfortunately when an industry shrinks, everyone can’t maintain the same income. As anyone knows who’s seen an industry die (like mine, typesetting; or steel in America, or what Detroit went through), it’s painful. Good people get hurt, and organizations fight for survival.

Medicine’s certainly not going to die – we need it – but the Institute of Medicine says (see links below) we have massive overspending, and when the overspending shrinks, that too will hurt.

Today’s Boston Globe has the newest item: Hospital charges bring a backlash:

Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay.

Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers. …

The Globe published a story in January about a patient charged $1,525 in operating room and facility fees for a minor skin procedure. Yeah, the doctor charged $354 for her services, and the hospital (Lahey Clinic) added $1525 of overhead. Another patient is quoted as sounding like (amazingly) an empowered consumer:

“I am willing to spend my money for my doctor — I am getting expert care,’’ said the New Hampshire resident. “I am not willing to pay $500 to sit in a waiting room.’’

Watch for more stories of overhead charges, and more, as organizations gasp for air, and ask consumers to bear the burden. See other stories in the links below, like the chain that put its E.R. docs on quota.

What to do: [Read more…]

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Collapse couldn’t happen in law, and it can’t happen in medicine. Right?

If you care (or worry) about the crunch-time that’s beginning in medicine, read this post last Tuesday on the Harvard Business Review blog:

Creative Destruction Visits the Legal Profession

It has strong echoes of what I wrote last month in As the crunch hits, will the best survive? That post talked about how much pain there’s likely to be as we try to solve the $750 billion of unnecessary spending in US medicine.  Until now I wasn’t aware of how much the legal profession has been hit by changing realities. Items from the HBR post:

  • “In the ten years or so since running that course, the assumptions underpinning a lot of the business models at law firms have come unraveled. Just as we argued, a lot of the lower-end, but profitable, work is now being done by cheaper providers or has been automated”
  • “Legal budgets have come under intense scrutiny as the Great Recession’s aftermath grinds on.”
  • “And — gasp — lawyers are now realizing that if nobody is looking after the business end of things — ahem — in other words, being strategic, the entire operation can come to a crashing halt. Witness the spectacular bankruptcy of once high-flying Dewey & LeBoeuf.”

Yeah, the bankruptcy of a once-high-flying law firm. More:

  • “The problems started to become urgent when young lawyers, armed with freshly minted degrees, either couldn’t get legal jobs or, worse yet, couldn’t get jobs at all.” Only 55% percent of 2011 graduates had a law-related job nine months after graduation.

Imagine if only 55% of med school graduates could find a job. Can’t happen, right?

That’s at the low end. And at the top?

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Pricing visibility – video interview with HealthWorks Collective

Last month I was interviewed by Joan Justice of HealthWorks Collective. She’d picked up on my “visible pricing” rant, and couldn’t agree more, so we did this nine minute Skype interview.  Her full post about it is here.

Her entire series of interviews on high quality, low cost healthcare is here. Thanks for including me, Joan – it was stimulating!

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Reprise: The healthcare waste pit is BIGGER than the fiscal cliff.

For my last post of the year, as word filters out that Washington still can’t fix “the cliff,” I’ll do something rare: repeat something from just a few days ago. This needs to sink in for everyone who wants to fix America’s medical costs:

The “fiscal cliff” is big, but America’s excess medical costs are 30% bigger.
(Not total costs – just the waste that needs to be trimmed.)

As we start 2013, think about that.
Think how much commitment and guidance
it will take to fix it.

Some providers are working really hard to improve effectiveness,
and some insurance companies are too.

Some aren’t.

A lot of people’s income depends
on keeping things the way they are.

During the change, how will we ensure
that families and the best workers in the system are protected
while inefficiencies are pruned?

Here’s this week’s post again, tweaked just a little:

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