From HX Refactored in Boston in June 2017, this – “Jeopardy Meets The Price Is Right, Healthcare Edition”
See this UPDATE, too.
Sundays are pretty quiet here in Mighty Casey Media Land. Yeah, there are those Sundays where I read my wall calendar without my glasses on, and totally think it’s Father’s Day when it’s really Flag Day … but that’s about as exciting as it gets most weeks.
Today is one of the latter Sundays, where I not only cause a Father’s Day panic on Facebook (yeah, that’s a thing), but also get Twitter DMs that set my hair on fire. Which you know, if you’ve been hangin’ round this water cooler for a while, is never a good thing.
This morning, I picked up my phone while I was waiting for my coffee to brew, and what ho – a DM from my friend HealthBlawg with a link to a “stupid patients, don’t Yelp doctors” piece on US News with the headline “Online Doctor Ratings Are Garbage.” The piece is by Niam Yaraghi, whose pieces on US News usually have me nodding along in full agreement … but not this time.
In the “don’t Yelp, bitch” piece, Yaraghi essentially tells people they’re too stupid to understand medical care’s value and outcomes, that we should just lie back and think of England and let those nice doctors do their work.
Let’s take ’em in order, shall we?
Patients are neither qualified nor capable of evaluating the quality of the medical services that they receive.
Seriously?? Does Yaraghi know any cancer patients, or people with MS, or ALS, or rheumatoid disease, or diabetes? I’m pretty sure the answer there is “no,” that he knows a whole bunch of polysyllabic “experts” due to his work at Brookings, but very few ASPs (Actual Sick People). The patient community is teaching the clinical community constantly about both medical research and business operations.
I’ll say it again: input from the patient community is, daily, saving the bacon of MDs/NPs/PhDs and other letter-after-name denizens of the medical-industrial complex and their minions.
So slow your roll, Niam, and the next time you meet an ASP, thank them for their *own* work on healthcare quality improvement.
If patients are not qualified to make medical decisions and rely on physicians’ medical expertise to make such decisions, then how can they evaluate the quality of such decisions and know that their doctor’s decision was the best possible one?
It’s spelled S-C-I-E-N-C-E, bitch.
But hey, most of gen-pop (people who are temporarily, not permanently, ASP – like when they break their leg, or get pneumonia) might not be as UpToDate (yes, many of us read PubMed, and even understand it) as a practiced e-patient ASP. So what do most people do when they need to find some on-the-ground help for a health issue? They hit the web … and usually find us. Or Dr. Oz, which is regrettable, but that snake oil PR machine has got a big f**king ad budget. But even if they hit Oz first, they usually wind up with us.
And hey, are DOCTORS even the real experts when it comes to evaluating the efficacy of their treatments? Plenty of evidence suggests that clinicians get as stuck in Usual Suspects-ville as does any other profession. I call it We’ve Always Done It This Way syndrome. It takes 17 years, on average, for proven science to arrive at the point of care. If you get diagnosed with [pick a really big disease], do you want to just trust that your MD is up on all the latest treatment options, or do you want to be *sure* s/he is? Welcome to Dr. Google, dude. Yelp reviews don’t turn up on condition-specific searches, but *we* sure do.
Since patients do not have the medical expertise to judge the quality of physicians’ decisions in the short run and are neither capable of evaluating the outcomes of such decisions in the long run, their feedback would be limited to their immediate interaction with medical providers and their staff members.
I’ve addressed the “science, bitch!” thing above, but let’s drill in on that “outcomes” point, shall we? Have you, yourself, ever tried to find outcomes data on a doctor? Pack a lunch. A lunch that can last for days. Physician Compare on Medicare’s (CMS) site looks like it could serve up some stats … but it doesn’t serve up much beyond “has EHR tech that fulfills Meaningful Use requirements.” Physician Quality Reporting System (PQRS – another CMS data bank project) serves up a whole lotta data – in table or spreadsheet form – but it’s pretty hard to parse “quality” from “takes Medicare” or “participates in PQRS” or “participates in eRX.” No notations as to whether s/he is Dr. Hodad.
How about, rather than bitch about patients who want to serve up UX (User Experience) data on their clinical teams, you use your keyboard to help create some clarity on quality reporting that can be understood BY. AVERAGE. HUMANS.
Instead of the quality of the medical services, patients would evaluate the bedside manners of physicians, decor of their offices and demeanor of their staff.
Bedside manner is no indication of the value of the care received at the hands of a clinician. I’ve had doctors look deep into my eyes, hold my hand, and then do a hard sell for a pharmaceutical product of questionable efficacy for my condition. I’ve taken a show about that on the road (sort of), which you can read about here.
Office decor reviews for doctors’ offices will only add ordnance to the arms race that US healthcare has become, where providers build more and more luxurious settings for us to get questionably effective care in … and then charge us higher fees for that care, since marble is really expensive.
To choose the best medical provider, patients are encouraged to rely on measures of medical expertise and avoid invalid online reviews.
And just how the French-pressed **** are we supposed to do that, Niam? Having the whole alphabet after your name on a list of medical specialty MDs is no guarantee, at all, of either efficacy of care, or basic humanity.
Dr. Farid Fata had a solid platinum set of credentials as an oncologist – residency at Maimonides Medical Center, an oncology fellowship at Memorial Sloan Kettering, and a respected practice in the Detroit metro area for over a decade – until the FBI burst into his offices on August 6, 2013 to arrest him for fraud. He’d diagnosed and treated people for cancer who did not have cancer. BTW, there were no Yelp reviews for his practice.
Here’s the thing: patients KNOW STUFF. Rather than telling us to shut up and stop Yelping, how about you recommend *listening* as a cure for what ails US healthcare? I’m a Yelp Elite reviewer – that and $4 will get me a crap fancy coffee at Starbucks – who’s a globally recognized patient voice, and I’ve posted four reviews of health/medical facilities (a 3% rate of review in my total number of 141 reviews to date). Two of those facilities are mammography practices. I’ve had breast cancer, so as experts go … yeah, I am one.
I don’t use Yelp reviews on my checklist for choosing a new member of my clinical care team, because I’m an e-patient expert with a massive global network in both the medical and patient communities.
So, hey, Niam, what’s your recommended roll for someone who’s got [insert suspected diagnosis here] and is looking for credible, actionable information to inform their decision tree? Until the clinical side of the house gets their outcomes reporting sh*t together … people gon’ Yelp.
Shut up and deal.
I had the great good fortune of being tagged as an ePatient Scholar for the 2013 edition of Stanford Medicine X. That allowed me to sit at the feet – literally, since the ePatients were the mosh-pit for the three day conference plenary stage – of some of the best and brightest minds in healthcare. And guess what? Many of those best/brightest were … PATIENTS.
MedicineX (a/k/a MedX and #medx) is the uber Patients Included medical conference. It grew from seeds planted at conferences like Health 2.0 and Patients 2.0, for which seeds-to-beautiful-flowers gardener credit goes to Dr. Larry Chu and his team from Stanford Anesthesiology AIM Lab, who seem to prestidigitate rabbits out of hats without breaking a sweat. Or the hats. Or the rabbits.
MedX – in my opinion, at least – trumps every other Patients Included event by not just including patients, but by putting them front and center throughout the program. In fact, I cannot think of a session that I attended that didn’t have someone who was there primarily as a customer of healthcare (commonly called “a patient”) on the platform, presenting or participating in a panel discussion.
My ePatient socks were knocked off from jump thanks to the opening keynote by Michael Seres and Marion O’Connor on “The New Engaged Patient,” which was the morning keynote on Friday. Michael uses his blog as his personal health record, up to and through a lifetime battle with Crohn’s disease that led to his becoming the 11th patient to ever receive a bowel transplant, and only the 6th to survive that transplant experience. Michael is hilarious, and Marion is exactly the sort of caring brainiac any patient would like bedside as s/he battled a life-threatening illness. Here’s the video of their session:
The rest of the day played out as a firehose of ePatient awesome, including the first presenter to bring me to tears: Sara Riggare, a brilliant woman who is, among many other things, an engineer and a Parkinson’s patient. During the panel discussion on “The Self-Tracking Patient,” and my (somewhat sobby) conversation with Sara afterward, was when I fully realized, even though I’d talked about it last year on one of my blogs, that I had been born an ePatient. Well, maybe not born, but them that brung me into the world also brought me to ePatient-cy. I felt my late father, whose Parkinson’s laid him low, and then to rest, over 10 years ago, standing by me as I listened to Sara talk about her own self-tracking and self-advocacy. My dad was a warrior – literally, a US Navy fighter pilot – and brought that warrior spirit to his battle with Parkinson’s. I’d like to think that Big Mike would be proud of the work I do today to bring sense, and sensibility, to the most human of all sciences: medicine. Here’s Sara on the main stage:
The Friday sessions ended with a “What If Healthcare …” panel discussion, conveniently tagged for the Twitter-verse as #whatifhc (click that link for a Symplur transcript of the conversation as it unfolded live). This session is the only one that pressed my buttons in a not-good way, and here’s why: there were a group of white-dude brainiacs, and one not-a-white-dude, on that panel. Don’t get me wrong, I like white dudes. Hell, I’ve married two of ’em (NOT at the same time!). But I found it sort of anachronistic that, as the “dream big” panel on the first day of a Patients Included medical conference on the campus of a major medical school (Stanford Med), the participants on that panel were so very white-dude, with the notable exception of healthcare artist/activist Regina Holliday. Regina herself mentioned the very-not-diverse makeup of the panel during the session. I made the observation on Twitter, as I listened to the panel’s conversation, that healthcare in the US is a great wealth-transfer system … but as a health-transfer system? Not so much. Here’s the first-look video of the session via the MedX YouTube channel:
Saturday opened with something for which I was utterly unprepared: hearing first-hand about the project that won the 2012 Intel ISEF Prize. Jack Andraka is the 16 year old kid from Baltimore who, at 13, decided that not having a reliable early-detection test for pancreatic cancer was a terrible thing. He resolved to create that test … and he did. It’s been patented in the US, and is in the process of being patented globally. Here’s the first-look video of his hilarious and inspiring call to action for open science:
Frankly, I count hearing that talk, and meeting Jack later that day at the MedX reception on the Dean’s Lawn, as the highest high point of my MedX experience. I told Jack that I couldn’t wait to see what he did next, but that even if he decided to rest on his uber-science-geek laurels with his mesothelin discovery, he’d given a gift to humanity unlike any other since Jonas Salk. Visit his website to keep track of this approachable, funny, huge-hearted young man who has the mind of a god.
The other big high of my MedX time was finally – FINALLY – being in the room with all three of the women who birthed #BCSM, one of the most powerful healthcare communities on Twitter. My ePatient journey may have been started by the voyage with my parents through their health issues, but it was forged into hardened steel by my own breast cancer experience. Connecting with Alicia Staley was one of the things that helped turn my book, Cancer for Christmas, into an Amazon bestseller in ’09. I spent much of the conference touching base with the #BCSM crew, who were in attendance in force at MedX. It was #BCSM Summer Camp!
The conference closed on Sunday with a keynote by Vinod Khosla, “2025: 20% Doctor Included?” Khosla’s viewpoint – which I share – is that technology will provide more reliable and efficient diagnostic tools, removing the mis-diagnosis risk that leads to most medical errors. He also stated that transformation of the healthcare system will not happen from within. Khosla backed up his positions with evidence, and I was nodding so hard in agreement I risked whiplash. It was the perfect close for the epic firehose of forward-thinking that was MedX 2013. Here’s the first-look video of Khosla’s talk:
What will I remember most about my MedX experience? I’ve listed some of it above, but even as I write this post I realize how much more mental food was served up during those three days. There were the conversations that happened over coffee, during lunch, with a frosty beverage in the Sheraton bar. I met people I’d known online for years, but had not had the opportunity to hug and thank for the impact they’d had on my life until MedX put us in the same room.
The Honor Roll there (in totally random order):
- Jody Schoger
- Dr. Alan Greene
- Thomas Lee and Audun Utengen, the men behind Symplur
- Gilles Frydman and Roni Zeiger of Smart Patients
- Dr. Bryan Vartabedian
- Katie McCurdy (who’s written a great MedX post you can read here)
- Dr. Rafael Grossmann
- Carla Berg Nelson
- Dr. Deanna Attai
- Dr. Leslie Kernisan
The list of people who I had not known before MedX, and who literally blew me away with their heart and insight? Here’s another random list:
- Joe Riffe
- Emily Bradley (Emily wrote a penetrating piece on how chronic pain affected her MedX experience, read it here)
- Erin Moore
- Liza Bernstein
- Spartacus. No, wait, CHRIS SNIDER. (I think Chris will get the joke there … )
- Amir Dan Rubin – the CEO of Stanford Hospital & Clinics, his master class on quality improvement will inform my hospital-med journo work for years to come
- Dr. Marc Katz (I hadda go to Silicon Valley to meet a terrific doc who practices down the street from me – go figure)
- Terri Wingham
- Dr. Berti Meskó
- Brett Alder
- Dr. Peggy Polaneczky
- Emily Kramer-Golinkoff
- Dr. Christian Assad
- Denise Silber
And the amazeballs of awesome that is Zöe Chu:
What did I learn at MedX? I learned that there’s hope. Hope for healthcare, hope for humanity, and hope for every single person who winds up a patient (and hey, we’re all patients, right?). The key is that medicine is a team sport. It requires the full participation of everyone in every health-related transaction.
So pick up your ball, and let’s play together, shall we?
I spent 20+ years working for NBC at 30 Rock. When I started exploring stand-up comedy, the first bit I wrote was based on my experiences working in the building behind what has become “America’s Christmas Tree” – or, as I came to call it, “that fucking tree”.
Since the thing was lit last night, I know the hell my former colleagues are going through. Here’s the bit, in its entirety:
Who’s really jazzed about Christmas? Who’s excited beyond words at all the decorations and the hoopla?
Well, I know one thing about all of you. You don’t work in 30 Rock.
I do. That fucking tree.
Imagine that your commute, which normally means pinballing across at least one train platform and at least several crosstown blocks, now also includes hacking your way through a literal mob of tourists.
The mob grows by the minute. You’re trying desperately to get to your office. You can see the revolving doors across the plaza, but …
There’s the Stroller Army, who aim at your knees and ankles as they press their little angels closer to that fucking tree.
There’s the Double-Wides, who stand tall as they wave their arms, pointing … right into your eye … at that fucking tree.
You’ve got the tour group from Thailand, in scattered clumps around the skating rink, wai-ing that fucking tree.
So you make your best broken-field run across the heaving horde, focused on those doors and what’s beyond them – black coffee, toasted bagel, dry, and your work day – and you have to join in on a chorus of When the Saints Go Marching In, just to achieve the lobby.
I tell you, there’s nothing about that fucking tree that couldn’t be cured with a can of gas and a couple matches.
Yes, kids, it’s that time of year again.
ChristmaHanaKwanzaKah is once again in the hearts and on the minds of everyone from sea to shining sea – and beyond – so it’s time for a remedial lesson on How to Succeed in Business Without Really Lying.
Here are the Mighty Casey Media rules for surviving the holidays with your sanity – and your client list – intact:
- Don’t be a grinch. If you’re not a big fan of the holidays, don’t trash those who are. You don’t have to go overboard and wear a pair of reindeer antlers all month, yet neither do you have to tell the office Christmas Elf that s/he is crazy for loving the holidays.
- Be a gracious guest. If you’re invited to a holiday celebration by a client or a colleague, accept with thanks. Attend with intent to find the cheer. Bring a friend along who could be a good prospect for the business. Holiday gifts can come in the form of customers. Take it from one who knows.
- Be a thoughtful host. If you host a holiday gathering, make sure to keep the conversation and connection flowing. Configure your party so there’s plenty of opportunity to interact, and make the rounds continually to ensure that everyone is enjoying themselves. And have a defined end-time for the party, which saves having to shovel folks out the door.
- If you can’t deal, deal yourself out. If the holidays drive you nuts, that seems like a great excuse to take off on a vacation, a retreat, or a sabbatical. Deal yourself out of the holiday merry-go-round, and return to the game refreshed after Santa’s blown town.
Merry ChristmaHanaKwanzaKah to all, and to all a way to make the end-of-year insanity work for you!
When I was still doing stand-up, one of my compadres had a regular bit where her punchline was “women: we make milk. We make eggs. We’re a dairy!”
I’m a big fan of the dairy. No, not the human variety, the kind you find in grocery & gourmet stores. So imagine my surprise when I saw the latest ad campaign from the US Milk Board. The Milk Peeps have been riding on “got milk?” for almost 20 years.
It seems that they saw a niche messaging opportunity, and ran with it. Did they run off a cliff? You be the judge.
I’m a big fan of the funny, as you know. However, when you deploy the funny in service of a brand message, you’ve got to make sure that everyone in your intended audience is on board. Women howled in protest from sea to shining sea when the campaign was launched about 4 weeks ago.
As someone who knows PMS only too well – totally an insider, trust me – I would have advised the Milk Peeps to make a woman the face of the campaign. She could warn her boyfriend/husband/boss/random strangers that their lives might be at stake unless dairy products were brought forth right-damn-now.
And it wouldn’t hurt to add some commentary on the potential risks of drinking milk that has rBGH (a/k/a bovine somatotropin, or bovine growth hormone) in it: like the pus from mastitis – udder infection – that cows who get pumped full of the stuff wind up suffering from. Who needs that, right?
The campaign has certainly kicked off some buzz. I don’t think it’s exactly the buzz that the Milk Peeps were looking for, but buzz is, after all, buzz. Just ask Rupert “help-I’m-strapped-to-a-buzz-saw” Murdoch.
That’s my story, and I’m stickin’ to it …