Category Archives: Culture

Should patients choose doctors who are friends?

Come with me?

Can I help you?

In the social media era, it’s common to read articles discussing the blurring boundaries in the doctors/patient relationship. Usually it’s some version of, “Should a doctor accept friend requests from patients on Facebook?” or “Is it ok for doctors to Google their patients?”

The Wall Street Journal (The New Boundaries Between Doctors and Patients) explores these issues and goes on to explore what happens when patients and doctors become friendly during the course of treatment. In the midst of this there’s a throwaway paragraph:

“Some boundaries are clear. Professional medical organizations have strict rules against sex and romance with patients. Doctors are also advised not to treat family or close friends, situations that could compromise objectivity and judgment.”

I have no problem with the part about sex and romance. I also kind of understand the family issue. But the friend one is more interesting to me.

I read a few pieces that discuss this topic. (Here, here and here.) The typical scenario is a friend asking for medical advice in a casual setting, often on a topic that’s not related to the doctor’s specialty. I get why that’s a bad idea.

In my own case I know many practicing physicians socially, and most are in the prime of their careers: mid 40s to early 50s. A couple years ago when I was having trouble finding a new primary care doctor after mine retired, I asked physician friends who they went to. That was a little too clever on my part, since I forgot to account for the fact that physicians get treated differently than regular people when they go to the doctor’s office. No NPs for them!

But after some so-so experiences with a particular medical specialty, I decided to ask a specialist friend if he would be comfortable being my doctor. He said yes and I started seeing him. He’s a longtime friend but not an extremely close friend. I’ve been extremely satisfied with the experience. Partly because he’s an excellent doctor but also because I feel he understands me better and may even provide a little extra attention. He trusts me enough to exchange detailed emails. I’m not embarrassed to share personal medical details that I wouldn’t be comfortable with sharing someone who’s just a friend. Honestly, for me I don’t see the downside.

I did the same thing when I a needed a new dentist and that’s worked out well, too.

I hope I stay reasonably healthy and then die peacefully in my sleep when I turn 100, so I don’t have to spend a lot of time as a patient. But realistically it’s likely that I’ll be seeing more specialists as time moves along. I’m definitely planning to keep friends in mind when it comes time to find people to treat me.

Image courtesy of stockimages at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

A wakeup call from the nanny state

Amber alert alert

Amber alert alert

My cellphone was off Friday night so I was lucky enough to miss the Amber Alert that was sent out at 1:45 am when a mom decided to drive home from Pennsylvania to have her son treated at Boston Children’s Hospital. I heard about it Saturday night from some friends who couldn’t believe this had occurred and were annoyed at being awoken.  From where I sit, the only good thing about it is that it’s literally a wake-up call to the whole community about how the system treats vulnerable people.

It’s hard to say exactly what happened. But from what’s been written, it goes something like this:

  • A nurse practitioner in Wilkes-Barre, PA told a mom to take her 2-month old to a nearby emergency room for treatment of severe dehydration
  • Mom felt she had gotten “the runaround” from the Pennsylvania clinic and decided to drive to Boston Children’s Hospital to have her son treated there. She is from Boston and apparently has a relationship with a doctor there
  • On the way back she dropped off her older son with a niece in Waltham so she could focus on the infant
  • Somewhere along the way, someone in PA decided to issue an Amber Alert –meant to be used when a child is abducted and “believed to be in imminent danger of death or serious bodily injury”
  • The Amber Alert went out, waking everyone up
  • Infant made it to Children’s, where he’s been admitted and is improving –but now in custody of DCF (protective services)
  • Other child was also taken by DCF
  • Mom was arrested in MA as a fugitive from justice in PA. Judge listened to her story and released her on a token $250 bail

As I mentioned I don’t know exactly what happened. But I tend to give the mom the benefit of the doubt. In particular:

  • Who knows the quality of care and clarity of instructions the woman received at the clinic in PA?
  • A general ED is no place for a 2-month old. Many are still totally unprepared for kids, never mind babies
  • Boston Children’s is rated the #1 pediatric hospital in the country and she may have relationships there already. Depending on the kid’s condition, who wouldn’t at least consider making the drive?
  • It’s hard to drag a toddler all over the place during an emergency, so why not drop them off at a relative’s house along the way?

The mom apparently has some moving violations and a charge for prostitution. I wouldn’t be too quick to judge her for those things.

It’s hard to know what to do when your kid is sick and you’re trying to navigate the healthcare system. That’s true even for a well resourced, well educated dad like me who works in healthcare. Without those privileges it appears all too easy to end up with Amber Alerts, arrested moms, and kids taken by the state when a mom tries to do what’s best.

I don’t like it.

Image courtesy of mrpuen at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

We want death panels!

Can you hook me up?

Can you hook me up?

From Kaiser Health News:

The public overwhelmingly supports Medicare’s plan to pay for end-of-life discussions between doctors and patients, despite GOP objections that such chats would lead to rationed care for the elderly and ill, a poll released Wednesday finds.

Of course it makes sense to pay physicians to discuss these difficult issues. The fear-mongering prompted by Sarah Palin’s characterizing these discussions as “death panels” has been harmful to patients and families.

It’s heartening to learn that most people have been able to cut through the nonsense on this one.

Image courtesy of foto76 at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Ready for the eyeSelfie for diagnosing health problems?

Ok Google, am I healthy?

Ok Google, am I healthy?

I spoke last night to a friend who lamented that his teenage daughter seemed fixated on taking selfies of her eyeball with his phone. He found these when he went to review his stored photos. I thought it was a little odd but suggested that maybe she was looking for just the right shot to send off to an ophthalmology lab for diagnosis.

I may not be far from the truth. Today’s Boston Globe included MIT Camera Culture Group develops the ‘eyeSelfie’ to help monitor eye health. Sure enough, my suspicions were confirmed:

Researchers at the Camera Culture Group, headed by Ramesh Raskar at the MIT Media Lab, have designed the eyeSelfie, an inexpensive hand-held device for taking a photograph of the retina, the optic nerve, and the vasculature, which is located all the way at the back of one’s eye.

Digital snapshots of the interior of the eye can help physicians detect and treat vision-threatening diseases such as glaucoma, macular degeneration, and diabetic retinopathy early. New research indicates that the snapshots can also be used to identify risks factors for hypertension, heart disease, multiple sclerosis, and Alzheimer’s disease.

Taking this back into the realm of speculation, let’s imagine that Google decides to use its new image recognition initiative to automatically analyze eyeball photos, like those of my friend’s daughter. If the technology improves enough it could give Google vastly more insight into users’ health status. It goes way beyond my speculation from eight years ago (What if Google finds out you have cancer before you do?) about Google’s ability to guess a person’s illness from search logs, even if the user hasn’t been diagnosed yet.

I could take this further. Right now the MIT camera is a specialized unit and it still takes a bit of jiggering to get a clear shot that can be analyzed. But as camera technology improves perhaps we’ll get to the point where we can analyze even regular smartphone snapshots, zooming in on the eyeballs of everyone in the frame and assessing their health status.

That will take a while but we should be prepared for when we get there.

Image courtesy of Serge Bertasius Photography at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

 

Fast progress on transgender benefits

Bruce Jenner’s transition to Caitlyn Jenner has brought transgender issues quickly to the fore. What I had not realized is that major employers and the federal government are well on their way toward providing coverage for transition-related health care. I’m not in a position to comment on the adequacy of the coverage, but just want to make the point that it’s advanced faster than I thought.

According to Business Insurance (Transgender benefits gain attention of employers), the Office of Personnel Management recently required Federal Employee Benefit Plan providers to cover transition-related care, citing an emerging consensus that such treatment is medically necessary.

About half of large employers offer transgender-related surgical coverage compared with 5 percent in 2007, according to a National Business Group on Health survey.

Transgender-related benefits are varied, and include “mental health counseling, hormone replacement therapy and gender reassignment surgery. Some employers… include coverage for facial feminization or reducing the Adam’s apple…” Not every employer offers all categories of benefits.

Private employers aren’t required by law to offer such benefits, but they have various motivations. They include:

  • An increasing belief that such coverage is medically necessary, and therefore in keeping with the overall philosophy of health insurance
  • A desire to increase competitive positioning in recruiting –including for employees that do not themselves expect to use such coverage but are looking for employers that are progressive
  • A realization that the overall costs are likely to be small, typically less than 0.5% of total health care costs
  • A defensive view that not offering such benefits could lead to discrimination claims

I don’t typically think about insurance benefits being in the social and cultural vanguard, but at least based on this example that may not be a fair assessment.

By healthcare business consultant David E. Williams, president of Health Business Group.

An inspiring product development tale

Just do it

Just do it

The times they are a changing, and in some ways for the better. Nike is releasing a new sneaker designed for people with disabilities who have trouble putting regular shoes on by themselves. The idea for the shoe came from a teen with cerebral palsy who wrote a letter to Nike that ended up with the CEO. A related request came from a Nike employee who had suffered a stroke.

The company then spent three years to design a sneaker with what USA Today calls “an elongated wraparound zipper system to allow a wearer to open close the show with one hand.” They collaborated with the teen to perfect the design.

This isn’t some clunky looking, medicalized shoe. Instead, the Zoom Soldier 8 Flyease is a variation on a Lebron James basketball shoe. It’s cool and stylish.

Advocates for the disabled are pleased, because Nike can make a significant impact on quality of life with this product, and because it represents a new phase of acceptance for people who are a little different. I won’t be surprised if the shoe is a big hit –there are lots of people who have physical challenges of various types who might really like it.

If Nike can make money on the concept, that’s good news for everyone because it will demonstrate that this is a profitable opportunity, which will encourage others to compete.

The situation reminds me somewhat of the highway safety movement a generation ago. Although the problem of avoidable automobile deaths was there if you looked for it, the auto industry –with the exception of Volvo– wanted nothing to do with it. But once the public started to express an interest in safety, the world changed, and car companies started to compete on safety as well as styling and power.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Hang up and dial 911

The easy button

The easy button

American consumers are used to fast access to service: Check the web to see when an Amazon package is arriving (sometimes same day now), speak to a customer service rep at Fidelity 24 x 7. If anything, convenience is increasing as pain points are being addressed. For example, I experienced frustration and poor service from the local cab company for 25 years, but now I can just press a button and summon an Uber in minutes, watching the driver’s progress on the map as the car approaches.

Healthcare sort of understands that it needs to change, but access to care is still difficult, tools are clunky, and CYA approaches reign.

One reason people go to the ED is that they know they can access care there. They don’t have to check the hours of operation and don’t need to sign up for an appointment that’s weeks or months away.

While there is a general understanding that ED visits should be reduced, in practice many providers actually encourage overuse. Call the main number of any hospital or physician office and one of the first things you’ll hear on the recording is, “If this is a medical emergency, please hang up and dial 911.” Is it any wonder that people get the message that 911 is the route to take for anything serious?

Generally, once an ambulance is summoned the patient is going to the hospital emergency department unless they convince the EMTs they are well enough to stay put. That’s why I was excited to read about a program in Reno, Nevada that preserves the convenience of 911 and the ED while avoiding some of the downside.

Paramedics are being trained to handle some primary care tasks –such as helping heart failure patients avoid complications– that often degenerate into an ED visit and hospitalization. They are also being given a broader set of destination options when they do transport, such as detox centers and urgent care.

As usual there are challenges: EMTs need different training if they are to fill the roles of primary care and visiting nurses, insurance may not pay for non-traditional approaches like this, and while this is a cheaper and better route than the ED, I doubt it’s cheaper or better than traditional primary care. Clearly Nevada doesn’t want to encourage more 911 calls.

I look forward to learning more about this experiment.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net


By healthcare business consultant David E. Williams, president of Health Business Group.