Imagine someone had been managing your data, and then you looked.

This is cross-posted from the e-patient blog. I wrote it as my own somewhat astonished observations, but I had no idea how much uproar it would create. The commenters added a lot, so if you're interested in this subject, go there and look.

This is a complex post, so don’t jump to any conclusions.

Two weeks ago (gad, was it that long?) I asked you to think about something for a few days:

Imagine that for all your life, and your parents’ lives, your money had been managed by other people who had extensive training and licensing. Imagine that all your records were in their possession, and you could occasionally see parts of them, but you just figured the pros had it under control.

Imagine that you knew you weren’t a financial planner but you wanted to take as much responsibility as you could – to participate. Imagine that some money managers (not all, but many) attacked people who wanted to make their own decisions, saying “Who’s the financial planner here?”

Then imagine that one day you were allowed to see the records, and you found out there were a whole lot of errors, and the people carefully guarding your data were not as on top of things as everyone thought.

Two weeks before that post, I’d had a personal breakthough in my thinking. For a year I’d been a rabid enemy of Google Health, but now I said: I’m putting my data in Google and HealthVault: “I’m concluding that we can do more good by aggregating our data into large, anonymized databanks that smart software can analyze to look for patterns. Early detection means early intervention means fewer crises.”

And I observed that the power of Web 2.0 “mash-ups” …

…lets people create software gadgets without knowing how they’ll be used, it lets people build tools that use data without knowing where the data will come from, and it lets people build big new systems just by assembling them out of “software Legos.”

So, I said, “I’m in.” I decided to punch the big red button and copy my personal health data into Google Health.

What happened is the result of PatientSite's "version 1" implementation, not their eventual full implementation, of the interface. To my knowledge, zero or one other hospitals have any interface at all, and as I'll say later, I'm not even sure how much of the Google Health side of the connection is complete. Nonetheless, what I learned about my own data was quite informative, and quite surprising.

(I've discussed what follows with hospital staff; this isn't gossip behind anyone's back. IMO, empowered people don't gossip, they communicate clearly and directly with the people involved.)

---

When Google Health launched last May, my hospital’s CIO blog said “we have enhanced our hospital and ambulatory systems such that a patient, with their consent and control, can upload their BIDMC records to Google Health in a few keystrokes. There is no need to manually enter this health data into Google's personal health record, unlike earlier PHRs from Dr. Koop, HealthCentral and Revolution Health.”

So I went into my patient portal, PatientSite, and clicked the button to do it. I checked the boxes for all the options and clicked Upload. It was pretty quick.

But WTF? An alarm: "! Requires immediate attention"

 

Okay, yes, HCTz is my blood pressure medication.

But low potassium? That was true when I was hospitalized two years ago, not now. What’s going on?

 

 

Then I saw the list of “conditions” it told Google I have. Here's a partial screen grab:

And here's the complete list that PatientSite transmitted: (spoiler alert; this stuff is biological)

 Acidosis
Anxiety Disorder
Aortic Aneurysm
Arthroplasty - Hip, Total Replacemt
Bone Disease
CANCER
Cancer Metastasis to Bone
Cardiac Impairment
CHEST MASS
Chronic Lung Disease
Depressed Mood
DEPRESSION
Diarrhea
Elevated Blood Pressure
Hair Follicle Inflammation w Abscess in Sweat Gland Areas
HEALTH MAINTENANCE
HYDRADENITIS
HYPERTENSION
Intestinal Parasitic Infection
Kidney Problems Causing a Decreased  Amount of Urine to be Passed
Lightheaded
Low Amount of Calcium in the Blood
Low Amount of Potassium in the Blood
Malignant Neoplastic Disease
Migraine Headache
MIGRAINES
Nausea and Vomiting Nephrosis
PSYCH
Rash
Spread of Cancer to Brain or  Spinal Cord
Swollen Lymph Nodes

Yes, ladies and germs, it transmitted everything I’ve ever had. With almost no dates attached. (It did have the correct date for my very first visit, and for Chest Mass, the x-ray that first found the undiagnosed lesion. But the date for CANCER, the big one, was 5/25/07 – four months after the diagnosis. And no other line item had any date. For instance, the "anxiety" diagnosis was when I was puking my guts out during my cancer treatment. I got medicated for that, justified by the intelligent observation (diagnosis) that I was anxious. But you wouldn't know that from looking at this.)

See how some of the listed conditions have links for More Info? Let’s see, I was diagnosed with optical migraine, an odd symptom that produces a little dazzling pattern in one eye occasionally. (See illustration; it happened for a brief period and stopped.) (I diagnosed myself, actually, by researching my symptoms and finding this illustrated site. That’s what e-patients do; it saves time in the doctor’s office… I brought a printout, with a dated list of episodes.) But optical migraine is not the impression you’d get from reading my Conditions list – in fact during my cancer workup one resident said “But you have headaches, right?” “No,” I said – “optical migraines, but without pain.”

So for that item in the conditions list, I clicked More Info. I didn’t get more info (i.e. accurate info) about my diagnosis, just Google’s encyclopedia-style article about migraines in general. (An optical migraine has little in common with migraines in general.)

The really fun stuff, though, is that some of the conditions transmitted are things I’ve never had: aortic aneurysm and mets to the brain or spine.

So what the heck??

---

I’ve been discussing this with the docs in the back room here, and they quickly figured out what was going on before I confirmed it: the system transmitted insurance billing codes to Google Health, not doctors’ diagnoses. And as those in the know are well aware, in our system today, insurance billing codes bear no resemblance to reality.

(I don’t want to get into the whole thing right now, but basically if a doc needs to bill insurance for something and the list of billing codes doesn’t happen to include exactly what your condition is, they cram it into something else so the stupid system will accept it.) (And, btw, everyone in the business is apparently accustomed to the system being stupid, so it’s no surprise that nobody can tell whether things are making any sense: nobody counts on the data to be meaningful in the first place.)

It was around this time that I commented on Ted Eytan’s blog, “when you’re exporting to a new system, the rule is, Garbage Out, Garbage In. (Hint: visibility into the data in your old system may leave you aghast.)”

We could (and will someday) have a nice big discussion about why the hell the most expensive healthcare system in the world (America’s) STILL doesn’t have an accurate data model, but that’s not my point. We'll get to that.

---

And now we get to why I said, at the outset, don’t jump to conclusions. I’m mildly bitching about PatientSite, but that alone wouldn’t justify staying up to 3 in the morning writing a 2800 word post; that one system isn't a big deal for e-patients everywhere. (And besides, although PatientSite is old and clunky, a 1999 system if I ever saw one, it beats what most hospitals offer, and it did the job very well for me during my illness. And this is just version 1 of the interface; the current folly is not a permanent situation.)

The BIG question is, do you know what’s in your medical record? And THAT is a question worth answering. For every one of you.

See, every time I speak at a conference I point out that my 12/6/2003 x-ray identified me as a 53 year old woman. I admit I have the man-boob thing going on, but not THAT much. And here’s the next thing: it took me months to get that error corrected, because nobody’s in the habit of actually fixing errors.

Think about THAT. I mean, some EMR pontificators are saying “Online data in the hospital won’t do any good at the scene of a car crash.” Well, GOOD: you think I’d want the EMTs to think I have an aneurysm, anxiety, migraines and brain mets?? Yet if I hadn’t punched that button, I never would have known my data in the system was erroneous.

And this isn’t just academic: remember the Minnesota kidney cancer tragedy just a year ago, which arose at least partly out of an error that ended up in the hospital’s EMR system. Their patient portal allowed patients and family to view some radiology reports, but not the one that contained the fateful error.

---

The punch line came when I got over my surprise about what had been transmitted, and realized what had not: my history. Weight, BP, and lab data were all still in PatientSite, and not in Google Health.

So I went back and looked at the boxes I’d checked for what data to send, and son of a gun, there were only three boxes: diagnoses, medications, and allergies. Nothing about lab data, nothing about vital signs. (So much for “no need to manually enter this health data into Google's personal health record.”)

And of the three things it did transmit:

• what they transmitted for diagnoses was actually billing codes
• the one item of medication data they sent was correct, but it was only my current BP med. (Which, btw, Google Health said had an urgent conflict with my two-years-ago potassium condition, which had been sent without a date). It sent no medication history, not even the fact that I'd had four weeks of high dosage Interleukin-2, which just MIGHT be useful to have in my personal health record, eh?
• the allergies data did NOT include the one thing I must not ever, ever violate: no steroids ever again (e.g. cortisone) (they suppress the immune system), because it’ll interfere with the immune treatment that saved my life and is still active within me. (I am well, but my type of cancer normally recurs.)

In other words, the data that arrived in Google Health was essentially unusable.

And now I’m seeing why, on every visit, they make me re-state all my current medications and allergies: maybe they know the data in their system might not be reliable. Hey wait, a new article in the Archives of Internal Medicine (co-authored by our own Danny Sands, my very own primary) says Clinicians override most medication alerts. Could it be they've been through this exercise themselves, and they consider the data unreliable? (Or do they just not trust computers?) (Hey Pew Internet, wanna check for generational differences?)

Who knows, perhaps the resident in the migraine story has learned early on that the data in his system is not to be taken at face value – I don't know.

In any case, my hospital is very proactive and empowering to staff about root cause analysis for failures, with its "SPIRIT" program, and they’ll add any process or form that can catch potential errors. That’s good.

But wait: On numerous visits, I’ve restated on those forms “no steroids.” But evidently what I write on the forms never gets entered into the system. Hm.

---

I work with data in my day job. (I do marketing analytics for a software company. We import and export data all the time.) I understand what it takes to make sure you’ve got clean data, and make sure the data models line up on both sides of a transfer. I know what it’s like to look at a transfer gone bad, and hunt down where the errors arose, so they don’t happen again. And I’m fairly good at sniffing out how something went wobbly.

And you know what I suspect? I suspect processes for data integrity in healthcare are largely absent, by ordinary business standards. I suspect there are few, if any, processes in place to prevent wrong data from entering the system, or tracking down the cause when things do go awry.

And here’s the real kicker: my hospital is one of the more advanced in the US in the use of electronic medical records. So I suspect that most healthcare institutions don’t even know what it means to have processes in place to ensure that data doesn’t get screwed up in the system, or if it does, to trace how it happened.

Consider the article in Fast Company last fall, about an innovative program at Geisinger. Anecdotally, it ended with this chiller:

… a list of everybody that accessed the medical record from the time he was seen in the clinic to two weeks post-op.'There were 113 people listed -- and every one had an appropriate reason to be in that chart. It shocked all of us. We all knew this was a team sport, but to recognize it was that big a team, every one of whom is empowered to screw it up -- that makes me toss and turn in my sleep."

In my day job, our sales and marketing system (Salesforce.com) has very granular authorizations for who can change what, and we can switch on a feature (at no extra cost) to track every change that’s made on any data field. Why? Because in some business situations it’s important to know where errors arose – an error might cause business damage, or an employee might sue over a missed quota.

So I’m thinking, why on earth don’t medical records systems have these protections? If a popular-priced sales management system has audit traces, to prevent an occasional lawsuit over a sales rep’s missed commission, why isn’t this a standard feature in high-priced medical records systems?

In any case, in the several weeks since these discoveries started, as far as I know they haven’t figured out how my wrong data got in there. And without knowing how the wrong data got in, there’s not a prayer of identifying what process failed.

---

BUT AS I SAID, this is not about my hospital; a problem at my hospital affects only one scrillionth of patients in the US, not to mention the rest of the world And please don’t blame my hospital’s CIO; I think what he wrote about the Google Health interface was overzealous, but I believe he’s a good man, committed to helping us own our own data (his work on the Google Health advisory board was unpaid), and this post isn’t about him: as far as I know, this hospital is farther along than anyone else: hardly anyone else has implemented a Google Health interface. (Perhaps for good reason.)

Nor is this a slam on Google Health. I haven't probed yet into whether there are limitations in what it does; might be fine, might not. Heck, neither PatientSite nor I have put any good data into it yet. (And I haven't even touched HealthVault.) None of that is my point.

Rather, my point is about the data that was already in my PHR, uninspected. For that, let’s return to my previous post:

Then imagine that one day you were allowed to see the records, and you found out there were a whole lot of errors, and the people carefully guarding your data were not as on top of things as everyone thought.

In my day job, when we discover that a data set has not been well managed, we have to make a decision: do we go back and clean up the data (which takes time and money), or do we decide to just start “living clean” from now on?

My point, my advice to e-patients, is:

• Find out what’s in your medical record. What’s in your wallet, medically speaking? Better find out, and correct what’s wrong.
• Get started, manually, moving your data into Google Health, HealthVault, or some such system. I’ve heard there are similar PHR systems (personal health records), not free but modestly priced, that can reportedly make this easier. I’m sure their friends will show up here in the comments. (Feel free to post product info links in the comments, everyone.)
• Let’s start working, now, on a reliable interoperable data model. I know the policy wonks are going to scream “Not possible!” and I know there are lots of good reasons why it’s impossibly complex. But y’know what else? I’ve talked to enough e-patients to be confident that we patients want working, interoperable data. And if you-all in the vendor community can’t work it out, we will start growing one. It won’t be as sophisticated as yours, but as with all disruptive technologies, it will be what we want. And we’ll add features to ours, faster than you can hold meetings to discuss us.
        I have to say, while researching this post I was quite surprised at how very, very far the industry has to go before reaching a viable universal data model. New standards are in development, but I'm certain that it will take years and years and gazillions of dollars before any of that is a reality. (What, like costs aren't high enough already?) In the meantime, your data is probably not going to flow very easily from system to system. Far, far harder than (for instance) downloading your data to Quicken from different credit card companies and banks.
        (Wizards and geeks refer to this "flow" issue as "data liquidity." We'll talk about that in the future.)
• Let’s start working, now, on an open source EMR/PHR system. The open source community creates functionality faster, and more bug-free, than commercial vendors do – and nobody can latch onto proprietary data in such systems to milk more margin out of us... because it ain't proprietary.
  
        The great limitation of open source is that it’s generally not well funded. But you know what? Every person in America (including software engineers) is motivated to have good reliable healthcare systems, and I assert that the industry ain’t getting’ it done on their own. As I said in my Thousand Points of Pain post (cross-posted on IBM’s Smarter Planet blog as A business thinker asks, what will it take to get traction?), it’s fine with me if industry vendors come along too – but I would not stake my life on their moving fast enough for my needs. Or your mother's.

Want a case study with real consequences? Recall what happened last year to famed Linux guru Doc Searls when he couldn’t read his own scan data, because good cross-platform image viewing tools weren’t available. (His prescription: the patient should be the platform and “the point of integration.”)

Well, okay, so Doc was a year ahead of me. I'm catching on. This illustrates why I think people from outside the profession may be our greatest asset in building what patients really need: patients tend to build what they want. And we who work with data all day know that these problems are not unsolvable.

---

My bottom line: I think we ought to get our data into secure online systems, and we shouldn’t expect it to happen with the push of a button. It’ll take work. So let’s get to work.

You know the work will be good for you, and heaven only knows what you’ll learn in the process. You’ll certainly end up more aware of your health data than when you started. And that’s a good thing.

Trust yourself. You know more than you think you do.

In the new Society for Participatory Medicine we assert that patients have a lot to contribute to their well-being and to their own care, and ought to do so.

We know some folks can't quite believe that, or aren't quite comfortable with the idea. So we scoured the earth for the newest, most radical thinker's opinion on this. His words are on the fridge magnet that I bought the other day at Whole Foods Market: "Trust yourself. You know more than you think you do."

No, wait ... that's Dr. Benjamin Spock, writing the very first words of his classic baby book.

In 1946.

A new dimension in doctor-patient collaboration :-)

I was emailing yesterday with Dr. Sands about our videotaping Saturday (see below). The producer was advising us on wearing camera-friendly clothes, and he said not to wear bright white. We'll pick this up mid-stream. How rude.


----- Original Message -----
From: "Tom"

The Navy jackets are fine. I was more worried about the shirts. Often, people take off their jackets and have white shirts for their taping.. Muted colors are cool blues and green, grays, tan, some pastels,and other colors that are not white or too bright.

----- Original Message -----
From: "Dave deBronkart"

I'm not takin' off my jacket.... as my doctor (ahem) knows, my profile looks MUCH better in a coat.

Seriously. I get higher ratings as a conference speaker when I keep my jacket on.

----- Original Message -----

From: "Danny Sands (dzsands)"

And the rest of your clothes, for that matter...

----- Original Message -----
From: "Dave deBronkart"

Hey! Did I just witness a violation of doctor-patient confidentiality???

I feel a blog post comin' on.

Gone are the days when all power resided in the medical office, buster. Today we are free to TALK.

Come be in the studio audience for the live taping of "Illness in the Age of E"

UPDATE 3/26: Directions have been added in a comment below.


This Saturday, March 28, Dr. Danny Sands and I will videotape the presentation we've given twice before: "Illness in the Age of E: A Case Study in Participatory Medicine." We're looking for interested, engaged people to be in the studio audience.

I first became Danny's patient in 2003. He's my kinda guy because he thoroughly believes in using the internet and he thoroughly believes in patient empowerment. This all turned out to be a really good thing several years later, when a routine shoulder x-ray showed an ugly cancer that had spread to my lung.

In the talk, we share the story of how we used the internet in every way possible: email, accessing my medical records online from home, sharing my login with others who could help, joining a patient community, forming a terrific support group in my online journal, even emailing diagnostic photos in one case.

People have said it's a moving, inspiring talk that opens the mind to a new realm of what's possible when patients are actively engaged in their care, and when health professionals support patients in taking a participatory role. Danny and I are both experienced business speakers, and we've designed the talk to be of value to professionals and patients alike.

We need a head count! RSVP to epatientdave at e-patients.net. It's at Bryant College in Smithfield, R.I. from 11 to 12.

Everyone's invited: patients, family, caregivers, doctors, nurses, hospice workers, Federal health officials, everyone. The only prerequisite is that you care about the future of healthcare.

Which, by the way, just might affect you some day. So get with it!

Reality is what it is, regardless of what we think

It's come time for me to say publicly something I've been saying since the beginning of my cancer case 26 months ago. It has to do with the power of our attitude, how we choose to view our circumstances.

Reality is what it is,
whether we know it or not,
and regardless of what we think.

In my community of other kidney cancer e-patients on ACOR, people are repeatedly faced with news they never wanted to hear, uncertainty, circumstances they were not raised to deal with. I know what that feels like, and no matter what your circumstances are today, chances are good that you too will face this – for yourself, a parent, a child, a loved family member, a loved friend.

Reality is what it is, whether we know it or not. For instance, as I'm fond of saying, "Oxygen was real and was doing its thing, long before Joseph Priestley figured out how it works." Among other things, this realization helps understand that we may have access to all kinds of things that science hasn't discovered yet. It also highlights that disempowering thoughts are useless, so why bother?

The other day in my ACOR community a woman named Sally (not her real name) wrote a note titled "Question for caregivers whose loved ones have passed," wondering about the decisions she and her husband are facing along the way. Here's my response.

---

Sally, I feel for you. I well remember those days in my case, knowing that what we had to do was educate ourselves and assess our choices. There was no way to know how it was going to turn out. It felt desperate at times. I'll never forget reading those words on the web pages for my disease: "Outlook is bleak." "Prognosis is grim."

I think everyone deals with this differently. After the initial shock I found myself saying "reality is what it is, whether we know it or not. I had cancer before the diagnosis; I have cancer after the diagnosis. The main difference is that now I know it. This is scary, but it also means I have much better ability to deal with it. What are my choices?"

With that approach, I had the experience that knowing I have cancer is empowering and enabling, MUCH better than not realizing it.

(I should note that for years I've taken courses from Landmark Education, a personal growth company that among other things teaches us to be clear about the difference between how things are and our thoughts about them.)

As I say, everyone's different. I personally have a strong gut feel that attitude makes a big difference, and the relatively new field of psycho-neuro-immunology supports this: they're studying how mood/attitude (psych) affects the nervous system (neuro) which ties to the immune system. There's real evidence now that attitude can boost the immune system. So I want my attitude to be strong, action-oriented, rather than victim-oriented.

Some might rightly say I'm a "victim" of cancer but for me there's no use in that.

We know that thousands of years ago the function of our anxiety was to help us be alert when a tiger might be about to pounce, so we could take action. Today, when we learn we have cancer, we get anxious and we take action. Beyond that moment, the anxiety has outlived its usefulness. So sometimes I'd remind myself "Yes, this stinks. Thank you for the alarm, Mr. Anxiety. Now, what are my options?"

All the while, I knew these really might be my end days. But there was no use for any other attitude than "what are my options?" With the attitude I chose, I became better able to fully experience life if it DID turn out to be my end days.

I also found that being in touch with my community (family, online CaringBridge journal, etc) about my status, thoughts, and feelings would help clear my mind. From them, I got back messages of support and encouragement. And some of them said "I can't believe you're being this way about it. You're amazing." And that left me feeling "Huh, maybe I can beat this thing, regardless of the odds."

---

Think about this,too: none of us knows how long we'll live, and patients with a fatal diagnosis have (oddly enough) the advantage of knowing that it's time to wake up and pay attention now. No sudden death for us, nosirree; we have advance notice.

My advice to patients everywhere, regardless of circumstance: Use your mind as an asset, not a liability.

No matter where you are in your journey, choose to be present in the moment, clear about your choices, and the master of your attitude.

Or, as my wonderful sister says about the game of life:
"Must be present to win."

Best intro to "health 2.0" I've seen

At the TEPR+ conference in February, where I spoke with my physician Danny Sands, I had the pleasure of meeting the venerable Dr. David Kibbe. An august fellow. Or so I thought. :)

See, I'd known David through his appearances on THCB (The Health Care Blog, where all the big-dog policy wonks hang out). He writes some seriously erudite (and wordy) stuff there, for instance his Open Letter to the Obama Health Team in December. And the reams of comments that he gets, from far wordier people, has usually meant that jumping into that sandpile over there has been more than I dared attempt.

So little did I know, until I met him, that David is One Of Us. Not only is he whole-heartedly into the bottom-up disruption of today's healthcare, in a wholly participatory empower-patient fashion, he's really good at story-telling and getting the idea across.

To illustrate that, here's a 16 minute "TV pilot" he put together to convey what "Health 2.0" is about. It's entertaining, stringing together interviews with some people I've met and others I haven't. (Oh, and did I mention he schemed up a way to weave it into a supposed motorcycle tour, making the whole thing a business deduction?)

I hope you enjoy it, and, more important, I hope you "get" what Health 2.0 is about: refocusing healthcare on us, out here in the real world, particularly in web-enabled ways, as opposed its previous focus inside the fortress. 16:38.



Please do drop me a comment so I have some idea what you think, y'all! I'm on a mission here - it's more fun if I have some idea whether it's working. :)

Extraordinary example of the mind's influence on well-being

A friend writes: "If you ever needed an example of the mind's influence on disease, please see the figure at the bottom of page 3 here: Impact of exposure to war stress on exacerbations of MS. Wow."

The article is about relapses of multiple sclerosis during the Hamas war in Israel in 2006. The caption reads "Number of relapses per month. Eighteen relapses occurred during the 33 days of the war compared with one to six relapses in comparable time periods over the 12 months preceding the war. There was no increase in relapse rates during the 3 months that followed the war compared with the same period of the previous year."

Brings to mind a couple of thoughts:

1. It strongly reminds me that during my own illness, I put a high priority on the power of my state of mind. At all times, even when all the information was not encouraging, instead of pondering all that for no benefit, I asked myself (and often said in my online journal), "What could be said that would make a difference?"
               Note: as those who read my journal know, I wasn't in denial – I'm talking about where I chose to focus my consciousness.
   
   
2. It reminds me, in a new way, of the sixties poster that said "War is bad for children and other living things."

Comprehending the US healthcare budget

A classmate steered me to PageTutor, a website for website developers. It happens to have a great illustration that helps comprehend the enormous amounts of money people are talking about these days in bailouts. And healthcare.

Here's a million bucks' worth of $100 bills. (That's 100 packets of 100 bills; each packet is 1/2" thick.)


Here's 100 times as much - a million hundred-dollar bills, $100 million:


Ten of those - a billion:



And a thousand of those - a trillion. Check out the little dude, who's now in the bottom left corner:

And, ladies and gents, the US healthcare spend for 2008 was estimated to be 2.4 times that much. And growing.

This helps understand what I was talking about when I wrote A Thousand Points of Pain, about how much money is at stake in this industry. The problem is that when we try to trim costs, there's going to be a LOT of money at stake. A lot. And right wrong or otherwise, when we try to cut something out, somebody's going to hurt. And there will be resistance.

So as I said in that post, I'm not waiting for the system to reform itself: I think we need to get busy at building our own solutions. The system may well improve, which is fine, but I ain't waitin' for it.

(btw, that's a big part of why I decided to go ahead with Google Health and HealthVault, as I wrote last month. That has turned out to be a bumpy road... I'll be writing about that soon.)

What if, in tough times, leaders could treat workers as responsible adults, and workers proved them right?

This warms my heart: management frankly discussing hard economic times with workers, eye to eye, adult to adult. From Paul Levy's blog, Friday, about the situation at Beth Israel Deaconess Medical Center:

Update on the economy and its effect on BIDMC

He suggests sharing pay cuts, and other sacrifices, to avoid as many layoffs as possible. (He's not the first leader to do this; it just warms my heart.)

Equally heartwarming is how the people have responded.

Town meetings @ BIDMC

As I read that second one, emotion swept over me, and I realized: this flies in the face of all the people who've told me over the years, "People will let you down. Watch."

I prefer to see the human spirit in its fullest, best expression. We can make it through hard times. It'll be hard and resolving the economic dilemma won't be quick. But I am so moved at good people's willingness to stick together and help each other - especially the strong favorable response to Paul's suggestion that they all take a bit greater cut to minimize the impact on the lowest-paid workers.

p.s. Please see the added comment below from the head of the Albert Schweitzer Institute, who works at BIDMC.

About the Renal Tumor Program at my hospital

As some of you know, a while ago my oncologist and surgeon, David McDermott and Drew Wagner, asked if I'd be willing to be videotaped talking about what I think about the Renal Tumor program they offer. Well, you know me – please don't throw me in that briar patch! Besides, since I feel pretty strongly that I owe them my life, the least I can do is tell the story to a million people or so.



In a couple of shots you can see my wife Ginny. And, very sharp-eyed long-time Bostonians may be able to recognize that the unnamed fellow in those shots is Gary Gillis, former sportscaster for WHDH-TV. He's the producer of this video.

More details about the Beth Israel Deaconess Renal Tumor Program are on their web site.

(As I write this, the video player is behaving very balkily for me. I don't know if it's my computer or the Brightcove video server. I expect they'll get it worked out.)