Dr. Mike Magee's BLOG | Health Commentary

Chances for Reform

Fri, 04 Jul 2008 13:03:24 -0400

CodeBlueNow! explores common ground; cross-sector platforms emerging

Will this be the season of Health Care Reform? With the economy swirling, and the current approach to health care in the U.S. arguably a deeply embedded complication, is it possible to imagine and implement a fundamentally different approach to care that promotes goodness and fairness, quality, access and choice? And can this be done without cues, waiting lines, and "manage-mania"?

Most agree next steps would require cross-sector cooperation, representation, and early agreement on common values and objectives. To this end CodeBlureNow's energetic executive director, Kathleen O'Connor, has pulled together an important “Town Hall” meeting in Seattle on Sept. 18th from 7 to 8:30 pm with two former Governors Arne Carlson (R-MN) and Richard Lamm (D-CO), followed by an invitational planning meeting of some key thought leaders and organizations the next day to plan for a spring 2009 “Confluence Conference” with several opinion leaders and organizations working around what Kathleen calls “Deep Reform.”

The Confluence Conference will be dedicated to refining some of the delivery system, management and financing models that various groups are proposing to see if together they can reach concurrence on a core set of values and templates worthy of bipartisan support. The city is behind the effort with supporters including:

These types of efforts are extraordinarily important, and an early bell-weather to indicate whether or not there is true readiness for "Deep Reform."

AMA's Virtual Mentor

Wed, 02 Jul 2008 14:23:45 -0400

A valuable resource for both teachers and students

Three things are happening to health education information these days. First, it's going electronic and virtual. Second, it's uniting various audiences, bringing them together, often in new and interactive ways, to inform, educate and bridge. Third, it's changing the power equation, emphasizing that we are all teachers and we are all students.

Case in point: The AMA's "Virtual Mentor"

What is it?

"Virtual Mentor is the American Medical Association's online ethics journal. The journal is open-access and advertisement-free... Founded in 1999, Virtual Mentor (VM) explores the ethical issues and challenges that students, residents, and other physicians are likely to confront in their training and daily practice."

For whom?

"... the journal is a valuable teaching resource for medical educators at all levels as well as for doctors and doctors-to-be. Each monthly issue of VM contains original articles and commentary on a given theme — e.g., access to care; quality-of-life considerations in clinical decision making, public roles of physicians, ethical issues in endocrinology, conflict of values in the clinic."

Who directs it?

"Virtual Mentor is student- and resident-driven. Theme-issue editors are selected in November of each year through a competitive process from among medical students and resident physicians who seek to broaden and deepen their education by taking the time to examine medicine's ever-increasing ethical challenges. The issue editors meet annually with VM editorial staff in Chicago, where we discuss potential topics for the upcoming year. Each editor identifies a theme and month of publication for his or her issue and then solicits articles and case commentary from experienced physicians and other experts in the field who can help VM readers think productively about the topic under discussion. The application process for theme issue editors is announced in VM each September."

I was especially drawn to the June, 2008 issue on Quality of Life for Older Americans exploring "the ethical challenges physicians face in preserving health and well-being in the elderly." Here's the lineup:

Jeanee Lee MD, PGY2 from Duke explores "Autonomy and Quality of Life for Elderly Patients" answering the question:"Why is it that the important problems of older persons are often not the ones that we know how to help?"

Muriel Gillick, MD, a clinical professor of ambulatory care and prevention at Harvard Medical School in Boston who practices palliative care and geriatrics with Harvard Vanguard Medical Associates, comments on "Family-Centered Decision Making" explaining how "the clinical staff's frustration with their inability to cure and locate a patient's infection can influence how they interpret treatment goals expressed by the patient and patient's family."

Mitchell T. Heflin, MD, MHS, an assistant professor of medicine and geriatrics, and the medical director of the Geriatric Evaluation and Treatment (GET) Clinic at Duke University Center for the Study of Aging and Human Development, explores "When Home Care Is Not Enough" and the health professional's "obligation to counsel a family that wants to care for an older relative in the home but may not be able to ensure the appropriate level of care and safety for the relative."

Daniel Callahan, co-founder of the Hastings Center and Senior Lecturer at the Harvard Medical School and Kenneth Prager, MD, clinical professor of medicine at Columbia College of Physicians and Surgeons in New York City and director of clinical ethics and chairman of the hospital's medical ethics committee sort out "Medical Care for the Elderly: Should Limits Be Set?", taking a close look at the future of Medicare's dwindling resources.

Healthy Behavior

Wed, 02 Jul 2008 11:32:22 -0400

Blending economics and psychology on behalf of healthDespite the great strides that we have made in health care over the last 50 years, we find ourselves in 2008 with an interesting problem: There is growing acknowledgement that human behavior has been unable to maintain pace with scientific understanding. When it first became obvious that we as a population were not seizing the opportunities for health that were right in front of our noses -- like not smoking, staying on medication for high blood pressure to avoid stroke, and maintaining healthy weights and exercise to avoid diabetes -- economists felt more information and mild financial incentives would do the trick. That hasn’t worked as planned and now the relatively new field of behavioral economics -- the marriage of conventional economics and psychology – is pondering this issue.

Behavioral economists say we are difficult to motivate not because we are bad persons or terminally obstinate, but because our brains are programmed in such a way that we are biased to make bad decisions. For example, we prefer to "stay put" rather than change. So our minds, presented with a change option, will place more value on the "status quo," and less value on the advantages of what is new. A whole host of behavioral factors get in the way of good decision-making when it comes to health.

So how can we start to drive behaviors in the right direction? According to the experts, some of the answers to behavior change involve simple common sense. Example: In schools, set up the food in the cafeteria so that items that are most nutritionally sound appear first. Many similar approaches can be applied, thanks to the new insights gained when we combine the theories of economics and psychology.

One thing is clear – our public institutions have to be aligned with personal incentives if we are going to affect health care behavior. To learn more, watch this week’s program, embedded with this blog, and then leave a comment. Are we providing the kinds of incentives that will lead to a healthier society?

Dr. Mike Magee's BLOG | Health Commentary

Chances for Reform

AMA's Virtual Mentor

Healthy Behavior

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