This is the time of year just after spring break when I enter the stress zone of planning the summer vacation.
I'm always on the quest of making everyone happy.
Finding some place that I can afford, where the kids will have fun and maybe get to experience something new, is always a challenge.
So, I search the internet far and wide for good deals and destinations. One site that I always check out is Trip Advisor.
This travel website is populated with information on hotels, resorts, air fare, deals, and even food and restaurants. But the heart of the site is the traveler reviews. These often number in the hundreds depending on the location and are many times candidly verbose.
Visitors can even give a score which is tallied at the top of the review to help you sort through the list.
So what does that have in common with health care research?
Well, frankly, if you relied completely on Trip Advisor you probably would never travel any where.
Let me show you what I mean.
Last year I thought I planned the perfect vacation (turned out, I did according to the family). We used every (I mean, every) frequent flyer mile I had and the four of us traveled to Kona, Hawaii, one of the most beautiful and mysterious places on earth.
We stayed at the Fairmont Orchid in Kamuela which is on a grand beach on the west side of the Big Island. The grounds are impeccable, the staff is always at your beck and call, and virtually every room has a nice view. I'm a member of the President's Club so the kids were able to get free internet as well as discounts on beach gear.
From the turtles that lounge on the beach to the prettiest sunset in the world, I could live there.
Now to Trip Advisor: here are the top reviews currently --
"I have to say that while we love the Fairmont, the level of service has become uneven, if not somewhat mundane."
"The service was average - long waits and average staff at breakfast. Room was nice, but dated. I saw three cockroaches in the hotel. The grounds were lovely but the overall experience was not worth the cost."
"For the price of this hotel, the room was a disappointment. First of all we were on the bottom floor, with people walking by constantly, so there was very little privacy. The bathroom had dust and dirt on the shelves, and the wall was filthy. There were 2 moldy pictures beside the bed..."
The take home message here is that each person has their own experience, and it is impossible to make everyone's stay perfect.
We live in a society where expectations often exceed reality. There is just no way to make everyone happy and provide perfection no matter how much you strive for this level.
That brings me to health care.
I recently had a lengthy discussion with someone regarding online treatments for a medical condition. He had done considerable research, wanted to know the ins and outs of every perturbation of treatment, and why some people reported good results and some did not.
He finally wanted my opinion, and wanted me to weigh in on making a further review of these treatments and these patient experiences.
He just couldn't understand why some patients didn't report perfect results with at least one treatment.
I told him that unfortunately it doesn't work that way. Every patient will have a different experience with virtually every treatment or procedure.
Sure, there is an "expected" outcome. But we are dealing with a human body that is dissimilar from every other one on earth. You just can't expect similarity.
But to even be more accurate, we are dealing with humans and their own expectations of what a successful outcome should be. And that is even more challenging than the biophysics and physiology. Humans rarely agree on anything.
So the take home message here is that research on medical procedures and treatments can be very valuable, but you should always take into context the individual nature of the reviews.
Otherwise, you would never travel anywhere, and you would never make a health care decision that could improve your life.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Wednesday, March 23, 2011
Saturday, March 12, 2011
"docdano. com Live" Protesting in Wisconsin: Is Obamacare at the root of the debate?
I spoke last night to a group of young physicians at a venue across the street from the Wisconsin State Capitol at the height of the protest against the state government.
Amid the drum beats and screams of union organizers chanting how workers' rights would be eternally devastated because of the loss of collective bargaining, I lectured to a group of resident physicians on the benefits that await patients with the explosion in health care technology.
The root of the problem centers around a state, like almost all in the country, that is saddled with loss of tax revenues due to the downturn in the economy. This has resulted in massive budget deficits and hard choices.
Many states including Wisconsin have ushered in a flurry of Republicans who ran on campaigns of no new taxes, the need to cut waste and spending, and more state's rights.
So that's what the Republican Governor did from day one in office.
He first attempted to limit spending on education to trim the budget, but because of collective bargaining the negotiation of this type of decrease in the state spending was not palatable to the unions.
It didn't matter, really, because the Republicans had the votes to pass it anyway.
But instead of voting on this budgetary issue, the Democrats chose to flee to the land of Obama in Illinois to prevent the state legislature from reaching the critical number of votes to make a quorum.
For three weeks this stalled the debate and decision on the issue, until the Republicans decided to pull out the budget issues (which require the quorum) and vote instead on non-budgetary items - like collective bargaining.
So this lead to more protests.
I literally visited with hundreds of people in Wisconsin over the past week and different opinions abound from every direction.
Clearly if you are a member of the "haves" then you have no desire to give up a benefit.
That's normal.
One person told me that his daughter is a unionized teacher and she pays a whopping $23 a month for health care insurance with no deductible. Even if you factor in that there might be some requirements for her to see certain physicians in network or limitations on formulary and specialist access, this is still a bargain.
He went on tell me that the Governor's proposal would have raised this to $123 per month. I don't know if these numbers are accurate, but the change in benefit structure certainly spurred part of the protest that had national attention.
If you've read this blog before, you know that I'm not a fan of the Obamacare bill. And I think you are seeing in Wisconsin one end of the spectrum of the problems with the bill.
Let me show you why.
To pay for the extra benefits offered under the bill (like no pre-existing illness exclusion, limitations on the right of rescission of insurance if you're too sick to be in the plan, or extended coverage for children), then there will have to be either more money (read tax dollars or higher premiums) or a decline in benefits for those that are members of the "haves."
It's really that simple.
State governments who have been charged with implementing many of the provisions of the federal health care bill don't have the ability to print money or sell treasury bonds. Their only source of revenue is tax dollars.
A significant part of Obama's plan was to provide health insurance for "all Americans." And, unfortunately, a large number of the uninsured were to be covered with the under funded, limited access Medicaid system -- much of which is paid for by the states.
Finding revenue for Medicaid means that other state funded services - like education, or health benefits for teachers - have to be cut and shifted.
That is the only possible way to fund insurance for the "have nots."
I've been derided for one of my statements in the past, but I stand by it: the Obamacare health regulation was the largest transfer of wealth in American history.
So the union supported President now finds himself supporting the union backed protesters who are fighting against changes in state government that would be used to pay for the health care bill that he (and the unions) supported.
Wisconsin is only a microcosm of what is happening in every state that is now grappling with implementing the federal health legislation in a time of budget crisis.
It is an expensive bill, and now we are starting to pay the price.
I'm a big fan of expanding health care access and coverage for the "have nots." A country like the United States should be ashamed for having citizens that don't have access to quality health care. I'm just not a supporter of the big, expensive, inefficient and over-reaching federal health care bill that was passed last year.
Let's face it: the bill cost the taxpayers almost $1 trillion.
The payment for the bill is due now.
And lest you think that non-government workers will get a free ride and this is just an issue for state employees - it will filter down to every American.
As health plans shift to include the new benefits, pay the taxes and fees that are now required by the IRS, and see declining membership due to employees shifting to government subsidized insurance products there will no doubt either be an increase in your health care premiums or a reduction in your benefits.
The problem is that for many insured Americans there is no union to fight for your corporate benefits.
It will be left up to you.
One Wisconsin young man told me that maybe the Republicans should have left Congress when the health care bill was passed.
I reminded him that democracy doesn't work this way. We elect people to represent us and sometimes we win, and sometimes we lose.
I think the Obamacare bill is failure, but I believe strongly that we can keep what's good and fix what's broken. We just have to continue the debate, make compromises, and yes, probably make some sacrifices.
So it probably won't be the last protest I'll attend. Maybe next time I'll get to carry a sign...I'm not much of a drum beater.
- Posted using BlogPress from my iPad
Amid the drum beats and screams of union organizers chanting how workers' rights would be eternally devastated because of the loss of collective bargaining, I lectured to a group of resident physicians on the benefits that await patients with the explosion in health care technology.
The root of the problem centers around a state, like almost all in the country, that is saddled with loss of tax revenues due to the downturn in the economy. This has resulted in massive budget deficits and hard choices.
Many states including Wisconsin have ushered in a flurry of Republicans who ran on campaigns of no new taxes, the need to cut waste and spending, and more state's rights.
So that's what the Republican Governor did from day one in office.
He first attempted to limit spending on education to trim the budget, but because of collective bargaining the negotiation of this type of decrease in the state spending was not palatable to the unions.
It didn't matter, really, because the Republicans had the votes to pass it anyway.
But instead of voting on this budgetary issue, the Democrats chose to flee to the land of Obama in Illinois to prevent the state legislature from reaching the critical number of votes to make a quorum.
For three weeks this stalled the debate and decision on the issue, until the Republicans decided to pull out the budget issues (which require the quorum) and vote instead on non-budgetary items - like collective bargaining.
So this lead to more protests.
I literally visited with hundreds of people in Wisconsin over the past week and different opinions abound from every direction.
Clearly if you are a member of the "haves" then you have no desire to give up a benefit.
That's normal.
One person told me that his daughter is a unionized teacher and she pays a whopping $23 a month for health care insurance with no deductible. Even if you factor in that there might be some requirements for her to see certain physicians in network or limitations on formulary and specialist access, this is still a bargain.
He went on tell me that the Governor's proposal would have raised this to $123 per month. I don't know if these numbers are accurate, but the change in benefit structure certainly spurred part of the protest that had national attention.
If you've read this blog before, you know that I'm not a fan of the Obamacare bill. And I think you are seeing in Wisconsin one end of the spectrum of the problems with the bill.
Let me show you why.
To pay for the extra benefits offered under the bill (like no pre-existing illness exclusion, limitations on the right of rescission of insurance if you're too sick to be in the plan, or extended coverage for children), then there will have to be either more money (read tax dollars or higher premiums) or a decline in benefits for those that are members of the "haves."
It's really that simple.
State governments who have been charged with implementing many of the provisions of the federal health care bill don't have the ability to print money or sell treasury bonds. Their only source of revenue is tax dollars.
A significant part of Obama's plan was to provide health insurance for "all Americans." And, unfortunately, a large number of the uninsured were to be covered with the under funded, limited access Medicaid system -- much of which is paid for by the states.
Finding revenue for Medicaid means that other state funded services - like education, or health benefits for teachers - have to be cut and shifted.
That is the only possible way to fund insurance for the "have nots."
I've been derided for one of my statements in the past, but I stand by it: the Obamacare health regulation was the largest transfer of wealth in American history.
So the union supported President now finds himself supporting the union backed protesters who are fighting against changes in state government that would be used to pay for the health care bill that he (and the unions) supported.
Wisconsin is only a microcosm of what is happening in every state that is now grappling with implementing the federal health legislation in a time of budget crisis.
It is an expensive bill, and now we are starting to pay the price.
I'm a big fan of expanding health care access and coverage for the "have nots." A country like the United States should be ashamed for having citizens that don't have access to quality health care. I'm just not a supporter of the big, expensive, inefficient and over-reaching federal health care bill that was passed last year.
Let's face it: the bill cost the taxpayers almost $1 trillion.
The payment for the bill is due now.
And lest you think that non-government workers will get a free ride and this is just an issue for state employees - it will filter down to every American.
As health plans shift to include the new benefits, pay the taxes and fees that are now required by the IRS, and see declining membership due to employees shifting to government subsidized insurance products there will no doubt either be an increase in your health care premiums or a reduction in your benefits.
The problem is that for many insured Americans there is no union to fight for your corporate benefits.
It will be left up to you.
One Wisconsin young man told me that maybe the Republicans should have left Congress when the health care bill was passed.
I reminded him that democracy doesn't work this way. We elect people to represent us and sometimes we win, and sometimes we lose.
I think the Obamacare bill is failure, but I believe strongly that we can keep what's good and fix what's broken. We just have to continue the debate, make compromises, and yes, probably make some sacrifices.
So it probably won't be the last protest I'll attend. Maybe next time I'll get to carry a sign...I'm not much of a drum beater.
- Posted using BlogPress from my iPad
Location:State Capitol, Madison, Wisconsin
Thursday, February 24, 2011
The new pandemic: Will viral social media lead a health care revolution?
As we watch events unfold around the world with social media orchestrated revolution you can see the power that this new media can play in change.
First in Egypt, and now in Libya, millions of people are hearing about democracy and demanding change via smart phones and iPads over the internet.
What started as merely a march toppled a world leader.
So can social media create these same kind of changes in health care?
Today the ability to stay connected almost anywhere in the world has made being "off the grid" almost impossible. Which means that patients and health care providers are almost always able to communicate.
And, effective communication is the key to any health care message.
For years the internet has provided and almost encyclopedic reference for any illness, ailment, treatment, or medication. It is a rare patient that comes into my office that hasn't Googled their problem first.
Our office has free WiFi for patients, so even in the exam room patients can look up our recommendations and interact about conflicting discussions on the internet.
With the advent of online images, patients often compare tumors and rashes with jpegs they find on Flickr. This is their first opinion.
I am their second.
But what we see now going in the world is much deeper. And it offers the opportunity for a revolution in how we interact and disseminate health care information.
And ultimately care for patients.
Though smart phones and iPads, with WiFi and 3G, people can now be connected virtually anywhere in the world. It has made being "off the grid" a dream weekend away for many techno-nerds.
This technology is fascinating in its ability to behave almost like a living creature.
The word "viral" has always been used to describe how messages and content can spread so quickly around the globe. We've all seen those videos that reach a million or so downloads days after they are posted.
Viruses though by nature are not truly "living and breathing." They are merely protein products that rely on transmission from one host to another.
Certainly they can morph and evolve, becoming resistant to treatments and more easily spread, but they never replicate alone and they eventually die with their host.
I would argue that our social media revolution is more than viral. It is becoming living and breathing.
It is becoming alive.
With 500 million or so folks on Facebook, new groups and pages are made every second.
Instantaneous social networks can be created on autism, HIV, depression, and on and on.
Testimonials, treatments, and even tears can be shed together over a continuous interactive stream of discussion.
And it takes on a life of its own.
Never was this more clear than in Egypt. Once the message commenced and the social debate was started, the government shut down the internet, wireless phones, cable television, and even the power to some satellite relay stations.
Yet the revolution continued. It was spread via rumor and from person to person.
Even to people who never participated in Facebook, Twitter, or any internet discussion.
So will we see this in health care communications? I think we will. Is it too far fetched to believe that patients will move beyond just Googling a treatment suggestion in an exam room, to rather posting the idea on Facebook and immediately being able to discuss the concept with friends and family for feedback and suggestions?
Physicians already post diagnostic dilemmas sans personal information on the internet for assistance. So as treatments and plans are discussed will the confluence of information become the new "standard of care" against which we are all measured.
That would mean that the "standard" will be constantly evolving and changing as millions of patients and physicians provide continuous feedback and input.
And will this impact spread beyond the electronic world to effect patients and physicians who have steadfastly refused to participate in social media?
There are certainly dangers involved here. Aside from the privacy concerns, it is clear that without physicians and other health care providers being involved in the process that this standard could evolve into bad medicine and harm for patients.
Imagine if you will that a viral video on antiperspirants causing Alzheimer's creates a national outrage against personal hygiene, Congressional inquiry, and a ban on your favorite roll-on.
Funny? Just Google "phthalates" and "small penis." I think you can see how science and medicine can be influenced by social media. Sometimes with junk science.
So, the take home message here? Social media communication is here, and it will continue to grow and influence how we treat and take care of patients.
It will become alive and self perpetuating regardless if you participate or not.
It's essential that all the parties embrace and participate in the technology. We should welcome patients to examine their care on the internet, and we should encourage physicians to become involved in internet based discussions, groups, blogs, Facebook, and Twitter.
There is an evolution in the doctor-patient relationship and it will revolve around social media interactions.
And it's not a bad thing.
I guess if you are reading this blog you are already participating in social media to some extent. So will these words become viral?
Self interestingly I hope so.
- Posted using BlogPress from my iPad
First in Egypt, and now in Libya, millions of people are hearing about democracy and demanding change via smart phones and iPads over the internet.
What started as merely a march toppled a world leader.
So can social media create these same kind of changes in health care?
Today the ability to stay connected almost anywhere in the world has made being "off the grid" almost impossible. Which means that patients and health care providers are almost always able to communicate.
And, effective communication is the key to any health care message.
For years the internet has provided and almost encyclopedic reference for any illness, ailment, treatment, or medication. It is a rare patient that comes into my office that hasn't Googled their problem first.
Our office has free WiFi for patients, so even in the exam room patients can look up our recommendations and interact about conflicting discussions on the internet.
With the advent of online images, patients often compare tumors and rashes with jpegs they find on Flickr. This is their first opinion.
I am their second.
But what we see now going in the world is much deeper. And it offers the opportunity for a revolution in how we interact and disseminate health care information.
And ultimately care for patients.
Though smart phones and iPads, with WiFi and 3G, people can now be connected virtually anywhere in the world. It has made being "off the grid" a dream weekend away for many techno-nerds.
This technology is fascinating in its ability to behave almost like a living creature.
The word "viral" has always been used to describe how messages and content can spread so quickly around the globe. We've all seen those videos that reach a million or so downloads days after they are posted.
Viruses though by nature are not truly "living and breathing." They are merely protein products that rely on transmission from one host to another.
Certainly they can morph and evolve, becoming resistant to treatments and more easily spread, but they never replicate alone and they eventually die with their host.
I would argue that our social media revolution is more than viral. It is becoming living and breathing.
It is becoming alive.
With 500 million or so folks on Facebook, new groups and pages are made every second.
Instantaneous social networks can be created on autism, HIV, depression, and on and on.
Testimonials, treatments, and even tears can be shed together over a continuous interactive stream of discussion.
And it takes on a life of its own.
Never was this more clear than in Egypt. Once the message commenced and the social debate was started, the government shut down the internet, wireless phones, cable television, and even the power to some satellite relay stations.
Yet the revolution continued. It was spread via rumor and from person to person.
Even to people who never participated in Facebook, Twitter, or any internet discussion.
So will we see this in health care communications? I think we will. Is it too far fetched to believe that patients will move beyond just Googling a treatment suggestion in an exam room, to rather posting the idea on Facebook and immediately being able to discuss the concept with friends and family for feedback and suggestions?
Physicians already post diagnostic dilemmas sans personal information on the internet for assistance. So as treatments and plans are discussed will the confluence of information become the new "standard of care" against which we are all measured.
That would mean that the "standard" will be constantly evolving and changing as millions of patients and physicians provide continuous feedback and input.
And will this impact spread beyond the electronic world to effect patients and physicians who have steadfastly refused to participate in social media?
There are certainly dangers involved here. Aside from the privacy concerns, it is clear that without physicians and other health care providers being involved in the process that this standard could evolve into bad medicine and harm for patients.
Imagine if you will that a viral video on antiperspirants causing Alzheimer's creates a national outrage against personal hygiene, Congressional inquiry, and a ban on your favorite roll-on.
Funny? Just Google "phthalates" and "small penis." I think you can see how science and medicine can be influenced by social media. Sometimes with junk science.
So, the take home message here? Social media communication is here, and it will continue to grow and influence how we treat and take care of patients.
It will become alive and self perpetuating regardless if you participate or not.
It's essential that all the parties embrace and participate in the technology. We should welcome patients to examine their care on the internet, and we should encourage physicians to become involved in internet based discussions, groups, blogs, Facebook, and Twitter.
There is an evolution in the doctor-patient relationship and it will revolve around social media interactions.
And it's not a bad thing.
I guess if you are reading this blog you are already participating in social media to some extent. So will these words become viral?
Self interestingly I hope so.
- Posted using BlogPress from my iPad
Location:Dallas, Texas
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