From Fareed Zakaria at Newsweek via Richard Florida:

“Generations from now, when historians write about these times, they might note that by the turn of the 21st century, the United States had succeeded in its great, historical mission—globalizing the world. We don’t want them to write that along the way, we forgot to globalize ourselves.”

Or in health care, forgot to even consider the impact that globalization could have on care delivery in this country.  If the hospital across the city isn’t forcing you to be your best, the one half way around the world will.  Ask General Motors.

Here is an explanation of Second Life.

From The Guardian via PSFK:

Spanish health authorities launched a virtual portal through the Second Life website yesterday designed to help young people too embarrassed to speak to a doctor about sexually transmitted disease or a drug problem.

Real doctors will log on and offer advice to their anonymous patients. What both will see is an image of a consulting room with a doctor and a typical patient.

Dr Rosario Jimènez, of the Adolescent Attention Working Group, is one of the doctors who will spend up to four hours a week answering their virtual patients’ questions.

She said: “Teenagers do not often go to see the doctor but this is an efficient and amusing tool to reach them because we can both use the same route. Even though they do not often suffer serious illnesses, they often expose themselves to risks which can develop into problems in the future.

“This is a way to talk about their doubts about taking drugs or sexual relations which they cannot do in a traditional consultation.”

Continuing to explore new methods of care delivery. Lots of buzz on American Well a few weeks ago. Basically a patient is able to access an array of physicians instantaneously through web communication tools. Some are still quite skeptical on care provided over the internet, but this model has some legs.

Here’s a detailed explanation (insight provided) from the World Health Care Blog.

Some more on virtual visits.

Obesity rates are climbing. Its impact is worsening. The issue is quite troubling.

Americans’ eating habits have much to do with obesity. Our sedentary lifestyle (little walking, avoidance of stairs, no exercise) is also a big factor.

But there is lots to discover within these two major factors. That information will help us target preventive/health care for addressing the obesity issue.

Freakonomics reports a study which “found that neighborhoods with dramatically more fast-food restaurants and convenience stores than supermarkets also have significantly elevated rates of obesity and diabetes.”

A program in Philadelphia is targeting this problem.

We know that our environment and lifestyles have a major impact on our health, even more so than medical care.

Obesity, and its ramifications, will be the largest health issue we deal with in the very near future. The role of the health system needs to become more community collaborative as our society becomes focused on “health.” Fighting obesity is very much a public health issue—and is encouraging a move toward preventive medicine. The health system’s role could be transformed by becoming part public health agency, part individual medical care deliverer. Call it individual public health. The larger the role a health system plays in a person’s health, the more sustainable these organizations will be.

Hello Health has a very cool concept.  Read about it here.

A more conservative approach to a new (er, recycled) delivery concept (call it a hearkening to the past).

BusinessWeek has a piece on the combination of medicine and cell phones that sheds light on some possibilities—predominately in the patient empowerment arena.

A personal mobile scanner that “plugs into the phone, which beams the data to the computer, generating an image that can be transmitted to a doctor or hospital far away.”

The cell phone may also be able to act as a constant monitor of vital signs.  A patient could also use the iPhone for mobile access to health information for a yearly nominal fee.

This may be a bit audacious, but I appreciate the goal:

“The cell phone is going to solve rural health-care problems, whether it’s rural India or rural Indiana,” says Kristin Tolle, Microsoft Research’s program manager for external research in biomedical computing.

From The Wall Street Journal last week:

U.S. medicine is in the middle of a cultural revolution, as young physicians intent on balancing work and family challenge the assumption that a doctor should be available to treat patients around the clock.

Who can blame them?  Since the time that physicians enter undergraduate school through the completion of their residencies (and beyond) they are expected to spend a massive amount of time on the task at hand—often foregoing social interaction.  In the past, when doctors have finished their education they were expected to be available 24/7/365 +40 (or so) years.

Combined with low reimbursement (relatedly speaking), it is no wonder why medical students pass up primary care residencies.

The trend is likely to continue.  Physicians may more and more become employed by the hospitals they work in.  Many will continue to decline excessive on-call hours.  Dr. Jay Parkinson has proven the ability of a young physician to find a sustainable life outside of the traditional system.  American medicine is beginning to utilize a team-based approach to medicine:

To adapt, American medicine is drifting away from the old standard — in which a single doctor handled almost all of a patient’s needs — and toward a more team-based approach. This system includes not only multiple doctors but also nurse practitioners and physician assistants.

While there are some concerns, it is good to hear of innovation in the care delivery model.  As more new physicians enter the world and continue to expect a fair work/life balance the innovation will need to accelerate to accommodate our health care needs.  Let’s get to work.

“Cynical people aren’t engaged in trying to make things better.”

Those the words of a leadership guru speaking on new world realities, specifically on the theme: The Cynics are Winning. While he was talking leadership, I’m talking health care.

“Cynicism is the tendency to be close-minded and disillusioned,” according to Kouzes and Posner.

The guru also cited a study that said half (that is, 50%) of the people in the United States are cynical. Well I figure that the health care industry employs over 12 million people (and growing). Mix in politicians and health care’s tendency to have issues with change generally, and I’m going to go ahead and guess that the majority of people involved with health care’s future are cynics.

There’s no other explanation for why we’ve been talking about problems in health care for 40+ years while watching safe, incremental change move along at the pace of an inchworm. And costs generally keep going up—more like the pace of a horse’s gallop.

Health care’s cynicism has got me sounding like a cynic, now. Well I’m cynical toward cynics. (I guess we can all be that way from time to time. But collective cynicism for 40+ years? Come on!)

Concierge medicine doesn’t deliver care fairly (and the current system is better at this how?). Continuity of care between PCPs and retail clinics is poor (as if all other providers communicate well?). And electronic medical records are too dangerous (the mounting number of medical errors are a fair trade off?).

Tom Peters has said, “It is an age that begs for those who break the rules, who imagine the heretofore impossible.”

There will be never be unanimous agreement on any health care innovation. There will be issues with every potential solution.

But gosh it beats inaction. It beats sticking with the same model that obviously isn’t working well. Let’s try new things. Let’s work through the problems that arise. I’m hardly arguing for tearing down what we’ve got. But don’t be afraid to experiment. Embrace experimentation.

A widely reported study has shed light on disturbing graduation rates in U.S. metropolitan cities—more than 1 million students drop out of high school each year.

The implications are scary, as Richard Florida writes, “Ponder the implications of this from everything to human development, crime, social cohesion, and economic competitiveness.”

Maybe the key to improving health in the United States is to keep those lost students in school.

Health and income are related.  As one study reports, “A doubling of income is associated with a similar effect on health, regardless of the point at which this occurs.”

Our employer-based health insurance system also makes it highly desirable to have a well-paying job with benefits.  This article reports a large gap between high school dropouts and those who graduated, “Adults who don’t finish high school in the U.S. earn 65 percent of what people who have high school degrees make.”

A healthy (and well-educated) America is a competitive America.

For whatever reason, I’ve read/heard several instances recently of people referring to the hospital and airlines/airplanes/airports/pilots metaphor.

To the best of my Google research, Donald Berwick and Lucian Leape started the trend, in an article published in 1999, by using the safety records of airlines to bring attention to high medical error rates in hospitals.

In the last few days I have seen pilot/doctor comparisons, hospital and airplane capacity comparisons related to financial issues, regulation comparisons of flying and doctoring…

Raise your hand if you have warm feelings toward airlines. Seeing none…

Type “hate airlines” into Google. Spend eight hours in airports to take a two-hour flight. Nickel-and-dime pricing. Canceled flights. Lost luggage. Waiting for hours on the runway. Some of these problems have arisen out of necessary circumstance—that isn’t the argument I want to make here. Believe me because I know, I’ve spent some time working in the airline industry.

The argument I do want to make is this: If we continue to connect hospitals with airlines to explain things, my fear is that patients are going to make the connection themselves, and I’m afraid those connections won’t always (if ever?) be positive. While the comparison may be useful, we should temper its use.