jenuesse health

I had intended no more blog posts for this year, but then Amanda died, and she merits recognition. Amanda Turner Russell, a labor and delivery nurse at my former hospital, a shining light in so many ways, was declared brain dead of head trauma and spinal chord injury caused by a motorist while she was engaged in one of her passions, training for the next charity run in the Boston Marathon. A relative on Facebook reported: In typical Amanda fashion her last wish was to help others. Tomorrow lots of people will be getting another chance at life and a little piece of Amanda will live on. All who knew Amanda were struck by her good nature and generosity.  She inspired her colleagues to take on new challenges, to develop personally and professionally.  She was a loyal friend. Working in the most optimistic part of our hospital, she saw and delivered joy.  She presented it--almost daily--to the rest of us in the form of a sunrise photograph (that she would label #bidmcsunr...

One last post before the New Year's blogging break: It doesn't take long after arriving in Australia for an American to be asked, "What on earth is the matter with your country, when it comes to guns?" These folks are great admirers of the US and close observers of our debate on the issue.  They even know about the Second Amendment to our Constitution and are quick to observe that the Founding Fathers probably had muskets in mind and not projectile weaponry capable of shooting down helicopters. Speaking of the latter, take a look at this humorous column on this serious subject, " Australia enjoys another peaceful day under oppressive gun control regime. " The lede: Due to the nation’s controversial and oppressive gun restrictions, no one has died as a result of a mass-shooting on Australian soil today, for the  7158th d ay in a row.     Local cinema attendant, Christina Upton can’t believe it has been a whole 19 years and 7 months since a heavily armed wh...

Check out this fascinating interview between Eric Topol and Bennet Omalu, the pathologist who made the connection between football and brain damage in the Mike Webster case.  This is the story that forms the basis for the new movie Concussion .  It's worth watching the interview before you see the movie. (Note:  The combination of poor Skype fidelity and Dr. Omalu's Nigerian accent may make it hard for some to understand the audio.  Just read along with the text as the interview proceeds if you need help.)

Whether here in Australia or anywhere else I've traveled over the last decade to review and assist in the health care world, I've seen a growing desire to engage patients more in the design and delivery of care.  As I noted back in 2013 : [P]atient-driven care does not mean foregoing the expertise, judgement and experience of clinicians.  Nor does it suggest the abdication of their clinical responsibilities. But we must go beyond patient-centered care, in which the doctors and nurses decide what is best for the patient.  Patient-driven care, in contrast, is based on a partnership between the provider and the customer. And, as my friend Danny Sands noted in a comment to that blog post: Healthcare is a collaboration around the health of the patients. Consequently, I think this appreciation and understanding needs to go both ways.  As we know participatory medicine is based upon mutual respect: the clinician respecting the self-knowledge, experience, and wisdom...

Here's a lovely article by David Silbersweig about the importance of liberal arts training for those in the medical profession.  Of course, his argument would apply to any profession, but it has particular relevance in this one, where the tendency to rely on the "hard sciences" is emphasized even in the undergraduate years. Excerpts: [M]y thoughts returned to my sophomore year at Dartmouth, when I went back to my childhood dentist during a school break. In the chit-chat of the checkup, as I lay back in the chair with the suction tube in my mouth, he asked: “What are you majoring in at college?” When I replied that I was majoring in philosophy, he said: “What are you going to do with that?” “Think,” I replied. And what a continuously giving gift philosophy has been. While it seemed impractical to my dentist, it has informed and provided a methodology for everything I have done since. If you can get through a one-sentence paragraph of Kant, holding all of its ideas...

It was with some dismay that I read Modern Healthcare' s article called, " The 30 events that rocked healthcare's world in 2015 ."  I jumped into the piece, confident that I would, indeed, find some developments that have made a difference in the quality and safety of patient care, that would introduce transparency, and that would encourage a greater partnership between clinicians and patients and families. What I found instead was a version of The Nightly Business Report --a series of stories mainly about the corporate and financial interests of pharma, insurance companies, big hospitals, and big government.  These stories have nothing to do with what actually happens on the floors and units of America's hospitals or in the offices of local physician practices.  There is nothing in the stories that is motivational to the doctors, nurses, and other health care professionals who have devoted their lives to taking care of us.  There is nothing in the stories that pr...

I'll be writing from Melbourne, Australia for the next several weeks.  I've been invited to be a " Thinker in Residence " at Deakin University, which has campuses here and in Geelong several miles to the south. Beside participating in university activities, I'll be offering advice to the Victorian Managed Insurance Authority ( VMIA ), which provides liability and other insurance to the various state agencies, including those involved in health care and infrastructure. And also to GMHBA , a non-profit private health insurer based in Geelong. I'm hoping my regular readers--and maybe some new ones--will enjoy some observations from here in Oz.  Given the reach of the Internet, I'll still be watching things back home, but maybe my observations about them will also benefit from the perspective that distance offers. In commemoration of the Christmas holiday and its emphasis on kindness, I want to start with one story from Dr. Kate Cherry, an infectious disease s...

Here are two excellent ways to reward your friends and loved ones with something pleasant to view, while helping good causes.  Warning: Note strong relative and friendship bias! First, for dancers and dance lovers in your life, a stunningly beautiful 2016 calendar produced by the Jacksonville Dance Theater.  JDT is a recent start-up that has added considerably to the cultural life of northern Florida and has also appeared at modern dance concerts throughout the US.  Proceeds from the sales go to support this budding non-profit arts organization. Second, a lovely picture book called What are Mothers For by Janice Lynch Schuster. A portion of the proceeds will go to Reading Partners Baltimore, which has volunteers working one-on-one with thousands of children ages 5-8 who are unable to read. Janice notes, "In my mind, pushing children through school despite their illiteracy is a form of prison, now and in the future." About the book, Janice adds, "Beyond the desire ...

Sometimes seasonal doggerel contains universal truth.  Here's an example about a Boston-area infrastructure issue from James Aloisi, a former state transportation official.  Like me, he can't figure out why the Massachusetts body politic can't get their collective heads together around the truism that a strong--and expanding--mass transit system is the difference between a city and a world class city.  He also recognizes that a failure to invest in such infrastructure assesses a hidden tax on the many people in a metropolitan area--in the form of longer commute times, a need to purchase cars, and limitations on employment--and on the businesses in that area--in the form of a reduced labor force pool and congestion of roads that adds to the cost of transporting goods. Excerpts: To commuters and riders With a simple request: For transit mobility, Why not the best? And history repeats itself Many times over As voices of retrenchment Get bolder and bolder. More yappy than be...

There is an understandable tendency for the public to take great interest in the health issues of our former national leaders.  Once they are out of office, political animosities die away, and we want to think about them more as people and, indeed, to express our concern for their well-being. That's a gracious and lovely sentiment. A problem can arise, though, from the media's coverage of such a beloved figure--a tendency to overstate good news surrounding that person's medical treatment. Harold DeMonaco over at Health News Review offered an excellent synopsis of such coverage in a recent article , "What the media got wrong about Jimmy Carter’s cancer 'cure.'" The lede: If you watched or read the news this week, you probably heard a story about former President Jimmy Carter’s ongoing battle with metastatic melanoma. . . . On Sunday morning, he told his bible class, “My most recent MRI brain scan did not reveal any signs of the original cancer spots no...

We've all seen stories in the press describing how inappropriate it seems for doctors to accept funding from drug manufacturers and other participants in the health care marketplace to attend conferences and the like.  In fact, federal rules now require doctors to disclose many types of such payments.  Well, here comes a story from Trudy Lieberman at Health News Review about reporters accepting invitations from industry sponsors to do the same. The title--"Is it ok for journalists to attend Bayer-funded training on new cancer treatments?"--buries part of the lede, in that it is not just Bayer who is behind the scheme.  Trudy notes later in the story: The Mayo Clinic is the money behind February’s obesity training in Phoenix, where Mayo has a branch operation.  But it goes deeper.  Trudy quotes Lauren Sausser, a reporter at the Charleston S.C. Post and Courier , [S]ometimes, Sausser told me, “The conflicts are hidden and sometimes they are just not clear....

Please check out this new article I've published over at the athenahealth Leadership Forum.

With all the highfalutin talk about the Triple Aim, payment reform, ACOs, population management, and the like, wouldn't it be nice if hospital administrative and clinical leaders focused on these categories of harm that have been identified by the patients and families who have experienced a medical error.* Instead, our "leaders" and their governing bodies focus on building their networks to gain market power and minimize competition, expanding their risk pool, minimizing corporate risk, and fighting over who should share the surplus or deficit from capitated contracts.  They are truly cost centers in search of revenue streams. This is the corporatization of American health care. -- *Yes, these are Massachusetts numbers, but they are duplicated in other jurisdictions.

Wikipedia summarizes : The Three Laws of Robotics   are a set of rules devised by the science fiction author Isaac Asimov. The rules were introduced in his 1942 short story " Runaround ", although they had been foreshadowed in a few earlier stories. The Three Laws, quoted as being from the "Handbook of Robotics, 56th Edition, 2058 A.D.", are: A robot may not injure a human being or, through inaction, allow a human being to come to harm. A robot must obey the orders given it by human beings except where such orders would conflict with the First Law. A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws. Now comes a practical application and a query by Eric Schwitzgebel in the Los Angeles Times : It's 2025. You and your daughter are riding in a driverless car along Pacific Coast Highway. The autonomous vehicle rounds a corner and detects a crosswalk full of children. It brakes, but your lane is une...

Check out this site from the New York City hospitals, an excellent example of clinical care transparency with regard to HIV treatment. In a simple graphic we can see the proportion of patients in care with suppressed viral load, and the trend from 2011 to 2014.  Congratulations to Dr. Demetre Daskalakis , the head of New York City’s Bureau of H.I.V./AIDS Prevention and Control in September, for his leadership in this arena--and to his staff for their accomplishments.  (Did I mention he was a resident and chief resident at BIDMC several years ago?)

As we watch many participants in today's political debates--and the public's reaction to them--it can be useful to consider the lessons set forth in this blog post and the article to which it refers,  "On the reception and detection of pseudo-profound bullshit" . Key findings: We focus on pseudo-profound bullshit, which consists of seemingly impressive assertions that are presented as true and meaningful but are actually vacuous. These results support the idea that some people are more receptive to this type of bullshit and that detecting it is not merely a matter of indiscriminate skepticism but rather a discernment of deceptive vagueness in otherwise impressive sounding claims. Our results also suggest that a bias toward accepting statements as true may be an important component of pseudo-profound bullshit receptivity. The authors' suggestion that a type of cognitive bias is at work is interesting. To whatever extent that is true, I would argue that society...

Bob Schuneman, one of several dozen men and women in and around the suburbs of Boston who have been playing soccer together for many years, just passed away after a long bout with cancer.  As our colleague Margot noted recently,  "Our soccer relationships are interesting.  We spend a lot of time together.  We really enjoy each other's company.  We have a ton of fun together.  Yet we know very little about each other." So for our group and for others, let me tell you a bit about Bob. I fortunately had a chance to visit with him just a few days ago, and I've found these end-of-life conversations to be remarkable in the level of honesty that occurs.  I asked, "How are you thinking about things?"  He said, "I've had an unbelievable 81 years.  Sometimes I can't believe that I've deserved such a good life."  And then I got his personal history, and learned a ton of things I hadn't known. For one thing, he was a very accomplished musi...

As a student of politics and public affairs, I find it interesting how the mileau in which events occur so dramatically affects the public's perceptions of individuals.  I was reminded of this while watching Bridge of Spies , in which the protagonist James B. Donovan is asked by the Court and his law firm to take on the defense of a man accused of being a Russian spy.  As the story takes place during the Cold War and the American public's panic about anything named "Communist," Donovan is roundly criticized--and worse. Indeed, at one point, his daughter 's peaceful viewing of 77 Sunset Strip on television is interrupted by gunfire through the living room window. A policeman arriving at the scene blames Donovan. "Why do you have to do this?" asks this officer sworn to uphold the Constitution, including the right of an accused person to competent counsel. John Adams faced similar censure when he took on the defense of the British soldiers who shot civilia...

As the world leaders meet to dicuss climate issues, it is illustrative to remember these quotes: For generations, we have assumed that the efforts of mankind would leave the fundamental equilibrium of the world's systems and atmosphere stable.  But it is possible that with all these enormous changes (population, agricultural, use of fossil fuels) concentrated into such a short period of time, we have unwittingly begun a massive experiment with the system of this planet itself. And:   We must have continued economic growth in order to generate the wealth required to pay for the protection of the environment.  But it must be growth that does not plunder the planet today and leave our children to deal with the consequences tomorrow. We should always remember that free markets are a means to an end. They would defeat their object if by their output they did more damage to the quality of life through pollution than the well-being they achieve by the production of goods and ...