Dr. Emmy Betz, sent me a note recently saying, “The Emergency Department sees traffic accident victims all the time and it’s frustrating. What happens when patients leave is important to us. The ED staff wants to work with the larger BID team including social workers, case managers and primary care doctors to provide help for those who need it.” So, she and Lissa Kapust decided to join forces. Lissa is a social worker in our behavioral neurology group and is well known for the Drive Wise program at BIDMC, which offers evaluations of drivers who have experienced neurological, psychological or physical impairments.
Noting that 417 people were killed in traffic accidents in Massachusetts in 2007, BIDMC’s Emergency Department was prompted to designate the month of October as Driver Safety Month. “October is timely because the state legislature is debating two major bills. One is about having the RMV test older drivers, which is the first time it has grappled with mandatory testing of drivers,” Lissa notes. “The second bill pushes health care providers to report patients with cognitive problems. There is a new focus in our state on driver safety.”
Emmy and Lissa have partnered to host a “Crash Course in Driver Safety,” an open house and lunch for our staff on Tuesday, Oct. 21, from 11 a.m. to 1 p.m. Speakers from the medical center and external organizations like the RMV will make presentations on a variety of topics from elderly drivers to impaired motorists to seatbelts for children.
By the way, there is some evidence that crash rates go up on election day because voters are in a rush, distracted, and driving in unfamiliar places. Also, I have been told that the Monday after clocks fall back an hour as we go from daylight time to standard time is known as a dangerous travel day. So, this initiative is seems timely on many fronts.
Tuesday, October 14, 2008
Friday, October 10, 2008
How Can I Help?
Monique Doyle Spencer has a new book, following her success with The Courage Muscle, A Chicken's Guide to Living with Breast Cancer. The new one is called How Can I Help? Here's a summary from the back cover:"Your loved one has been diagnosed with cancer and you're at a loss for what to do. You want to help -- but you're afraid you'll do or say the wrong thing. Written in a friendly and conversational manner, How Can I help? offers you specific advice on what to do for a friend or loved one in need. It's full of practical and compassionate suggestions."
Monique generously asked me to write the preface, but the really good stuff starts on page 1, once you get past the pages with little Roman numerals.
The book is published by Adams Media and is available from that company, Amazon, and book stores. It is available at quantity discounts for bulk purchases from the publisher at 1-800-289-0963.
Thursday, October 09, 2008
Wednesday, October 08, 2008
Corporate Campaign -- The next chapter
Here's a message I sent out today to our staff concerning the recent ad campaign by the SEIU. I mentioned the bus stop ads here last week, but there are more now on radio, mobile billboards, and newspapers. As always, I welcome comments on all sides of this issue.
Dear BIDMC,
Many of you have sent me notes during the last few days expressing your dismay at the negative advertising and other activities being carried out by the Service Employees International Union (SEIU). I thought I would take a moment to put this all in context.
We live in a free country, where people and organizations are free to say pretty much anything they want in public media. Thus, SEIU can say and imply a lot. But, saying these things is not the same as being truthful in what it is saying.
It is clear that SEIU is engaged in what is called a "corporate campaign," an attempt to harm the reputation of our hospital and denigrate the people working or volunteering here. Another goal of such a campaign is to isolate us and to turn our closest friends against us. Why would the union do this? Well, its goal is to put such enormous pressure on the management and the Board of Directors that we agree to concessions that would make it more likely for the union to be successful when it gets to the point of trying to organize workers in this hospital. It wants us to sign a contract – negotiated only between management and high-level union leaders –that would govern the union organizing process and would rob our employees of their right to a vigorous and open debate prior to a meaningful secret ballot election.
Many months ago (in May 2006), I wrote to you on this topic. For those who are newly arrived since then, or for those who have forgotten, here is what I said:
The other major change in the local environment is the announcement by a national union that it intends to organize the workers in the academic medical centers in Boston. I want to make our position clear with regard to this effort and union organizing efforts in general. We intend to follow the law with regard to labor relations, a law that is designed to give a fair opportunity both to employees who favor unionization and those who oppose it. Congress has been very clear that employers have to give workers a fair choice in these matters. Accordingly, we will vigorously oppose any efforts to short-circuit the legitimate process by which employees of this hospital can consider, debate, and vote on this issue. For me the underlying question is whether a union at BIDMC would enhance your ability to deliver the kind of patient care that is so important to all of us, to strengthen our research program, to improve our education programs, to strengthen our ability to serve the community, and to improve our employees' chances for personal and professional development and advancement. I do not believe that it would, and so I intend to advise you against creating a union here. Ultimately, though, the choice will be yours, and we will respect your judgment on that matter if and when the time comes for a fair and free vote on this issue.
Now, we see real evidence of this corporate campaign. SEIU is spending thousands and thousands of dollars on mobile billboards, bus stop ads, newspaper ads, and ads on expensive radio stations to get across its current messages. We do not have access to union dues, nor do we currently choose to spend our funds to counter these types of ads in the public media, and so it will likely feel unfair to you that the union's charges go unanswered in those forums.
I do not feel it is productive or a good use of time to try to rebut each and every charge made by the SEIU. But, you should rest assured that any and all complaints and allegations raised with regard to issues like our rates, our delivery of charity care, human resources policies and individual cases are governed by a variety state and federal regulatory agencies. The public will know through these agencies when we make a mistake. But as you well know, our hospital is committed to levels of transparency that are unprecedented in the Boston area. For example, we even publicized when we made a serious medical error so that we could engage in a constant process of improvement on behalf of our patients!
Instead of recognizing our good intentions, our attributes and our intiatives on behalf of patients and employees, SEIU seeks to muddy our reputation with inaccurate and exaggerated claims. That it chooses to do so mainly with regard to BIDMC rather than other hospitals in Boston may be a direct result of my decision to call out its strategies and behavior in a public way, for example on my blog and in public appearances. I felt it important to do so to inform public officials, the media, and corporate leaders on this important matter. I believe many CEO colleagues in other Massachusetts hospitals agree with me, but they have chosen to be quiet about the issue, probably in the hope of not being targeted by the union. I believe that is a mistake on their part, in that they will likely be next in line, as the president of SEIU has said that the union will not rest until every hospital worker in Boston is unionized.
I know that for some of you it is difficult to be placed in the middle of this campaign. The union may say that it has no intention of harming you personally, but you understand that it is the people who make a hospital, and that nasty statements about the hospital are, in essence, an attack on you personally. I am sorry that this is the case. All I can say is that, while the ads and allegations can be upsetting, you should continue to be proud of your commitment and dedication to our mission of quality care and compassion for those in need. That mission continues unabated and strong, even in the face of these terribly misleading ads. Thank you for all that you do. As always, I am happy to hear from you individually if you want to share your personal concerns and suggestions.
Finally, some of you have asked what you can and should do when approached by people representing a union. As guidance, many months ago, our Board of Directors adopted a code of conduct consistent with the National Labor Relations Act with regard to this issue. Here it is:
Beth Israel Deaconess Medical Center
Dear BIDMC,
Many of you have sent me notes during the last few days expressing your dismay at the negative advertising and other activities being carried out by the Service Employees International Union (SEIU). I thought I would take a moment to put this all in context.
We live in a free country, where people and organizations are free to say pretty much anything they want in public media. Thus, SEIU can say and imply a lot. But, saying these things is not the same as being truthful in what it is saying.
It is clear that SEIU is engaged in what is called a "corporate campaign," an attempt to harm the reputation of our hospital and denigrate the people working or volunteering here. Another goal of such a campaign is to isolate us and to turn our closest friends against us. Why would the union do this? Well, its goal is to put such enormous pressure on the management and the Board of Directors that we agree to concessions that would make it more likely for the union to be successful when it gets to the point of trying to organize workers in this hospital. It wants us to sign a contract – negotiated only between management and high-level union leaders –that would govern the union organizing process and would rob our employees of their right to a vigorous and open debate prior to a meaningful secret ballot election.
Many months ago (in May 2006), I wrote to you on this topic. For those who are newly arrived since then, or for those who have forgotten, here is what I said:
The other major change in the local environment is the announcement by a national union that it intends to organize the workers in the academic medical centers in Boston. I want to make our position clear with regard to this effort and union organizing efforts in general. We intend to follow the law with regard to labor relations, a law that is designed to give a fair opportunity both to employees who favor unionization and those who oppose it. Congress has been very clear that employers have to give workers a fair choice in these matters. Accordingly, we will vigorously oppose any efforts to short-circuit the legitimate process by which employees of this hospital can consider, debate, and vote on this issue. For me the underlying question is whether a union at BIDMC would enhance your ability to deliver the kind of patient care that is so important to all of us, to strengthen our research program, to improve our education programs, to strengthen our ability to serve the community, and to improve our employees' chances for personal and professional development and advancement. I do not believe that it would, and so I intend to advise you against creating a union here. Ultimately, though, the choice will be yours, and we will respect your judgment on that matter if and when the time comes for a fair and free vote on this issue.
Now, we see real evidence of this corporate campaign. SEIU is spending thousands and thousands of dollars on mobile billboards, bus stop ads, newspaper ads, and ads on expensive radio stations to get across its current messages. We do not have access to union dues, nor do we currently choose to spend our funds to counter these types of ads in the public media, and so it will likely feel unfair to you that the union's charges go unanswered in those forums.
I do not feel it is productive or a good use of time to try to rebut each and every charge made by the SEIU. But, you should rest assured that any and all complaints and allegations raised with regard to issues like our rates, our delivery of charity care, human resources policies and individual cases are governed by a variety state and federal regulatory agencies. The public will know through these agencies when we make a mistake. But as you well know, our hospital is committed to levels of transparency that are unprecedented in the Boston area. For example, we even publicized when we made a serious medical error so that we could engage in a constant process of improvement on behalf of our patients!
Instead of recognizing our good intentions, our attributes and our intiatives on behalf of patients and employees, SEIU seeks to muddy our reputation with inaccurate and exaggerated claims. That it chooses to do so mainly with regard to BIDMC rather than other hospitals in Boston may be a direct result of my decision to call out its strategies and behavior in a public way, for example on my blog and in public appearances. I felt it important to do so to inform public officials, the media, and corporate leaders on this important matter. I believe many CEO colleagues in other Massachusetts hospitals agree with me, but they have chosen to be quiet about the issue, probably in the hope of not being targeted by the union. I believe that is a mistake on their part, in that they will likely be next in line, as the president of SEIU has said that the union will not rest until every hospital worker in Boston is unionized.
I know that for some of you it is difficult to be placed in the middle of this campaign. The union may say that it has no intention of harming you personally, but you understand that it is the people who make a hospital, and that nasty statements about the hospital are, in essence, an attack on you personally. I am sorry that this is the case. All I can say is that, while the ads and allegations can be upsetting, you should continue to be proud of your commitment and dedication to our mission of quality care and compassion for those in need. That mission continues unabated and strong, even in the face of these terribly misleading ads. Thank you for all that you do. As always, I am happy to hear from you individually if you want to share your personal concerns and suggestions.
Finally, some of you have asked what you can and should do when approached by people representing a union. As guidance, many months ago, our Board of Directors adopted a code of conduct consistent with the National Labor Relations Act with regard to this issue. Here it is:
Beth Israel Deaconess Medical Center
General Code of Conduct Regarding Organizing Activities
BIDMC has a strong commitment to its mission of community service in providing excellent clinical care, conducting medical research, and training future generations of medical professionals. As an academic medical center and prominent member of the corporate and civic communities, BIDMC is committed to an environment of respectful and open discourse and debate among its management, employees and physicians. It is of the utmost concern to the Board of Directors that this fair and unhindered exchange of points of view is maintained and supported during all times, including any attempt by unions to organize staff at BIDMC. Therefore the Board of Directors adopts this General Code of Conduct.
Conduct Standards
BIDMC has long believed that managers, supervisors and employees best serve the interests of patients by working together. Further, it is imperative that everyone in the work environment remain focused on patient care while continuing to have open communication and professional interaction respecting everyone's freedom of belief.
Managerial and Supervisory Employees of BIDMC
When communicating with employees, including regarding union activities, managers and supervisors are encouraged to promote an open and robust dialogue and share with employees factual information. Managers and supervisors also should feel free to express their opinions and encourage employees to ask questions. On the other hand, in any discussions with employees, respect is paramount. Specifically in the union activities context, managers and supervisors must not threaten or interrogate employees about their union activities, nor may managers or supervisors make promises to employees to induce them to be against the union. Finally, managers and supervisors must not conduct surveillance of union activities.
Non-Managerial/Supervisory Employees of BIDMC
Non-managerial and non-supervisory employees may engage in union organizing activities only on non-working time and only in non-patient care areas. BIDMC’s “No Solicitation and No Distribution” policy, “Use of Public Space Policy” and the Human Resources Department are available as resources to answer questions in this regard.
Non-Employees
Finally, individuals not employed by BIDMC may not engage in union organizing activities on BIDMC property.
Additional Information
Anyone with questions or concerns regarding this General Code of Conduct is urged to contact the Beth Israel Deaconess Human Resources Department or the Beth Israel Deaconess Office of Business Conduct.
BIDMC has a strong commitment to its mission of community service in providing excellent clinical care, conducting medical research, and training future generations of medical professionals. As an academic medical center and prominent member of the corporate and civic communities, BIDMC is committed to an environment of respectful and open discourse and debate among its management, employees and physicians. It is of the utmost concern to the Board of Directors that this fair and unhindered exchange of points of view is maintained and supported during all times, including any attempt by unions to organize staff at BIDMC. Therefore the Board of Directors adopts this General Code of Conduct.
Conduct Standards
BIDMC has long believed that managers, supervisors and employees best serve the interests of patients by working together. Further, it is imperative that everyone in the work environment remain focused on patient care while continuing to have open communication and professional interaction respecting everyone's freedom of belief.
Managerial and Supervisory Employees of BIDMC
When communicating with employees, including regarding union activities, managers and supervisors are encouraged to promote an open and robust dialogue and share with employees factual information. Managers and supervisors also should feel free to express their opinions and encourage employees to ask questions. On the other hand, in any discussions with employees, respect is paramount. Specifically in the union activities context, managers and supervisors must not threaten or interrogate employees about their union activities, nor may managers or supervisors make promises to employees to induce them to be against the union. Finally, managers and supervisors must not conduct surveillance of union activities.
Non-Managerial/Supervisory Employees of BIDMC
Non-managerial and non-supervisory employees may engage in union organizing activities only on non-working time and only in non-patient care areas. BIDMC’s “No Solicitation and No Distribution” policy, “Use of Public Space Policy” and the Human Resources Department are available as resources to answer questions in this regard.
Non-Employees
Finally, individuals not employed by BIDMC may not engage in union organizing activities on BIDMC property.
Additional Information
Anyone with questions or concerns regarding this General Code of Conduct is urged to contact the Beth Israel Deaconess Human Resources Department or the Beth Israel Deaconess Office of Business Conduct.
Tuesday, October 07, 2008
Simply the Best!
This is Emergency Nurses Week, a tribute to people throughout the country and world who work in these high impact settings. The theme, "Simply the Best!", is certainly born out here at BIDMC and at BID~Needham every day as our nurses help those in emergent need of care with sensitivity, expertise, and caring. We are celebrating with seminars, poster sessions, raffles, and -- of course -- many opportunities for food!
Many thanks to our ED nurses and to others out there elsewhere who devote their lives to helping others at intense moments of need.
Many thanks to our ED nurses and to others out there elsewhere who devote their lives to helping others at intense moments of need.
Knowing when to cheer
I am NOT saying this to gloat after the recent American League Division Series. Really. My Boston-bred daughter, watching one of the games in Anaheim, was heard to say, "I like being from a town where the fans don't have to be told when to 'Make Some Noise!' on the electronic scoreboard."
Monday, October 06, 2008
Back to the future
In a move that could help increase home ownership rates among minorities and low-income consumers, the Fannie Mae Corporation is easing the credit requirements on loans that it will purchase from banks and other lenders.
The action, which will begin as a pilot program involving 24 banks in 15 markets -- including the New York metropolitan region -- will encourage those banks to extend home mortgages to individuals whose credit is generally not good enough to qualify for conventional loans. Fannie Mae officials say they hope to make it a nationwide program by next spring.
Fannie Mae, the nation's biggest underwriter of home mortgages, has been under increasing pressure from the Clinton Administration to expand mortgage loans among low and moderate income people and felt pressure from stock holders to maintain its phenomenal growth in profits.
In addition, banks, thrift institutions and mortgage companies have been pressing Fannie Mae to help them make more loans to so-called subprime borrowers. These borrowers whose incomes, credit ratings and savings are not good enough to qualify for conventional loans, can only get loans from finance companies that charge much higher interest rates -- anywhere from three to four percentage points higher than conventional loans....
In moving, even tentatively, into this new area of lending, Fannie Mae is taking on significantly more risk, which may not pose any difficulties during flush economic times. But the government-subsidized corporation may run into trouble in an economic downturn, prompting a government rescue similar to that of the savings and loan industry in the 1980's.
''From the perspective of many people, including me, this is another thrift industry growing up around us,'' said Peter Wallison a resident fellow at the American Enterprise Institute. ''If they fail, the government will have to step up and bail them out the way it stepped up and bailed out the thrift industry...."
Mind and brain
Dr. Alvaro Pascual-Leone, from our Department of Neurology, kindly sent me this link to a lovely column written by Harvard Medical Student Ishani Ganguli, on her blog Short White Coat, which is posted on the Boston Globe's White Coat Notes.
He, in turn, was prompted to comment:
Basically, given the insights on brain plasticity as an intrinsic property of the brain across the lifespan, it seems that the nervous system might best be viewed as a continuously changing structure of which plasticity is an integral property and the obligatory consequence of each sensory input, motor act, association, reward signal, action plan, or awareness. In this framework, notions such as psychological processes as distinct from organic-based functions or dysfunctions cease to be informative. Behavior will lead to changes in brain circuitry, just as changes in brain circuitry will lead to behavioral modifications.
Leading to the conclusion that, "Psychiatry and neurology do need to come closer together (again), and perhaps we should be thinking of departments (or institutes) of brain health and well being, rather than psych and neuro departments."
I recall similar statements being made several years ago by the former Dean of HMS, Joseph Martin, himself a neurologist. I wonder how psychiatrists and neurologists reading this would react to this hypothesized convergence of the two fields.
For that matter, since even those specialists really don't know for sure, how about the rest of you? Any thoughts, er, feelings, er, instincts, er, analysis on the matter? It makes sense to me, but what do I know? If Alvaro is right, whatever I do know is highly changeable anyway!
He, in turn, was prompted to comment:
Basically, given the insights on brain plasticity as an intrinsic property of the brain across the lifespan, it seems that the nervous system might best be viewed as a continuously changing structure of which plasticity is an integral property and the obligatory consequence of each sensory input, motor act, association, reward signal, action plan, or awareness. In this framework, notions such as psychological processes as distinct from organic-based functions or dysfunctions cease to be informative. Behavior will lead to changes in brain circuitry, just as changes in brain circuitry will lead to behavioral modifications.
Leading to the conclusion that, "Psychiatry and neurology do need to come closer together (again), and perhaps we should be thinking of departments (or institutes) of brain health and well being, rather than psych and neuro departments."
I recall similar statements being made several years ago by the former Dean of HMS, Joseph Martin, himself a neurologist. I wonder how psychiatrists and neurologists reading this would react to this hypothesized convergence of the two fields.
For that matter, since even those specialists really don't know for sure, how about the rest of you? Any thoughts, er, feelings, er, instincts, er, analysis on the matter? It makes sense to me, but what do I know? If Alvaro is right, whatever I do know is highly changeable anyway!
Saturday, October 04, 2008
Where have all the g's gone?
Have you noticed that both sets of presidential and vice-presidential candidates now agree on something in their zeal to portray themselves as men and woman of the people -- that the "g" at the end of "ing" words is no longer necessary. Also, "gonna" has replaced "going to."
I am not even gonna try to address the "nukular" issue.
I am not even gonna try to address the "nukular" issue.
Friday, October 03, 2008
Magic and fan loyalty
As we go through the baseball post-season, I want to collect some stories about fan loyalty and serendipity. For example, here is one from a friend about losing (and finding) her Red Sox hat in the Alaskan Tundra. If you have other examples of unusual or inexplicable rewards for fan loyalty, please post them. (Note: This is not limited to Red Sox Nation.)
Thursday, October 02, 2008
Lab pathology?
I received this note many months ago from a member of our Pathology Department, expressing some opinions and concerns based on a lecture he heard at an annual meeting. I had meant to post it back in March, when I received it, but the delay does not affect its relevance. I do not have the expertise to offer an opinion on this matter, and so I present it for your consideration and comments.
Dear Paul,
I just returned from our Academy of Pathology meeting in Denver. Chris Fletcher from Brigham and Women's Hospital delivered a pessimistic keynote lecture on the "future of academic pathology."
He cited commercial labs as one of the major threats. These labs claim to offer a faster, cheaper service, and often hire prominent pathologists to enhance their letterhead. Due to their sample volume and available capital, these labs can offer expensive specialized clinical tests before university hospitals.
Dr. Fletcher argued that these labs siphon off low complexity cases (small biopsies and chemistry tests) from the market and leave the low profit margin cases to us. With the resulting strain on salaries and budgets it will become increasingly difficult for academics to maintain the staff and resources needed to train new residents and maintain research programs. In the worst case scenario (my extrapolation, not Fletcher’s), we are currently training residents to work for those private labs–academic salaries will not be able to keep them. In future, the companies could start their own resident training programs away from university affiliations and clinical colleagues, and all research requiring human tissues would depend on commercial for profit tissue banks.
There is no doubt that these labs provide a good service. Probably 90%+ of the lab samples and biopsies are routine (I could train any ‘top 10% of his class’ college graduate to report a diagnosis). The letterhead experts act as consultants for that last 10%. The labs are faster since they do not have the delays and expenses intrinsic to a residency-training program. They have good marketing people and customer service (i.e. you will get a glossy colorful report with a well worded, yet automated, interpretation).
However, academic labs do offer added value. Lab data is not a printout from a machine. It has to be interpreted, and interpretation without clinical context leads to poor patient management and wasteful test utilization. A doctor’s office-manager does not think twice about splitting up a panel of blood-tests between labs to save a buck; never thinking that that those labs use different reference values or testing methods. Clinicians may not understand the limitations of the particular testing methods and are forced to rely on marketing menus rather than the confidence of a pathologist colleague.
Hospital based labs facilitate communication and consultation. Most patients who have never visited a Tumor Board Conference or Multidisciplinary Conference would be shocked to learn that their surgeon or obstetrician does not run their lab tests like on television (House or CSI). They have no idea that two women with a pathology report for stage 2 uterine cancers might be treated differently because of pathologist input.
How can we compete when our own doctors are using these labs?
Inform the public. Patients shop around for oncologists and surgeons: Why not pathologists? Tell patients to ask where their samples are being sent. The answer, "a reputable lab that has been certified by the College of American Pathologists" is not good enough. Does your doc know his pathology colleague?
Commercial lab reports tend to be simple and easy to read, using templates. Template based reporting can clarify communication (and perhaps we should take their lead), but template are also a way of covering up for cheap inexperienced staff. Our own BIDMC oncologists insist on internal pathology review prior to therapy to identify such frequently missing information. Biology does not conform to multiple-choice answers-and I don’t choose my doc based on how they did on their board exam.
As for being cheaper, we know that the listed cost of a hospital-based test has very little to do with the negotiated charge billed to an insurer or the government. As for speedy results, the turn-around-time for blood test is probably similar in commercial and academic labs; for small biopsy where academics is slower, the rush is not driven by patient care since the results will not get to the patient until the follow-up visit a week later.
Of course, academic labs such as ours could and should offer better service, but we already offer better care. This message should be broadcast before it is too late.
Dear Paul,
I just returned from our Academy of Pathology meeting in Denver. Chris Fletcher from Brigham and Women's Hospital delivered a pessimistic keynote lecture on the "future of academic pathology."
He cited commercial labs as one of the major threats. These labs claim to offer a faster, cheaper service, and often hire prominent pathologists to enhance their letterhead. Due to their sample volume and available capital, these labs can offer expensive specialized clinical tests before university hospitals.
Dr. Fletcher argued that these labs siphon off low complexity cases (small biopsies and chemistry tests) from the market and leave the low profit margin cases to us. With the resulting strain on salaries and budgets it will become increasingly difficult for academics to maintain the staff and resources needed to train new residents and maintain research programs. In the worst case scenario (my extrapolation, not Fletcher’s), we are currently training residents to work for those private labs–academic salaries will not be able to keep them. In future, the companies could start their own resident training programs away from university affiliations and clinical colleagues, and all research requiring human tissues would depend on commercial for profit tissue banks.
There is no doubt that these labs provide a good service. Probably 90%+ of the lab samples and biopsies are routine (I could train any ‘top 10% of his class’ college graduate to report a diagnosis). The letterhead experts act as consultants for that last 10%. The labs are faster since they do not have the delays and expenses intrinsic to a residency-training program. They have good marketing people and customer service (i.e. you will get a glossy colorful report with a well worded, yet automated, interpretation).
However, academic labs do offer added value. Lab data is not a printout from a machine. It has to be interpreted, and interpretation without clinical context leads to poor patient management and wasteful test utilization. A doctor’s office-manager does not think twice about splitting up a panel of blood-tests between labs to save a buck; never thinking that that those labs use different reference values or testing methods. Clinicians may not understand the limitations of the particular testing methods and are forced to rely on marketing menus rather than the confidence of a pathologist colleague.
Hospital based labs facilitate communication and consultation. Most patients who have never visited a Tumor Board Conference or Multidisciplinary Conference would be shocked to learn that their surgeon or obstetrician does not run their lab tests like on television (House or CSI). They have no idea that two women with a pathology report for stage 2 uterine cancers might be treated differently because of pathologist input.
How can we compete when our own doctors are using these labs?
Inform the public. Patients shop around for oncologists and surgeons: Why not pathologists? Tell patients to ask where their samples are being sent. The answer, "a reputable lab that has been certified by the College of American Pathologists" is not good enough. Does your doc know his pathology colleague?
Commercial lab reports tend to be simple and easy to read, using templates. Template based reporting can clarify communication (and perhaps we should take their lead), but template are also a way of covering up for cheap inexperienced staff. Our own BIDMC oncologists insist on internal pathology review prior to therapy to identify such frequently missing information. Biology does not conform to multiple-choice answers-and I don’t choose my doc based on how they did on their board exam.
As for being cheaper, we know that the listed cost of a hospital-based test has very little to do with the negotiated charge billed to an insurer or the government. As for speedy results, the turn-around-time for blood test is probably similar in commercial and academic labs; for small biopsy where academics is slower, the rush is not driven by patient care since the results will not get to the patient until the follow-up visit a week later.
Of course, academic labs such as ours could and should offer better service, but we already offer better care. This message should be broadcast before it is too late.
Wednesday, October 01, 2008
SEIU at the bus stops
SEIU is now purchasing ads at bus stops in Boston. Just more of the same corporate campaign tactics. Please note, too, the insinuating "What else does the BI have to hide?" tag line. Regular readers here know how we "hide" things in view of the entire world. SEIU might want to take a page from that approach itself, so it won't be caught surprised by its own problems.
Messages from Lambaréné
From my friends at the Albert Schweitzer Fellowship comes news that two of our current Lambaréné Fellows are keeping online journals while they are serving at Dr. Schweitzer's Hospital in Gabon. Katie is a fourth year student at Dartmouth Medical School and Marie is a fourth year student at East Carolina University Brody School of Medicine.
Remember, you can support this cause here on Facebook.
Remember, you can support this cause here on Facebook.
Monday, September 29, 2008
Alan Lupo: Reporter
I had planned to take this day off, but I am moved to write this short note in memory of Alan Lupo, a beloved Boston reporter, who died today. I am lucky to be among those many who were blessed by friendship with this fine, kind, thoughtful, and genuine man. Over the past year, he was a patient at our hospital, and as much as it saddened me to see him there, I rather selfishly was pleased that I had a chance to spend time with him during my visits to his room. I loved his company. We had lots of good laughs and traded stories from the past 3+ decades of life in Boston.
When I say that Alan was a reporter, I choose the word carefully. I don't mean journalist, although that could apply, too. I mean that he was a down-in-the-streets reporter, who got news stories and columns the old fashioned way. He would talk to people and ask questions. And they were great questions, probing to the heart of the matter at hand. They could be tough questions, but they were never mean. (Actually, as I think about it, I don't ever recall Alan being mean.)
My first exposure to this guy was in the 1970s when I watched a show called The Reporters on WGBH, the local public TV station. Here's how it worked. Alan and his colleagues would walk around the streets of the city with a still camera and take black-and-white pictures and conduct interviews. The news would then be presented as a voice-over on TV, with the pictures of the interviewees and of the street scenes and other pertinent views. I think I recall that each segment lasted about 15 minutes, but I might be wrong about that. If you have watched Ken Burns' specials, you can get the idea, but this was not a history show. It was a current events news and feature show. It was engrossing, informative, entertaining, and gave as complete and fair a presentation on each story as you could imagine.
I was always sad that The Reporters went off the air. I assume it could not compete with the glitzier news programs that are based on television stations' belief that viewers have attention deficit disorder. But, I actually think there could be a place for such a show even today -- if it were done with the professionalism, depth, and empathy shown by Alan and his colleagues.
I have not met a person in Boston who knew Alan who did not love and admire him. Think of that. A person who conducted investigative journalism in one of the toughest political environments in the country, and he ends up beloved and admired. Over these last few months, as I have talked with other people who knew that he was terminally ill, none of us could mention him without choking up in sadness at the thought of losing him. Now we have lost him, and the tears can flow freely, as they do as I write this on the eve of a holiday that is otherwise wrapped in happiness and hope for the coming year.
When I say that Alan was a reporter, I choose the word carefully. I don't mean journalist, although that could apply, too. I mean that he was a down-in-the-streets reporter, who got news stories and columns the old fashioned way. He would talk to people and ask questions. And they were great questions, probing to the heart of the matter at hand. They could be tough questions, but they were never mean. (Actually, as I think about it, I don't ever recall Alan being mean.)
My first exposure to this guy was in the 1970s when I watched a show called The Reporters on WGBH, the local public TV station. Here's how it worked. Alan and his colleagues would walk around the streets of the city with a still camera and take black-and-white pictures and conduct interviews. The news would then be presented as a voice-over on TV, with the pictures of the interviewees and of the street scenes and other pertinent views. I think I recall that each segment lasted about 15 minutes, but I might be wrong about that. If you have watched Ken Burns' specials, you can get the idea, but this was not a history show. It was a current events news and feature show. It was engrossing, informative, entertaining, and gave as complete and fair a presentation on each story as you could imagine.
I was always sad that The Reporters went off the air. I assume it could not compete with the glitzier news programs that are based on television stations' belief that viewers have attention deficit disorder. But, I actually think there could be a place for such a show even today -- if it were done with the professionalism, depth, and empathy shown by Alan and his colleagues.
I have not met a person in Boston who knew Alan who did not love and admire him. Think of that. A person who conducted investigative journalism in one of the toughest political environments in the country, and he ends up beloved and admired. Over these last few months, as I have talked with other people who knew that he was terminally ill, none of us could mention him without choking up in sadness at the thought of losing him. Now we have lost him, and the tears can flow freely, as they do as I write this on the eve of a holiday that is otherwise wrapped in happiness and hope for the coming year.
Dirty Americans?
A guest post from Dr. Val Jones, a blogosphere friend. I was going to have a simple post today to wish my Jewish readers "l'shana tovah", but perhaps this will also get them thinking about those Rosh Hashanah apples in a different way! (BTW, I'll be off-line starting this evening and through tomorrow for the New Year's holiday.)I took a beginning Spanish course at the University of Zaragoza, Spain, about ten years ago. One day I was at a local grocery store, picking through some apples and oranges when I noticed several women looking at me with utter disgust. I couldn’t imagine what was bothering them and returned their gaze with an innocent shrug.
“Sucio!” [dirty] uttered one under her breath. And the women shook their heads and pushed their shopping carts away from me in a huff.
My mind went into overdrive trying to figure out what I could possibly have done that was so utterly distasteful. I watched other women at the apple bin and slowly noticed that they had a systematic way of selecting their fruit. First they pulled a plastic bag off the roll, then they opened it and put their hand in it (as if it were an ill-fitting surgical glove), and then they began picking up the apples and oranges one by one to inspect them for defects. When they found one they liked, they simply inverted the bag and kept the item inside, without ever having skin-to-fruit contact.
“Ah hah,” I thought, “that’s why they thought I was ‘dirty.’ I was touching the fruit with my bare hands.” And from that day on, I have used the “surgical glove” approach to fruit selection. It’s a cleaner way to shop.
I was at a local farmer’s market today with my husband, and I noticed him rifling through an apple bin with a bunch of other eager shoppers. True to their “dirty” American upbringing, they were all inspecting the fruit with bare hands. I told my husband about my Spanish experience and asked him if he thought all the hands on the fruit might be spreading E.coli or other bacteria around.
He replied simply, “Well, I’d be more concerned about the foreign farmers fertilizing their plants with human manure than about the grocery store buyers touching the fruit. Besides, we wash our hands in America.”
Well, I’m not sure if the second statement is correct – Paul Levy will testify to just how difficult it is to get hospital employees to wash their hands! My bottom line is – please wash your fruit.
Sunday, September 28, 2008
Another problematic ad
In a post below, I talk about a recent radio ad that I felt was inappropriate. Yesterday, I heard another one. In this ad, there is discussion of a recent research finding that presents the possibility of being able to detect cancer cells in the bloodstream of patients. This is truly great stuff, in that it might someday enable doctors to know if they were successful in removing or killing all of the cancer cells in a person or might enable them to obtain earlier detection of cancer than is currently possible. The people who did this research are outstanding scientists. We all are so fortunate that they devote lifetimes of time and energy to helping humanity.
But the problem with the ad is that it gave the impression that because this discovery was made in one hospital, that hospital can offer superior cancer care to patients. As we know, even if this discovery were ready for clinical application, advances of this sort are made widely available to the world and are not held as proprietary by the discovering institution. (In this case, especially so, in that the discovery is actually part of a multi-institutional cancer research program in which results are widely shared among all participants.)
To be clear, the hospital buying the ad is a superb place to get diagnosis and treatment of cancer. What is objectionable in the ad was the decision to cite a promising research finding and to overstate its relevance to the current delivery of medical care in this hospital. This is particularly troubling in the cancer arena, where patients hunger for new treatments and cures and can easily leap to the conclusion that an experimental finding is already available to them. Perhaps some of you will view this as too fine a line of distinction, but I think we need to be careful here: All of this affects the entire medical community's credibility over time.
But the problem with the ad is that it gave the impression that because this discovery was made in one hospital, that hospital can offer superior cancer care to patients. As we know, even if this discovery were ready for clinical application, advances of this sort are made widely available to the world and are not held as proprietary by the discovering institution. (In this case, especially so, in that the discovery is actually part of a multi-institutional cancer research program in which results are widely shared among all participants.)
To be clear, the hospital buying the ad is a superb place to get diagnosis and treatment of cancer. What is objectionable in the ad was the decision to cite a promising research finding and to overstate its relevance to the current delivery of medical care in this hospital. This is particularly troubling in the cancer arena, where patients hunger for new treatments and cures and can easily leap to the conclusion that an experimental finding is already available to them. Perhaps some of you will view this as too fine a line of distinction, but I think we need to be careful here: All of this affects the entire medical community's credibility over time.
Saturday, September 27, 2008
Caption contest
Just for fun, let's have a caption contest for the picture above. The caption should relate to the current US financial crisis. Please submit your entries!
Friday, September 26, 2008
Shoe on the other foot
A story by Mark Hollmer in today's Boston Business Journal summarizes a recent report by the Mass. Hospital Association, entitled Hospitals Rate Health Plans: A Critical Look at Performance Variation. I'm told that the full report will be on the MHA's website on Monday. Here's an excerpt of Mr. Hollmer's article:
Hospitals prefer to deal with local health plans over their national counterparts. But Bay State providers still want them to try harder to reduce inefficiency and extra costs, according to a new survey released Friday by an industry trade group.
"What we found is that no one plan is really performing at the top at every attribute," said Lynn Nicholas, president and CEO of the Massachusetts Hospital Association. "But all plans have strengths and weaknesses, which provides a great opportunity to learn from those who do it well in an effort to improve the field overall."
...[H]ospital executives said they want insurers to update and distribute more evidence-based clinical guidelines to help promote more cost-effective care. They also want health plans to better educate their members about their insurance and obligations so they can make more informed consumer decisions.
I am sure this report will be viewed as self-serving by the insurance companies, but the points made and the language used are remarkably similar to the comments those companies often make about hospitals. My conclusion: Both segments of the health care industry have a long way to go. Transparency in both sectors would go a long way towards self-improvement.
In that regard, let's do an experiment. Check out the websites of your favorite insurance companies and hospitals. See how many have adopted quantifiable audacious goals for quality improvement, patient satisfaction, or efficiency -- and how many post their actual operating results to hold themselves accountable? (If you find some that do, please submit their links as a comment.)
Hospitals prefer to deal with local health plans over their national counterparts. But Bay State providers still want them to try harder to reduce inefficiency and extra costs, according to a new survey released Friday by an industry trade group.
"What we found is that no one plan is really performing at the top at every attribute," said Lynn Nicholas, president and CEO of the Massachusetts Hospital Association. "But all plans have strengths and weaknesses, which provides a great opportunity to learn from those who do it well in an effort to improve the field overall."
...[H]ospital executives said they want insurers to update and distribute more evidence-based clinical guidelines to help promote more cost-effective care. They also want health plans to better educate their members about their insurance and obligations so they can make more informed consumer decisions.
I am sure this report will be viewed as self-serving by the insurance companies, but the points made and the language used are remarkably similar to the comments those companies often make about hospitals. My conclusion: Both segments of the health care industry have a long way to go. Transparency in both sectors would go a long way towards self-improvement.
In that regard, let's do an experiment. Check out the websites of your favorite insurance companies and hospitals. See how many have adopted quantifiable audacious goals for quality improvement, patient satisfaction, or efficiency -- and how many post their actual operating results to hold themselves accountable? (If you find some that do, please submit their links as a comment.)
Thursday, September 25, 2008
Double Talent
Former Boston anchorwoman Heather Kahn has joined forces with BIDMC's Rhonda Mann to create a series of broadcasts on two Boston media-affiliated websites. One partnership is with Channel 5's website, the BostonChannel.com and the other is with 105.7 WROR. You can watch here or here to see our latest segments on back pain.
Proverbial Wisdom
I am listening to a delightful interview by Tom Ashbrook on his show On Point on WBUR radio with David Crystal about his new book As They Say in Zanzibar, a compendium of proverbs from around the world. It is worth hearing right now or when it is repeated tonight or on the WBUR website.
Just yesterday, I heard a good one from China: "You can't cross a chasm in two small jumps."
If you would like to post your favorite proverb, please submit it as a comment. Let's see what people come up with.
Just yesterday, I heard a good one from China: "You can't cross a chasm in two small jumps."
If you would like to post your favorite proverb, please submit it as a comment. Let's see what people come up with.
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