There were several news stories last week that reported that Pfizer had abandoned its efforts to have its Lipitor brand of atorvastatin made available over the counter, without a prescription. I was never a big fan of OTC statins (more on that later) but I was struck by the reason that Pfizer put out:
The study did not meet its primary objectives of demonstrating patient compliance with the direction to check their low-density lipoprotein cholesterol (LDL-C) level and, after checking their LDL-C level, take appropriate action based on their test results.
Left unstated (and unclear) in this is exactly what the appropriate action was supposed to be. I guess they were implying that patients were supposed to check how they responded to the drug and then figure out if they should keep taking it, change the dose or seek professional advice about next steps.
Continue reading Right Call; Wrong Reason
A few recent experiences have me thinking about death.
The first was hearing a story on the radio about how physicians “manage” their deaths. The gist of it was that physicians are more likely to die at home without aggressive life-extending interventions than the general public. The implication was that more people would have a “better” death, more in accord with their own wishes, if frank discussions about end of life care were more common.
I didn’t think too much about the story, which registered only a “no kidding” in my mind when I heard it, until I thought about it in the context of two deaths that touched me this past week.
Continue reading Talking About Death
I had two experiences recently that reminded me that many doctors and nurses remain resistant to measuring and improving how patients experience the care we provide. One was a face-to-face discussion with a senior physician. The other was reading an article by a nurse. Both the doctor and the nurse denounced the growing focus on the patient experience by citing the threat to quality of care, and I believe both of them were totally wrong.
The encounter with the physician came as I addressed a group of newly hired physicians. As I typically do in these circumstances, I outlined our Medical Group’s commitment to increasing the visibility of the results of our patient experience surveys. We have been providing our physicians with reports on their patients’ feedback for the better part of a year, and we anticipate posting physician-specific results on our public website within a few months. During the Q&A, one of the physicians objected to the plan, saying that “patients can’t judge the quality of care that we provide.”
Continue reading Mistakes about “Patient Satisfaction”
I was disturbed by a recent article in the New York Times about the Texas Medical Board. The piece described the decision by the Board to sharply curtail the use of telemedicine in the state. Specifically, the Board mandated that telemedicine services could only be provided in the context of a pre-existing patient/physician relationship, and that such a relationship must be established face-to-face, and not via electronic means. According to the Times, the restrictions were strongly supported by the Texas Medical Association.
This seems to me to be a wrongheaded, backward looking and overall pretty lame attempt to stem the inexorable tide of patients and physicians connecting in new ways. I really wish I could believe the Board member who said he voted for the new restriction because he was “terribly, terribly worried about the absence of responsibility and accountability” in electronic encounters. It sounded to me, instead, that he was “terribly, terribly worried” about a new business model for medical care that provides greater convenience and lower cost to patients than traditional office visits.
Continue reading Patient Advocates? Really?
I recently wrote about the wonderfully inspirational documentary Rx: The Quiet Revolution, which tells the story of how four different groups are transforming health care for the better. Each group has some pretty amazing physicians who are committed to putting the patient at the center of the system, and they all have a lot to teach the rest of us about truly caring for patients as we “deliver care.” That got me thinking about physicians in our own Health System who are role-models for great care, and also about assuring that future physicians are just as caring and empathetic.
Well, as far as role-models go, it is hard to imagine a better group than the winners of this year’s Patients’ Choice Awards, given to those members of our Medical Group who achieved the highest scores on their patient experience surveys. They are:
Continue reading Great Doctors of Today and Tomorrow
A recent piece in the New York Times profiled a young man with a remarkable medical history, and an equally remarkable approach to sharing it. I think it raises some profound issues regarding the self-monitoring movement and the “ownership” of patients’ health information, both of which have the potential to change our traditional practices in a big way.
The guy – Steven Keating – is not your average Joe. He is a graduate student at MIT who trained as a mechanical engineer and is working in the cutting-edge MIT Media Lab. He also had a brain tumor the size of a tennis ball. His website hosts all of his medical records, including his pre- and post-op brain scans and, believe it or not, a video of his tumor resection surgery.
Continue reading Whose Record Is It?
I had the good fortune last week to see a screening of excerpts from an extraordinary documentary film that will be shown on PBS television stations in April. The film is called Rx: the quiet revolution and highlights four case studies. Each is an inspiring example of new models of health care delivery that are advancing the “triple aim” of better care for individuals, better health outcomes for communities, and lower costs. Our own remarkable Dr. Jennifer Mieres is the film’s executive producer.
The screening left me inspired and in awe of the great work being done by front line professionals all across the country. It also introduced me to a fabulous metaphor for the importance of engaging patients in their own care.
Continue reading There is Good News Out There
I recently learned about a new business called “medibid.” Billing itself as “the only real solution” to rising healthcare costs, medibid acts as a broker, allowing patients to register (for a fee) and describe what kind of healthcare service they are seeking and allowing physicians (who also pay a fee) to “bid” for the business at a stated price. As they say on their website: “MediBid has been called the ‘Priceline of Healthcare’ or the ‘Travelocity of Healthcare’ because of this.”
Wow, I admit to being fascinated and a bit horrified at the same time. On the one hand, I had a, “Boy, I wish I had thought of that” moment, followed quickly by, “OMG, is this really where we are headed?” Continue reading Are You Ready for This?