Mission: Transform the Culture of Medicine

PUBLISHED ON  October 20, 2009

WRITTEN BY  Roni Zeiger

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Today I’m proud to share that a special online journal has launched: the Journal of Participatory Medicine. The simple goal is to learn what methods really work for patient-doctor collaboration, and in doing so transform the culture of medicine.

Why is this important? It turns out that doctors can’t do it alone. This isn’t news, and “e-patients” have been at it for years now, improving their own outcomes and the outcomes of others by supplementing and often going beyond what their doctors can alone do for them. Participatory Medicine is a new approach that encourages and expects active patient involvement in all aspects of care.

Have a look at the launch issue: www.jopm.org. It’s peer reviewed by doctors and patients.

How do you want to participate in your care?

Mission: Transform the Culture of Medicine

My Doctor Says: Get a Boob Job

PUBLISHED ON  August 18, 2009

WRITTEN BY  Roni Zeiger

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My wife, my children, and I are all patients at the Palo Alto Medical Foundation (PAMF). I am grateful for the world-class care that we all receive there, and I continue to refer many friends and colleagues there.

We recently received a mailer from PAMF, addressed to my wife and personalized with her name showing what they think her summer to do list should include. (I’ve blacked out her name in the photo of the mailer below.) The list ends with: “Do something REALLY special for myself!”

My Doctor Says: Get a Boob Job

Cute, I thought, and wondered what would be inside. Perhaps some tips on exercise or eating smart, or a reminder to get caught up on important screening tests. My jaw dropped when I opened the pamphlet and saw: “To look and feel your best, you don’t have to look far”, and listed the following services:

– Breast Reshaping
– Tummy Tuck
– Face, Eye, and Neck Lift
– Liposuction
– Rhinoplasty (Nose Reshaping)
– Laser Skin Rejuvination

I think it is entirely appropriate that PAMF offers these services. However, I am deeply concerned that they are advertising them as the way — for a woman in particular — to do something really special for herself and feel her best. Body image issues aside, what does this say about our physicians? PAMF represents my wife’s primary care doctor (and mine), and I suspect many patients see this type of promotion as coming from their doctor. Did she approve this, we wondered? If so, what should we think when she recommends a mammogram or a colonoscopy? It begs the question of whether the primary goal is my health or profit for the health care provider.

I’ve commented previously on Atul Gawande’s eye-opening piece in the New Yorker about McAllen, Texas, a town where health care costs are among the highest in the country, while the quality of care is no better than average. Gawande explains:

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

Perhaps we are asking too much of physicians. They should have only my well-being in mind, while at the same time their decisions about my care often impact whether they can afford to send their kids to college. In case you’re worried about your own bills, don’t worry — as you see in the screenshot below, for these procedures you can get a FREE private consultation and financing options are available.

Ideally, it won’t be long before we get much better at measuring the quality of care, and physicians will get payed for delivering quality. In the meantime, demand the facts and make informed decisions.

P.S. I originally posted this on Huffington Post. I couldn’t export the comments and there were some great ones, so feel free to read the comments there.

 

Who Is the Most Important Stakeholder in Health Care?

PUBLISHED ON  June 17, 2009

WRITTEN BY  Roni Zeiger

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Like many other doctors, patients, and President Obama, I’ve been thinking about Atul Gawande’s brilliant piece in the New Yorker on the root causes of spiraling health care costs in the U.S. One aspect that has not yet been given enough air-time is what role patients should play in this discussion. Gawande describes a thought experiment performed by him and a cardiac surgeon:

A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.” — that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”

I’m not naive enough to think that we will do well if patients negotiate on price for how many of their coronary arteries should get un-clogged. And while few patients are ready to use a microscope to diagnosis their own Crohn’s disease, those that do should remind us who has the biggest incentive for sustainable, high quality health care. It is critical that patients be a part of this conversation.

When the best treatment is well understood, and should not vary by the patient’s values or preferences, then our traditional paternalistic system works well for many consumers: Doc, tell me what to do, and let’s do it. However, in the many cases where the best data says there are two or more equally good options — e.g., whether to have surgery for low back pain — then we need more innovation and thought leadership on how to have these conversations effectively. How do patients best understand risks? How can we organize data about effectiveness of treatments for the top 100 conditions so that average doctors can keep up and discuss options with their patients? These are solvable problems.

It is awesome that Peter Orszag himself (Director of OMB) offered a thoughtful and data-rich response to Gawande’s article on the official Whitehouse website. Let’s also keep front and center the need for the consumer to be part of the conversation, and that doctors and patients alike need better access to basic data about what works and what doesn’t. Doctors should increasingly expect patients to ask: “What is the likely outcome if we choose this option?”, and patients should expect an answer.