Unhealthy Industry

From The Australian newspapers’ health section

AT THE COAL FACE: Gabriel James

January 09, 2010

SINCE the introduction of Medicare in 1985 we’ve had more than 20 state and federal health system reviews.

Each identifies lack of money, poor planning and weak primary care as big issues. Each proposes blue-sky goals such as better rewarding of prevention, creating interdisciplinary teams and training more doctors. But what has changed?

If Australian healthcare were a business its stock price would be tumbling. It’s time we recognised that to be sustainable, health must be like any other industry. Instead, our inflexible workforce, burdensome regulation and consumer segregation makes health a nationalised fiasco, with a small proportion of private entities taking the cream.

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Innovation opinions by McKinsey

McKinseys had a few good articles on innovation posted yeasterday. I’d recommend them for a read – and particularly the comments below each article which are quite insightful and perhaps better in content terms also.

This article, on how economic downturns drive innovation was quite controversial. I found one of the comments by a Paul Hamann quite insightful:

Here’s three big ideas for innovation resulting from this recession:

1. Medicine will become an application of computer science. This innovation will finally end the health care crisis and expose the incompetence of most doctors. That’s why the Obama administration won’t compromise on linking physician compensation to outcomes. It’s also why they won’t cap malpractice awards. That’s 17% of GDP finally subject to competition. Info Tech companies will take most of it. Google and Intel will do well. They already are.

2. Computers will become carbon-based instead of silicon, resulting in unlimited compute cycles that are nearly free. This advance will result in absolute ubiquity. It will also enable NP-complete problems to be efficiently solved. That will lead to enormous leaps in engineering and science.

3. The distinction between mobile phone, desktop, and server will go away. We’ll see hardware and Linux-based OS’s become interchangeable across the three categories. This innovation will ultimately benefit Google and end Microsoft’s dominance in software. It will also give a huge boost to the open source movement, benefiting developers and niche software providers. Finally, it will severely disrupt the economics of cloud computing. After all, every new technology gets over-hyped. It’s already time to ask what the cloud computing bust will look like.

I included all three of his points for completeness, but can only comment about the first. It’s a fairly broad sweep but there is some truth in it. It’s by no means an original idea, with the likes of Clayton Christensen and the author of ‘Supercrunchers’ (name?) predicting the exposure of doctors incompetence when health goes truly digital.

The next question for doctors is then how to best prepare for this from an educational perspective. Do we just wait for the innovation? Or should we begin to change our ways of practising medicine in anticipation?

I believe many doctors already are adapting as patients gain access to knowledge and tools they never had previously. As I’ve suggested before, we are becoming more like health managers than health teachers.

Finding Time Out as a Trainee Doctor

We have all been warned many times over the years. but I still think most of us push a bit too hard. So it was great to read this little piece by a junior doctor on ‘burnout. I quote the part that refers to a recent study on doctor burnout:

According to a study from the Johns Hopkins University School of Medicine in Baltimore, I am far from the only doctor who has behaved this way. The researchers interviewed residents, or doctors in training, from seven different specialities and found that they set themselves up for burnout by accepting, even embracing, what they believed would be a temporary imbalance between the personal and professional aspects of their lives. While the young doctors interviewed defined well-being as a balance between all those parts, many felt that their medical training was so central to their ultimate sense of fulfilment that they were willing to live with whatever personal sacrifice was required, even if it meant a temporary loss of a sense of self.

Read the LA Times piece here.

Websites that Rate Doctors having an Impact

In a world where patients can sound off about their doctors at RateMDs.com, Yelp, DrScore, Angie’s List, Vitals.com and some 35 other sites, what’s a doctor to do? In some cases, they’re striking back by demanding that patients sign contracts prohibiting them from making online comments in any media outlet without prior written consent from their practice.For more details read this Washington Post piece.

This trend is only just beginning is Australia where RateMDs.com now has quite a few Aussie doctors on it’s books. But it will change the way doctors operate, just as feedback should.

Some doctors are particularly concerned about the issue. In 2007, the Australian Medical Association condemned the idea. A company in the USA called, Medical Justice, offers a sample privacy agreement starting a $495 and monitors online comments for its 2,000 members. The general feeling is that online comments may do serious damage to a doctor’s reputation while revealing little about their real skills.

There has been some discussion about medical performance indicators in Australia for some time. There was talk of uploading information about a doctor’s mortality, complication and infection rates. This idea was squashed, particularly by surgeons who feared the stats might be misinterpreted where some surgeons do more difficult cases etc.

My view is that there is no way doctors can stop this trend. Feedback will happen some way some how. Where once it was through the daily gossip mills, now it’s online. This is all part of the consumer revolution that will bring, to use another mans term, disruptive innovation to medicine.

The Gender Imbalance

Not so long ago, everyone spoke about the male domination of senior healthcare positions. This is slowly changing, and perhaps even set to accelerate if recent research holds true.

This article, Boys will be doofuses, in Meratornet, highlights research by Mark Penn that shows men are behind women on almost every significant sociodemographic measure in the USA. It is worth a read, particularly for those involved in the mentoring and education of men.

It is also worth considering what impact this will have on the future healthcare workforce. There have been numerous reports (and here) since the 1990’s outlining the impact the increasing number of female graduates will have on the healthcare workforce, but what has been done to deal with it?

Study: One out of five patient visits ‘difficult’

From FierceHealthcare:

Over the last 30 years, physicians have consistently reported that at least one out of every five or six patient visits was “difficult.” A recent study published in the Archives of Internal Medicine only underscores that conclusion.

To conduct the study, researchers surveyed 449 general internists and family practitioners at 118 U.S. clinics, asking them to estimate how often they had contact with patients exhibiting any of eight behaviors considered to be the most difficult. Those behaviors include insisting on unnecessary tests or medications, dishing out verbal abuse or disrespect, having unrealistic expectations for care and persistent complaining despite a physician’s having done everything possible to assist that patient.

The researchers found that primary care doctors who said that they dealt with a large number of difficult patient encounters were typically younger and more likely to be female. The most frequently-seen difficult behavior reported was patients insisting on being prescribed an unnecessary drug, a problem cited by more than one-third of responding physicians.

Are doctors influenced by advertising?

A study published in the Internal Medicine Journal has been cited as evidence that doctors are influenced by drug advertising.

It shows a correlation between prescribing behaviour and and the launch of various advertising campaigns. It should come as no real surprise. Who would have thought that pharmaceutical companies would bother spending money if they saw no impact from their advertising?

Websites for the Connected Doctor

A continuing medical education website has been launched that provides free virtual access to educational conferences and meetings. Medical Update contains video and power point slides from events from around the country. The site has been live since October, and currently includes presentations from local and international clinicians covering a variety of topics including eating disorders, cardiology and ophthalmology. 

A Facebook-style website has also launched for Australian doctors. Multimedix is designed for both professional and social use. On the site you can search  for friends, colleagues and contacts; discuss cases, ask clinical questions in a secure forum-like setting; and form special interest groups.

Digital Healthcare needs Incentives

This blog has often remarked that much of the healthcare system is either too distracted, poorly planned or too old-school to evaluate and implement digital solutions for practice and hospital management software.

The US government is trying to overcome this with incentives. Starting in 2011, physicians who show that they are “meaningfully” using health IT would be eligible for $40,000 to $65,000, and hospitals would be eligible for several million dollars. The incentives would be phased out over time, with penalties in place by 2016.

This news comes as another study is published showing that hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs.

The Australian government is trying to implement a Practice Incentives Program that encourages IT uptake, but is running into problems with disagreements over architecture.