Different theories on the bottleneck in Healthcare

Jim Kim has a slide that he likes to use in his talks about what is wrong with the healthcare system. The logic goes something like this: we spend billions on high tech R&D for new drugs and devices when we don’t yet utilize our current technologies in a judicious and cost effective way. In fact, we don’t even know how well we use our current technology because that data on outcomes and the quality of patient care is often not even collected. Thus the need is for a science of implementation aka the science of healthcare delivery to go alongside the traditional basic and clinical sciences.

I learned the other point of view today which can probably be best illustrated through an example of two conditions which are both treated by antibiotics: Cdiff infection vs Cellulitis. Cdiff may well be an area in which the value of healthcare delivery can be easily seen. Both the diagnosis using a highly sensitive and specific test Cdiff toxin in stool as well as  the outcome, cessation of the cardinal symptom (diarrhea) supported by laboratory evidence from stool samples of negative Cdiff antigen is quite clear. This is an area where providers can be assessed on the proper diagnosis and the outcome of treatment. Perhaps this is an area amenable to the science of healthcare delivery.

On the other hand, take cellulitis, an area where the diagnosis is often by expert opinion and prescribing patterns are highly variable. Science of HCD people may argue, well thats exactly where we should apply the science to systematize the expert opinion and measure improvement in outcomes. However, one may also see this as an area in desperate need of better diagnostic and treatment modalities.

Thus the alternative point of view is that until a disease can be diagnosed and its natural history predicted with 90% accuracy and its treatment is 90% effective, there will always be a need for further products.

Which one is right? I personally intend to hedge myself so that I can learn about and participate in both as an academic physician working in healthcare delivery and life science entrepreneur building disruptive innovations.

Greece – who cares?

1) Eu growth slows demand for US products
2) Depreciated euro will compete in exports with US/China
3) Will capital markets crisis devolve into 2008 style crisis? Niall Ferguson

When gov outspends taxes choices
-sell debt to private investors
-default (in 3yrs?)
-transfers from other gov (145bn bailout)
-inflate away value of debt by selling to central bank print money (ECB buying Greek debt)

Greece has funded large CA deficit with capital account surplus which is savings of other countries vs Japan who funds their large debt/GDP with their large savings rate

Happiness is cheap!

I’m sitting on the steps of Collis on a perfect sunny New England day, sipping a smoothie getting ready to read all about how the Brits got massacred in Kabul in Peter Hopkirks book the Great Game. I had lunch at Yamas with Kevin and I think his passion for the topic really inspired me to want to read about blood gore and adventure. I am still looking for that job where I can make relationships for a living with interesting people. I suppose that is why I chose medicine and business but even in those there really isn’t a perfect function where all you do is build relationships without the crap of staying up all night filling out forms and writing notes all night. Sigh, maybe life is all about being able to be on vacation or unemployed . . .

Medicine is one large decentralized organization

It occurs to me that healthcare suffers from a simple issue that many large organizations face. Namely as individual practitioners are given autonomy over major decisions that affect quality and costs, of course you will have variation in outcomes. The management solutions in this situation are simple, to centralize decision making (lobbying medicare to require certain algorithms of care), changing performance system (Pay for Performance), change accounting system to take into consideration poor outcomes.

Stop apologizing

I am taking a course called Communicating with Presence in my last term at Tuck. We did an exercise recently called “Conversation with your Inner Critic” that I found illuminating. It basically consisted of assuming one’s critical voice when it comes to public speaking and voicing ones own doubts about oneself. It was a strong example of how we are all our own worst self critics. I remember being suprised at how critical I was when we role played in class going so far as to tell myself to “go home” since I was never going to be a good public speaker. Pretty crazy.

What I found quite interesting in all of the relaxation and self reflection exercises is this. In finding one’s confidence, one’s voice, one only has to overcome ones own fears and self doubts. For me, I have decided that this means to STOP apologizing for things I do and just try to be myself and accept both the good and the bad decisions I make.

Let’s see how we do! :)