Blog | Tuesday, January 22, 2013

The great and powerful


Well, I did it. It wasn't easy, but I did it. But that comes later.

Yesterday, Forbes sponsored a Health Care Summit. It was a fascinating day-long conference featuring some of the most innovative minds in health care, policy, and technology, especially in the private sector. And me.

The tech stuff was very, very cool, but probably doesn't actually address the immediate needs of the health care system--delivery of better, more cost-effective care to more people. But it was an interesting glimpse into the future.

I got to ask Gov. Rick Perry of Texas a question during Q&A. Steve Forbes interviewed him about a health care boom in his state. Gov. Perry is a pretty impressive guy. He's tall and thin and folded himself into his chair a bit like a mantis, all angles and articulations. And I could see why a presidential run might not have suited him. Aside from the fact that I disagree with nearly all his policy ideas, he sat very much like a person with chronic back pain, one hand bracing him on the arm of the chair. I'd imagine Jack Kennedy looked similar, a mixture of pain, intelligence and charm.

But Perry is no Jack Kennedy. He emphasized his state's ability to attract doctors and researchers through tax cuts, tort reform, and other classically Republican economic ideas (not that I'm gonna complain about tort reform).

So I asked him, "Governor, what percentage of all of these doctors coming to Texas are primary care docs? Because we have a shortage. Only 4% of American medical grads choose primary care, mostly for economic reasons. How will you get PCPs down there?"

He admitted he didn't know much about the numbers, but that he was considering incentives including paying for education in exchange for service. This has always been a good idea, but our system doesn't make it worthwhile. Almost any specialist can make enough in a short period of time to pay off their loans, so unless you are drawn to primary care strongly enough, the economics don't work out.

Still, the dude answered the question directly. Maybe his policies help the Texas economy, but they aren't going to scratch the real health care problems. Like most policy makers, he doesn't seem to understand where the real problems lie.

I had a great conversation, which I hope to continue, with the President of the Joint Commission, Mark Chassin. I learned a ton about the Commission I hadn't known. For the non-medical peeps, the Joint Commission is a private entity that accredits U.S. hospitals, assessing them for safety, quality, etc. A failure to pass a JACHO inspection is a very, very big deal, and when they're in the house, entire hospital staffs tend to lose their shit.

To those of us on the ground, many of the JCAHO policies seem insane (and many of them probably are). Hospitals will prepare docs by giving them copies of the institution's "mission statement" so it can be dutifully recited to inspectors.

What concerns me more than mission statements is quality. We had a little chat about initiatives that JACHO has offered hospitals to, for example, make transitions from hospitals to home or nursing homes safer. Right now, when a patient of mine leaves the hospital, they, and I, get a many-page discharge document that no normal person could ever understand (and I include myself in that category).

Much of the reason for this sort of thing is hospital efforts to meet JCAHO and Medicare standards, standards that are often confounded with each other, an effort that is usually ham-fisted and non-sensical. It's not supposed to be that way.

As I gather my thoughts, I hope to share with you more from the conference, but first …

The night before, Steve Forbes hosted a reception at his offices. The surprise of the evening was an appearance by Dr. Mehmet Oz, one of the most disruptive forces in medicine, and someone who in my opinion, confounds sideshow barker nonsense with real medical science. He gave what was supposed to be an inspirational talk, but really, he just rambled from topic to topic, often contradicting himself. And everyone was starstruck.

It seems famous people like other famous people for being famous. I cannot think of a thing Dr. Oz has to offer American health care, other than his retirement from public life. But they flocked to him in the low-ceilinged gallery, jostling each other in the close space as if fighting for a New York cab, the kind that's never around when you need it.

I blame David Kroll for egging me on. I nudged slowly through the crowd of admirers and introduced myself, as a "fan and a critic." I told him I was a fan of his ability to communicate, but that my patients don't bring to me the message he thinks he's delivering. They would rather find some raspberry ketone than exercise and eat better.

"I don't sell any products. People use my image. Blah blah."

I thanked him for his time and nudged my way back out of the crowd.

The telling moment for me was during his speech. He closed with a joke, about a patient who had made use of a ton of "complementary medicine" during her hospital stay. When confronted with the bill, she replied, "but it's complementary!

That's not funny. Health care is expensive, people struggle to pay their bills and are terrified for their lives. To joke about billing them for services that are worse than useless, like reiki and acupuncture, is cruel and shows a lack of compassion.

But I got my say. As my dad says, "I don't think he'll lose any sleep over it."

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.