Do You Know Who Your Insurance Commissioner Is?

Posted on | September 6, 2017 | Comments Off on Do You Know Who Your Insurance Commissioner Is?

Who’s My Insurance Commissioner – and was she/he elected or appointed?

The Changing U.S. Workforce

Posted on | September 6, 2017 | Comments Off on The Changing U.S. Workforce

With U.S. health care now consuming nearly 20% of a GDP, and somewhere between $4 and $5 trillion annually, its not surprising that jobs in the health field are exploding as well. But for every one US physician, 16 others are employed in non-clinical health care jobs. But American jobs aren’t what they were three decades ago. How has the American workforce changed from a Human Resources point of view? Here are a few of the shifts outlined in a recent WSJ report.

Category: Uncategorized

Compounding Our Weaknesses – Gray Market Drug Collusion.

Posted on | September 6, 2017 | Comments Off on Compounding Our Weaknesses – Gray Market Drug Collusion.

Mike Magee

In the realm of pharmaceutical disaster deja vu, Tennessee deserves special recognition. In early September, 1937, the S.E. Massengill Company of Bristol, Tennessee, distributed tainted elixir of sulfanilamide nationwide. Before the disaster ended, 104 patients, most of them children, had died. Nearly 80 years latter to the date, Dr. April Petit put in a call to the Tennessee Department of Health, reporting his suspicion that an injection of steroids received from a middle man manufacturer had caused a systemic fungal infection in a Tennessee patient. Systemic candidiasis is the most common fungal infection among hosptilized people in high-income countries, including the United States. Diagnosis can be difficult, especially when the Candida is not found in the bloodstream. To cure systemic candidiasis, you need to buy Diflucan online without rx

Seven days after that call, the FDA was called in and traced the source to the New England Compounding Center (NECC) of Framingham, MA. The next day, 17,000 vials of supposedly purified injectable steroids were recalled. But it was already too late. The product had been distributed to 20 states. By final count, 753 were infected and 64 died.

The problems were obvious at NECC, a compounding pharmacy firm whose inspection had fallen through the regulatory cracks of a deeply flawed and financially weaponized entrepreneurial American Health Care system. When the FDA did investigate the facility on October 2, 2012, one representative lot of the supposedly pure steroid vials had floating “greenish black foreign matter” in 83 samples. 100% of 50 vials tested were positive for microbial growth. Manufacturing equipment was spotted with “greenish yellow discoloration.” Cleaning and disinfection records had been forged, and air-conditioning (essential to the maintenance of a sterile environment) had been routinely shut off each night to save money. As one FDA official stated, “The entire pharmacy was an incubator for bacteria and fungus. The pharmacy knew about the contamination and did nothing.”

Fourteen NECC employees, including president Barry Cadden and pharmacist Glenn Chinn, were arrested in 2014. Cadden and Chinn were charged with second degree murder. Their company had already gone bankrupt after being forced to established a $200 million dollar compensation fund. Cadden was acquitted of the murder charges but convicted of conspiracy and fraud and sentenced to 9 years, after trying to shift the blame on his pharmacist, Chinn, who is plea bargaining.

Historically, U.S. drug law has always tracked disasters. Horse tetanus tainted typhoid vaccine killed 13 children in St. Louis in 1901, and led to improvements in drug labeling and oversight in the Pure Food and Drug Act of 1906. The Massengill tragedy gave FDR the boost he needed to pass the Federal Food, Drug and Cosmetic Act of 1937. And the Thalidomide tragedy fueled support for the Kefauver-Harris Amendments that demanded proof of efficacy as well as safety prior to FDA new drug approval.

In each of the cases above, victims could be quite certain that some lasting benefit would come from their personal sacrifices. But for families and friends affected by the NECC felonies, the final record is less clear. Large batch compounding of pharmaceuticals continues to fall between the cracks. They are not your neighborhood pharmacist laboring over mortar and pestle and they are not giant pharmaceutical houses strictly regulated to comply with Current Good Manufacturing Practices (CGMP) by the FDA. They are something in between, and they are growing, sometimes with the active financial participation of physicians.

In the United States, up through the end of World War II, we relied primarily on local pharmacists to create and package pills and elixirs behind their counters following formulas laid out in the physician prescription. Drugs were tailor made, compounded and individualized on demand. Most of the drugs available today are produced by highly regulated large manufacturers. About 3% of drugs are produced by “compounders”, increasingly large enterprises selling across state lines. They are weakly and variably regulated within their own states.

The FDA was aware of quality concerns well before the 2012 disaster. Between 1990 and 2005, the agency catalogued 240 serious illnesses and deaths due to the products. Nothing was done about this because compounders were state vs. federally regulated if at all. Beyond safety, the FDA also found serious efficacy issues. A 2006 study by the agency revealed that roughly 1/3 of products tested lacked uniformity for potency and dosage compared to a failure rate of 2% with FDA regulated pharmaceuticals.

The FDA has been trying to get their arms around renegade compounders for two decades. In 1997 the Food and Drug Administration Modernization Act included the 503A section that exempted compounders from CGMP’s and the need to file new drug applications in return for prohibitions against advertising and promotion and soliciting prescriptions from doctors. But a group of compounders sued the government claiming their 1st Amendments right to speech had been denied, and the FDA was forced to abandon enforcement.

Even if they had the clear power or budget to enforce inspections, compounders have actively resisted. Between 2002 and 2012, the FDA was forced to obtain federal warrants to complete inspections eleven different times. After the 2012 event, legislation was passed – The Drug Quality and Security Act. One part of the law distinguished between local pharmacy compounding in response to specific patient prescriptions and large industrial compounders preparing inventory without prescription. According to their trade association, the International Academy of Compounding Pharmacists, we need these middle-men to fill the gray market gap. The association says compounders provide product when major manufacturers discontinue a medication (because it’s hard to make or unprofitable), for patients with special allergies or dosage requirements, for special combinations of drugs otherwise unavailable, and to create lotions and liquids when a patient can’t ingest pill forms.

But critics say these ever enlarging concerns are not compounding. They are manufacturing outside regulatory control. The 2013 law draws on the 1997 version, exempting large compounders from having to file a costly new drug application for each of their concoctions and allowing the unlimited manufacturing and sale of product without a prior prescription in return for voluntarily filing their company as a “outsourcing facility” which includes a willingness to submit to FDA inspections, comply with CGMP’s, and use only drugs on the official bulk ingredients list.

For those who choose not to register, they theoretically can be challenged on the basis of preparing “new drugs” without FDA approval, but this is unlikely in a federal agency already functioning with inadequate resources. Rather the FDA is actively encouraging hospitals and other providers to do their gray market purchasing only through compounders who have registered as a federally endorsed “outsourcing facility”. In addition, some states like Massachusetts have stiffened their laws with more inspections and better oversight. But this varies from state to state. The Office of Management and Budget is scheduled to do a three year analysis of the federal law to gauge the effectiveness of the voluntary compliance system in the near future. Currently 72 facilities have received the federal designation.

A continued gray area is “office-use medications”. In all states, physician’s prescriptive powers are broadly protected. And though not actively encouraged, the AMA and others allow physicians to sell pharmaceutical products out of their offices. This is common fare for oncologists, dermatologists, ophthalmologists, orthopedists, pain management specialists and others. Some entrepreneurs see this as a growth industry. For example, one firm, Physicians Compounding Alliance (PCA), advertises to doctors online saying, “Add thousands per month in additional income to your practice”, and claiming that “82% of physicians dispense on a daily or weekly basis, but only Physicians Compounding Alliance makes it possible to provide office-dispensed compounded prescriptions. Capture the extra business that you now send to others while providing your patients better care and greater convenience.” The AMA Code of Ethics provides ample wiggle room for such activities stating, “Physicians may dispense drugs within their office practices provided such dispensing primarily benefits the patient.”

Some worry that physicians, as small business people, are more price conscious than hospitals and health systems. For these customers, low price may win out over federal “outsourcing facility” designation. As a NEJM piece cautioned, “If providers constantly seek out the cheapest compounded drugs, then the unregulated compounders will have an unfair competitive advantage…”

Labor Day Recovery and Resilience: Insights From Patrick Kennedy

Posted on | September 4, 2017 | 2 Comments

Mike Magee

Today, Labor Day, I was greeted by a comment to “moderate” on a piece I wrote 2 years ago. The comment read: “Hello Mike – This post is so touching. Thanks for sharing.” It’s the nature of writing a weekly column for the past 10+ years that it’s often difficult to recall the subjects, let alone the words, you’ve written. And when you go back to review and recall, often they resonate in a different way because the environment has changed.

When I originally wrote the piece below, the 2016 election was still a year off. Today, the citizens of Texas, Louisiana and the surrounding areas, having struggled to survive Hurricane Harvey, are now laboring to envision a pathway forward. How and when will they put their lives back together? The piece below, about Patrick Kennedy’s struggles with mental health, his courage and resilience, and his leadership on behalf of justice and health parity continue to instruct us all. I share it today – Labor Day – in that spirit.

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This week, on October 6th, I hung on to “Morning Joe” a bit longer than I normally do to hear the interview of Patrick Kennedy by Joe Scarborough. My interest was personal, knowing some of the players, but also as a member of a large Catholic family (12 kids) with our own credo of family loyalty and our own share of trials and tribulations.

Two days earlier, Lesley Stahl had interviewed him on “60 Minutes”, his first public interview promoting his new memoir, “A Common Struggle”. That interview had veered off subject to Patrick’s father – Was he an alcoholic? Did he suffer from PTSD in the wake of his brothers’ assassinations? Valid questions I suppose, but coming close to suggesting this as just another book about America’s most famous (and tragic) family.

But in reality, Patrick’s book is much more than that. In it, he displays a modern understanding of the meaning of health as “human potential”. He clearly explains that unhealthy behaviors are often inherited, as both genetic and social constructs. And most importantly, he reveals that families, in their conspiracy of silence, often contribute to the problem rather than to the solution – and that communities and leaders are complicit.

In thirteen minutes, last Tuesday, Patrick Kennedy provided more health education on the subject of alcohol addiction, mental health, and their treatment, than I received in nearly a decade of training to be a physician.

As the interview opened, Joe Scarborough alluded to the fact that Patrick had broken some silent code, and at least some family members had reacted angrily. Why did he write the story?

Patrick’s answer, a simple three word sentence, declared his emancipation, and his right to both health and happiness, for he and his wife and children. He said simply: “It’s my story.” But what came through was, “It’s my life, and I’m taking control of it.”

He explained, “Often times you’re expected to keep your parents secrets. And yet it will bedevil you your whole life because we all grow up to be our parents. And everything that happens to you as children, we will live with that for the rest of our lives. And what makes that worse is keeping that secret or thinking that you’re keeping that secret…What I’m saying is that my story about keeping quiet in my family is like every other family in America who has these illnesses. Say nothing! Do nothing! See nothing!”

Patrick goes on to explain that the book explains in detail the policy issues involved with achieving expanded coverage and care for those suffering from mental illness and and addiction. He explains how he and his father wrote the Parity Law. Back then, law makers wanted nothing to do with it. As Patrick said, “No one wanted to be the author of Parity. No one wanted the words mental health and addiction next to their name.” When it did pass, he says, insurance companies wasted little time in figuring out how to renege on their obligations.

It is an individual disease marked by shame. In his words, “One of the biggest barriers is no one wants to be known as a patient who is getting mental health treatment or addiction treatment.” But that shame, for him, was uniquely reinforced by a secret code of silence. This extended not only to his parents, siblings and extended family, but also to the many important visitors and guests who wandered the hallways of his famous home in his formative years. Routinely, he was forced to witness his inebriated and incapacitated mother wandering in bathrobe midday past friends and family, heads down, all of whom refused to acknowledge, let alone confront, the disease. That was its’ cruel power over the family, and in part, over him, until recently.

At the core of his family was this secret, eating away at everyone’s health. As Patrick experienced it, “It’s an illness and we are running away from it. My family does not want to be identified with mental illness. That should tell you something about the shame and stigma that still surrounds this issue.”

So where did he find the courage to stand up to it? For whom, and why now? He said, “I have kids now. I don’t want my kids to feel ashamed because they have a genetic predisposition for mental illness and addiction. I want them to get treatment for them. I don’t want them to keep secret the fact that they have an emotional life, a spiritual life. We ought to be paying as much attention to their mental health as the rest of their physical health.”

The reaction from the family has been mixed. His older brother and his mother have issued statements disavowing and criticizing the book. Most family members have remained silent. And a few of the extended family have voiced support. Those who have focused on his right to speak out. In his words, “… a number of members of the family said I love your message that this is about breaking the silence and shame because all of us are saddled with the hangover of a shame that comes with growing up where you are not supposed to tell anything about what happened to you personally. That affects somebody if they are growing up in a family where everything is supposed to be kept quiet.”

As for the disapproval of his older brother, he said simply, “I love him, and I will always love him.” And added, “All I can do is do the next right thing and pray that my brother will understand that what I’m trying to do here is bigger than both of us. And that’s what my dad was all about – trying to make a difference for more people. I’m trying to move the ball forward as he did in his life.”

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For Health Commentary, I’m Mike Magee

Category: leadership, Uncategorized
Tags: Hurricane Harvery > Labor Day > Patrick Kennedy > recovery > resilience

Universality is The Goal: Incremental Movement Toward Single Payer Options Makes Political Sense.

Posted on | September 1, 2017 | Comments Off on Universality is The Goal: Incremental Movement Toward Single Payer Options Makes Political Sense.

Mike Magee

As Trump continues to dabble in undermining the ACA, Democrats are pushing forward on an internal debate over the future of Obamacare. And although tactics and strategies are up for debate, there is close to a consensus on one issue – our government should guarantee universal health insurance coverage for all citizens. Our Code Blue campaign contains five core principles, listed below, that provide common ground in the debate.

The weaknesses of our current approach are now well-established including:

1. Not Universal: A CBO report predicting 27 million remaining uncovered by 2026.

2. Reporting Requirements: “Mind numbing” and time consuming requirements for documentation and reporting.

3. Administrative complexity: Robs time with patients.

4. Limited comprehensiveness: A trend toward “skinny plans” which are little better than no coverage at all. Physician and hospital panels are narrowing.

5. Underinsurance: A tripling of deductibles and “punishingly high copayments” paid by consumer.

6. Failure to Control Costs: ACA “has elicited ubiquitous gaming of risk adjustment and quality measure” incentives, spawning giant moves toward hospital and insurer consolidation.

7. Market-Based: “Any method of payment can create perverse incentives in a market-based system.”

The tension points in the internal debate were drawn into sharper relief when Sen. Brian Schatz (D-HI) released a new plan that would allow anyone in participating states to extend the opportunity to “buy-in” to their state Medicaid program. Essentially this would create open enrollment. According to Schatz’s vision, reimbursement rates for doctors and hospitals would rise to match Medicare rates insuring broad provider panels. Currently Medicaid reimburses at 72% of the rates of Medicare. Of course, states that passed on ACA Medicaid expansion (29 states under Republican governors) might pass on this offering as well.

The competing Democratic approach as outlined in a bill sponsored by Rep. John Conyers (D-MI) would go all-in on a national single-payer system. This has the virtue of actually achieving universal coverage since all individuals would be mandated to participate. The downsides include a predicted political firefight, massive disruption of the private insurance market (which would be relegated to providing supplemental insurance plans only – though back door involvement through plans mirroring Medicare Advantage might survive), and tax increases in the area of 10% likely to help finance the effort.

Schatz’s plan is not brand new. The Nevada legislature passed just such a plan this year, but Republican Gov. Brian Sandoval vetoed it. Way back in 1965, when Canada endorsed a single payer approach for all Canadians, Americans did the same – but only for those over 65. We called it Medicare, and while it has had issues over the past half century, Americans long ago decided they couldn’t live without it. Of course, until now, they also consented to widening income disparity and health inequality based on a system of “have’s” and “have-not’s” when it comes to the good fortune (or lack of the same) of possessing health insurance.

Medicaid expansion under the ACA celebrated a new approach (within the corridors of defined eligibility) of universality, access, health planning, portability, and integration with other social service programming. 18 of the 31 participating governors were Republican and liked the fact that the Obama expansion program was well funded, that the benefit package was broad (not a sham like the HSA induced high deductible/ empty benefit products proliferating everywhere), and that they preserved the flexibility within bounds to set the priorities on spending and defined how best to advance the overall health of their state populations. Add to this CHIP, a federal offering likely be extended, that provides coverage to economically needy children who find themselves slightly above poverty levels. In the wake of failed Repeal and Replace efforts, the remaining 19 hold-out Republican governors must now reconsider their ideologically driven stances. Some at least will reverse their stands.

The governors who have participated already have learned that centralized administration of a universally available health insurance offering carries distinct cost savings. Specifically, governor guided single payer health delivery under Medicaid came in 22% less costly than privately insured comparators. Governors like John Kasich of Ohio were left to wonder what might be the economic impact on Warren Buffett’s belief that health care was a “tapeworm on the American economy”. Analysts evaluation of single payer back office administration combined with state controlled and planned integrated health delivery shows a potential immediate 15% savings on our 4 trillion plus annual bill simply by consolidating management of coverage and payment systems.

Governors also could see that the human resource implications of such a move. Our purposefully complex program, which now threatens to break the American economy in much the same manner as reckless military spending collapsed the Soviet Union, has spawned 16 non-clinical jobs in health care for every one clinical role. A shift toward availability of single payer, if poorly planned and transitioned, could carry with it massive unemployment. But if you look at innovators like Kasich, what you see is the potential to reassign jobs by skill in a manner that could advance the strength of the social service network in areas like housing, nutrition, education, transportation and the environment.

Today’s Medicaid Numbers? 74 million or 20% of Americans currently covered; 11 million added under ACA; 40% of children covered; 50% of all births covered; 10 million disabled covered; 2/3rds of nursing home patients covered; 16% of health care spending nationwide; only 13% of citizens oppose Medicaid expansion.

Sen. Schatz recognizes a fundamental and permanent shift at work. He notes, “One of the unintended consequences of the Republicans trying to cut Medicaid is they made Medicaid really popular. This conversation has shifted. There was a time where Medicare was really popular and Medicaid was slightly less popular. What this ACA battle did was make both of them almost equally popular.”

The Code Blue Campaign endorses five core principles:

1. Universality: Health coverage and quality accessible health services are a right of citizenship in the United States.

2. Public Administration: Administration of basic health coverage is organized in the most cost-efficient manner possible with central oversight by the government. Incremental steps allowing the option of public sponsored plans to those already insured should be encouraged.

3. Local Control of Delivery: The actual delivery of services to ensure quality and cost effectiveness is provided by health professionals and hospitals at the local and state levels.

4. Health Planning is a Priority: Creating healthy populations is a high priority for each state governor. Working to establish health budgets and priorities, leaders must integrate health services with other social services, advance prevention planning and manage vulnerable populations.

5. Transparency: Providers submit bills. Government ensures payment of bills. Patients focus on wellness or recovery. Not all services will be covered. For uncovered services, those with the means to pay will be encouraged to purchase private supplemental insurance.

Category: health care reform
Tags: aca > Code Blue > Gov. Brian Sandoval > Gov. John Kasich > health reform > medicaid expansion > Obamacare > Rep. John Conyers > Sen. Brian Schatz > single payer

A Faustian Bargain Comes Home to Roost – Already!

Posted on | August 28, 2017 | 2 Comments

Valerie Huber

Mike Magee

“The Department of Health and Human Services is shaping up to be a huge headache for the radical Left”, crowed the Family Research Council in a June 12, 2017 release. Commenting specifically on the appointment of controversial nominee Valerie Huber, formerly head of the National Abstinence Education Association, as chief of staff for the Office of the Assistant Secretary for Health at HHS, it stated, “While conservatives cheered the move, the Left fired off a series of angry press releases, accusing Huber of being everything from anti-woman to anti-science. It’s almost comical…. The Left is so confused about basic biology that it doesn’t even know which bathroom to use!” “Congratulations, Secretary Tom Price, on another stellar pick!” Their words, not mine.

The appointment continued a Price/Trump trend begun in April, 2017, with the appointment of Charmaine Yoest, former president of Americans United for Life, as the Assistant Secretary of Public Affairs in HHS. She had worked earnestly to restrict access to abortion state by state, and along the way labeled transgender people “crazy”.

All of this is reminiscent of 2002. At the time, the new President Bush was knee deep in a tortured position on Stem Cell Research and the Pro-Choice/Pro-Life battle was in full swing. Candidates for service at HHS at that time had to make it through a phalanx of conservative evangelical organizations with names like Traditional Values Coalition, Family Research Council, Concerned Women for America, National Right To Life, U.S. Conference of Catholic Bishops, and of course Pat Robertson himself at the Christian Coalition.

The most controversial appointment surprisingly was Surgeon General. While the clearing venues varied, the temperature was consistent – somewhere between cold and frozen solid. In short, the very mention of the position of “Surgeon General” was a giant turn-off. The messages were clear and consistent. Number 1: We hate Koop because we supported him and he betrayed us. (C. Everett Koop MD, by then a decade out of service, had unleashed God-less AIDS education, advocacy and condoms on school children in their view.) Number 2: We’re never going to put ourselves in that position again.

If the message was clear, so were their preferences. Number 1: That the position of Surgeon General should be abolished or at least remain unfilled. Number 2: If it has to be filled, it must be filled by someone who would do absolutely nothing. Ceremonial only.

At the time, President Bush relied on a highly centralized White House personnel program to ensure the integrity of appointees to HHS. At the helm was one Ed Moy, Special Assistant to the President for Personnel. Ed was the only son of Chinese immigrants who settled in Wisconsin and established a successful Chinese-American restaurant there. He worked at the restaurant as a kid and attributed his strong focus on conservative economics to that experience. After dropping out of Pre-Med at the University of Wisconsin, he chose to double major in Economics and Political Science. At the same time, he met his future wife, Karen Johnson, a devout student interested in campus ministry.

Moy’s first job was as a salesman for managed care health policies at Blue Cross & Blue Shield of Wisconsin. During his ten year tenure there, he managed to become an ordained Christian minister and applied his skills to the benefit of students and faculty at his former alma mater. After working on Papa Bush’s campaign in 1988, he did a stint as the head of Managed Care for Health and Human Services in Washington. He returned to government service some years later when the second Bush gained the Presidency. His role this time, however, was as Special Assistant to the President for Personnel, a critical appointment to the self-proclaimed “born-again” George Bush who had anchored his campaign and owed his victory in part to the fierce loyalty of his supporters and to a pious pledge to support a new era of “compassionate conservatism”.

Control over personnel and messaging was designed to assure the right pedigree, values, and above all loyalty to George Bush. Under these conditions, evangelicals like Moy could be counted on to perform with “religous zeal” in assuring policy purity within the department.

When the AMA and AAMC offered a full-throated endorsement to Tom Price as Secretary of HHS, in return for a pledge of support of their parochial interests, they knew well this trade off. Some AMA Federation members like The American Congress of Obstetricians and Gynecologists (ACOG) hedged their bets. Here’s part of an ACOG’s letter to Price soon after his appointment: “Planned Parenthood clinics provide critical preventative healthcare services to women and men. Abortion is healthcare. ACOG remains committed to protecting each of these critical aspects of women’s health.” But those remarks were paired with these, “Your consistent efforts to find common ground and work together on shared goals are laudable, and your commitment to accomplishments, rather than talking points, is unfortunately all too rare in Washington. We hope that you will use your new role as an opportunity to expand on these collaborative practices.”

One need not be a genius to have predicted that in the age of Trump, this Faustian bargain would come home to roost in short order – yes, that Faust, “the magician and alchemist in German legend who sells his soul to the devil in exchange for power and knowledge.” So no surprise when the Trump administration this week abruptly announced the elimination of the final two years of funding for the Teen Pregnancy Prevention Program, a previously successful comprehensive federal effort that provides $89 million a year to 81 organizations. No matter that birth rates in teens, including minorities, are down significantly.

Bill Albert, spokesman at the National Campaign to Prevent Teen and Unplanned Pregnancy in Washington, D.C. sees the hands of Valerie Huber pulling the strings. “Maybe they don’t like the content of the program. They care more about telling kids to say ‘no’ rather than supporting programs that help teenagers.” Well known to Tom Price’s sponsors – in her position, Ms. Huber will directly impact the output of 12 public health offices including HIV/AIDS, Women’s Health, and Adolescent Health.

An early 16th century Faust play, often portrayed through puppetry, suggests a moment of truth:

“He laid the Holy Scriptures behind the door and under the bench, refused to be called doctor of Theology, but preferred to be styled doctor of Medicine.”

Category: leadership, organized medicine
Tags: aamc > ACOG > ama > Donald Trump > Ed Moy > Faustian Bargain > HHS > medical leadership > organized medicine > Tom Price > valerie huber

Post-Charlottesville – We Need Caring Health Professionals More Than Ever!

Posted on | August 17, 2017 | Comments Off on Post-Charlottesville – We Need Caring Health Professionals More Than Ever!

Source: Jason Lappa, NYT

Mike Magee

Collectively health professionals have a unique role in American society. Across cities and counties, rural and urban, we are asked to be available and accessible to help keep people well and respond when they are sick or injured. Those wounds come in all shapes and sizes – wounds to the body, wounds to the mind, wounds to the spirit. As important as are our diagnostic and therapeutic interventions to society, they pale in comparison to a larger, often over-looked function. Together, collectively, we process day to day, hour to hour, the fears and worries of our people, and in performing this function, create a more stable, more secure, more accepting and more loving nation.

With Charlottesville etched in the American psyche, good-willed Americans are in search of our true center. As a physician, I recall patients whose goodness and courage and kindness brought out the best in me and my colleagues. That after all is the true privilege and reward for doctors and nurses and all health professionals – the right to care.

Nearly six years ago, my wife and I were blessed with the arrival of our eighth and ninth grandchildren – two little girls, Charlotte and Luca. We were also introduced, for the first time as health consumers, to the Neonatal Intensive Care Unit (NICU). The girls came early, at 34 weeks, and struggled to work their way back up to their due date. They are doing great today, but in those early days, it wasn’t easy on them or their parents or the care teams committed to their well being.

Viewing them from my grandparent perch, the Connecticut Children’s Hospital Center NICU team at Hartford Hospital did a great job, balancing high tech with high touch, providing wisdom and reassurance, inclusion and training to the girls’ parents, who were inclusively inducted as part of the team on day one. Viewing it all from my vantage point as a former surgeon, hospital administrator and health policy analyst, I was impressed, but not surprised.

When people claim that “America has the best health care,” they’re usually referencing groups of highly skilled doctors and nurses and other caring professionals, committed to their patients and to each other, armed with experience, judgment and technology to – collectively – heal and provide health, and keep us whole in the process. It’s really a holy thing to observe.

What that NICU experience illustrates is that we health professionals are fully capable of collaborative and humanistic care, especially when faced with a complex crisis. But the challenge today, in the face of purposeful Presidential segregation of our citizenry, is to extend the same blend of knowledge, skill, compassion and partnership to all patients on a day-to-day basis. How do we assist them in creating healthy homes, healthy families and healthy communities?

If you deconstruct the success factors embedded in our NICU experience, what do you find, independent of the scientific skills, sophisticated technology and ultra-focus on the patient?

There are three elements that are worthy of note.

1. Inclusion: For most humans, the first instinct when faced with trauma or threat is flight. And yet, these NICU professionals’ first instinct was inclusion. With IVs running, and still groggy from her C-section, our daughter and her husband were wheeled to the NICU and introduced to their 3 lb. daughters. They were shown how to wash their hands carefully, how to hold the babies safely and without fear, and – while given no guarantees – experienced the transfer of confidence from the loving and capable caring professionals to them. Those were remarkable first day gifts to this young couple.

2. Knowledge: Coincident with the compassionate introduction to their daughters, there was a seamless transfer of information – each of their daughter’s current conditions, an explanation of the machines and their purposes, the potential threats that were being actively managed, and the likely chance of an excellent outcome. This knowledge – clear, concise, unvarnished, understandable – delivered softly, calmly, and compassionately, reinforced these young and fearful parents’ confidence and trust in each other, and in their care team, on whose performance their newborn daughters’ lives now depended.

3. Accessibility: Clearly a NICU is a 24/7 operation. But that alone did not assure that the needs of these patients and their family would be met. First, members of their care team needed to demonstrate “presence.” By this I mean, by communication, touch, voice, and face, they needed to connect to the parents, to signal that they cared for these unique individuals. The outreach needed to be “personal.” This was not a rote exercise for them, not just another set of parents, not just another set of tiny babies. These were these specific parents’ precious children, their lives, their futures were now in the balance. And the performance needed to be “professional.” The team needed to be consistent and collaborative, with systems and processes in place, no descent and little variability in performance, rapid response, anticipatory diagnostics and confident timely management of issues as they arose.

As we recover as a nation from Charlottesville and Trump’s self-inflicted wounds, we caring health professionals need to mirror a better way – holistic and inclusive, humanistic and scientific, where goodness and fairness reside side-by-side. How might each of us actively demonstrate a commitment to inclusion, knowledge transfer and accessibility, and in doing so, assure that our patients respond with confidence and trust in America?

Category: Uncategorized

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