Sunday, November 30, 2008

Happy Birthday to this blog, part 4

Continued from part 3

The final quarter of my first year started with an unpleasant inquiry into something I think is one dirty little secret in our insurance-dominated healthcare system: the "MIB" is a databank run by the insurance industry, to protect it against fraud by you, but with no protection at all for you. This racket needs reform like the credit rating agencies needed reform, to level the playing field.

After my first post about it, to my amazement, an MIB employee contacted me, and in an extended email exchange, simply argued with me and wouldn't answer whether anyone is responsible for the accuracy of the information they have about you. You should request your free copy of your record.

9/5: What's in *your* MIB?, and part 2 (after the email exchange) on 9/27

9/18: "Patient Centered Medical Home" makes it into NEJM

10/2: New York Times special section on healthcare

"...something's starting to come clearly into focus for me: to a very large extent, healthcare delivery in America is a stinking mess. ... In the broad population, there is not much listening, yet, for open, transparent discussion of what works and what doesn't. ... What people don't realize is that today patients have access to far more power-bestowing information than we did 50-60 years ago. But even then, Dr. Spock was excoriated by many of his peers for telling mothers "you know more than you think you do." ...

We all need to be aware that healthcare in general is extremely (and I mean extremely) behind the times, compared to other modern enterprises. In a modern factory, things simply don't get lost the way they do in hospitals, and the reason is simply that not enough hospitals have thought out how to prevent the loss, or done anything about it."

10/2: Obnoxious ad against my hospital

10/7: What is Health 2.0?
Here's the definition I like: "Health 2.0 is participatory health care. The combination of content and community enables the patient to be an active partner in their own health care and the citizen to be an equal partner in improving the health system."

In October I was slated to speak at a dinner with Philip Longman, author of Best Care Anywhere: Why VA healthcare is better than yours, so I figured it'd be a good idea to read his book. Fortunately, it turned out to be a great book. I serialized my notes:

10/9: Highlighted in Best Care Anywhere - part 1
Part 2, part 2a, part 3, part 4 (the "Hard Hats" revolution), part 5 ("patient for life")

10/10: Human propulsion device for wheelchairs

10/17: "Medical home": where everybody knows your name
Explains what PCPCC has been talking about when they say "medical home." Dr. Ted says the concept has a marketing problem, because consumers (that's us) hear the term and think "nursing home," which is not at all the idea.

10/19: Runnymede: making light of the colonoscopy thing. (Results here.)

10/22: Important: All MRIs are not created equal
(Applies to MRI, not CT.) Vital information. I've had a few scans, and trust me on this: your hospital will not want you asking how their scanner compares to local alternatives. But your accurate diagnosis can depend on it, and you will have to push on it.

10/24: "Half of doctors routinely prescribe placebos"

Then the big event - my first serious speaking engagement at a healthcare conference:
10/29: Dr. Dan and I speak at Connected Health

Another book I've been reading is Anticancer: A New Way of Life, about things we can do to improve our odds. One thing it taught me is wonderful: dark chocolate fights cancer!
11/8: Chocolate Therapy!

The quarter nears an end with a decision to start questioning one of the principles I'd learned about in the past six months, evidence-based medicine. It's an important improvement in healthcare practice in recent decades, but it has limitations.

And this led to a flurry of increasingly informative posts both here and on the e-patient blog, which have rapidly changed my whole view of who and what we can rely on, as we search for information to save our butts when everything is at stake:

11/11:Evidence-based medicine
"On the fringes of medical knowledge, lives are at stake and medicine doesn't have the answers yet. What do you do?"
This was my first post to be picked up by notable others. AmyT of the highly rated DiabetesMine blog posted about it, and Terry Graedon of The People's Pharmacy sent praise. (I don't mean to sound puffy; my point is that I've been working to educate myself so I'm able to converse at a reasonable level, know what I'm talking about, and eventually perhaps contribute some original insights. So this post is indeed a milestone for me.)

This arose from, among other things, reading The End of Medicine (medicine as we know it, anyway), which was recommended by a longtime industry friend. That book mentions the evidence for the effectiveness of statins such as Lipitor. That led to a series of incisive posts on the e-patient blog, including e-patient doctor John Grohol introducing me to a great paper:

11/15: Making Sense of Health Statistics and part 2 (11/17)
11/22: More on statistics: deadly omissions, deadly conflicts

Finally, I participated in a "blog rally" - at least 80 95 healthcare-related blogs posted this over Thanksgiving weekend:

11/26: Engage with Grace: The One Slide project


Posts not directly related to my healthcare education:

Two updates on the status of my cousin Chris and his spinal chord injury:
11/7: PT equipment for tall people?
11/22: Sled hockey

And the usual ration of diversions sprinkled throughout -
9/20: Waking Up Is Hard To Do - nurse anesthetists doing a Neil Sedaka parody
10/1: Splitting this blog - announcement of the ImPatient Dave blog
10/10: Grass Roots Candidate (the e-Patient Dave Express!)


So ends my first year as a blogger. I can barely imagine what the next year will bring, but I bet it'll be fascinating and fun!

1 comment:

  1. My understanding of EBM as a layperson:

    Evidence-based medicine is where the health care provider applies statistically significant and relevant evidence acquired through quality and valid clinical trials utilizing the scientific method.

    The health care providers assess the risks and benefits of how they choose to treat or not to treat their patients. This paradigm of a practicing health care provider is to better predict the outcomes of their treatment of their patients. Such providers recognize the need for quality in medicine and place tremendous value on their patients' lives.

    There are three areas of evidence-based medicine:

    1. Treat patients according to what is reasonable and necessary based on the evidence that exists regarding the treatment options health care providers select.

    2. Health care providers review this evidence in order to judge and assess the best treatment for their patients.

    3. Recognize that evidence-based medicine is in fact a movement that emphasizes the usefulness of this method to practice medicine.

    Two types of evidence-based medicine:

    1. Evidence-based guidelines- Policies and regulations are produced to ensure optimal health care.

    2. Evidence-based individual decision making- This is how restoring the health of others is practiced by the health care provider.

    Dan Abshear


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