End of life care needs more attention

I mentioned these videos in class and I highly recommend you watch the eye-opening 15 minute talk by Dr. Diane Meier on long term care (just scroll to the bottom): http://www.healthaffairs.org/issue_briefings/2009_08_20_fact_vs_fiction/2009_08_20_fact_vs_fiction.php

I worked with Dr. Meier at Mount Sinai Medical Center and she is such a ground breaker in Palliative Care advancement. She is the director of the Center to Advance Palliative Care at Sinai and is a Geriatrician/Palliative Care physician, but she is planning to take a 1 year leave to move to DC and work on healthcare reform.

If you follow the topic, her name will continue to appear like in her recent Newsweek article on the Death Panel controversy. In her powerful healthaffairs.org speech, she talks about 2 patients at the end of their lives, each of whom have VERY different experiences. If we want to control costs, this issue urgently needs to be pushed to the forefront of the political discussion. The way we treat very sick and very elderly patients sometimes defies all reason and I have always wondered why. Is it the way we educate medical students? Is it our pervasive fear of death? Demands from patients and families? Is it all about money and physician incentives?

"Did you hear the one about..."

... The woman whose kidney surgery had to be redone after Medicare stopped paying for her anti-rejection drugs? Just ran in the Times:

http://www.nytimes.com/2009/09/14/health/policy/14kidney.html?ref=health

Yes, it's another potentially incendiary story that will inevitably be mentioned in one of Obama's upcoming speeches, but it's also an example of potential good will that doesn't go far enough, often out of necessity.

"The rationale for leaving out younger transplant recipients was simply that the money was not there, Congressional aides said." Not to be nihilistic, but it's useful to remember that policies put forth with the best of intentions can fall short, independent of our tireless efforts; but it's no reason to stop trying.

Medical Ethics during Hurricane Katrina

Hey Everyone,

I read this article in the New York Times Magazine a few weeks ago, and found it really interesting. The article tells the story of a for-profit hospital in New Orleans during Hurricane Katrina and the difficult decisions its physicians faced in deciding how to evacuate its patients during the storm. Some of the physicians have been accused of hastening the deaths of some terminally ill patients by delivering lethal injections of medications to those they deemed not able to survive the storm. I am looking forward to hearing everyone's perspectives on the article:

http://www.nytimes.com/2009/08/30/magazine/30doctors.html

Doug

Redefining the level of Health Care Competition

If there was one defining article I read that convinced me that I needed to go back to graduate school to learn more about how to change a non-system, this was it.

Porter, M. & Tiesberg, E.O. "Redefining Competition in Health Care". Harvard Business Review. June 2007

http://ucelinks.cdlib.org:8888/sfx_local?genre=article&issn=00178012&title=Harvard+Business+Review&volume=82&issue=6&date=20040601&atitle=Redefining+Competition+in+Health+Care.&spage=64&sid=EBSCO:bth&pid=

HBS Professor Michael Porter and Darden School Professor Elizabeth Olmstead Tiesberg discuss the various stakeholders in the health care system and how each can potentially undergo a transformational change to improve the quality and outcomes of the US health care system.

If you find this article enlightening, I HIGHLY recommend reading their book, "Redefining Health Care" (2007). It is by far one of the best books I have read on innovation in health care.

If you have read the article or the book, do you agree with their suggestions? Are some of their suggestions too radical (not as in right-wing but as in idealistic)? Which ones are the most feasible?

Let's discuss!

Healthcare Reform, Illustrated

For those who - like me - feel embarrassingly uninformed about the details of healthcare reform, I thought I'd pass along this set of "napkins" illustrating the main points of the debate. I can't vouch for the presence/lack of bias, but it helped clarify some things for me. Also, there are pictures!

Click here for the full slideshow.

"Meaningful" Reform?

I enjoyed the discussion at the HPM workshop this afternoon, but I think one point that was glossed over was the idea of "meaningful" reform. For the sake of argument, let's suppose that Professor Robinson's predictions come true: Obama signs a bill in the next few months that includes an individual mandate, no public option, some malpractice reform, etc. But none of these components - and really none of the discussion that I've seen of health reform so far - have given any real evidence of containing costs.

I certainly think it would be an accomplishment to pass a plan that makes a dent in the huge number of uninsured, but covering more people isn't necessarily going to contain costs. I understand the argument that with more people, particularly young healthy people, in the insurance pool paying premiums the costs per patient may go down slightly, but I don't see how this could cap any skyrocketing costs due to technological advances and expensive pharmaceuticals, for one. So my question is: can we call a plan without any real cost-containing measures "meaningful" health reform?

Welcome to Fall 09 HPM Class

Hi everyone - welcome to the Foundations class blog. I hope you find it a vibrant place to post, comment, share, discuss over the semester. Lots to talk about! Hope you are all planning to watch the President's speech tonight and I expect a firestorm of blogging as a result!

Kim