Saving Lives, Old-School Style
What if there was a simple, old-school style procedure that could save tens of thousands of lives every year?
Better yet, what if it could be implemented at minuscule costs (about $3 million to rollout nationwide), and would require very little change in anyone’s procedure or daily lives?
What if that procedure was something as simple as going down a checklist before running any procedure on a patient?
A Fatally Flawed Medical Educational Model
This week, many news outlets reported on how residents should be given 5 hours of sleep after working 16 hours straight.
Think about that for a moment.
In what other job — any job in the world — would it be acceptable to even use the term “after working 16 hours.” The 16 hour workday went out with the Industrial era here in the U.S. (Residents can actually be required to be on-call for up to 30 hours at a time on a single shift, which is even more absurd.)
Florence Nightingale, passionate statistician
A tip of the twitter-hat to @TimOReilly for this, from Science News:
When Florence Nightingale arrived at a British hospital in Turkey during the Crimean War, she found a nightmare of misery and chaos. Men lay crowded next to each other in endless corridors. The air reeked from the cesspool that lay just beneath the hospital floor. There was little food and fewer basic supplies…
Illness in the Age of ‘e’: A case study in participatory medicine
Last month, the Connected Health Symposium at Harvard Medical School saw a first: a full-length case study in participatory medicine, described concurrently by both the patient and his physician. The physician was our own Danny Sands MD, and the patient was our e-Patient Dave. It was “a remarkable story,” as Matthew Holt said on The Health Care Blog:
… a great session in which e-Patient Dave (Dave deBronkart) and his physician, Danny Sands described his use of listservs, the Internet, email and BIMDC’s PatientSite and other tools in his (successful!) battle with renal cancer—after being told median survival was 24 weeks. I won’t tell the whole story as they’re trying to get it published in an authoritative journal—so that physicians will pay attention and promote this use of technology by patients.
The presentation was videotaped, and we present it here.
Read more
No *other* conflict of interest, huh?
What’s wrong with this picture?
While continuing to search for information regarding the collective statistical illiteracy issue covered a couple of days ago, I found a brand new article in the New England Journal of Medicine.
As an exercise I decided to reorganize some of the paragraphs of the article, bringing to the top a couple of paragraphs that are located at the bottom of the original. FYI, the conclusion of the article is simple: “In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin (Note by G.F: Crestor, manufactured by AstraZeneca) significantly reduced the incidence of major cardiovascular events. ” Surprise, surprise! Crestor is good for you, even if you don’t have high cholesterol levels. Read the rest, it may explain:
Lies, Damn Lies And Statistics: Collective Statistical Illiteracy
Everyone knows the supposed origin of the phrase. But as you can see here it goes back to Medicine:
“Look at the dozens of operations by me this year without a death,” says the operator. His less enthusiastic neighbor thinks of the proverbial kinds of falsehoods, “lies, damned lies and statistics” and replies “reports of large number of cases subjected to operations seldom fail to beget a suspicion of unjustifiable risk”.
In “Some Surgical Sins”, John B. Robert A.M, M.D., Chairman’s Address on Surgery and Anatomy, 45th Meeting of the AMA, June 1894.
It looks like no much has changed since then.
Using Aggregate Data to Help Public Health
Public health is different than our personal health. Most people take for granted the role public health agencies play in our lives, but its primary emphasis is tracking disease data across the country in order to prevent a nationwide epidemic or pandemic. Nobody wants another bubonic plague, right?
Public health agencies carry out their mission by standard health data surveillance methods, which usually includes aggregate data hospital reporting and similar methods. They’ve been doing this for decades, and it results in a single agency having a pulse, if you will, on the health of the nation. Such efforts protect us from something like the bird flu, if it ever spread within a human population in this country.
The problem is that this data, collected by the Centers for Disease Control and Prevention (CDC), often relies on “old school” collection procedures and is therefore often delayed by weeks before the data becomes something we can actually make decisions upon (”actionable”). What if there was a way for technology to help streamline this process?
Information Silos Are Everywhere. But So Is The Internet!
Information Silo: An information silo is a management system incapable of reciprocal operation with other, related management systems… “Information silo” is a pejorative expression that is useful for describing the absence of operational reciprocity. Derived variants are “silo thinking”, “silo vision”, and “silo mentality”. (from Wikipedia)
Although much has been written about them, information silos are becoming far more recognized as the major reason why organizations are unable to take full advantage of the Internet’s power to interconnect business processes.
One of the great presentations at the Connected Health Symposium was “Illness in the Age of “e”: A Case Study in Participatory e-Medicine”, a conversation between e-Patient Dave deBronkart and his PCP, Danny Sands, M.D., MPH, who shares his time between a general internist practice at Beth Israel Deaconess Medical Center (one of the Harvard teaching hospitals), and serving as the Senior Medical Informatics Director at Cisco Systems. Danny is also an early proponent of patient empowerment and one of the authors of the e-Patients White Paper.
Do Doctors Read?
Okay, after monitoring e-patients.net and The Health Care Blog, I have to ask: Do doctors read? And if so, what? Read more
How Good Are Doctor Rating Sites?
Ruth Given has written a paper entitled, MD Rating Websites: Current State of the Space and Future Prospects (PDF), that was recently published on THCB. It’s a 39-page informal analysis (with an emphasis placed on informal) that takes a fairly good and comprehensive look at the space of doctor rating sites as they exist today.
I think that the main issue Given hit upon in the report (but I’m not sure she recognizes as the primary challenge of doctor rating sites) is the numbers issue. With over 700,000 physicians in the U.S., a ratings database of 10,000 or even 20,000 is pitifully and woefully small.
And not only is such a number small, it is statistically troublesome, likely painting an inaccurate picture of providers listed. If most sites only have one or two ratings for any given physician (and such data is statistically useless, if the average family physician is covering between 2,000 to 2,500 patients), then the sites themselves provide little added value outside of the directory listing. Which, as Given notes, is inaccurate or nonexistent more often than not.
white paper
e-Patients:
How They Can Help Us Heal Healthcare
