The Wall Street Journal a few weeks ago put out some numbers on the contributions by the health care industry to the presidential candidates. The numbers show you can’t fit into one category the political persuasions of this industry. Both democrats and republicans seemed to enjoy the favor of health care’s corporate contributors. John Edwards was missing in action from most of the list (no surprise there) with the exception of Kaiser Permanente. This ‘love-you-all’ line up will be interesting to follow as the field of candidates starts to narrow down. As you know, following the money is one good test to find out what direction the political wind is coming from, and who is on the receiving end.
Medical Education Internet Style
September 17, 2007 — Fred FortinA recent press report by Hayley Mick of Canada’s GlobeandMail.Com, shows an interesting model for medical education that could be expanded through organizing medical volunteers or mounting a social entrepreneurial effort.
The report describes the activities of one doctor, Allan Okrainec, who has established a Tuesday routine wherein he teaches — in this case — several Botswana-based surgeons the basics of a minimally invasive surgical technique that is increasingly common in Western nations due to its health benefits - but rarely used in Africa. The only equipment required in both countries is a laptop, a television screen and a web cam.The cost is really nothing except, of course, for the time of those involved. For many areas of the world, translation services would also be required as well.
What is interesting is that the effort of one individual combined with this technology can make a significant difference in the quality of care for those living in remote or under served areas of the world. And it is applicable to many of the health care disciplines. What if we had several hundred professionals across the country volunteering to spend an hour or two a week or month teaching using methods appropriate to the technology, the applicable skills involved and the accreditation requirements of the various professional organizations? How about those who may be retired from work but not from life taking this up as a new humanitarian vocation?
The possibilities start to grow exponentially the minute you start thinking about these opportunities.
Lost in Translation: The Health of Chinese Netizens
September 15, 2007 — Fred FortinA recent report on a China survey says that about “73 percent of Chinese netizens are in sub-healthy state with 70 percent of them suffering from psychological problems.” But here’s the key quote: “More than 70 percent netizens have suffered amnesia, anxiety and scatterbrained problems, however, 90 percent of them never resort to psychological doctors, the survey showed.”
What?
Is being scatterbrained now in the DSM (Diagnostics and Statistical Manual of Mental Disorders)? Is it a treatable condition? Will I be able at last find my car keys?
Maybe we’re talking about a little ADD (attention deficit disorder) here which sounds a bit more in line with what you would expect.
The Continuing Struggle over America’s Bicycle Commons
September 14, 2007 — Fred Fortin
“The thing that troubles us about the industrial economy,” writes Wendell Berry, “is that it tends to destroy what it does not comprehend, and that it is dependent upon much that it does not comprehend.”
Salon writer Katherine Mieszkowski offers up a nice retrospective on the recent controversy surrounding Secretary of Transportation Mary Peters’ remarks made in her August 15th appearance on PBS’s “NewsHour With Jim Lehrer”. The discussion was a follow up to the tragic Minneapolis bridge collapse on August 1st.
The Secretary inflamed cyclists and pedestrians across the country when she spoke about the “real problem” in shoring up the nation’s aging infrastructure was that not enough of the current money raised by gas taxes goes to highways and bridges.
“There are museums that are being built with that money, bike paths, trails, repairing lighthouses. Those are some of the kind of things that that money is being spent on, as opposed to our infrastructure,” she said. The Secretary added that projects like bike paths and trails “are really not transportation.”
Really not transportation? And was she really laying the blame – even indirectly — for the bridge collapse on cyclists? Well in any event, them’s are certainly fighting words. And Mieszkowski chronicles a bit of the fiery response to the Secretary’s remarks and offers up a few political reasons why Secretary Peters would say such a thing.
But here’s the thing. There is an ongoing struggle to embed in the American imagination a vision of what we can call a ‘bicycle commons’: a mash up of community funded safe travel ways, support services, and social networks built on a respect for the ecological value, physical wellbeing and psychological balance cycling brings to our collective life. As David Bollier observes, “Learning to see and understand the dozens of commons in our very midst is one of the preeminent challenges of our times.”
Remarks like those of the Secretary reveal once again that our leadership still doesn’t get it, doesn’t see it and doesn’t understand the public need for it.
WHCB:”China Internet Development Information Compiled”
September 13, 2007 — Fred Fortin
“The growth of the Internet in China is, and will be, a significant force for health care development in the country. So I thought I would put together a short compilation of some history as well as facts and statistics on this amazing social and technical phenomenon. This information was gleaned from a series of articles thanks to Beijing Review.com.
First a brief China Internet history.
In September 1987, with the support of a scientific research group led by Professor Werner Zorn, of Karlsruhe University in Germany, a working group built up an email node and successfully sent out an email to Germany on Sep 20th. The email title was “Across the Great Wall we can reach every corner in the world.”
See my entire post over at the World Health Care Blog.
“Smoking with Aloha” Campaign: No Comment
September 12, 2007 — Fred FortinThis new campaign to promote Hawaii as a Japanese tourist destination just speaks for itself.
The Do-It-Yourself Electronic Personal Health Record: A Big Non-Starter
September 12, 2007 — Fred Fortin
Matthew Shulman writes in U.S. News and World Report about how you can put together your own electronic personal health record (PHR). “Hospitals and physicians are putting their cumbersome paper medical records into much more easily accessed and manipulated electronic form. Now you can, too,” says Shulman. He points to a number of programs on the market that can make sure you have “essential health care information at your finger tips.”
Shulman does admit that “it takes some work—and computer savvy—to get started,” since of course “it’s up to the patient to gather the data from his or her team of doctors and upload or input the information into the program. ” No kidding.
Herein lies the rub. For most people, this is a non-starter. Nah gonna do it. At least not in the numbers that would make any difference to anyone, say if there were another Hurricane Katrina.
The sad truth is that adoption and use of PHRs is minimal even when it’s free and the personal health info is automatically populated by health plans or medical providers. What people say they want in surveys, and what they actually use are often at odds with each other, with PHRs being an unfortunate case in point.
Now, there are a few survivalists, geeks and other compulsive types who may want to go in this direction. You know who you are and god bless you all. For those of you so inclined you can click over to MyPHR.com. to get advice on how to create a PHR. It’s actually pretty good.
And while I wish the rest of us would get on board with you, I’m afraid you’re still a lone voice in the American health care wilderness.
Health Care Quote of the Day: John Goodman
September 11, 2007 — Fred Fortin“Economic theory predicts that in any system in which all the actors find it in their self-interest to overuse resources, fail to improve quality and impede access to care, there will be system-wide problems of cost, quality and access. And this prediction holds not just for the United States, it holds for the health care systems of Britain, Canada and other countries as well.”
See John Goodman’s Health Blog for his entire post!
Searching for an Intelligent EHR?
September 11, 2007 — Fred Fortin
The people at the Mayo Clinic are doing some research on making electronic health records (EHRs) more intelligent and useful to doctors. Thanks to Brian Robinson at Government Health IT writing on “the ultimate health care record” for the heads up.
Robinson writes that smart EHRs could lead the way to a “minimally invasive informatics”, one that would not require disruptive changes in the way physicians manage their practices. These EHRs would go well beyond the current technology of simply collecting data in small, categorized areas of a record. He cites Dr. Peter Elkin, a professor of medicine at the Mayo Clinic, who with his colleagues have proposed intelligent EHRs as a way of “squeezing all kinds of information out of an electronic record without physicians adding any more tasks to their day.”
Intelligent EHRs would try to address both the current physician resistance to EHR adoption as well as the desire to maximize the secondary health care benefits that electronic records would offer in areas such as promoting evidence-based medicine and improving public health surveillance. But, as Robinson observes, these systems will have to deliver the ROI goods if they’re going get off the academic farm and go into the big city.
Has Health Care Become a Performance Art?
September 10, 2007 — Fred FortinThink about this carefully for a moment. The question(s) in its long form goes something like this:
In our media-savvy, consumer infotainment society, has health care — as a professional, technical and cultural practice — become so ceremonial and ‘branded’, that we could call some of its players ‘performance artists’?
Or let’s look at it from another angle:
For patients and doctors to successfully negotiate the financial complexities, physical risks and legal vulnerabilities of the modern day clinical interaction, does each have to be so competent in their role, so adept in directing the movement of information, that the whole exchange comes to resemble a scene from some grand but unknown performance art ‘happening’?
While I might be stretching a bit — may be more than a bit — the usual understanding of ‘performance art’, there is a sense of performance art that works to uncover aspects of ordinary life that have become, how do we say it, over-stylized. And when the performance is not on stage, but right in the hospital admissions office, the ER, or the doctor’s exam room, one may experience a surreal jolt about the authenticity of the encounter.
The discomfort of whoever happens to be the spectator comes in when he (or she) senses that the combination of interior design, attire, status symbols and scripted language is intended to have an effect. And while the effect itself may remain illusive to the spectator — and thus oddly becoming ineffective — there is at some point an invitation to play a part in the performance.
But have no fear of ‘performance anxiety’ (sorry). Just as there is an art to being a doctor, there may be an equivalent art to being a patient. The artistry on both sides has been in fact nurtured by decades of television, movie and magazine stories about these classic medical encounters. So most every adult American should be well trained.
Yet, of course, there remains the unsettling question of how ‘real’ is the ‘performance’ being staged? How well have the mediated roles communicated, and attended to, the actual situation at hand? As Raul Vaneigem has argued, every day life is the ultimate measure of all things. If the roles become too rigid, too ceremonial, too far afield from the pain, then the script needs to be rewritten, and the performance needs to be directed by someone else.
Or better yet, maybe the performers, should follow Kalle Lasn’s advice and trade in the prepackaged experiences and media events for real living.
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