Archives for posts with tag: National Physicians Alliance

21st Century Cures Act will distort the meaning of ‘FDA approved’

The term “FDA approved” means a lot to those of us working in health care and the patients we treat. But if the 21st Century Cures Act becomes law – the House of Representatives approved it Wednesday and the Senate will vote on it next week – this mark of trustworthy stewardship will become a shadow… (more…)

Here is a talk I gave at the annual meeting of the National Physicians Alliance on October 20, 2013, in Washington, DC. The briefest version is this: Everyone talks about patient-centered care and realizes that our system is doctor-centered. How do we square the circle and get from one to the other? Patient-centered care is a mantra more often repeated than deliberated on and well defined. We must recognize that patients are unique individuals, and that the relationship between the primary care provider and the patient, a pillar of an improved system, must include all sorts of patients – no matter what their desired involvement in decision-making.

Cross-posted to the blog.

I’m going on some smaller and longer trips over the next weeks, which put the topic of health disparities in comparative contexts. Disparities is the scientific term for health inequities. In short: everyone should get the same healthcare, but not everyone does. You get worse care if you’re black, or poor (unfortunately, those are obvious). What about if you are older, or LGBT, or speak a language other than English, or live in a rural area, or have a chronic illness, a disability, or a mental health issue? Probably. But the question is not just yes or no, obviously, but how, why, and what the solutions are.

Next Friday, October 24th, is the most local of the events. I’ll be giving a 400-second talk, that’s 20 slides in 20 seconds each, at PechaKucha Baltimore, the first local rendering of the speedy-talk format that has already been done in a number of other cities. My topic will be Talking Heals. And, while I won’t be mentioning specific health statistics about Baltimore inequalities (400 seconds isn’t enough for statistics!) I will certainly have in mind the great, abiding fact of Baltimore life. “The rich are different from you and me,” as F. Scott Fitzgerald said in another context: yes, they have more money (as Hemingway is supposed to have responded), and thus more health. How can we bridge the gap? Part is access (the poor in Baltimore can’t get in to see doctors, there’s a shortage of internists), part is cost (for obvious reasons) – but part is also quality. And part of that quality piece is to make sure that doctors and patients can communicate across lines of race, class, and origin.

On the preceding Sunday (I’m discussing these events out of their chronological order), October 20th, I’m giving a talk at the National Physicians Alliance: how do we make our doctor-centered system into patient-centered care? You might not be surprised to hear that the solution I proffer is neither all one thing (patient centrism, the advice of the doctor be damned!) nor all the other (status quo and to heck with EMRs!) but something in between: investing in and maintaining relationships.

Finally, in December, I am heading to Peking Union Medical College Hospital in Beijing, at their kind invitation. I hope to acquaint myself with their system and China’s system at large, which I am sure demonstrates some inequities unique to the Middle Kingdom and some shared with the US as well. From what little I know about the current Chinese socioeconomic climate, there is rapid and thoroughgoing social change – which I hope has not swallowed up previous governmental plans to provide better primary care access to millions of Chinese.

Through these multiple dimensions of care, quality, and access, applied across various regions, we can aspire to great change. Lots to do!

Cross-posted – you know where. The Talking To Your Doctor blog!

Your book is called Talking to Your Doctor but really it’s doctors who need to learn how to talk to patients. Doesn’t this expect too much of us? After all, our doctors don’t have enough time to talk to us anyway.

Our intuition tells us that doctor-patient visits are subpar because there’s not enough time. However, research shows that patients and doctors can have satisfactory visits in countries where the general practitioner has even less time for the visit. In the book, I point out that it’s not so much the “clock time” devoted to the visit as it is the “visit time”: the attention, mindfulness, and concentration each party brings to the interaction.

 
Read more questions and answers at the National Physicians Alliance website.

If I may, a blogpost about something other than the book. Last week I went to a happy hour at a Baltimore watering hole* organized by the National Physicians Alliance. The NPA is an organization that I have felt warmly towards ever since they started the ball rolling on the Choosing Wisely movement. It is a group that wears its ideology and advocacy proudly on its white-coate sleeve and hanging from its stethoscope. (I talk more about the Choosing Wisely campaign in the book, which means this post is actually related. Whew!)

The people I met there were wonderful and of that ideology: primary-care centric, against the blandishments of Big Pharma, for evidence and for the patient at the same time. I don’t remember their names, but many of them were in preventive residency programs (most at Hopkins) and a number were specialists in family medicine.

It was with a family medicine doctor that I had the conversation that sticks with me most, more even than the beers I had. I told him I thought a single-payer health care system would never be a reality, and he pointed out that it could, on a state-by-state basis. While all such state-level single-payer proposals have failed (except in Vermont), it wasn’t too long ago that gay marriage was illegal in all states – and that too has made its way to legal acceptance through piecemeal, state by state progress.

Which is not to say that these issues are entirely comparable, of course. The permissibility of gay marriage is to my mind a moral cause, and not a hard call at all, while incrementalists have made powerful arguments that single-payer health care is not the only way to go. The long-term question, I suppose, is what comes next after the Affordable Care Act (i.e. Obamacare). Will access, quality, and (hopefully) cost continue to be improved under our employee-based model? Or will we make that leap that I more and more think is necessary, to care for all, indepdendent of employment?

The get-together with the NPA folk was inspiring. And, since most of them were a fair bit younger than I am, it bodes well for at least a corner of the future of healthcare.

*The Brewer’s Art, where I was excited to see an artisanal beer called Migdal Bavel [the Tower of Babel, in Hebrew]. How often do you see a Hebrew-named beer in the US? So I asked for it from the bartender. Who couldn’t understand what I was saying until I pointed it out on the list. I guess my beer-Hebrew pronunciation is off.