Category: Healthcare Management

Skipped Appointments

Check this out. And, this as well. What you will see at both URL’s are teasers for WSJ articles discussing the impact of patients skipping medical appointments during the pandemic. From postponed colonoscopies to delayed detection of diabetes, most experts believe that it will be a decade or more until we realize the full impact of this procrastination. As one Oncologist discussant in my On Doctors’ MindsSMconversations reminded me, “Cancer has a long tail.”  

Two driving factors here. Institutions being shut down for routine visits and elective procedures over an extended period of time didn’t help. Patient fears about being infected with COVID in a medical setting are even more long lasting and are still causing delays in medical treatment.  

As we have discussed before, only well on into the months of the pandemic did we start to see advertisements by pharmaceutical companies encouraging patients not to postpone needed care.

Bottom Line. So, I wonder. What did we learn from this that will cause us to do something differently the next time? And who is the “us” that is responsible for keeping healthcare on track???

Really???

Check this out. What you will see is an interesting 2-minute video, from our old friend the Country Doctor, on why he doesn’t order “fasting” blood work anymore. In a nutshell, he feels that this testing denies him information concerning the usual state of his patients’ lipids. Put another way, while the fasting blood work provides a reliable measure, it is of questionable validity.  

As usual, this got me to thinking. As a guy who has wrestled with hypertension all his life, I have been carefully instructed by my physician as to how to take my blood pressure at home. Sit quietly for 5 minutes. Uncross my legs. Arm and bp cuff level with the heart. Every time I do that, I ponder whether what I am measuring has any relationship to my blood pressure as I run around the golf course during the day, get stressed at board meetings, etc.

I also think of a good friend of mine, unfortunately recently deceased (Is there cause and effect here?) who took great delight in cleaning up his diet and stopping drinking a week before his blood was to be drawn for his annual physical. Using this trick, he was always able to show his doctor what a healthy life he was living. Right!!!

Bottom Line. How many things in life do we measure the easy way? The way that gives us reliability rather than validity? The same headset is operative in marketing research, where we tend to measure things the way that make the results easy to interpret? Carefully sidestepping all of the complexities of our customers’ real-world experiences, which would often add the words “It depends on….” to the beginning of their answers!

Delays In Cancer Diagnosis “Thanks To” The Covid-19 Pandemic

Check this out. But like yesterday’s post, there is no need to study this article too closely. In fact, its message is largely encapsulated in the graphs shown above. Quite simply, this article reports a clear demonstration that the detection of colorectal cancer in England was slowed significantly by the coronavirus. More specifically, referrals for colonoscopies and their prompt scheduling fell precipitously at the pandemic’s outset.  

This lines up perfectly with the On Doctors’ MindsSM  conversations I have been conducting with U.S. Oncologists. Many of them are talking about “stage shifting,” i.e., patients presenting with later stages of cancer than is usually the case thanks to their fears of going to medical facilities fostered by the pandemic. Failure to obtain timely colonoscopies, mammograms, etc. is believed to be having a significant negative impact on survival. Interestingly, my discussants are telling me that once diagnosed, treatment is occurring according to the usual schedule.  

Bottom Line. Wolf Blitzer continues to do an excellent job of providing us with nightly updates on COVID-19 deaths. It is important to keep in mind, however,  that the number of preventable deaths related to delay in cancer diagnosis and treatment might actually dwarf these numbers.  

Mental Illness And Life Expectancy

Check this out. What you will see is an analysis that demonstrates that people with mental disorders die 8.2 years younger than do those without such afflictions.  

Rather than getting hung up in all the correction factors and “p values,” just picture this fact as a check on your intuition. If I had asked you about these comparative mortality rates, I bet you would have gotten the directionality correct. Probably even the order of magnitude. I would have guessed that people with mental disorders die 10 years younger. BUT…

Bottom Line. To make things really interesting, spend a few minutes pondering another, related question.  

Why???

Covid-Delayed Medical Care

Check this out.  What you will see is an article clearly outlining the kinds of medical procedures that are being postponed due to COVID-19 pandemic. As summarized in the article “Even with telemedicine, there were 6.9 million fewer mental health visits. Early childhood immunizations declined by 22%. And 31% of adults avoided preventive care in 2020.”

In the On Doctors’ MindsSM interviews I am conducting every month; I am repeatedly hearing Oncologists expressing concerns about the “stage shifting” that they are seeing in their practices. Translated, they are seeing patients initially presenting with more advanced cancers as the result of missed screenings through colonoscopies, mammograms, etc.  

One physician told me a really scary story in this regard. In 2019, a routine screening found one of his patients to have a PSA of 12. Not good. The doctor told the patient to come back in a few months to have that value rechecked. Along comes the pandemic and the patient cancels his recheck appointment, being too fearful of the virus to show up in the doctor’s office. In 2021, the patient finally got up the nerve to come in for the recheck.  His PSA? 127! His prostate cancer? Widely metastasized!  

Bottom Line. Doctors are telling me that it will take years for the total impact of postponement of care to be realized. . . BUT. This article points out a few “Red Alert” symptoms that cannot be ignored, even in the short term. Hint. If you have chest pains or shortness of breath, get to the hospital quick, even if there are patients upstairs being treated for COVID!  

Amazing that people have to have this pointed out to them, but Cardiologists are telling me that especially in the early days of the pandemic, when everybody was totally confused and fearful, their usually busy cardiac care units were silent and empty. Explanation? People were having “silent heart attacks,” ignoring their chest pains and just staying home. 

Bad idea!!!

The “Charting Coach”

Who would have thunk it??? Check this out. What you will see is a family physician who has made a business out of helping physicians free themselves up from the heartbreak of charting “backlog.” Doctor after doctor with whom I have spoken, especially in recent years, has reported having problems in this area. One physician comes to mind who had been up at 4:30 AM the Friday of our conversation, busily pounding away at patient charting. He reported that he would be similarly occupied that night, and well into Saturday morning.

Bottom Line. The major point of this “Charting Coach” is that backlogs are better avoided than dealt with ex post facto. For example, charting after each patient visit is much more efficient, and more psychologically healthy, than doing all of the charts at the end of the clinical day.  

Words to live by in our own careers! “I can always do it  later” is typically not a good thing to be saying to yourself!!!

10 Important Healthcare Trends For 2021

Check this out. What you will see is a listing of the ten most important trends in healthcare, as identified by a company, Augmedix, that specializes in using technology to help physicians make better use of their time by automating repetitive activities in their practices. Some of these trends, like Telemedicine, are obvious. Others, like “Asynchronous care,” actually made me stop and think for a minute.  

Bottom Line. My recommendation? After you consider each of these trends individually, stand back and look at them in their totality. What you will see is that in 2021, healthcare in the U.S. is going to be undergoing a fundamental and broad reaching metamorphosis.  

Those of us who work in the healthcare marketing vertical had better be prepared!!!

There Are Three Kinds Of Primary Care

Check this out. What you will see is a fascinating little piece by our old friend “The Country Doctor,” pictured here. In it, he explains the three functions that a PCP serves. Sick Care, Chronic Disease Management and Disease Prevention and Screening are all inherently parts of being a Family Physician.” Goes without saying. BUT. The real point of this piece is that the emphasis that is placed on each of these areas of practice requires some careful thought and is really situation specific.  

For example. “Sick Care” is what immediately comes to mind when most people think about primary care. The rapid proliferation of Doc-In-A-Box facilities and telemedicine, both of which are focused on immediate care for the sick, are supportive of this perception. Sick Care is sort of all they do.

On the other hand, at Hilton Head Island’s Volunteers In Medicine, where I am proud to be on the Board of Directors, we emphasize the other two functions. Given that the majority of our 10,000 patients are underserved minorities, we feel that we can do the most good by helping them to manage conditions like hypertension and diabetes, and by making sure that they get screening procedures like mammography done according to guidelines. Sure, we treat the sniffles too, but that is a secondary function.  

In most private Primary Care practices, as the good doctor points out, there is a real issue of the availability of time to perform all of these functions, so prioritization becomes extremely important. For example, Disease Prevention, if left to its own devices, can be very time consuming. Because of its “routine” nature, this post suggests that an MD degree is not required to perform this function. Support personnel and media like emails and letters can meet this need very adequately.

Bottom Line. SO. Again, the optimal emphasis of primary care really comes down to “setting.” As usual, reading Dr. Duvefelt’s piece got me to thinking. What is the primary value of being a member of a “concierge” practice, such as the one of which I am fortunate to be a member? Is it more the ability to get a same day appointment if you are sick, or to have a doctor with time available to service you in all of these three areas? I am thinking the latter. 

The title of this post is correct. We should in no way confuse the three functions of primary care. Rather, we should consider each of them and decide, for a particular practice setting, which should be emphasized.  

“Horses for courses!”

The Importance Of Role Models

In our previous post, we talked about the importance of eliminating “implicit bias” in healthcare through more culturally sensitive training for healthcare practitioners. Today’s post is just a quick addition to the thought. Check this out. A simple idea here. That is, in eliminating implicit bias, based on race, sex, etc., it is essential to have in place role models that are diverse. When we say the word “Doctor,” we want the listener to be as likely to picture a person of color or a woman as they are to flash on a nice, white “Marcus Welby, MD.”  

Bottom Line. As was noted in the previous post, there is still a paucity of racial minorities in the physician ranks. Therefore, is essential to get these practitioners out and visible to the community, as role models, as an important part of our efforts to eliminate implicit bias.  

WHOOPS!!!

You may recall that few years ago, I wrote breathlessly about the joint venture being mounted by Berkshire Hathaway, Amazon and J.P. Morgan aimed at bringing health care costs under control in their organizations, and likely going beyond that corporate triad to offer the services they came up with to other companies as well.  

BUT. What you will see is that, despite my bullish predictions, this  venture is going belly up. The reasons? Check this out. Lots of things went wrong here. Atul Gawande, noted physician and healthcare thinker, had been appointed CEO. He bailed on the organization, as did other key players.

More generally, the venture, ironically named Haven, didn’t turn out to be one. Rather, three years of experimentation taught Haven’s team one major lesson. Healthcare is tough and multifactorial, and bringing together plans that could satisfactorily serve the employees of these disparate organizations turned out to be a tougher nut than they originally believed.

Bottom Line. There are apparently limitations to the generalizability of  expertise. Mastering overnight delivery, investment banking or running a conglomerate doesn’t necessarily guarantee success in a complicated space like healthcare!