Poll Says Most Americans are Satisfied with their Health Care: Do They Live Here?

November 30, 2007 — Fred Fortin

Arghh, the American public, they’re a fickled lot, captain.

In a previous post I called your attention to the Kaiser Foundation Health Tracking Poll revealing that 50 percent of respondents said they didn’t know, or couldn’t name, or that none of the candidates represented their views on health care. Well now we know why. With everybody shouting that the system is totally broken, half of the American public are sort of happy with the health care system we’ve got. At least that’s according to Gallup’s annual health care survey.

What are we going to do with these guys? Don’t they read the papers? Do they live in this country?

And listen to this:

Eighty-three percent of Americans rate the quality of health care they receive as excellent or good, while 15 percent rate the quality as poor. Seventy percent say their health care coverage is excellent or good.

I am not making this up. Ok, there’s a 3 percent error rate, but even so. Amazing.

At least they’re not happy with the cost of care. But as the pollster says a “surprisingly large number are content with the health insurance and health coverage they currently have.”

Now those in the business of actually delivering care have always had a sneaky suspicion that this level satisfaction has been there all along. But there is a fear in the current climate to come out and say it. Got to avoid seeming self serving. Now, however, the American public has now spoken the unspeakable — or at least its voice has been channeled by Gallup.

The importance of these numbers is that people will resist change if it means giving up what they now see as valuable. That will mean some kind of compromise for health care reform that makes sense. Get too ideological, and they will walk away from the deal.

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Is the 15 Minute Physician Office Visit Losing Ground?

November 30, 2007 — Fred Fortin

Use to be that when you visited your doctor you had about 15 minutes on average to make your case, get treated, and get your parking ticket stamped. A new study documents that time now as 9 minutes and 48 seconds. As we’ve written about previously here and here, be prepared to speak quickly and use that time well! Oh, also try not to bring more than 1.9 problems to that visit. Might not get to them. And if you have a psychological problem, you will get, on average, a full 2 more minutes of quality medical time.Anyway,the office visit face time was just an artifact of the study which went on to talk about how doctors use computers during the office visit. Three “styles” of use were observed: (1) the “end user” who only used the computer at the end of a consultation to summarize the consultation; 2) the “continuous user”, who interacted with the computer throughout the consultation; and, 3) the “minimal user” who only used the computer at the end of the consultation mostly to issue prescriptions.I thought of another category. I would call it the “swing user”: the physician who actually never uses the computer during the office visit but keeps one around to play virtual golf for the rest of the hour.

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Continued Tension between Doctors and Patients in China

November 29, 2007 — Fred Fortin

Some months ago I wrote about the growing concerns over violence towards health care workers in China and the possible future role of emerging health plans to mediate these disputes much as they do in the U.S. today. Oiwan Lam of Global Voices and a China bridge blogger notes Chinese blog talk of continued tensions. She writes that “Zengying points out (zh) that the relation between Medical practitioner and patient is very tense in China. A major reason is the marketization of medical care, which turns the relation into purely “buying” and “selling” of service. And there isn’t any mechanism to solve the conflict between the hospital and patient.”

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Facebook Comes to Health Care and Vice Versa

November 29, 2007 — Fred Fortin

Ben Adler at Politico writes about about how young uninsured are starting to use Facebook to share their experiences and ideas about what’s happening in health care. This is a good thing. They’re mostly committed to one or another of the proposals for universal coverage offered up by the democrats. That’s probably as it should be as well. Adler writes that some pundits wonder whether health care will resonate strongly enough with young folks to sway votes. This is the $64,000 question (I know, dated reference and old school).

Yet the Kaiser Family Foundation finds that 42 percent of young people are very worried about being able to afford the health services they think they need, according to Adler. And they are organizing. Given those signs, I think health care could weigh heavily on the youth vote for president. But health care reform proposals are nasty for dishing out incomprehensible details. So the program might be less important than if the message is sent by the right person. My money would be on Obama.

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WHCB: “What Will Patients Expect in the Completeness of Their Electronic Medical Records?”

November 28, 2007 — Fred Fortin

Just briefly, I want to talk about the electronic medical record (EMR) from the point of view of patient expectations of how they will be managed. We ‘ve talked about errors in the record, as well as the complexity of the privacy issues. But what about omissions and patient expectations?

See my complete post over at the World Health Care Blog

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That’s Why They Sometimes Call it “Friendly Fascism”

November 27, 2007 — Fred Fortin

Bryan from Hot Air blog says,

Hillary Clinton and Barack Obama have of late engaged in a back-and-forth over their respective health care plans. Now John Edwards is swinging into the fray with a plan that is best summed up in a single word: Totalitarian. Not making this up.

He goes on post a number of fairly strident quotes by Edwards, such as

“I’m mandating healthcare for every man woman and child in America and that’s the only way to have real universal healthcare.”

What he is responding to is the feeling that being forced to do something in the name of the collective good sometimes doesn’t feel so good. And sometimes the ends do not justify the means (add your own cliché here).

But not allowing for people to opt out of some universal coverage scheme is hardly totalitarian; I personally like the term “friendly fascism” as my own personal exaggeration of things I dislike but am compelled to do. It represents a little better the attitude of self-righteous smugness that we find in healthcare from time to time.

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Are There Mistakes in Your Medical Record?

November 21, 2007 — Fred Fortin

Alicia Chang, a science writer for Associated Press, writes about recent discussions among physicians about mistakes in patient medical records. She recounts one doctor who, upon visiting a specialist, out of curiosity examined his own personal medical record. He was surprised to find a note saying he had a stroke. He never had one. Chang says,

Medical chart blunders are not uncommon. Sometimes, the mistakes can be harmless, but others such as an inaccurate diagnosis or a wrong medication could have serious consequences.

Errors can creep into medical charts in various ways. Doctors are often under time pressure and may find themselves taking shortcuts or not fully listening to a patient’s problems. Others rely on their memory to update their patients’ files at the end of the day. Other mistakes can arise from illegible handwriting or coding problems.

And while electronic medical records can help with accuracy, you know the old saying — garbage in, garbage out — still applies.

Mistakes in the medical record are serious business and have implications for the care you may receive. And while health experts recommend that patients periodically check their medical records, just navigating that record as well as understanding what you are reading, may be asking a lot from patients.

 

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Microsoft’s Bill Crounse Responds on Virtual Doctor Visits

November 16, 2007 — Fred Fortin

I’ve been having some technical problems with WordPress, so just to make sure this doesn’t get buried or lost in the digital netherworld, here’s Bill Crounse, MD, Worldwide Health Director for the Microsoft Corporation, response to my post on Microsoft’s new pilot program to have their health insurer pay for employee virtual physician visits.

The pilot program at Microsoft is based on reimbursement for structured e-mail exchanges between a physician and his or her patient. I was involved in a pilot project with Microsoft about 10 years ago where we tested true “virtual visits’ using Net Meeting audio and video connections, but at the time the technology was a bit too complex for wide adoption. All of that is now changed with advances in Unified Communication technology, VOIP, more ubiquitous broadband, etc. The day will surely come when “virtual visits” are routinely conducted between physicians and their patients with participating physicians appropriately reimbursed for their services. In the meantime, we are taking baby steps, but very important steps in the broader scheme of things.

Thanks Bill. We’d love to keep track of any innovations in this area.

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Microsoft’s Health Insurer to Pay for Virtual Visits

November 16, 2007 — Fred Fortin

From Bill Crounse, MD, Worldwide Health Director for the Microsoft Corporation, we read:

I received e-mail notification today from our Employee Benefits Group that a pilot between Microsoft and a well known Seattle healthcare delivery system is being expanded and that our healthcare insurer will start paying for “virtual visits” between Microsoft employees and their personal physicians.

No more details, but it’ll be interesting to follow developments here. I hope it just doesn’t come down to just email consults which is not really cutting edge although work still needs to be done in expanding this basic capability between patients and their doctors.

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Hillary and I

November 15, 2007 — Fred Fortin

Hillary Clinton and I were both 21 in 1968. I was in the SDS. Hillary was not. Obama was 7 years old.

As Daniel Henninger recounts,

The year began with sales of the Beatles album, “Magical Mystery Tour.” In retrospect, it was a premonition. In late January, North Korea captured the USS Pueblo and crew members. A week later, the North Vietnamese army launched the Tet offensive. On Feb. 27, Walter Cronkite announced on CBS News that the U.S. had to negotiate a settlement to the Vietnam War. On March 12, Sen. Gene McCarthy defeated incumbent President Lyndon Johnson in the New Hampshire primary, aided by antiwar students that Sen. McCarthy called his “children’s crusade.” Two weeks later, LBJ announced on TV that he would not run for re-election. One week later, Martin Luther King Jr. was assassinated. It was only April 4.

There were race riots everywhere. On April 24, students occupied five buildings at Columbia University, protesting the war. In May bloody student riots erupted in France, likely witnessed by the impressionable Mr. Sarkozy.

On July 3, Valerie Solanas shot Andy Warhol in a New York City loft. The next day, Sirhan Sirhan assassinated Robert F. Kennedy Jr. In August, the Soviet Union occupied Czechoslovakia. Seven days later, antiwar demonstrators at the Democratic convention fought pitched battles with the Chicago police.

On Nov. 4, having absorbed all this, the people of the United States voted. They gave 43.4% of their vote to Richard Nixon and 42.7% to Hubert Humphrey. Alabama Gov. George Wallace got 13.5%. Four years later, George Wallace was shot and wounded while running for president. 1968 lasted a long time.

Indeed, 1968 has lasted a long time. A lifetime. And maybe too long.

Obama is now telling Hillary and I that the 60’s is over. That our generation is so ossified in its politics, that forward movement is impossible unless the grip is broken. How can this be we wonder? It feels like we just got here and now the 7 year olds are telling us to move on.

As Henninger says, 1968 may still have to act itself out one more time. But that will be Hillary’s mission and not mine. We’re breaking up she and I. In fact, I’ll admit we’ve been separated for a long time now. The old times still weigh heavy with meaning. But there was another lesson in 1968 that still has not been learned: maybe it’s better to gracefully step back when the fate of the nation requires, rather than forcing the nation to kick you out. Al Gore seems to have learned it and may be you too, Hillary, should take another look.

We still have many things to contribute in the years ahead. Silence, however, maybe the biggest value we can offer right now.

 

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