Survey: What Do You Think About Telemedicine?

Take our 2 minute survey and share your thoughts and opinions about the future (or lack thereof) of telemedicine!

Telemedicine is gaining at least a toe-hold in health care at both ends of the health care spectrum. For some large hospital groups and insurers it offers an ability to scale with significant cost savings, and on the other end individual physicians like those in concierge practices are using telemedicine to stay in touch with patients and offer services on-demand.

We're asking you for a few minutes of your time to take this survey an answer a couple of simple questions to see what providers are thinking about telemedicine.

We'll aggregate the answers and create a report outlining the sentiment of physicians and other providers around telemedicine.

Here's a direct link to share with your networks: https://storyteller.typeform.com/to/CFMq33

Watsi.org - Crowdsourcing Medical Care For People In Need

Crowdsourcing is changing the way that new organizations can be funded. Watsi.org is an example in healthcare.

You may hear more about Watsi in the near future.

Right now their run completely by donations but that could well change. They've also become the first non-profit to make it into Y-Combinator, a premier technoloty accelerator in San Francisco.

Visit Watsi.org

Here's what Paul Graham of Y Combinator says:

After about 30 seconds of looking at the site, I realized I was looking at one of the more revolutionary things I'd seen the Internet used for. Technology can now put a face on need. The people who need help around the world are individuals, not news photos, and when you see them as individuals it's hard to ignore them.

I've seen what happens—at Airbnb for example—when the Internet's ability to connect people peer to peer enters a domain that had previously been dominated by narrow channels. Historians will probably identify this as one of the most powerful forces at work in our time. And Watsi is this force applied to a big lever.

Working at a higher resolution also enables Watsi to offer a much higher level of transparency. At Watsi, 100% of your donations directly fund medical treatments. Watsi.org is separately funded. They pay all their operational costs from their own funding, and none from your donations. They even eat the credit card processing fees. So when you donate to Watsi, you never have the uncomfortable feeling that lots of your money will be eaten up by administrative costs. Your money has impact you can measure.

The 90/30 Conundrum: How To Change Medicine (If It's Even Possible)

Guest post by Aaron Schenone

Is it possible to change the healthcare industry?

I recently read an article entitled “Rebels at Work: Motivated to Make a Difference” a conversation with Lois Kelly. In her research she refers to the 90/30 conundrum where 90% of respondents agreed activating creative thinking can improve culture and drive innovation, yet only a third of those respondents were satisfied with innovative individuals’, the so called rebels, ability to provide that outcome.

Her research goes further defining these innovative individuals as creative, curious risk takers that aren’t driven by monetary gain, but by the ability to make a difference. They aren’t afraid to call out problems or be the first to do things differently. She also found people are uncomfortable with these individuals who challenge the status quo, circumvent the rules, question organizational leaders, and initiate projects without permission. Too often leaders react by throwing these habitual truants into the trapped box with the label “Rebel” on it.

It’s no surprise that innovative individuals gravitate to the world of entrepreneurship, starting their own organizations where they can create a culture that not only understands their purpose, but more importantly can provide an outlet for their ideas to make a difference in the world. We intuitively know some of these types of individuals such as Steve Jobs, and Richard Branson, but these individuals are in every industry and industry leaders are starting to recognize their value. People like Carmen Medina, former CIA Deputy Director of Intelligence, who supported the creation of a novel and dynamic approach to searchable actionable intelligence through a program affectionately called Intellipedia.

In medicine many of our innovative medical students and residents have had similar frustrations often being misunderstood and thrown into the trapped box with the label “Cowboy” on it. We feel misunderstood, locked out and all too often make an early exit from the very organizations and patients who need our ideas the most. I believe the 90/30 conundrum is a reflection on the challenges innovative people and organizational leaders have had in attempting to build trusting, productive relationships. It’s something that as innovative minded medical students and residents many of us have been battling since we sat in our first years of didactic lectures. We continue to ask whether actionable change is possible in such a large numbers driven industry.

Today, I believe it is possible to make actionable change in the healthcare industry. But to get there we must first gain the trust of our leaders. We must prove we’re not just cowboys without a cause; we’re passionate activists ready to drink H. Pylori to prove there’s a better way.

About: Aaron Schenone Third Year Medical Student in St Louis, studying clinical research in oncology

Healthcare: The Desirable Duopoly Of Doctor & Patient

Guest post by Daniel Kaufman MD

Ask any corporate tycoon what the toughest business structure to beat is, and surely they'll tell you it's a duopoly - two co-dominant institutions presiding over a market, essentially cutting out all other competitors or outside influences.

Are the two big players friends or foes? One can make a case for both. Republicans and Democrats, Ford and GM, and even Magic and Bird - all dominant duopolies that symbiotically blasted and outlasted their competition. That is, of course, until the third party showed up - the new kid on the block. Traditionally, the third party, or its potential to arise from obscurity into the limelight, has been a great offsetting entity to the status quo of the omnipotent duopoly. Just ask the Tea Party, Chrysler, or Michael Jordan. These entities, the consummate "start-ups", all served to destabilize the ruling double-team, and thus helped democratize whatever industry they were involved in. As it turns out, this destabilization, a requisite force of the free market, serves to wipe up the cobwebs of industry stagnation, and create new avenues and vectors for ingenuity and prosperity. But not all third parties share in this benevolent intention. Some third parties have done the exact opposite. 

It might sound like blasphemy coming from a libertarian, whose inherent belief system is governed by the ultimate aspiration for democratization and equalization of opportunity; but, we need to reinstate the desired duopoly in medicine: the Doctor and Patient. Since the dawn of humanity medicine has always been a two-person dance. An elegant, professional, distinctly intimate interaction guided by altruism and professionalism on the doctor's part and self-preservation on the patient's part. This exchange of privileged professional services, the provision of healthcare from doctor to patient, does involve, however, an economic exchange as well. This is where the vultures and hyenas of society smell the blood. They’ve noticed something: an opportunity for profit and control. Insidiously, the third party of medicine, be it commercial healthcare insurance companies or government-run programs, has been let into the doctor's office, and predictably, has done nothing to improve quality or cost of healthcare. Third party payers have so entrenched themselves into the healthcare system, that they no longer serve as a typical “insurance” entities, but now serve as all-powerful administrators and “approvers” of medical care. The healthcare insurance industry is no longer used only for coverage of catastrophic events, but is now “approving” CT scans, X-rays, mammograms, and blood work, to name just a few. They’ve also been deemed authoritative enough to decide whether a procedure is “medically necessary”, all without ever meeting the patient. Now, how does this make any sense?

Patients need to realize that their healthcare insurance carrier is not in the business of caring – they are in the business for profit. Corporate medicine, that is healthcare controlled and administered by centralized, detached, omnipotent bureaucrats, ultimately leads to a frustrated and powerless workforce – the doctors themselves. Ultimately, the very people delivering healthcare are driven out of the business, both materially and spiritually. Now don’t get me wrong, one mustn’t blame the corporation for being a corporation. It is, after all, acting in its own best interest and well within its moral imperative. Profit drives it, and that is good. But the ballooning administrative control that third party payers have achieved has hardly contributed to an improvement in the quality or diminution of the cost of healthcare. In fact, this burdensome control only siphons money out of the system, away from doctors and nurses and towards middlemen and pencil-pushing bureaucrats. The federal government’s solution to the problem, the Center for Medicare and Medicaid Services (CMS), has an even worse track record than private entities. Medicaid and Medicare reimbursement fees are so abysmal (perpetually controlled by the flawed Sustainable Growth Rate (SGR) formula) that many doctors can't afford to take care of those patients, ultimately decreasing access to quality healthcare. Insolvency is all but an inevitability, and sooner or later, the system is headed for complete collapse. Dr. Milton Friedman once reiterated: “there's no free lunch” - to mean that nothing in this world is for free. Not any product and not any service. Sadly, medicine, as we know it in 21st century America, has become the last bastion of serfdom. A virtual expectation that, at times, the doctor work for free. It is, after all, a profession born of altruism and compassion….

So, how do we fix the problem? Let us reestablish basic principles. Let us return medicine back to its free market roots. But let’s not ask narcissistic, corrupt, temporary politicians to do this by legislative fiat or decree. Let’s just do it on our own. Let us not accept the status quo of the insurance healthcare fraud. Let us unshackle ourselves from their administrative hegemony and price point controls. Let us be sovereign, willing agents of the free market. Let us rise and fall by the merits of our professional actions and demeanor. Let us educate and empower our patients to act as their own advocates and take the fight to their insurance carriers. Let us get all the pretenders and imposters out of the doctor’s office. Let’s restore the fiduciary relationship between doctor and patient, and get back to the desirable duopoly.

About: Dr. Daniel Kaufman is a Board-certified plastic and reconstructive surgeon and a Surgical Facility Inspector for American Association for the Accreditation of Ambulatory Surgery Facilities. He is the founder and medical director of Discreet Plastic Surgery, PC, with offices in Manhattan and Brooklyn. He blogs at Medical Spa MD.

US Health Care vs. The World

This cart presented without editorial comment.

source: National Geographic

Hospital Administrators Are Not Always Honest

Guest post by John Di Saia, MD

Hospital administrators have an agenda that's not always aligned with yours.

I used to do emergency work at a hospital in a large chain. It was hardy profitable and became less so over time. When I moved an hour away I sought to limit my emergency exposure for obvious reasons. The hospital administration cited sections of the Bylaws and Rules and Regulations that mandated that surgical specialists take call. This was specified for Plastic Surgery and Orthopedics.

Later and entirely by accident, I found out that the Orthopedists were being paid to take this emergency call by the same administration that was citing those hospital documents. Essentially they were being paid to take call from 15 minutes away whereas I was required to take call for free from four times the distance. Needless to say I dropped that hospital after briefly entertaining legal action. So soon after my divorce I hardly wanted to enrich another attorney. They are much smarter about getting paid than physicians are. I did inform a contact at the local newspaper who passed on the story stating that the public doesn't really care if a doctor gets screwed over. I found that a bit amusing.

As the story evolved I extended my practice up the street not so far away and something similar almost happened again. This time the administration in my new acute care hospital sought to get into an arrangement with me to take call. They were very quick to stipulate that this arrangement was to be secret. It was to involve some kind of payment from the hospital. The thought left a bad taste in my mouth. Emergency call is a loser. I just stopped taking it.

The moral of this story is that you should not expect hospital administrators to be honorable people. Entering into any kind of business arrangement with them especially a secret one is liable to be unfair, unjust or just plain illegal. You might want to avoid that.

About: John DiSaia MD is a plastic surgeon and blogger who also writes at Medical Spa MD.

By Far The Most Common Conversation In A Hospital Is Complaining

By Tamara Moores, a fourth year medical student at Loma Linda University specializing in Emergency Medicine.

They tell me that I’ll change.

They always do.

In our first two weeks of medical school, freshmen students are assigned to shadow senior students working in the hospital. When I was a freshman, my senior student’s final comment to me was “Wow. You’re really enthusiastic… That will change.”

Now as a fourth year medical student, today’s version of the story was – “intern year will change you. You may look the same on the outside, you may portray that same bubbly, sunshine personality, but inside you’ll be different – harder, less tolerant, mean.”

They say it with confidence, they say it with authority, brooking no disagreement, allowing no doubt. Attendings, residents, nurses – they all deign to tell me my future – “there’s no way you can stay that energetic, it’s incompatible with a medical career.” Over and over I have heard this. As a medical student, I am supposed to listen and learn - to be guided by these wise elders. This morning when I heard the prediction for the 100th time, like always I politely listened with a half-smile. Yet silently my spirit roared “How DARE you smugly tell me the fate of my soul?! How DARE you justify your own insecurities about your passionless heart by attempting to degrade mine?”

Medicine is a unique environment. In my short foray into this time-honored, traditioned society, I have been buffered and shocked by the rampant negativity that oozes through the hospital walls. People seem to even take pride in their ability to bemoan their situation.

“Oh God, another consult from the ED, think they managed to even do a physical exam before calling?”

“That professor has no idea what’s on boards.”

“I can’t believe we have to be here.”

“This computer system is a joke.”

By far the most common conversation in a hospital is complaining. Tomorrow, try something different - stop and listen to the myriad people talking at work. The ratio of negative to positive conversations will overwhelm you.

Why is hospital culture like this? Shouldn’t a place of healing be full of warm emotions, positive thoughts, and uplifted people? Why is a ‘negative nancy’ the most common type of medical professional we meet? What are we doing wrong? These questions often come to mind during my workday. There is no easy answer. At the very least I know my top goal is to NEVER become that stereotypical cynical physician, and instead be the uncommon doctor with true passion for medicine.

So how do I accomplish this in such a caustic environment? Have no doubt, even at my current bubbly baseline, it is a daily war to maintain my heart for this career. So many physicians before me have fought this battle and lost. How can I succeed where they have failed?

A resident who I highly respect recently told me ‘be careful what you say, because talk patterns become thought patterns.’ This, more than anything, is my first defense against cynicism. It is SO easy to fall into conversation filled with complaints. These tiny conversations seem harmless, but over the course of a lifetime they shape your soul. Now at the end of my medical schooling, and at the cusp of residency, I am awed by the power of the spoken word. It’s undeniable - what we say both molds and reflects what we think.

Overall I believe the best weapon against developing permanent pessimism is to be deliberate in how we react to daily adversity. How do we respond to a floridly difficult, unpleasant patient? Do we moan about how annoying they are? Do we ruminate about how unfairly they treated us? Permit me to suggest a different response. Instead of focusing on how unjustly that patient has treated me, I instead try to feel gratitude. Whether or not it’s right, these difficult patients make me grateful that my life has not put me in their position. They must be really unhappy inside, to so poorly treat the people who are trying to care for them. When I am mistreated by an attending, I remind myself that they are but a momentary discomfort, and soon will be gone from my life. Over and over I find myself fighting to see the positives in my life. It is a deliberate, intentional strategy, which allows me to shine out with joy even in the little moments of the day.

I firmly believe that working as a medical professional can be a path to a life filled with meaning and passion….if we let it. Not all days are perfect, but most days I feel like I’m the luckiest girl in the world to be in my chosen career. The patients are interesting, my skills are stretched, and I feel fulfilled. Beyond these personal reasons, more than any other career, medicine reminds us how short and precious life is. We deal in broken bodies, lives cut short by car collisions, by strokes, by chronic disease. How lucky we are to be able to move our bodies without wheelchairs, to be relatively self-sufficient. Working in the medical field reminds me daily that everything can change in a moment. It is this acute awareness of the frailty of life, which makes me embrace life with so much abandon. It is this knowledge that gives me joy in the workplace, even during the rough days. To put it bluntly, life is too darn short to be grumpy.

So why am I reflecting via this forum? Perhaps because I hope that I am not alone in this fight. Perhaps I hope that by starting a discussion, we might nudge forth a change in the standard hospital culture. Maybe with forums like this, we can shift the caustic paradigm. Here’s to hope.

About:: Tamara Moores is a fourth year medical student at Loma Linda University. She is specializing in Emergency Medicine. https://www.facebook.com/reflectingthelights

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