Category: Future of Healthcare

Why Did This Take So Long???

Check this out. What you will see are descriptions of new high-tech hospital “behavioral health areas” being instituted by some hospitals to promote “calmness” in young, agitated patients awaiting care. 

This makes a lot of sense. Juxtapose the spaces described in this article, that can be custom-tailored to meet the psychological needs of a specific patient, with the cold sterile spaces in which such patients are often detained which increase, rather than decrease, their level of agitation. 

Significant literature exists on the impact of architecture and interior design on behavioral health and psychological wellbeing. One of the classics is a study that demonstrated that if you put mental patients in a building with LONG hallways, like the old state hospitals, they respond by pacing up and down those hallways. Incessantly! 

Bottom Line. While the institutions referenced in this article are certainly to be commended for redesigning their mental health spaces to be more suitable for younger patients, let me ask one more time.

What took them so long???

Telehealth Use Up, Patient Satisfaction Down!!!

Check this out. What you will see is common sense as it applies to telehealth. Quite simply, the pandemic hastened the proliferation of telehealth platforms and of physicians ready, willing and able to use them. The fact that third-party payers, in many cases for the first time, compensated doctors for telehealth visits was a significant driving factor here. Just so, patients seeking safety and convenience stood ready to try telehealth visits during the pandemic.

BUT. Challenges in actually using the telehealth technology reduced patient satisfaction, as did confusion about treatment costs and lack of a “provider details.” Also, rather common sensical is the fact that telehealth is seen as being more satisfactory by the relatively well than by those in poorer health, who are looking for more support from their physician interactions. 

Bottom Line. All of these J.D. Power findings line up rather nicely with the results of my On Doctors’ MindsSM conversations, wherein doctors are telling me month after month that it is the less complicated, follow up patients, and those demanding special handling in terms of safety and convenience, who are now the only ones getting serviced through telehealth platforms. Especially for specialists, the loss of direct physical examination and patient relationship management inherent in telehealth visits causes most doctors to far prefer in-office patient visits. 

Pink Coat, MD

Check this out. What you will see is an interesting potential juxtaposition to the physician that we talked about yesterday. Remember? Dr. MacKenna was an “Integrative Psychiatrist” who incorporates tai chi, nutrition, sleep management, and other lifestyle factors into her approach to helping her patients optimize their level of mental health. 

Today we see Dr. Tammie Chang, of all things a pediatric hematologist-oncologist, whose coaching practice focuses on helping female physicians develop “boundaries” in their practices, and in their lives, which can then serve as foundations for “loving their lives as female doctors.”

Bottom Line. Like I said in my last post, there are a lot of different spins that can be put on the development of coaching practices by physicians and for physicians. Which are long-term winners? Which are instant losers? What is the best way to market these services? 

Maybe these coaches need coaches! 

There’s $$$ in Serving the Underserved!!!

Check this out. What you will see is that substantial funding is being captured by Cityblock Health, a company that specializes in providing care for “marginalized patients with complex needs.” Keep reading and you will see an interesting strategy. While many organizations are attempting to “disrupt primary care,” most of them focus on more well-to-do patients. Going where the money is makes sense, but so does Cityblock’s strategy of shooting at the other end of the financial spectrum where there is less competition and plenty of Government funding.

Bottom Line. This is another one for us to keep our eyes on. If Cityblock Health can deliver on its vision to serve 10 million patients by 2030, they will become a major force to be reckoned with in Primary Care. What impact will this have on other models, like Federally Qualified Health Centers and Free and Charitable Clinics, that are currently serving the underserved? And how will we promote to this new practice model?

It may be time to start thinking about the answers to these and other important, related questions!

The Ethics of Telemedicine

In my On Doctors’ MindsSM research that tracks the adaptations that office-based physicians have made to the COVID-19 pandemic, I have been fascinated to learn about how quickly clinicians were able to adapt to telemedicine, and some of the hurdles they encountered going up the learning curve involved in using this new technology.

But check this out. What you will see is a discussion of whether it is ethical for a physician to limit the treatment of unvaccinated patients to telemedicine visits. Survey results revealed that 69% of doctors thought this was ethical given the risk such patients pose to medical staff. A medical ethicist weighing in on the same topic agreed, but put in the caveat that if a patient’s condition requires personal contact for good treatment, e.g., in the management of a movement disorder, it was incumbent upon the practitioner to either allow personal visits or refer the patient to an HCP that would provide such service.

Bottom Line. Think about it. The COVID-19 pandemic brought with it, among many other things, a slew of new and important ethical questions with which healthcare providers must wrestle daily. As with so many aspects of the pandemic, I am thinking that the results of these wrestling matches will substantially modify thinking in the field of medical ethics for years to come.

If not forever!

Surgical Concierge

Check this out. Press the Eye On Health SurgiQuality button and watch a fascinating video with an interesting premise. More specifically, the point of the video is that when patients are told that they need surgery, they are “shocked”, “nervous”, “scared” and “they don’t know what questions to ask.” Sounds right. Follow through the video and scroll around the SurgiQuality site, and you will see a service designed to deal with all these issues.  A service that will gather all of the paperwork necessary to approach surgery intelligently, or even to pursue non-surgical options which might be recommended by other clinicians. Case materials will be distributed to multiple providers to determine, if a patient elects to proceed with surgery, the highest quality and most cost-effective provider to employ.

Bottom Line. This approach is a very different one from what usually happens in real life. When a patient is told she needs surgery, the usual response is to proceed with the surgeon who has made the diagnosis, and to assemble as much paperwork as necessary to get the procedure scheduled and paid for. 

Does the SurgiQuality approach appear to be more rational than this? Absolutely! But I have two questions. First, to what extent will patients actually seek out this service rather than simply relying on the surgeon who has made the diagnosis and who has at least the beginnings of a viable patient relationship? Second and perhaps even more importantly, to what extent will surgeons repeatedly review cases, offer opinions and make bids for surgeries that they know that they will most likely not wind up being compensated for in most cases? This “competition,” which is described by SurgiQuality as being healthy, might seem less so to a doctor who is asked repeatedly to spend precious time without the guarantee of remuneration.

This will be an interesting one to watch!

A Time for Doctors to Shine???

Check this out. What you will see is a physician author describing physicians as going through Kubler-Ross’s five stages of grief in terms of their professional autonomy and compensation. Over the last couple of decades, doctors have increasingly been forced to cede their power, and much of their incomes, to stronger forces. Insurance companies, medical systems, etc. Early on, we saw doctors in the first stage of grief. Denial. Doctors denied that their lives were being tampered with, and they stayed silent. Mentions of physician “unions” were rebuffed. 

Over subsequent years, the doctors predictably marched through the other stages of grief. So now they are where they are. Interestingly, as COVID-19 looked like it was passing off into history, doctors believed that this would be an ideal time for them to recapture their pre-grief former lives. Not so fast! Many of our citizens are facing difficult financial times as a result of the pandemic. Small businesses are struggling to stay open. AND. Many Americans are mindful that among developed countries, the US has the least cost-effective healthcare system on earth. Not a great time for doctors to be asking for more money and more autonomy.

Bottom Line. SO. Dr. Pearl is suggesting that American physicians move on to the last stage of grief. Acceptance.  No, not acceptance of the fact that our healthcare, and doctors’ lives, will continue to get worse and that there is nothing to be done about that.  Nope. Acceptance of the realization of what is broken, e.g., an uncoordinated fee for service system. And making the commitment to fix the problems. 

Then, and only then, will physicians and patients be able to stop grieving!

Cannabis M.D.

Check this out. What you will be led to is the web presence of Jill Becker, M.D.  Trained in Ob/Gyn, Master’s Degree in counseling psychology, ordained Minister, etc.  BUT. Her main claim to fame is that she has extensively studied the use of cannabis used to deal with a large variety of medical problems. She will “work with your care team” to figure out the right cannabis program to cure what ails you. AND. Talk about a practice that is perfect for using telemedicine! She can work with patients nationwide using telemedicine platforms and can also help patients avoid any stigma that might accrue to being seen sitting in her waiting room. 

Bottom Line. Got me to wondering. How many other doctors have figured out this schtick??? Do the Google search and roam around like I did and you will know what I know. LOTS!!! All doing it via telemedicine.

Smart. I can see this specialization filling a real and important need that many (most?) doctors wouldn’t touch with a ten-foot pole!

Digital Therapeutics

Check this out. What you will see is the announcement of the launch of the first FDA-approved video game designed for the treatment of ADHD. Being marketed through, you guessed it, digital media. 

Go to their website and watch the trailer

One wonders how many more videogames will come onto the market, FDA approved, requiring an Rx and costing $100 per month, to compete with this initial offering. Or will this be a monopoly? 

Lots of other questions come to mind. What will the receptivity of healthcare practitioners be for this offering in particular, digital therapies in general? Will parents pony up the $100 a month for three months of initial therapy? How effective will the therapy be? Will parents reup after the initial trial? 

Bottom Line. Don’t you just love it when something genuinely new like this comes along? All the new research avenues that one gets to pursue! 

Industrialized Medicine

Check this out. What you will see is a psychiatrist, who specializes in helping physicians and their organizations deal with “complex personal challenges,” asking his colleagues a question. Are they “healers” or are they “widgets.” According to Dr. Adelman, the trend over the last 50 years toward “industrialized medicine,” where doctors’ workflows are controlled by corporations rather than by their own wills, has caused there to be so much “coming at them” that they are like Ethel and Lucy in the chocolate factory. They just can’t keep up. They become unable to do “their best work.”

A powerful quote from Adelman’s post:

Malaise sets in when you realize that you have become an almost inanimate object.  This is ‘physician burnout,’ which has been conceptualized by some as a form of moral injury visited upon us by industrialized medicine.

Bottom Line. The move away from being a healer and toward being a widget seems inexorable. This is not likely to get better in coming years.

My question? Then what will “worse” look like in years to come???