Mappy Health Train Express

 

What word rhymes with happy? Why Mappy of course ! What social media platform gives instantaneous information,in real time as to outbreaks of infectious diseases? Mappy can track the outbreak of mosquito borne diseases, influenza outbreaks, and a multitude of other potentially harmful infectious diseases.

Mappy was the result of a ‘Challenge” by HHS for development of innovative health software. 

HHS describes it’s new application, developed by: Social Health Insights.  Early on it is tracking the outbreak of West Nile Virus

“We are Tracking Disease Trends, 140 characters at a Time !”

 

MappyHealth - Monitoring disease trends, 140 characters at a time -#NowTrending2012 Challenge from Mark Silverberg

Twitter challenge sparks innovation in tracking local health trends
New web-based app leverages Twitter for real-time early warning of disease outbreaks.

Local public health officials can use a free new Web-based application, MappyHealth , to track health concerns in real time in their communities using Twitter, the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) announced today.

MappyHealth is the winning submission of 33 applicants in a developers’ challenge, “Now Trending: #Health in My Community,” sponsored by ASPR. Health officials can use data they gain through the app to complement other health surveillance systems in identifying emerging health issues and as an early warning of possible public health emergencies in a community.

The challenge grew from a request made by local health officials to ASPR for help in developing a Web-based tool that could make social media monitoring more accessible to local health departments. Studies of the 2009 H1N1 pandemic and the Haiti cholera outbreak demonstrated that social media trends can indicate disease outbreaks earlier than conventional surveillance methods. However, many Web-based apps look back after a disease outbreak, rather than attempting to identify health trends as they emerge in real time.

This more than clever and highly usable application (web based) allows for selection of criteria by selecting criteria on the top banner, such a condition, location, and twitter trend.  A visually captivating feature is the ‘running ticker tape” display of trends in episodes such as tick-borne diseases, typhoid, tuberculosis, varicella with indications as to increases or decreases in the last 4-24 hours depending upon the magnitude of each criteria.

Social Media here performs well for quick display of important information translated from tabular chart data sets into friendly, usable and easily identifiable data sets in a graphic user interface.

Kudos to Social Health Insights, LLC

 

del.icio.us Tags: social media,social health insights,twitter,cdc,public health,infectious disease,HHS challenge,medical software,epidemics,twitter trend,health trends,real time,mappyhealth,2012 challenge

Governance….is it in the Right Place?

 

There seems to be a similar problem with government and healthcare.

It comes down to governance. Congress and the executive branch seem to be inept at the least, incompetent, or at times malicious.

It is time to take back not only the United States, but healthcare as well. Our leaders despite their best attempts have failed and continue to fail.

I read a blog by a respected family physician yesterday, who has decided to leave the practice that he started almost 20 years ago. He is the type of physician who has always been an innovator, beginning with his use of EMR over 15 years ago. He is known for speaking at national meetings about the benefits of health IT long before there was an ONCHIT, or RHIOs and the ARRA and HITECH. You can read his story. He  articulates very well his consternation with his group practice which took on a life of it’s own and clearly sets his new goals with firm guidelines as to how it will operate.

Rob Lamberts MD has been a dedicated physician who has worked within a difficult system. ….he is making a healthy move for himself and his family. We cannot expect providers to operate in a health system for the betterment of their patients in a constant state of frustration which evolves into what I call a “traumatic stress disorder” We cannot expect more physicians to fall on their sword to overcome the enormity of what government has done to us all (in the name of balancing budgets, preventing fraud, proper coding, treatment paradigms and more. When I read of Dr. Lamberts decision I was ‘blown away’. He is not the type to make a compulsive move.  He has acted responsibly and given more than 90 days notice to his partners and patients, alike.

I cannot speak for Dr. Lamberts, it would be far easier to throw up one’s hands and go with the flow. He knows, he already had started a successful medical practice, investing hundreds of thousands of dollars, or more likely millions of dollars in his medical practice, adding new physicians, equipment, and facilities.  Anyone who has started a medical enterprise knows the pitfalls of taking on new associates. Contrary to popular opinion group practices can be more inefficient than small closely held or solo organizations.  Eliminating insurance will eliminate much overhead, and rightly give back that responsibility to those who buy it…the patient.  This one feature will engage and empower patients in their health care costs.

Before I digress further, let me close and stay on topic.

Good luck Rob Lamberts, M.D.  You are far from alone. I only hope that most on a new path will succeed. The next step is to leave medicine altogether, some get an MBA then become health care executives (at least they have choices then). Some will become ‘entrepreneurs”, some will become disabled, or retire early.

Health Care is much too important to allow politicians to control and make decisions which have repeatedly gone sour.  They ignore good advice, take direction from the wrong directions, from powerful self-interest groups, foundations, non profit organizations, academia, pharmacy and insurance conglomerates. 

Sometimes we wish for something and when we get it we realize what a mistake it is or was.  Perhaps now is that time to reassess what health reform should be, not what it is turning out to be.  As we step through meaningful use stage I, stage II and eventually stage III it becomes apparent how flawed PPACA has become. It was all there, but no competent people read it before it was passed by a highly partisan congress.  Each side was out for it’s own selfish motives, righteousness and truly unconcerned about the burdens and extent of PPACA.

Yes, it is time to retrieve our responsibilities as physicians to govern. Most of us were intensively trained in decision making.  As regulations increase bureaucracy increases exponentially, with increasing cost, complexity, and diminished accountability.

Numerous new forms of physicians practice have appeared, concierge practices, direct practices, and cash retainer practices.  All do away with the physician being responsible for processing insurance claims. 

The present situation evolved shortly after Medicare developed mandatory assignment with direct payment to the provider. Then it progressively became worse, fueling medical inflation.  Following the curve I expect the same will occur with Obama care….Although I want health care for all and affordability.  Obama care is wrong for our patients.

 

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Mitchell Poll Reveals that Boomers will Purchase Health Care Apps

 

How important is social media to mobile health apps?  Very, according to Mitchell Research, a national polling company based in East Lansing, Michigan. Susie Mitchell is founder of MitchellPR a consulting firm focused on helping technology deliver mobile health and wellness apps to Baby Boomers.  A 30 year journalist and public relations veteran, she has a keen understanding of the 78 million person cohort. She is president of the nationally recognized marketing research, public relations and public affairs firm Mitchell Research & Communications, Inc. writes the BoomerTech blog and a weekly blog for AARP called App of the Week.  She is co-author of the book, Growing into Grace: Adventures in Self Discovery through Writing, which assists women in finding peace with their lives as they age.

There is a lot more to purchasing a mobile health app.  Providers need to be involved, and training sessions increase the likelihood they will be used as designed. 

And price point for the app is important.  About 36% would spend $1 or $2 on a medical app and 30% would spend $3 to $10.  This is good news, for app developers, insurance providers and doctors.

A common conversation amongst Boomers is that we all want to live longer and we all want more active lives.  Ask almost any Boomer what he or she thinks about getting older and you’ll hear the proclamation, “I’m not giving into aging.”

And we often say we will go to great lengths to keep the tentacles of Father Time at bay.

Now a new study shows that a majority of Baby Boomers (those born between 1946-64) who own smart phones are willing to put their money where their mouths are and purchase health apps that help monitor and combat chronic diseases.

The takeaway

Boomers want to help manage their chronic disease care, they are willing to pay for the mobile apps to help them―but they need assistance in learning how to use the apps.  There’s an opportunity for health care providers to develop 12-step type app/disease management programs to help get this medical giant under control.

What is troubling, however, is the resistance of older Boomers to be digitally connected.  The group that needs help the most is missing out on terrific apps to help them manage chronic disease. 

Lessons learned

·Just because chronic disease apps exist doesn’t mean they are used.
·Just because someone downloads a chronic disease app doesn’t mean he or she will use it.
·There needs to be a human liaison between the app and the Boomer user.
·Once the group gets comfortable together, they are willing to share their ideas and outcomes, which will make adherence to the app more likely.
·And, once they get used to it they are very likely to share their app with friends, increasing the number of users!

Searching for support groups:  Facebook groups, Twitter lists, Google Circles are a good place to find others who are familiar with health apps. Search YouTube, there are many professional and amateur training videos available.

Doctors need to step it up and encourage Boomer patients to download and use the health care apps.  If they don’t already own a tablet, trends show they will be purchasing one soon.

In my next post we are going to discuss the ideal platform…smartphone vs. tablet and operating system, iOS vs. Android.

                 

 

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The Real Low Down on Social Media, Is it B.S.?

 

Stolen from The Gilmorr Gang

 

Well, despite my commitment and interest (prurient, perhaps) I am beginning to sense a high ‘smell factor’.

Does this apply to #hcsm as much as other venues?  I think not. Most of our content is real and applies to very interesting and important content. I mean there are some interesting pundits pundit ting constantly about reform, deficits, HIT, Medicare, ACOs, PPACA……in addition to SOPA…

Is it my civil right to Google, tweet or Facebook?  Ask my spouse….no rights without responsibility.

Please do comment here, or on G+Gary Levin or +Digital Health Space ,  Facebook me, or even G-d forbid a quick ‘tweet @glevin1 .

Waste in the American Health Care System?

 

 

According to the influential Institute of Medicine, (AP) — The U.S. health care system squanders $750 billion a year — roughly 30 cents of every medical dollar — through unneeded care, byzantine paperwork, fraud and other waste, the influential Institute of Medicine said Thursday in a report that ties directly into the presidential campaign. (As printed on the BenefitsPro website today) in an article posted by Ricardo Alonso-Zaldivar , in an article titled, “Waste Not, Heal Not.” 

The ‘nuclear option’ of $750 billion dollars does little to itemize and correctly identify needless spending. It lumps it all in one bucket, private medicine, institutional medicine, government medicine (military and/or Veterans Hospitals and outpatient (ambulatory) or in patient health care.

President Barack Obama and Republican Mitt Romney are accusing each other of trying to slash Medicare and put seniors at risk. But the counter-intuitive finding from the report is that deep cuts are possible without rationing, and a leaner system may even produce better quality.

Here are some of the quotable from the article:

"Health care in America presents a fundamental paradox, ……

"The past 50 years have seen an explosion in biomedical knowledge, dramatic innovation in therapies and surgical procedures, and management of conditions that previously were fatal ...

"Yet, American health care is falling short on basic dimensions of quality, outcomes, costs and equity," the report concluded.

If banking worked like health care, ATM transactions would take days, the report said. If home building were like health care, carpenters, electricians and plumbers would work from different blueprints and hardly talk to each other. If shopping were like health care, prices would not be posted and could vary widely within the same store, depending on who was paying.

If airline travel were like health care, individual pilots would be free to design their own preflight safety checks — or not perform one at all.

IOM panel members urged a frank discussion with the public about the value Americans are getting for their health care dollars. As a model, they cited "Choosing Wisely," a campaign launched earlier this year by nine medical societies to challenge the widespread perception that more care is better.

Politicians inflame opinion and obscure the reduction of useless health care as ‘rationing of care’, when in reality inefficient and wasteful health spending creates shortages and unintentional rationing causing many to go uninsured.

More than 18 months in the making, the report identified six major areas of waste:

Unnecessary services ($210 billion annually);

Inefficient delivery of care ($130 billion);

Excess administrative costs ($190 billion);

Inflated prices ($105 billion);

Prevention failures ($55 billion),

Fraud ($75 billion).

Adjusting for some overlap among the categories, the panel settled on an estimate of $750 billion.

The present mindset is that our health system. or lack thereof is not and major reform is necessary, which brings us to step II.  Our usual cure for a problem (i.e., to make things more efficient and  less expensive are to throw money at the problems, which includes things such as incentive payments to MDs for acquiring electronic health records, the HITECH Act which provides resources for training health IT personnel, the enormous expense of designing, planning and implementing Accountable Care Organizations, the inefficiencies of disruptive technology and disruptive reorganization. 

If one want to create more chaos and dysfunction, then do exactly what is happening now. 

Examples of wasteful care include most repeat colonoscopies within 10 years of a first such test, early imaging for most back pain, and brain scans for patients who fainted but didn't have seizures.

The problem with preventive recommendations and/or recommended testing and treatment protocols is that they are often wrong, are used for many years, and then rescinded, creating confusion and loss of trust by patients.

The expected outcomes are far from being accomplished by PPACA.  It remains to be seen if it will be affirmed by the next congress.

 

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Health Insurance–Motivated Disability Enrollment and the ACA

 

Jae Kennedy, Ph.D., and Elizabeth Blodgett, M.H.P.A.  September 5, 2012 (10.1056/NEJMp1208212)

The United States relies on employer-based health insurance to cover working-age adults and their families. As a result, Americans who are unable to engage in full-time work because of a chronic health condition must not only seek out wage replacement but also pursue alternative sources of health insurance.

We believe that HIMDE is an important driver of the unsustainable growth in enrollment in public assistance programs for people with disabilities. The Social Security Administration currently has programs — such as the Ticket to Work and Medicaid Buy-In programs — that address this problem by preserving health insurance benefits for disability-program enrollees who return to work. These programs cannot address the system wide cost and structural factors contributing to HIMDE, but certain reforms included in the Affordable Care Act (ACA) do address such factors — meaning that stabilization of federal disability programs through a reduction in HIMDE is an unacknowledged but important benefit of the ACA.

Although Medicare and Medicaid funds are not as immediately vulnerable as SSDI, and the cost of these programs is a perennial concern. Unsustainable enrollment growth in disability programs contributes to this cost because Medicare and Medicaid coverage are closely linked to receipt of SSDI and SSI: SSDI beneficiaries receive Medicare 24 months after their financial benefits start, and most new SSI beneficiaries are simultaneously deemed eligible for Medicaid coverage.

In addition to making the private insurance market more accessible, the ACA will also change the public insurance landscape for disabled workers. The law originally required all 50 states to provide Medicaid coverage for persons with incomes below 138% of the federal poverty level, but the Supreme Court has ruled that such an expansion is not mandatory.4 The effect of Medicaid expansion on HIMDE will therefore vary by state. States that currently have very low income-eligibility thresholds or do not cover childless adults will dramatically increase the number of adults eligible for Medicaid if they opt to expand their programs. Adults with potentially work-limiting disabilities residing in these states will be able to obtain Medicaid without first obtaining SSI through disability eligibility.

The current process of directing applicants to SSI and/or Medicaid for benefits creates added bureaucracy and eligibility also requires asset determination as well as prior income from Medicare employment contribution.

The system is ‘rigged’ against those who never or could not gain enough credits to be eligible for SSDI.

A Simple and Inexpensive Message

 

This inspirational quote says it all. No need for multi-million dollar studies by institutes, government agencies, nor non-profit agencies.

 

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Health Insurers are Feeling the Pressure of Looming PPACA

 

In a series of announcements it becomes apparent that things are not well in the health insurance industry.

Shareholders of WellPoint (Blue Shield in California) are griping about a reduction of their dividend by lowering its 2012 adjusted earnings forecast to a range $7.30 to $7.40 a share, down from $7.57 a share (yes, that’s correct….approximately 15 cents/share. Times must be even tougher for them than the uninsured, and unemployed.

Further investigation

Shares of the nation's second-largest health insurer fell 12% in midday trading, and the disappointing results dragged down shares in other insurance companies.

In contrast, rival UnitedHealth Group Inc. raised its full-year profit estimate when it reported second-quarter results last week.

WellPoint said second-quarter profit decreased by 8%, which also fell short of Wall Street expectations.

The company reported earnings of $643.6 million, or $1.94 a share, compared with $701.6 million, or $1.89 a share, in the same period a year ago. More shares were outstanding in last year's second quarter.

Enrollment during the quarter ending June 30 dropped 2% to 33.5 million members as WellPoint cited heightened competition in certain markets.

The company said it expects medical costs to rise by about  7.5% for 2012, a slight increase over its previous forecast. Overall, revenue in the quarter ended June 30 rose nearly 2% to $15.4 billion.

Angela Braly, WellPoint's chief executive, said, "We are disappointed with the need to lower our guidance but believe it is the right action to take given the challenging market we see."

Later in the day Angela Braly was sacked by the Board of Directors

Angela Braly, the chief executive of WellPoint Inc., resigned late Tuesday after intense pressure from shareholders who have been unhappy with the company’s performance.

WellPoint announced that John Cannon, its general counsel, would temporarily fill the CEO role until a replacement is chosen. Cannon is not seeking the role permanently.

WellPoint, one of nation's biggest insurance companies, is the parent of Woodland Hills-based Anthem Blue Cross.

“Now is the right time for a leadership change,” Jackie M. Ward, the company’s lead director, said in a statement. “We believe the remaining executive team is dynamic and strong, with great potential to drive WellPoint’s future success.”

Shareholders have been vocal in their dissatisfaction with the performance of the company under Braly. They have decried the company's lagging stock, managerial missteps and disappointing earnings.

Still, the timing of Braly’s resignation is a bit unusual in that WellPoint agreed last month to purchase Medicare provider Amerigroup Corp. for $4.9 billion. It is uncommon for companies undergoing a significant acquisition to change leadership so soon after the announcement of a deal.

The investor unrest follows years of consumer fury that beset WellPoint as it repeatedly raised premiums on many families and small businesses by 10% or more. The nation's second-largest health insurer runs Blue Cross plans in California and 13 other states and has more than 33 million customers nationwide.

A New York hedge fund, Royal Capital Management, sent a letter to WellPoint's board last week saying that Braly has "failed miserably" as CEO and that "it is incumbent upon the board of directors to fulfill its fiduciary responsibility to shareholders by changing leadership." Royal Capital, which held about 838,000 shares of WellPoint as of June 30, declined to comment further Monday.

It’s not encouraging to know that Wellpoint’s patients’ welfare is in the hands of hedge fund experts, who are not exactly known for their pristine ethics or morals.

Let’s hope that the  free market enterprise system can self correct to overcome the foolishness of Obamacare.

 

Technorati Tags: Wellpoint,Blue Shield,hedge fund,obamacare,Angela Braly,United Health Group,PPACA,Amerigroup,Medicare

Online Physician Ratings: Know What's Being Said About You By Simon Sikorski, MD | August 13, 2012

 

This?                                            or  This?

                     

Last week, 50 doctors in New York gathered for a meeting to discuss one of the biggest controversial topics affecting their association: Each doctors' online reputation. Most of the attending physicians have embraced patient reviews into daily activities while others have not. How serious has the issue of online reputation become?

Like it or not, physicians are being drawn into social media.  One of your group associates may be online in other settings which might influence your own reputation.

It behooves you to ‘Google” yourself and read what is on the internet, and if necessary do whatever is necessary to edit the content.   Not having a Google identity can also have a negative connotation as much as ‘negative review’.  Ignore social media and Google at your own risk.

In less than one year, patients’ online behavior of how they look for doctors has changed by 65 percent. Eighty percent of new patient volume will screen their doctors on Google. In 2011, physician ratings sites accounted for only two percent of that behavior. Now it’s 60 percent, according to comparison of our 12 case studies vs. 120 online marketing campaigns in 2011. In early 2012, most of the digital health companies have started big advertising campaigns competing to list physicians and offer statistics about their practices.

Doctors are becoming very concerned about how their colleagues’ online reputations impact the profitability of their organizations. In one case study for an ambulatory surgery center, we showed that improving the reputation for six of 15 doctors brought in 33 new out-of-network cases in less than four weeks. Why was this so significant? Because previously the same ASC had to spend about $8,000 in advertising just to get five out-of-network patients.

Physician Reputations and Review Websites: Who Owns Your Name?

There are no longer any doubts that patients Google their doctors. In the case of patients seeking fee-for-service options, the behavior of turning to “Dr. Google” occurs 100 percent of the time. What your patients find at that point is critical for your bottom line. The information below will help you understand why taking charge of physician online reputations has never been more important and why you should take action now.

The reason for taking action now is because there are now over 100 doctor review websites creating businesses structured around your name. Any doctor without a strong online presence by the end of 2011 is already affected. At this point, any doctor with a license already has a profile somewhere. This is especially true for group practices and hospital-employed doctors who almost never have any other public-facing profiles they own outside of what their employer publishes about them on the corporate website.

The impact of doctor review sites on a medical practice and hospitals. The implications for the hospital brand and their profitability were severe. In one example, a small ASC was outcompeting a local hospital purely on the fact that their doctors embraced patient reviews and the hospital was still afraid of even featuring the doctors on its own website.

Here are some of the most disturbing findings about what physician rating sites publish and why you should do something about it now:

1. Outdated reviews, some from four to five years ago

2. Outdated addresses and phone numbers. Why is that significant? When that phone number rings at your old practice, that’s where you’re losing your patients to. Again, for group practices and hospital-employed doctors, this is even more significant because some hospitals are monetizing on this while the actual place where they do work, is failing. Yes, that's right. When patients call a physician's old phone number the receptionist schedules those patients to see their doctors.

3. Old patient satisfaction scores marked as percentages. Most of the surveys were filled out years ago by one to four people. The two most important questions for you are: How many patients do you see during the year? Are between one and four reviews representative of that number?

4. Physician rating websites advertise on Google for your name. This is perhaps the most unethical practice. Here’s the hidden business structure:
• The company publishes advertisements for your name
• Public clicks on the advertisements to go to a website where either bad reviews are posted about you, or an empty profile exists
• Next to your name are doctors that purchased an advertisement on that website and are displayed front-and-center
• In effect, your name is directing your possible patients to other doctors
•Those listings offer patients ability to call for an appointment or schedule one via their platforms

So in addition to paying for a subscription, physicians advertising on these sites are paying for new patient leads. Furthermore, the company has to be “fair” to all subscribers so it will advertise for different doctors at different times so that patient volumes can be distributed more evenly or more patient leads can be given to subscribers who pay premium fees.

For doctors in New York state, the problem is even more significant. The New York Department of Health forbids doctors to publish patient testimonials, while these businesses can. When I spoke to our legal counsel, I found out that the regulation is so broad in its meaning that it prohibits the doctors to use patient reviews in any format. There is no such regulation for the ratings websites.

“Dr. Google” has become the most feared background check available to anyone with access to the Internet. Mobile phones made that access possible to virtually everyone. In effect, Google has become a reference check that establishes a level of trust for an appointment to be scheduled. What patients find is completely up to you. I hope this short expose proves of value for doctors still thinking whether they should invest in their online reputations.

 

Simon Sikorski, MD is the CEO of Healthcare Marketing Center of Excellence. He is a regular speaker at physician conferences about reputation management, brand advertising, and ROI from internet strategies and social media. E-mail him here.

 

Technorati Tags: google search,doctor rating sites,reputation management,social media,sikorski MD,angies list,healthgrades

Breaking News on the Social Media Frontier

 

                            

The Second Generation of Social Media advances on health care. We are just at the frontier of social media engagement in healthcare.

I am one who sees things out of the box. I rebel at walls, at being defined by others and observe a wave of rapid advancement triggered by the infinite number of interactions between physicians and physicians and patients and patients and patients. (read that one slowly).  Rather than being bridled by old rules in a new medium, unless we adapt and change we will be swept away by new media just as newspapers and print book now play a much less dominant role in publishing.

It becomes apparent how mobile health is revolutionizing health care in countries that have a much greater shortage of physicians and larger population health challenges. In those countries there is no ‘box’ to restrict innovation and growth. It will be necessary for us to break down barriers and ‘rule’ set forth by government which decrease efficiency and increase costs.

Events in social media evolve at a quickening pace.  At a time when healthcare has accepted social media, social media evolves further.

Not so  subtle changes are being announced by the creative genius of what I would call “socialite media experts.  Simplicity of design, intimacy of intercourse, and        .

New domains, such a Medium, Branch, Beyond, Lift, all the progeny of Obvious (the original owners of Twitter).

Lift has a blog describing it’s goals .

Obvious describes itself in this manner, “The Obvious Corporation is more of a philosophy than a company or product. We focus our long term view on ideas and technology that can be generally described as “world positive.” When opportunities resonate with our worldview, we do what makes sense to help them succeed. So far, a small portfolio of companies across a variety of disciplines and a vision for how publishing could be improved have grabbed our attention.”

Medium presents a forum for stories, as  “collections” , which are defined by a theme and a template, as well as photographs.

Meanwhile  check out these:

Been There. Loved That 

Look What I Made

The Writer’s Room

 

All of these sites have popped up in the past several months. All are currently in beta and being rolled out by invitation .

As Steve Jobs said,

“Stay hungry, Stay Foolish”  (Stanford University 2005, commencement address)  His statement was not original since it originally appears on the back page of THE WHOLE EARTH CATALOG 1974

                                      

Is Social Media the current  iteration of “The Whole Earth Catalog?”  Is Social media a form of counter-culture revolution in the same manner as the catalog was at that time?

 

Technorati Tags: blogs,social media,mobile health,whole earth catalog,steve jobs,stanford,beyond,branch,lift medium

Hippocratic Oath, Then and Now

 

In the midst of chaos and turmoil for physicians in America it is as important as ever to maintain our hippocratic oath.  Now is the time to review what we swore to (if your medical school even does this at graduation. )  This should excite you as much as your first ‘white coat’.

 

As you will read below it has been modified somewhat.

           OR          

Let this be your ‘straight ruler’ to compare to what we are all going through at the moment, and remember, it too shall pass, and change….but real meaningful ethics barely change. The FTC, FDA, SEC, CMS and government  will change and change as people do. Physicians, Ministers, Rabbis, ( I include Priests) (and MDs are ministers to your health)

Few medical schools today require students to recite the classical version of the oath. Enlarge Photo credit: public domain

Hippocratic Oath: Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

Just as medical textbooks have come a long way from Hippocrates' archaic writings, the modern versions of the oath veer far from the classical. Enlarge Photo credit: Aldus Manutius/public domain

Hippocratic Oath: Modern Version

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

 

                             

 

Editor's note: To add your own comment as a doctor or a non-doctor,

 

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Mayo Clinic Report on Physician Burnout

 

A national survey of 7,288 physicians (26.7 percent participation rate) finds that 45.8 percent of physicians reported at least one symptom of burnout, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

The Mayo Clinic today released the finding of a study on physician burnout. Not surprisingly (if you are a physician) the stunning findings, perhaps to the public, is that over 30% of physicians in general have documented burnout (according to psychiatric standards), and the highest rates of over 50% were among emergency room,family doctors (primary care physicians) and the internal medicine specialty.

Symptoms and signs include depersonalization, lack of involvement with patients, insomnia, loss of appetite and other signs of clinical depression. It was also found that over 50% of physicians are considering leaving clinical practice, early retirement or part-time medical practices.

This is occuring at a time when patient load will increase by about 25% due to health reform, which includes increasing bureaucracy not directly connected with patient care.

Most physicians recognize their own burnout symptoms and categorize it as depression. It however has other signals which differentiate it from clinical depression. It mimics post traumatic stress disease, seen in the military. The duration of chronic stress exacerbates signs of burnout.

There are physiologic and biochemical changes which occur during burnout, much like clinical depression. It is well known that anxiety creates the release of circulating hormones such as norepinephrine and corticosteroids as well as changes in neuro-mediators in the brain, such serotonin and inhibitors.

The obvious outcome of this is markedly reduced physician efficiency, increased errors, and disability, either acute or chronic.

The figures reveal how health care is impacted by these numbers.

A lack of control about the future and working conditions in many professions reveals that these factors also lead to apathy and burnout.

In medicine this is apparent. Most physicians know that physicians have little to do with the operations of the business of medicine, health insurance reimbursement, regulations, medicare and medicaid regulations.and find a greater and greater percentage of work time involves non- clinical work.

When queried physicians in the majority enjoy charitable care, however cannot individually support it in the present setting of medicine in the United States. While medicare payment have a due process for adjudication of disputed or rejected claims, often times state medi-caid plans do not have a mechanism which is usable to dispute disagreements. These factors contribute much to the uninsured challenge.

 

For providers time is money just as it is for all employers/employees. There is a limit as to how long a medical business can pursue these claims. It is also possible to seek legal relief, however the cost of this is prohibitive for small groups. Some hospitals or larger groups can afford the legal fees to pursue this course, and occassionally successful. While a patient can be sent to collections, how does one send medicaid or medicare to collections. In fact the provider is effectively extorted to agree to the rules present in the credentialling process. It's one thing to say okay I am going to extend 'credit' or discounted rates by choice, but another to coerced or mandated discounts. In fact most insurers have a disclaimer that their rates can be altered at anytime. The provider is free to disenroll or accept the changes. The provider has an ongoing ethical and legal obligation to continue care or be sued for abandonment if continuing care is not arranged.

While patient care can be stressful, the training process usually deals with clinical issues that cause stress. It is all of the above collateral challenges that cause burnout. Long hours, lack of recognition and the blatant disregard for physicians by insurers. Rarely does an insurer send a note of appreciation to their panels for 'good care' for the companies insured.

The fact that almost 1 in 2 U.S. physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals," the authors conclude. "Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients."

 

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Money Money, Who’s Got The Money?

 

Most of us know where the money is going, and it’s not to physicians or providers. There is much money to be made and had in our health system, whether it becomes socialized, nationalized or universally paid.  Universal payor? It’s your wallet. What’s left? Not much.

Insurance companies are doubling down  to hedge their bets.

Health insurance companies bitterly opposed the health care reform law but, as the merger between Aetna and Coventry Health Care announced Monday shows, the industry knows there's still money to be made.

The $5.6 billion Aetna-Coventry Health Care merger is the biggest in the health care sector since President Barack Obama enacted the reform law in March 2010. The deal will give Aetna, the third-largest health insurer in the U.S., a big increase in Medicare and Medicaid customers, including poor elderly people on both programs, and in the number of people who buy insurance on their own or get coverage from small businesses. Aetna will gain 5 million new customers when the merger is complete and stands to get even more in the near future.

"You've got an arms race going on in health care," said Robert Laszewski, a health care consultant and president of Health Policy and Strategy Associates in Alexandria, Va. Laszewski said health insurance companies, hospitals and other players are merging into bigger entities in hopes of restraining their own costs and grabbing larger shares of the markets as they are reshaped by health care reform. What the Aetna-Coventry Health Care merger won't do, at least in the short term, is lower anyone's health insurance premiums, he said.

The health insurance industry is undergoing a transformation as a result of the health care reform law, which the Supreme Court upheld in June. Twenty-five million people will buy health insurance on the law's regulated "exchange" marketplaces in the states, according to the Congressional Budget Office. Many of those small businesses and people who don't receive health benefits from their jobs will get federal tax credits. Medicaid will also add 11 million poor people and states are expected to contract with private health insurance companies to cover them.

Huffington Post expands on this post.  It’s worth reading….Health Insurance companies, like the American Medical Association and others did the ‘FLIP-FLOP’ at the last minute, they saw where your money is going….

                                      

 

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