Princess Health and Two 'Perspective' Pieces in NEJM for 05-05-05. Princessiccia

Princess Health and Two 'Perspective' Pieces in NEJM for 05-05-05. Princessiccia

Gusty 12:01 Add Comment

With enormous pleasure I have just read the 05-05-05 number of the New England Journal of Medicine. The journal's innovations, including 'front-ending' the so-called 'Perspectives' writings, here clearly pay off.

It is surely no accident that Aneez Esmail's piece, 'Physician as serial killer,' on the UK's good Dr. Shipman--surreptitious killer of well over 200 elderly patients between 1970 and 1998--and Abraham Verghese's piece, 'The calling,' on the physician as reader, appear back to back.

The issue in both cases is our old bugabear of 'professionalism,' refracted through the classic dual prisms of regulation and the self made man. Nurture versus nature.

Verghese wins.

Esmail calls for more regulation--otherwise how to 'equalize the power imbalance'?--but doesn't really say how to make such a thing work. In these blogger pages we have seen just how well the watchdogs perform. Do cattle chutes make better cattle?

On the other hand, Verghese's essay is enormously winning and worth a read by anyone who wants to understand what true professionalism is all about. This, from the pen of a writer brave enough--huzzah!--to call the usual pabulum by what is really is.

'I have marveled,' notes Verghese, 'at the way in which selected fiction discussed in a medical school class effectively conveys the tenets of professionalism and multiculturalism without ever invoking those soporific words.'

Indeed, the whole push to codify, regulate, and legislate 'professionalism' strikes us as just another bloviation in the ongoing Pogo Revolution in healthcare. My recommendation: the astute Dr. Verghese, or someone like him, should be the next Flexner. The prognosis for this happening: well, what day is it today and how do you feel today?

Princess Health and Two 'Perspective' Pieces in NEJM for 05-05-05.Princessiccia

Princess Health and Two 'Perspective' Pieces in NEJM for 05-05-05.Princessiccia

Gusty 12:01 Add Comment

With enormous pleasure I have just read the 05-05-05 number of the New England Journal of Medicine. The journal's innovations, including 'front-ending' the so-called 'Perspectives' writings, here clearly pay off.

It is surely no accident that Aneez Esmail's piece, 'Physician as serial killer,' on the UK's good Dr. Shipman--surreptitious killer of well over 200 elderly patients between 1970 and 1998--and Abraham Verghese's piece, 'The calling,' on the physician as reader, appear back to back.

The issue in both cases is our old bugabear of 'professionalism,' refracted through the classic dual prisms of regulation and the self made man. Nurture versus nature.

Verghese wins.

Esmail calls for more regulation--otherwise how to 'equalize the power imbalance'?--but doesn't really say how to make such a thing work. In these blogger pages we have seen just how well the watchdogs perform. Do cattle chutes make better cattle?

On the other hand, Verghese's essay is enormously winning and worth a read by anyone who wants to understand what true professionalism is all about. This, from the pen of a writer brave enough--huzzah!--to call the usual pabulum by what is really is.

'I have marveled,' notes Verghese, 'at the way in which selected fiction discussed in a medical school class effectively conveys the tenets of professionalism and multiculturalism without ever invoking those soporific words.'

Indeed, the whole push to codify, regulate, and legislate 'professionalism' strikes us as just another bloviation in the ongoing Pogo Revolution in healthcare. My recommendation: the astute Dr. Verghese, or someone like him, should be the next Flexner. The prognosis for this happening: well, what day is it today and how do you feel today?

Princess Health and US HHS Secretary Wants to Use Living Wills to Save Money. Princessiccia

Princess Health and US HHS Secretary Wants to Use Living Wills to Save Money. Princessiccia

Gusty 14:33 Add Comment

A brief story in the Washington Post about a speech given by the US Secretary of Health and Human Services, Mike Leavitt, to some "hospital administrators," about "incorporating living wills into Medicare consultations."
Leavitt said, "It may be that we could build into Medicare a means by which there was a consultation as part of the Medicare physical where the decision [by the patient to sign a living will] could be discussed and potentially made and ... it would not just save families anguish but would likely save the system a remarkable amount of money, allowing that money to be spent in other ways and other places."
The reporter added, "but presumably, if such a proposal is put in place, the government would not spend money keeping alive terminal patients who had filled out living wills rejecting life-prolonging medical care."
This is a despicable example of the slippery slope that having health care run by managers and bureaucrats puts us on. Of course, pressuring people to sign living wills would save money for the government, but at what moral cost?

Princess Health and US HHS Secretary Wants to Use Living Wills to Save Money.Princessiccia

Princess Health and US HHS Secretary Wants to Use Living Wills to Save Money.Princessiccia

Gusty 14:33 Add Comment

A brief story in the Washington Post about a speech given by the US Secretary of Health and Human Services, Mike Leavitt, to some "hospital administrators," about "incorporating living wills into Medicare consultations."
Leavitt said, "It may be that we could build into Medicare a means by which there was a consultation as part of the Medicare physical where the decision [by the patient to sign a living will] could be discussed and potentially made and ... it would not just save families anguish but would likely save the system a remarkable amount of money, allowing that money to be spent in other ways and other places."
The reporter added, "but presumably, if such a proposal is put in place, the government would not spend money keeping alive terminal patients who had filled out living wills rejecting life-prolonging medical care."
This is a despicable example of the slippery slope that having health care run by managers and bureaucrats puts us on. Of course, pressuring people to sign living wills would save money for the government, but at what moral cost?

Princess Health and "The Catastrophic Collapse in Morale Among Doctors". Princessiccia

Princess Health and "The Catastrophic Collapse in Morale Among Doctors". Princessiccia

generic managers ill-informed management

Gusty 14:25 Add Comment

In the April 30 Lancet, a scathing editorial about the untoward influence of managers and politicians on British health care.
(Not available without a subscription, the citation is: Anonymous. The unspoken issue that haunts the UK general election. Lancet 2005; 365: 1515.)

Here are some key quotes:

• "But sadly, Labour, Conservative, and Liberal Democrat politicians have failed to address the single most important factor hindering the improvement of health services - the catastrohic collapse in morale among doctors. Doctors at all levels within the NHS are utterly demoralised."
• "They are cynical about a new cadre of managers who have little clinical understanding but create a massively overmanaged health service. And they feel let down by their own leaders, who have consistently failed to articulate a positive and assertive vision about the contribution modern medicine makes to society."
• "What UK medicine needs is a new and stronger political voice, one that is more concerned with augmenting professional standards than with protecting professional status."

Sounds familiar here in the US. As an American physician, I feel my British colleagues pain. Maybe we can get together across the Atlantic and figure out how to fight overmanagement and foster our professional values.

Princess Health and "The Catastrophic Collapse in Morale Among Doctors".Princessiccia

Princess Health and "The Catastrophic Collapse in Morale Among Doctors".Princessiccia

generic managers ill-informed management

Gusty 14:25 Add Comment

In the April 30 Lancet, a scathing editorial about the untoward influence of managers and politicians on British health care.
(Not available without a subscription, the citation is: Anonymous. The unspoken issue that haunts the UK general election. Lancet 2005; 365: 1515.)

Here are some key quotes:

• "But sadly, Labour, Conservative, and Liberal Democrat politicians have failed to address the single most important factor hindering the improvement of health services - the catastrohic collapse in morale among doctors. Doctors at all levels within the NHS are utterly demoralised."
• "They are cynical about a new cadre of managers who have little clinical understanding but create a massively overmanaged health service. And they feel let down by their own leaders, who have consistently failed to articulate a positive and assertive vision about the contribution modern medicine makes to society."
• "What UK medicine needs is a new and stronger political voice, one that is more concerned with augmenting professional standards than with protecting professional status."

Sounds familiar here in the US. As an American physician, I feel my British colleagues pain. Maybe we can get together across the Atlantic and figure out how to fight overmanagement and foster our professional values.

Princess Health and Another Multi-Million Dollar Managed Care CEO to Retire. Princessiccia

Princess Health and Another Multi-Million Dollar Managed Care CEO to Retire. Princessiccia

Blue Cross and Blue Shield of Massachusetts executive compensation

Gusty 14:15 Add Comment

It seems that whenever the CEO of a large health care organization is about to step down, the news media opens a tiny, but revealing window into how such organizations work.
The Boston Globe reports on the impending retirement of Blue Cross of Massachusetts CEO William C. Van Faasen. The interesting parts are that Van Faasen's qualifications to be CEO were an MBA degree from Michigan State. His "hand-picked" successor, Cleve L. Killingsworth, at least has a MPH from Yale. It is not clear, however, whether he ever directly worked in health care. His previous position was CEO of the Health Alliance Plan in Detroit.
The article also revealed Van Faasen's current compensation, most recently a cool $2.4 million a year, "making him by far the highest paid chief executive of any of the state's major health insurers." (Recall that the CEO of Harvard Pilgrim only makes a paltry $1 million a year, as we mentioned earlier.)
It's funny that with all the concerns about the rising costs of health care, few question whether managed care CEOs with little health care background and million dollar plus salaries are the best qualified people to figure out how to control health care costs without further impacting quality and access.