Category Archives: Quality of Care & Safety

Innovative aspects to improving the quality of care and protecting patient safety.

Advancements in Understanding Head Trauma and Preventing Long-Term Problems

Posted on by
1

When I was training to become an orthopedic surgeon, one of the senior physicians said that the two best learning sources for orthopedic surgeons were football and war.  Over the past year I’ve been talking with friends and colleagues about another connection between war and football – how minor repetitive head trauma has long-term serious consequences.

It has become clear with the increasing reports about the neurological, cognitive and personality problems military personnel have experiences after repeated minor concussive events, (often from being inside vehicles hit by IEDs), that this is a real and serious situation.  While the VA health system has taken steps to understand the consequences of repetitive minor head trauma and work to provide appropriate diagnostic and treatment methods, I have been telling people that this new understanding of neuro-trauma will have implications for football.

There have been more than a few reports about former NFL players having neurological problems after retiring; In particular, former Patriot Ted Johnson, whose problems with post-concussive syndrome was reported 2 years ago in the Boston Globe.  And just today, the Boston Globe had an article about how the brain of an 18 year old football player, (who died from nonviolent causes), showed early signs of irreversible damage from repetitive head trauma – something that had not been documented in professional football players younger than 36 years old.

War is different than football: In war, the goal is to avoid head trauma and steps can be taken to avoid it or minimize its effects through better vehicles and helmets – and by taking people out of harms way after head trauma has occured.  Conversely, in football, the contact, hits and subsequent head trauma are essential parts of the game.  While helmets have been made better and players can be taken out of the action after even minor head trauma, football can’t be played with complete cushion suits like those sumo-style outfits used in late-night and reality TV shows.  Last summer I wrote about how professional baseball teams are becoming more aware of the lasting effects of concussions on their players – but baseball isn’t inherently a contact sport.  I wish I had a good answer for football and football players.  Unfortunately I don’t think switching to flag or touch is going to make it as an alternative to full contact football. I’m a fan, but I don’t have good suggestions, and understanding the long-term consequences of repetitive minor head trauma, often makes it difficult for me to watch a football game – professional, college or high school.

Quality of Care in Medical Practices – Size Does Matter

Posted on by
6

The Journal of General Internal Medicine published a study last month that looked at primary care medical practices in Massachusetts to see how well they were able to provide the quality improving capabilities of Patient-Centered Medical Homes.  These structural capabilities represent process measures that assess the quality of care in medical practices.  However, these same measures could also help patients select their own primary care physicians.

Study Finds Larger Practices Have More Quality Related Capabilities
Not surprisingly the study found that larger practices, (and to a lesser extent those affiliated with larger networks of practices), provided more capabilities to improve the quality of patient care. The most significant difference in capabilities was seen in practices with 5 or more physicians, and these included:

  • Practice meets to discuss quality more frequently than every quarter
  • Practice regularly open to provide care on weekends
  • Use of Electronic health records that provide medication list, problem list, and electronic reminders

In addition, practices with 9 or more physicians were more likely to have specialty trained staff to assist with patient self-management, and there was an overall trend for larger practices to have reminder systems for preventive care:

Quality Improving Capabilities Increase with Practice SizeAsking Questions to Improve Quality
The questions used by the researchers in this study are clearly useful for assessing the quality relate capabilities of primary care practices, but additional research certainly it warranted to determine how well these process measures translate into actual improvements in clinical and economic outcomes. In addition, as such lists are developed and validated further, they could also be used by individuals looking for their own primary care physicians, and by patient advocacy organizations seeking to both promote quality improvement and to “grade” primary care providers.

The specific questions used in the study’s survey was:

Quality Capabilities for Primary Care Practices

One of the challenges for individuals or groups to effectively use any list of this type is that it needs to be customized because they will have different priorities and concerns. For example, the availability of translation services might be important for one family or advocacy organization, but less so for others.

Conclusion
Much has been written about using checklists to improve quality and reduce errors in hospitals – and particularly in the operating room.  But perhaps checklists could be derived from this type of Medical Home capabilities survey for use by individual patients and their advocates to assess outpatient clinical sites.   While the operating room checklist concept was based upon the airplane pre-flight checklist, maybe the checklist for assessing primary care practices could be likened to the checklist that home inspectors use to help home buyers understand the strengths and problems of a house. If individual patients and their collective advocacy groups regularly used checklists of this type, it could create a significant patient driven force for transforming the structure and operations of outpatient medical care in the United States to improve quality and control costs.

Making Physicians Better, and Making Better Physicians

Posted on by
5

A few recent reports point to ways for improving the quality of physician delivered care that has little to do with technology or complex interventions.  The first involves how physicians interact with patients, and the second examines the work hours for physicians in training.

Etiquette in Medicine
The first article, by Dr. Michael Kahn in the New York Times, describes six recommended actions for physician to create a good rapport with hospitalized patients. Dr. Kahn collectively calls these actions “etiquette-based medicine”:

  1. Ask permission to enter the room; wait for an answer
  2. Introduce yourself; show your ID badge
  3. Shake hands
  4. Sit down. Smile if appropriate
  5. Explain your role on the health care team
  6. Ask how the patient feels about being in the hospital

Clearly these actions are all directed towards creating a stronger person-to-person connection between the physician and the patient as a step toward improved communications – which is the foundation for developing and effectively delivering a treatment plan to and for the patient.

Physicians Getting Rest
Another challenge physicians have in this process is being awake and aware enough to actually engage in those 6 steps. (Having enough energy also would effect their ability to engage patients empathetically – something I’ve written about before.)  [Also see the previous posting about napping being better than caffeine for improving verbal and physical memory and learning.]

How much sleep physicians need to act appropriately – and avoid making errors – is the subject of a recent Institute of Medicine report, (“Resident Duty Hours: Enhancing Sleep, Supervision and Safety”), that makes new recommendations for limits to the work hours for physicians in training:

  • Duty hours should not exceed 16 hours per shift; For 30 hour shifts there should be an uninterrupted five hour break for sleep
  • Residents should have variable off-duty periods between shifts based on the timing and duration of shifts to increase residents’ opportunities for sleep each day, as well as regular days off that enable residents to recover from chronic sleep deprivation.
  • Medical moonlighting, (additional paid healthcare work), should be restricted
    [A chart comparing the current and new recommendations is available here.]

While all these changes would certainly make for more aware and awake residents, the IOM also estimates that recruiting and paying professional staff to substitute for the work hours the residents would have been (over)working, would cost about $1.7 billion.

Besides figuring out how to pay for these new staff hours, one policy question for implementing these recommendations is how to find the clinicians to actually work these hours considering there is such a shortage of non-physician clinicians.

Anther policy question these recommendations raise, is why they should they only apply to physicians in training?  Why shouldn’t they also apply to physicians who’ve finished their training and are supervising, teaching, and mentoring residents and medical students – and of course are directly responsible for patients?  While it might be argued that most physicians don’t work these long hours, for some that may not be the case – particularly in hospitals without many residents.

Considering that many quality improvements for medicine have been taken from the airline industry – such as the pre-flight/pre-surgery checklist – then why shouldn’t the limits on pilot shifts and hours also be applied to fully licensed physicians?  [I suspect that this will not make me popular with some physicians, but I wonder how they will defend their right to treat patients round-the-clock without sleep?]

Conclusions
Perhaps work hours and etiquette should be other aspects of quality improvement and patient safety that are considered as part of health reform discussions at the Federal and State levels. Certainly well-rested, empathetic physicians trained to interact with their patients with etiquette should improve the quality of healthcare by reducing errors and making physician-patient communications more effective.

How to integrate all these “innovations” into physician training and practice will be a significant challenge, because teaching such skills and promoting their use is not very exciting or technological, and it will be hard for such behaviors to be tied to economic incentives – which are often the carrot or stick for quality improvement initiatives.  Hopefully, as health reform ideas move forward and become crafted into comprehensive packages and plans, they will expand beyond direct economic incentives for improving clinical processes, to include non-economic inducements to promote quality enhancing actions and attitudes for clinicians as well as patients.

Napping to Increase Productivity

Posted on by
1

The New York Times had a great short report about a scientific study comparing a short nap to caffeine for improving a person’s memory.  The study found what many people have suspected for years – a nap is better than caffeine.

The benefits of napping are something that proponents of “power napping” have known for years. (Disclaimer: I’ve used the 20 minute power nap for years to re-energize and turn an afternoon impaired by a severe case of “the weakies” into several very productive hours.)

The study specifically found that naps were better for improving recall of a word list after both 20 minutes and 7 hours.  Naps were also better than caffeine for improving performance on a finger tapping task.  (This tested the ability to recall physically learned memories rather than the word list’s verbally related memories.)

The study also found that the caffeine group performed worse on the finger tapping test than the placebo group, and both napping and caffeine were better than placebo on a perceptual memory task of discriminating textures.

Questions Raised & Possibilities for More Research
Why caffeine is better than placebo for the perceptual task is an interesting finding?  Perhaps caffeine has some performance improving effect in peripheral nerves or nerve receptors.  This possibility could be examined by studying how caffeine effects other perceptual senses such as vibration and proprioception.

The statement from the study author in the New York Times that, “People think they’re smarter on caffeine,” points to the possibility that caffeine’s central neurological effects create false impressions of performance.  This might be another interesting avenue for research.  Particularly what does this increase in believed performance ability have on errors rates in important tasks such as flying an airplane or performing medical procedures?

Postscript: Reading this study also reminded me of a discussion I had many years ago with a corporate HR person about napping.  She had distributed information about identifying employees who had substance abuse or health problems that included “sleeping at work” as one of the warning signs.  The next day, the newspaper had an article about power-napping for productivity – which I sent to her, and she later confirmed that this was not what was meant by “sleeping at work.”

Engage With Grace

Posted on by
1

Many bloggers are posting information today about a initiative to encourage conversation about a very difficult topic: How we want to die. This collective effort to prompt discussions about this topic at the beginning of the holiday season is very timely, and it is a good complement to my post last week about empathy and compassion in healthcare.

What follows is essentially the same text that appears on many other blogs along with a picture of the “One Slide” listing the 5 conversation promoting questions that are at the core of the Project:

———————————————————-

Engage with Grace: The One Slide Project is an astonishingly simple idea that literally touches everyone. Alexandra (“Alex”) Drane, whose sister-in-law died in the hospital, (at age 32 of glioblastoma – seven months post diagnosis – grab your tissues and see the backstory), has set in motion a talking/blogging/thinking campaign to get us to deeply consider how we want to die.

Alex’s one slide has five conversation-starter questions about dying, really simple stuff like: given the choice, do you want to die at home or in the hospital; do you want medical intervention or not…etc (see below) – and then she did the networking thing. Now bloggers have agreed to post her message about the campaign as a Thanksgiving project. We’re all posting the same message – with a lead-in of our choosing on Nov 26 – and leaving it up throughout the holiday weekend (yay! an enforced break from blogging – my family will be so happy).

The One Slide from the Engage with Grace Project

There’s also a great video with Alex explaining how she used the very best of networking principles to keep this really really simple. We make choices throughout our lives – where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don’t express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.But our end of life experiences are about a lot more than statistics. They’re about all of us.

So the first thing we need to do is start talking. Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences.

And we’re asking people to share this One Slide – wherever and whenever they can.at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had. Here is what we are asking you:

Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Help ensure that all of us – and the people we care for – can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.)

———————————————————-

P.S. – I just wanted to add that I have had several friends and relatives succumb to brain tumors, so I have a personal connection this story and this project’s goals.

Proposals for Expanding the Full Range of Compassionate Care

Posted on by
3

Two recent events made me think about how traditional medical care and medical education address the issue of compassion.

The first was at the annual dinner for the Kenneth B. Schwartz Center when they gave out their annual Compassionate Caregiver Award, and reviewed the accomplishments of  previous awardees.  These individuals have all made remarkable differences in the lives of patients and families through their empathy and personal connections.

The second event was reading about the passing of Florence Wald, the former Dean of Nursing at Yale who organized the first hospice in the United States in 1974 because of her interest in compassionate care at the end of life.

While there has been much discussion about:

  • Shortages of primary care clinicians
  • How medical school graduates are increasingly going into specialties
  • Medical schools are thinking of replacing the requirement that applicants have taken organic chemistry with requirements for more biochemistry or genetics
  • A survey of physicians finding that over the next three years 49% plan to reduce the number of patients they see or stop practicing entirely, and 60% would not recommend medicine as a career

All these relate to the structure and content of physician education and training.  And I have two proposals:

First, while  medical school education has progressively shifted from teaching in hospitals to more out-patient and community care, I think doing more to show medical students and residents the rewards of community primary care would be a good step for increasing the number and prestige of primary care clinicians.

And second, while medical schools require students to go through rotations in pediatrics, Ob/Gyn, medicine, surgery and psychiatry, I don’t know of any that require students to go through a hospice rotation.  This may be because medicine and society try to discount death as a failure, but a hospice rotation would be a great opportunity for teaching students about empathy and compassion, and shifting the discussion of death within the context of medical education so that it is viewed more as part of the continuum of life.  In addition, having medical students in a rotation where they are not reporting to (and trying to impress) senior physicians, but rather working with nurses and social workers, also might provide them with a better perspective on teamwork in healthcare delivery – as well as a dose of humility.

The value of hospice (or palliative care) rotations for students does seem to be growing.  An article from 2006 reported that the University of Arizona was thinking about requiring a hospice rotation.  And the American Association of Medical College’s web-site has an article from 2004 about how Mt. Sinai has integrated palliative care into their curriculum.

Does anyone know of any medical schools that require hospice rotations for medical students or have integrated these types of programs into their core curriculum?  (BTW – A major focus for the Schwartz Center is grand rounds and other educational programs about compassionate care and patient-caregiver communications for both established clinicians and students.)

And lastly, it should also be recognized that expanding young physicians communications and empathy skills should help them work better with their patients, (and patients’ families), which could help reduce unnecessary and costly care.

Personalized Medicine – Fulfilling the Promise of Genetic Research

Posted on by
Reply

It has been 55 years since the discovery of the structure of DNA, and 40 years since James Watson published his account of that discovery in his book, “The Double Helix.”  (A picture of my autographed copy is below.)

Double Helix - James Watson - Signed Copy

Ever since DNA was discovered to code for the structure of most living things, there has been the hope that understanding abnormal genetics would lead to the ability to treat or cure a vast array of illnesses.  Unfortunately, that progress hasn’t been as rapid as originally hoped.  But medical science is now beginning to put genomic research discoveries into actual medical practice, and start customizing medical treatments based upon each individual patient’s genetic makeup – the fundamental concept of “Personalized Medicine.”

What are genetic tests and how are they used?
The simplest genomic tests are those that inform a clinician about the choice and/or dosage for a medicine to treat an individual patient.  This type of test is generally easy for clinicians understand and use since it provides information that it is very similar to antibiotic resistance testing – a test that clinicians have used for decades.  Currently, this type of genetic testing to guide pharmaceutical treatments is being used to guide chemotherapy for cancer – where the genomic make-up of the cancer cells can indicate susceptibility or resistance to certain medicines.  It is also being used in a few other ways, including identifying individuals whose genetic make-up indicates that they should receive lower (or sometimes higher) dosages of certain medicines.

New Reports on Personalized Medicine
Several publications and reports have come out recently about advances in Personalized Medicine.  The most recent of these was three articles in the November/December issue of Health Affairs.  These articles point out the challenges for turning scientific advances into better clinical and economic outcomes.  In discussing this very broad issue these articles emphasize the progression from the laboratory, to clinical research tools, to clinically useful tests that can provide information to guide medical care, to actual treatments designed to interact with or alter the individual’s genetic makeup.

There are obviously many additional facets and nuances to this progression, and it is a very challenging road on which reimbursement plays a very important part in determining speed of development and research priorities.  That is, reimbursement amounts and policies not only influence access to genetically-based tests and treatments, but they also create incentives that guide the development of future tests and treatments.

Another recent publication is from FasterCures, titled “Patients’ and Consumers’ Interests and Perspectives in Personalized Healthcare.”  This paper provides patient perspectives – which are not overtly addressed in the Health Affairs articles.   To present a broad picture of patients’ perspectives, FasterCures surveyed various groups and individuals, and they found that:

  • Patients are just beginning to understand the concept and potential of “personalized medicine” – although the term may not be recognized or fully understood by many people.
  • Many see personalized healthcare as an advancement that should be consistent with and support “patient-focused care,” and that it should help improve the quality and cost-effectiveness of healthcare.  However, many also recognized that new tests and treatments have the potential for increasing total healthcare costs – at least in the short-term.
  • Patients want to be educated and involved, not only in their direct clinical decisions, but also in the research and development process that relates to their particular health concerns.  And there was also a recognition of the tension between genetic testing being available, and the results of those tests being meaningful and useful.  (This tension was also discussed in the Health Affairs papers.)
  • And of course, patients are concerned about the privacy of their genetic information.

The FasterCures paper concludes with a 4 point Action Plan for speeding the process of making personalized healthcare a reality:

  1. Involve Patients in Medical Research
  2. Transform the Drug Development Process
  3. Protect Patient Privacy
  4. Focus on and Deliver Patient-Centered Care

Growing Interest and Meeting Information Demands
Interest in applying genomic research to clinical medicine is clearly growing, and genetic tests and treatments will increasingly become standards of care.  For this to happen, clinicians, patients, and other key stakeholders will need a greater understanding of these tests and treatments, and their proper role in clinical care:

Clinicians will need to keep up-to-date about the latest clinical applications involving genetic tests and treatments so they can educate patients in their role as “learned intermediaries” – the term sometimes used to describe how clinicians explain to patients what is causing their medical problems and what are the best treatment options.

Patients will need to be educated about the value and meaning of possible genetically based tests and treatments. And while physicians can do some of this educating, they have limited time.  This gap has begun to be filled by Genetics Educators – a masters level clinician who can work with patients to help them understand the implications of the results of any genetic tests or family history. While there is currently a shortage of Genetics Educators, in the future they may fill a role much like nutritionists do for diabetics, but for a wide range of genetically based tests, treatments and conditions.

And lastly, recognizing that there is a rapidly expanding need to educate other key stakeholders about genomic issues, the Personalized Medicine Coalition (PMC) was formed just over 4 years ago to “to foster understanding and adoption of personalized medicine for the benefit of patients.”  The PMC was started by a couple of dozen biotechnology, pharmaceutical and information technology companies and groups, but has grown into a much larger coalition that includes academic institutions, government agencies, patient advocacy groups, payers, clinical testing companies, and others.  Collaboration among these types of groups that will be necessary for developing, validating, determining appropriate uses and reimbursements for genetically based tests and treatments so that Personalized Medicine will become part of the solution for increasing the quality and cost-effectiveness of healthcare.

Medical Homes, Hammers and Nails

Posted on by
2

Medical homes are being promoted as a way to improve health care delivery by increasing the coordination of patient’s primary and specialty medical care.  The goal of medical homes is to ensure that patients’ care is comprehensive, appropriate and patient-focused.

One of the benefits to the patients and the healthcare system is that medical homes can help sort out the confusion that can arise from the phenomenon sometimes described as, “When you’re a hammer, everything looks like a nail.”

Hammer & Nails

In healthcare delivery what this means is that sometimes the diagnoses or treatment recommendations from specialized clinicians will reflect their expertise – and thus their may be inconsistencies or conflicts in the recommendations coming from several  specialists. The challenge for the patient is to determine the best course of action for them.  And that’s where the value of their primary care clinician in a medical home – they have access to all the patient’s information and can help coordinate and translate all this information for the patient, so together they can make the most informed and appropriate decision.

This coordinating and translating task is important for acute and serious illnesses, as well as for chronic conditions – particularly when their is no generally agreed upon standard of care, of if the accepted course of treatment does not prove satisfactory for the patient.

This situation arose recently for a friend at the same time there was an article in the New York Times where the author described her nearly identical series of interactions (and frustrations) with the medical care system when dealing with hallux limitus or rigiditus – basically, limited motion of the big toe, accompanied by pain caused by bone spurs and/or arthritis.  The “hammer sees a nail” phenomenon here is that the surgeon sees primarily a problem that can be solved with surgery, while the podiatrist sees primarily a problem that can be helped by an orthotic.  As the New York Times author discovered, there may be other options that could work for her.  But from her writing – and my friend’s experience – this was discovered because of the patient’s diligence and not from the coordinating role of her primary care clinician in a medical home.

Another way to view the function of the medical home is to look at a medical home as trying to replicate the close interpersonal relationship between each patient and their primary care clinician that existed decades ago, while still enabling the patient to take full advantage of medical advances.  In addition, such relationship building could help reduce malpractice costs since it should improve both the quality of care, and patient-clinician communications about the goals and expectations from possible treatment options.

Challenges to Creating Medical Homes
Building these homes faces several challenges, including the shortage of primary care clinicians who need to be at the center of the coordination process working with patients and other clinicians to define realistic and patient-specific goals and treatment plans. Another challenge to creating well-run medical homes is that specialists may balk at being part of such a formal coordination process.

Implications for Health Care Reform
What this mean for health care reform is that while medical homes should be promoted, they cannot easily be created for everyone from our existing resources.  Therefore, they should first be built where they can have the greatest impact – for people with chronic and multiple medical problems, while at the same time our overall capacity of primary care clinicians is increased.  These two initiatives can be complementary because creating successful medical homes should increase the economic attraction of primary care as a medical career, while also demonstrating to medical students and residents the value and attractiveness of primary care when practiced in a medical home type setting.

In addition, other important health reform initiatives such as electronic medical records, and turning the findings from comparative effectiveness research into actual medical practice, will support of the creation of medical homes that can improve the quality of medical care, help reduce waste and improve the overall efficiency of health care delivery.

And lastly, it is clear that there is a desire for medical home type services since this is basically the concept underlying concierge medical practices.  For those not familiar with concierge medicine, this is where the primary care clinician signs up a limited number of patients who pay $1,500 – $25,000 per year, and the clinicians commits to spending more time with them, will explain in greater detail their medical issues and options, and take on the role of coordinating their care amongst all needed specialists.  While I don’t have the data, I’m guessing that individuals who are are paying for these concierge services are not the patients who would receive the most clinical benefit from medical homes.  And clearly, with too few primary care clinicians, having these physicians limiting the number of patients they will see doesn’t alleviate that shortage.  So, while I understand the motivations and market forces driving the creation of concierge medical practices, given the current problems in our healthcare system, I don’t think they are pushing the use of limited resources in the best direction to benefit society overall.

Communicating Health Information and this Blog’s Goals

Posted on by
Reply

Noting that I’ve written about a wide variety of health and biomedical research issues, someone recently asked me about the focus of this blog.  My response was that my goals are two-fold:  First, to present synthesized information – created by combining different sources and analyses – in ways that provide new perspectives on important issues so that people have both broader and deeper understanding of these issue.  And second, to reach multiple audiences with this information and perspectives so that the spectrum of healthcare stakeholders can better communicate and understand each other.  Which is just stating in a different way what I wrote in my first posting, that the reason I started this blog was “to provide stakeholders of all types, (such as patients, clinicians, administrators, payers, researchers, regulators, legislators, etc.) a forum for discussing healthcare policy issues. The focus of these discussions will be about how the development and use of innovations can effect clinical and economic outcomes.”

I view these two goals are complimentary, since together they help people crystallize insights about issues and make them more able to consider what specific actions would be most productive.

Sometimes my analyses take the form of questioning how information is presented to different stakeholder groups, and how that could be done more effectively.  For example, in the last two days I saw that the FDA notified a company about selling two unapproved over-the-counter medicines (asprin plus nutritional supplements), and issued a warning about a banned ingredient in a food product (Mexican “vanilla”). The challenge for the average person is to first hear about this information, so they can be aware of any risks, and second, to put it into a context useful for them -  such as the potential problem with “Mexican vanilla” if they are taking blood thinning medicines.

For both these situations the FDA issued a press release and notices intended for consumers.  Newspapers generally pick up these stories, and print them in ways that appropriate for the scope of the issue – usually a few inches on an inside page.  My concern is that some people who should know this informaiton might not be made aware of it because the FDA’s very broad mandate and limited resources means that different outside advocacy groups and the media need to spread the word.  Certainly better internet communications and increased FDA funding should help improve this, but as I’ve said before, I think there needs to be broader evaluations of how people get their health informaiton and what they do with it.

We clearly have a health information gap this country – and if this gap was in medical technology or military capabilities then the general public, the media, and politicians would be more engaged and upset.  Thus, the challenge for our country is to expand our discussion of the development and delivery of useful, (some would say actionable – but I don’t like that word), information to people so they can change the decisions they make that affects their health and wellness.

Another example of communications challenges involved the start of Medicare’s new system for paying physicians in the early 1990s.  While the methodology was very complicated – and is still somewhat contentious – the communications issue that rankled many physicians was how the new system was described as distinguishing between what were called “cognitive” and “non-cognitive” services. What this really came down to was differentiating between health care delivery involving a procedure, (like an operation), and testing, talking and prescribing.  As you might imagine, surgeons were not too pleased to be told that what they did was “non-cognitive.”  The reason I raise this old example, is that one of the major challenges facing the US healthcare system is the shortage of primary care clinicians.  And I can imagine that there will be some communications challenges with both patients and clinicians about how to improve this situaiton in the future.  While any policy changes might not pit surgeons v. non-surgeons, it very well might find specialists and primary care clinicians at odds over terminology, status, and of course….. money.

So those have been my goals for this blog, and a couple of examples of the challenges of communicating health related information to different stakeholder groups.  I hope that my postings have at least partly fufilled my goals, and from the comments left here, the emails I’ve received, and direct feedback from readers, I think there’s been some success.  I will continue working to build on those successes, and if you have any comments or suggestions, please let me know – either as a comment here, or via email.

Rx for Excellence Leaders in Quality Award

Posted on by
Reply

I often find it hard to tout my own accomplishments, so I’m happy to report that Dave Dykeman, a colleague and friend, nominated me for the Massachusetts Medical Law Report’s Rx for Excellence Leaders in Quality award.  After what I’m told was careful consideration, I was selected as one of the people to receive this award – in part because of the success and substance of this blog.

I’m very honored to be included with the other distinguished awardees – including Atul Gawande, my old Congressional colleague. (You can see write ups of the awardees here.)   And I hope that their decision is not only in recognition of our past achievements, but a vote of confidence for our accomplishments yet to come.

There is also a short video clip of some of the winners – don’t blink at the beginning or you’ll miss me. And on Friday, October 31st there is an awards ceremony in Boston. (This should be a great event.)

Well, enough about me.  Next week back to more about health policy issues, including issue advertising around the presidential campaign – something I’ve been watching for several months now.