Dispatches from the New World of Work

Never Walk Alone!

If airline self-inflicted errors matched hospital self-inflicted errors, we'd need a special daily newspaper section to record the crashes and associated obits. (And there's no hyperbole in that last remark.) Still, we do get sick—and catastrophic error rate notwithstanding, we must necessarily subject ourselves to these health"care" danger zones. But, if there is any possible way at all—never walk [into a hospital] alone.

Melinda Beck writes the "Health Journal" column in the Wall Street Journal. Her page D1, 28 October column, "Bedside Manner: Advocating For a Relative in the Hospital," begins, "Don't go to the hospital alone if you can possibly help it." She begins with an, alas, garden variety story of a friend in a hospital for hip surgery following an accident. Her friend's daughter was the one "who noticed that she was having an adverse reaction to a pain medication." And it was her daughter who recognized that her mom's "IV drip had pulled out of a vein and was pumping her arm full of fluid." And it was her daughter who observed that "the blood-sugar test she was about to be given was meant for her roommate instead." The hospital, not to my surprise, was described as "one of the best hospitals in the country."

[P.S. I admit this stuff pisses me off. Really, really pisses me off.]

At any rate, I commend the article to your attention, especially the suggestions with which Ms Beck concludes. If I were offering one of my "success tips," the only thing I can think of is the ever-helpful "Don't get sick." (And if you do, "Bring a friend.")

Addendum

Susan read yesterday's post, and informed me that in her conversations at the dinner in question there was discussion of one of our friends' sisters having a recent colonoscopy—in which the intestine was inadvertently punctured, with a nasty infection ensuing. (The victim, uh, patient, did live—I guess that's something.) Could it be that the odds of a screwed-up colonoscopy are higher than the odds of detecting a problem relatively early enough to justify the risk? I don't know the answer in this instance, but I do know that in any number of situations "Stay the f#^* away from the hospital" is the statistically correct choice.

Furious!

Do most healthcare professionals care? My evidence is clear: Yes! (Exclamation mark deserved.)

Docs.
Nurses!!
Lab techs.
CFOs.
CIOs.
Etc.

Not good enough.

Hang out with old people, and the topic invariably turns to health—or the lack thereof. Well, I was at a small dinner last night, four couples. Among the men I was the youngster at 65, though 70 was the upper end. I've gotten in the habit, for professional reasons, of digging a little when the likes of surgery is discussed.

So, here's last night's scorecard:

***Bypass surgery: nearly died of infection in ICU.
***Other open-heart surgery: nearly died due to anesthesia problem; nurse caught it when patient's color went all haywire.
***Kidney surgery: nearly bit the dust due to badly wrong meds administered during recuperation—nurse caught it when patient turned odd color.
***Death: best friend of one of us died last year when pneumonia went un-diagnosed, patient was sent home and croaked in 72 hours.
***TP (me): bought my farm because 52-year-old prior owner had bypass surgery, went home, had severe pain, was told by phone it was routine—and died of infection in 48 hours.
***Etc.

Conclusions:

(1) Every one of us had relatively recent personal (family, close friend) horror stories.
(2) None of us, except for the installation of my pacemaker, could recall a personal hospitalization without errors worthy of remark.
(3) None of the horror stories involved the "it;" e.g., the surgeon's work during the procedure.
(4) Hence, all the above are preventable errors.
(5) Thank God for nurses!!!
(6) All agreed, not prompted by me, that a fulltime, "24/7" advocate (family or friend) was needed for any hospitalization.
(7) None of the above took place at a small "boondocks" hospital—all were in med centers of high repute.
(8) None of us or our friends in question was uninsured—we all had at least Buick coverage.

This really pisses me off.
And I shall continue to say so at every opportunity.

There are no excuses.
None.
Zip.
Zero.

Make no mistake, this is a story of lousy management and sloppy leadership—not, primarily, the result of lousy health policy.

Make no mistake, this is a story of unconscionably lousy management and almost criminally sloppy leadership—not, primarily, the product of bad health policy.

Creeping (Raging?) Cynicism

My absence is a tribute to a good summer. Last weekend we broke from VT's deluges and went to visit friends in Sunny Chicago—awesome theater at Steppenwolf (Tracy Letts' Superior Donuts) and my 1st Wrigley Field visit were highlights. This week vigorous brushcutting has topped the agenda, plus a visit by some wonderful friends.

But last night, right after Michael Phelps' 6th and latest, my spirits plummeted. Admittedly, I am in a deep-deep funk over Georgia. (Humankind sucks.) But it was two back-to-back articles in the Wall Street Journal that iced the cake.

On Page A1, "Bad Blood: New Therapy For Sepsis Infections Raises Hope But Many Questions." We die by the freighterload from sepsis infections, and a relatively new therapy looks promising. But wait: The basic supporting research apparently has enough holes to drive my Kubota through. For example, in one sample, 30% of folks getting the new therapy died, compared to 46% mortality for those treated using traditional approaches—fine, except a ton of un-cited studies show that in general 30% mortality is the norm. Then there is the "missing subjects" problem—25 cases that have evaporated. And, surprise, the folks who performed the "unbiased research" seem to be hooked up to the folks who are providing the fix. There's a lot of contention over the facts, but there's a distinct odor to the air.

Move on to page B6, and the headline shouts: "Research Study For Boston Scientific Stent Is Found To Have Flaw." The BS study (excuse the abbreviation) reports a statistically positive outcome—but 16 other data analysis regimes provide different and non-positive conclusions.

While I am well aware of the contention that revolves around research activities, and I am also aware that two similar articles in the same day's paper is doubtless coincidental, I am nonetheless overwhelmed by the Infinitely Long Encyclopedia of Horrors that seems to attend the Wonderful World of American Healthcare. (Our system performance is ranked #37 by the World Health Organization—though we do come in 1st in costs.)

Attached you'll find some new slides I'm adding to my Master Health"care" Presentation. They are from Skin in the Game: How Putting Yourself First Today Will Revolutionize Healthcare Tomorrow, by John Hammergren (CEO, McKesson) & Phil Harkins. To preview, there is the report of 140,000,000 illegible prescriptions a year in the U.S. of A. And the fact that of the annual 1,500,000,000,000 healthcare claims filed annually, 30% have errors—which is not quite as bad as it sounds, because 15% of the claims are simply lost.

Georgia tops my short-term nausea list—but, increasingly, American healthcare seems to border on hopeless. (You know there's a problem when Hammergren and Harkins use the airline industry as a good example.)

On a brighter note, go Cubbies!

Proposed Hospital "Organization Chart"

What follows is obviously hopelessly bureaucratic—hence, tongue mostly in cheek. The idea is to demonstrate the mostly missing elements at senior levels in the typical hospital, as suggested by yesterday's Post, "The Healthcare14: U.S. Healthcare Trauma in 2008." However, the post of "Deputy CEO/Patient Safety & Quality" is not bureaucratic—it is a non-negotiable "must-do-now" in "my" hospital, regardless of size.

CEO, CMO/CHIEF MEDICAL OFFICER, CNO/CHIEF NURSING OFFICER, CFO, ETC. [traditional jobs]
DEPUTY CEO/PATIENT SAFETY & QUALITY
   Director "Hands Clean" Mandate
   Director Error-free Medications Program
   Director Simple-Tools-That-Save-Lives Programs
   Director Over-treatment Evaluation & Management
CHIEF CLINICAL EVALUATIONS OFFICER
   Director Evidence-based Medicine Initiatives
   Director Best-practices Program
   Director Error Reporting & Evaluation Initiative
CISO/CHIEF INFORMATION SYSTEMS OFFICER
   Director Electronic Medical Records
   Director Cross-functional IS Engagement &
      Implementation Teams
DEPUTY CEO/HEALTH & HEALING & COMMUNITY OUTREACH
   Director Wellness & Prevention Programs
   Director Follow-up Patient Behaviors Program
   Director Public Health Initiatives
   Director Wellness Programs
   Director Kids' Education Programs
CPCCO/CHIEF PATIENT-CENTRIC CARE OFFICER
   Director Patient Experience Programs
   Director Planetree Practices Programs
   Director Patient "Home Port" & Self- & Family-
      Management Programs
DEPUTY CEO/PEOPLE
   Director Teams-based Organization
CCCO/CHIEF CHRONIC-CARE OFFICER

DEPUTY CEO CROSS-FUNCTIONAL COORDINATION OFFICER
   Director Patient-Treatment Teams Implementation
   Director Cross-functional Communications Initiatives

[See Tom's Healthcare Master (PPT) posted 9 April 2008.—CM]

The Healthcare14: U.S. Healthcare Trauma in 2008

I have screamed and shouted about customer service—to the point of physical and mental exhaustion and near collapse. I have screamed and shouted about our failure to embrace design as a rock-solid basis for differentiation. I have hissed and booed from on high and on low at the mis-direction of our education system in an age where creativity counts most. I have screamed and shouted and harangued and begged and cajoled and sworn like the sailor I once was on the topic of truly putting people first. I have screamed and shouted and been vicious and rude on the topic of women in leadership roles. I have insulted, with maximum verbal violence, every marketer I can find on the topic of inattention to the market power of women and boomers-geezers. I have pilloried every CEO I can lay voice on over the utter stupidity of 9 out of 9.1 major mergers. And I have begged and begged and begged some more on the topic of ... Stop talking, get on with it, whatever your "it" may be.

And now I'm engaged in another hysterical, and perhaps quixotic, campaign. This time the topic and target is American health"care." No doubt of it, I am the beneficiary of incredible care and have been aided by extraordinary medical devices and the skilled hands of exceptionally well-trained surgeons. (Just as I have gotten great service at the gazillion-dollars-a-night Four Seasons hotels in which I sometimes park my weary carcass.) Nonetheless, the American healthcare story is by and large a nightmare—and I don't just mean the un-insured. Below, after a dozen-years study, the last two of which have been rather intense, you will find my summary, shorthand List of American Healthcare Sins. Moreover, and most important, you will see that, in my opinion, most of these problems could be reversed without resort to either Mr McCain's or Mr Obama's Big Policy Initiatives. Using a simple, paper airline pilot-like checklist in ICUs can reduce infections and stays dramatically. Supplying simple compression socks to in-patients could avoid thousands upon thousands of deaths via deep-vein thrombosis. Clean hands—don't get me started. Scanners to certify accurate drug administration to in-patients—don't get me started.

As with customer-care and people practices, we have the wherewithal within to make Giant Performance Leaps. So when will we do so with the Total Determination the issue demands?

Tom Peters/The U.S. Healthcare14

U.S. Life expectancy rank: #45.
WHO, overall American healthcare system performance: #37 (#1 in cost).
Access: Denied to 10s of millions un/underinsured.
Unnecessary annual health-system deaths: 200,000-400,000 or more.*
Performance/top med centers: Problematic re quality of care and follow-up.*
Over-treatment (meds, tests, procedures): Pandemic.*
Use of hard evidence in medical decision-making: Spotty at best.*
Collection of evidence based on reported treatment errors: Low.*
Use of S.O.P.s in treatment regimes: Spotty.*
Incentives for appropriate care: Low.*
Incentives for inappropriate care: High.*
Emphasis on prevention and wellness: Low.*
Emphasis on chronic-care: Low.*
State-of-the-art IS/IT: Rare.*

*Fixable without legislation or major societal change—e.g., can by and large be improved dramatically without some form of mandated universal access to care and in the absence of, say, a full-fledged War on Obesity. (Evidence in support of this proposition is the fact that in every category starred above there are Pockets of Excellence—hospitals and other health-service organizations, facing the same realities as their peers, that really "get it.")

NB1: Many of these problems are equally applicable to other nations. But as is true with education issues, various nations use various approaches, so de facto generalization is dangerous.

NB2: This rant was triggered by a testy conversation with a client who inferred (in no uncertain terms) that I was being too hard on the healthcare folks. And to think, I thought I was letting them off too easily!

[Michael Millenson, author of Demanding Medical Excellence: Doctors and Accountability in the Information Age, which Tom has been quoting since its Y2000 publication, sent him this link to Millenson's 8-Day Health Care Diary (it mentions Tom, by the way).—CM]

The HFMA Event: More

Tom spoke to the Healthcare Finance Managers Association on June 26. In his speech he touted their magazine Leadership, and he insisted that we point you to its website. It provides stories about "compelling and inexpensive efforts" from all over the U.S. to address such pressing issues as patient safety. Tom added that "it proves this stuff can be done—and a million bucks of funding, or a twentieth of that, is not required to get on with it."

As a result of this engagement, Tom also got a chance to meet Michael Millenson in person for the first time. For years Tom has been quoting Millenson's book, Demanding Medical Excellence, and he credits it with fueling his interest in healthcare. I found this quote from the book in a Master presentation dated 20 June 2001: "A healthcare delivery system characterized by idiosyncratic and often ill-informed judgments must be restructured according to evidence-based medical practice." You can read more of Millenson 's commentary at his website, HealthQualityAdvisors.com.

Ten Years in the Making!

The attachment herein [updated 7 April], more heavily annotated than any I have done before, took 10 years of preparation. I have been working on and off with healthcare issues for a decade. Thanks in part to a slew of gangbuster books that have recently appeared, I have been able to reach some temporary closure. Hence, you will find here my best shot at compassing the healthcare issue as I see it. As I say at the outset in my annotation, this presentation is not about Hillarycare or some such. It is about turf upon which I can claim some expertise—organizational and operational effectiveness. For instance, healthcare financing—except as it causes horrid distortions in priorities, a bias against improving our health—is not dealt with. (By choice.)

I hope that you will "enjoy" this, though most of the story is grim. And I hope that some of you might spend some serious time on the presentation, and give me your feedback. And of course, as always, I hope you will "rob me blind"—and use some of this material in your own work.

Americans mostly think we have the best healthcare in the world, even if the most expensive. In short, that doesn't fit with the fact that our life expectancy is 45th globally and dropping, that our hospitals unnecessarily kill hundreds of thousands of us each year, and that seeking care at our most prestigious healthcare centers will surely reduce our lifespan compared to care at "St Elsewhere," as one writer put it.

Read on!

Beyond Belief!
(Not!)

In my ever-changing, annotated "Implementation" Presentation, version 0119, at Slides 137-145 you will find a riff on the power of "simple" checklists in reducing hospital errors. My presentation drew this incredible—ever so credible!—Comment by Manoj Pawar, M.D.:

Regarding the slides based on information described in the excellent New Yorker article by Atul Gawande, "The Checklist": [checklists] are ever so important.

The next chapter in this story is extremely important, as described in the NY Times Op-Ed piece by Dr. Gawande.

I urge you to read the Op-Ed piece.

The gist: A simple checklist, similar to pre-flight checklists used by pilots, has been proven to reduce ICU deaths. People die less ... much less ... as a result of this. Plans to spread this nationally in the US were underway. Simple. Elegant. And primed for implementation on a broad scale, BUT ...

The Office for Human Research Protections (OHRP), upon learning of this, stopped the project immediately.

Why? The OHRP treats this as research (despite the fact that results are proven). Because they see it as research, they feel that it was unethical that patients were not informed that a checklist was being used, and that its use was being measured. In essence, they treated this in the same way that they would a study in which patients were being given a medication with unknown efficacy.

Can they really do this? Sure. And in fact, they can cut off all federal funding to groups (hospitals, researchers, etc.) that fail to obey.

Since that 12/30/07 decision, health care institutions and quality improvement specialists across the country have been running scared, fearing the wrath of the OHRP and the subsequent loss of funding. They've asked their quality improvement folks to stop doing what they're doing immediately, based on these legal and regulatory concerns.

A number of prominent healthcare bloggers share their concerns. Check out healthbeatblog.org to see Maggie Mahar's blog.

We all are left asking, "WHY?"

With such great results, who would want to stop this work? Maybe it's the folks who fear exposure of how truly bad our hospitals currently are. Imagine the loss in market share for those that don't use the checklist! Maybe it's about money.

Analogy: We've done process improvement work to look at and improve compliance with ideal handwashing guidelines (yes ... not all doctors wash their hands as much as they should). But imagine if we had to get informed consent for patients to participate in this work! "You may be subject to an intervention ... your doctor may actually wash his/her hands, and, as such, you may be exposed to something that isn't consistently done."

Innovation isn't common when it comes to healthcare operations and processes. When it happens, (even if it's something simple like a checklist), do we really want to squelch it? The lesson for implementation: Watch out for the barriers to implementation. And when barriers sometimes seem insurmountable, there are times when radical action is necessary. When our Denver-based healthcare think tank met last night, I suggested civil disobedience as one approach. Do it anyway, and worry about the consequences later. Be radical ... be remarkable!

Manoj Pawar, MD, MMM
Posted by Manoj Pawar at January 19, 2008 12:13 AM

Patient Safety as Job One

Good for Medicare! It will stop covering claims that stem from preventable errors. [NYT, 19 Aug 2007]

Hospital administrators are screaming about more paperwork snarls. I agree. Paperwork will get worse. Definitions are mushy. Cheating—attributing adverse outcomes to nonpreventable causes—will take place. Willingness to admit errors will decline, even plummet.

While I acknowledge the problems associated with the new regime, and even acknowledge the severity of said problems, I can only say to my hospital administrator friends, "You asked for it!" Medicare is using a blunt weapon out of frustration. Hospitals are, in my experience, now focusing on preventable errors, no doubt of it. But there is an enormous gap between "focusing on" and becoming "fully devoted to." That is, there are now numerous patient safety "programs"—but few on the order, say, of American industry's 179-degree about face-strategic realignment on product quality in the 1980s. There is little doubt that we lose far more lives to preventable errors (like those that stem from the failure to wash hands carefully!) than we save via sexy new surgical procedures. I once told a group of hospital CIOs that implementing electronic medical records would allow them to save more lives than the entire surgery department—perhaps that's an exaggeration, but not by much.

So I pray on bended knee, especially as an "old guy," that such blunt instruments as the new Medicare policy will encourage, at gunpoint if necessary, hospital administrators to move patient safety off the "important programs" list and instead to the top of the "strategic survival right f***ing now" issues list—and keep it there until the problem is brought under control. Remember, the definition of "preventable" is "preventable"—and the bulk of the fix is not cost intensive. Recall how "quality is free" went from consultants' gag line to Holy Writ in industry—and turned out to be true.

The Wrong Debate?

I agree. It's appalling that such a wealthy country as the U.S. has over 25 million people, including many children, without healthcare insurance. (Which is not to say I want a Socialist solution.)

But I think the financial-coverage debate should be secondary to a debate-dialogue about what the hell we're buying with the megabucks going into our current healthcare investment.

We spend a ton and a half of money on patching ourselves up ... and rank 40th in life expectancy worldwide.

Correctable, in the main, errors in hospitals cost us over 100,000 lives per year.

Correctable errors cost us perhaps 2 or 3 million wounded in hospitals, doctors offices, etc.

Spending wildly overemphasizes after-the-fact fixes rather than prevention and wellness.

Incentives wildly favor specialists who save a few lives (e.g., mine) and their specialist tools over Internists, Family Practice, and Public Health.

My rant: Let's spend as much time and energy fixing the fixable enumerated above, 99% independent of the insurance debate, and seeing if we can tease out longer lives as a result of our investment. If our life expectancy is so damn low compared to those spending much less, aren't we at some level getting screwed? I know that's crude and bizarrely over-simplistic—but there's also a big kernel of truth to the intemperate statement, isn't there?

(My current picks re healthcare reading:

Better: A Surgeon's Notes on Performance, by Atul Gawande
How Doctors Think, by Jerome Groopman

Both are excellent writers.)

The Patient Experience

I am sure many of us have been in the hospital or other health care facility and experienced less than satisfactory care. Quality of care isn't just about how the doctor or nurse performs their duties, but everyone you come in contact with. As Mike Neiss said in an earlier blog, we would call these encounters "touchpoints." I can recall being in the hospital and the janitor was mumbling and stumbling around my room early one morning. He seemed to be indifferent to the fact that I was there. Or perhaps it was the technician who came in to draw blood (never a fun activity), who scored zero in bedside manners. There are tons of stories out there, I'm sure.

But recently at the Cleveland Clinic, they have decided to give the total patient experience a high priority. According to the Cleveland Plain Dealer, the clinic has hired a person to be their Chief Experience Officer, and her job is to ensure that the patient receives a great experience throughout the process of the hospital stay. The process starts long before a patient arrives in the hospital, unless it is an emergency, so this new CEO has her hands full. But what a wonderful challenge to take on!

What suggestions would you offer this new CEO (or, as Tom calls it, cXo) for improving the patient experience?

More to Come

It's a "twofer."

As you saw from an earlier Post this week, I spoke at the remarkable Johns Hopkins Bloomberg School of Public Health. As in the case immediately above, I was put to shame by my ignorance as I "read in" to the event. The Hopkins story is peerless—and has resulted in successes since 1916 that are responsible for millions upon millions of lives saved and more millions upon millions of years added to people's lives. Healthcare (or, rather, health—there's an enormous difference) has become a recent professional obsession of mine; and the fire was fuelled by this Hopkins opportunity. Wellness, prevention, mass public health, and family practice are my hot buttons (in addition to the hapless state of acute care safety). I intend to fatten my public health library in the months to come—my newfound JHU friends have agreed to mentor me. And a new "Tom Campaign," as my colleagues sometimes call it, is in the offing.

Leapfrog Measures Safety

You have to be intrigued by a group that calls themselves "Leapfrog!" The Leapfrog Group is an organization that focuses on promoting health care quality and safety. They have created an assessment to determine the safety readiness of hospitals across the country. According to a recent press release, "Fifty-nine U.S. hospitals have been named to the first Leapfrog Top Hospitals list, based on ... results from the Leapfrog Hospital Quality and Safety Survey, a national rating system that offers a broad assessment of a hospital's quality and safety. The survey results from over 1,200 hospitals ... reveal significant findings ..."

Part of the survey has revealed that 9 out of 10 hospitals have implemented procedures to avoid wrong site surgeries. In our language, that means they assure operating on the right part of the body! Hmmm, do you wonder what the rest of the hospitals are doing?

The Leapfrog Group publishes and updates hospital data regularly, and it can be viewed by consumers at no charge on their website, www.leapfroggroup.org.

See if your hospital has made the top fifty-nine list: Leapfrog_Top_Hospitals_2006_list.pdf

Outsourcing Surgery

Thursday on ABC News, I watched a special on Outsourcing Surgery in India. At a hospital in India, some Americans are finding a solution to having surgeries that aren't approved by their health insurance. One woman flew 30 hours to have a 30-minute surgery at 1/3 the cost in America. Because her condition was considered "pre-existing," she was not covered by her health plan. Her condition made it painful to walk and sit for any length of time, and she was in constant pain—not how we should want people to live their lives. But she worked for a small company, and the insurance wouldn't cover it. Her employer, however, kept searching for a different solution to help her fix the situation. The answer was PlanetHospital.

PlanetHospital takes care of all the details, meets the patient at the airport, and takes them right to the hospital. Even though this particular patient arrived during late hours, the hospital received her and prepared her for surgery. The hospital in India supposedly has lower infection rates when compared to the U.S. Interestingly enough, India is in the process of building more medical facilities closer to the airport.

Surgery, anyone?

Take Care

My old friend Hal Rosenbluth is up to something ... very good. Or at least I think so. He built his travel services firm, Rosenbluth International to a progressive giant with in excess of $3 billion in revenue, then peddled it to American Express. Now he's taking on healthcare. His vehicle is Take Care. Take Care establishes walk-in mini-clinics in retail establishments. The likes of CVS, Wal*Mart, and Target are on the implementers' list. With generous funding aboard, over 1,000 locations should be up and running by the close of 2007.

Nurse practitioners staff the centers, a charge of $25–$50 is the norm, and a series of common tests and the likes of flu shots are the product. As at his travel firm, Hal is utilizing the most advanced software, including artificial-intelligence systems to be part of a featured self-diagnostic process.

I am still appalled at the lack of health care availability at a reasonable price for many Americans, including children. But, without being a radical on the topic, I'm also intrigued at the way the market is responding. A couple of weeks ago the Wall Street Journal did a front page piece on how members of high-deductible plans were responding. Most have, as hoped, become far more involved in healthcare decision-making than before. Web-based information and the likes of Take Care are also part of the burgeoning portfolio of options.

Shortcomings and abuses will be part of the shakedown process, though they could hardly be worse than the current system that features such things as ambulances aimlessly circling cities with acutely ill people aboard—as they seek an ER willing to take them.

Good show, Hal. May a hundred hundred flowers—imaginative experiments—bloom! Though, as I said, deeply distressed by holes in our system, certainly this portfolio of experiments is preferable to a centralized government-run system fecklessly controlling 20% or so of our economy!

Ouch!

Where do I get off offering weight loss advice? Dunno. I've fought the Forces of Heavy for decades. At the moment I'm in a "less worse than usual" hiatus. And I'd like to keep it that way.

All advice on weight reduction is suspect—that is, there are three, if not thirteen, sides to every suggestion. Nonetheless, I came across the following somewhere or other, and it's been devastatingly effective (though, indeed, counter to much conventional wisdom). Namely: WEIGH IN EVERY MORNING!

Yup, water retention, or some such, is up one day and down the next. Sorry, if the base over the span of a few days is up, it means your weight is up. Obviously, the "demoralizing" counterargument is the most persuasive. I agree that it's often demoralizing. But, for me, if I don't do "it" every day, then I often find myself rationalizing why I "can just wait another few days" before hopping on the scales.

As I said, for what it's worth. (And it's been worth a lot to me.)

Amazing!

In our realtime world I love to run across a thoroughly new, well-researched idea that hasn't been reported on. (Or at least hasn't caught my attention).

BusinessWeek has a barnburner of a cover story this week (0925), "What's Really Propping Up the Economy." Long-time, brilliant BW economics reporter Michael Mandel begins, "Since 2001, the healthcare industry has added 1.7 million jobs. The rest of the private sector? None." Paradox: We decry h-care spending—and without it, at one level, we're sunk. Interesting, no?

Speaking of healthcare & "amazing," on another note I remain fully captivated-blown away by the Planetree Alliance; their "patient-centered" acute-care model is more or less (more more than less per me) peerless. "Patient-centered" is no hollow slogan with these folks. Attached is an updated Plantree PowerPoint FYI. Not so incidentally, they are the only acute-care operation (their flagship Griffin Hospital in Derby, CT, that is) to make the "100 best companies to work for" list—7 times running, currently at a robust #4.

Purell Time (Again)!

Fall, of course, is officially here. FluTime ain't that far away. While at my local/Boston pharmacy (a GREAT "small company," by the way—Gary Drug on Charles Street), I bought my Fall-Winter supply of PURELL. It's my favorite, easy-to-find anti-bacterial hand wipe.

Health Rule #1: WASH YOUR HANDS! I've been (recently) turned into a gen-u-ine fanatic. Consider:

"If God spoke to me by saying, 'Mark, you're down to your last three words: What would you want to say to your fellow humans that would make the most positive impact?' It would be a close call between 'Love Thy Neighbor' and 'Wash Your Hands.' A close third would be 'Move, Move, Move.'"—Mark Pettus, M.D., The Savvy Patient

"The most important thing you can do to keep from getting sick is to wash your hands."—CDC/National Center for Infectious Diseases

Purell has 62% alcohol, which serves my purposes pretty well—though 80% or more is recommended. Of course in "speech world" I shake hundreds of hands—but that's not the point. If you don't shake a hand a week this matters—a lot.

Surgeons as Secondary Players

One of my favorite parts of talking to IT execs is the hospital CIOs. I call them "mass murderers" (with a smile, of course)—and I mean it (with a frown). We're finally making some halting progress in healthcare safety, but we still have a long, long, long way to go to tame the killing fields. And my point to my hospital CIOs was that they are far, far more important & central to the safety improvement process than a stadium full of surgeons. We are in desperate need of "EMR" (Electronic Medical Records); and the likes of DSS (Decision Support Systems) would help do the unthinkable—actually bring evidence to bear on docs' decision making!

Last year when I got my Medtronic pacemaker I survived the hospital—as I read the stats, I can only conclude that I was lucky. And I'd rather depend on something a little more solid than luck. Yes, damn it, I believe every word of what I said in Rancho Mirage yesterday: We are faced with an emergency, and a disgrace (we know how to fix the problem)—and the IT gang must lead the way out of the conflagration. Period.

(No surprise, some hospitals are doing a great job on safety and safety improvement. A couple of CIOs gave me their cards and invited me out; I will probably take them up on their offers, as I am determined to learn much more about this issue. Incidentally, the Veterans Administration's hospital system is, among big systems, leading the parade.)

The New American Dream?

The cost of health care continues to spiral out of control. I cringe when I get the annual envelope telling me how much my insurance will be for the upcoming year. I am a healthy individual, yet my insurance payments have escalated each year for as long as I can remember. I received an insert with my premium notice this year advising me to take advantage of the free health screenings that are available. Hmmm, was that a nice way to tell not to go to the doctor?

A recent survey, as reported in the August 15th Wall Street Journal noted that only about 58% of small businesses are offering health insurance and many are looking to drop coverage in the upcoming year.

Once we all dreamed of owning our homes, now many of us dream of affordable health care.

P-L-E-A-S-E

Got my cholesterol test results back today. "Bad" cholesterol nicely under 100. Good for Tom. And: Thank You LIPITOR.

I want my Lipitor. Will I be able to keep it? It, too, is now under attack. Of course I don't want anyone to have nasty side effects. But if a jillion of us are taking it, there will doubtless be a few problems, given the different wiring each of us brings to the party. Lipitor is saving (not too strong a word) tens of thousands of us. I am willing to face the odds of a one-in-a-jillion chance of harm in return for a, what, 50 percent chance of doing (lots of) good.

P-L-E-A-S-E don't take my Lipitor away!

Seconds!

Above are the mashed potatoes that go with the fried chicken—I guess they fill that little hole in the picture below. While I think of obesity and the USA in the same breath, an M.D. in my Singapore audience told me, as I recall, that youth obesity there has soared from 10% to 40% in the last decade. Pandemic, anyone?

(Dan Quayle Award to TP. Thank God for spellcheck! Above, the LRL/Little Red Line appeared under "potatoes," which I initially spelled "potatos.")

Ye Gads! Holy S*&%!

I'm spending more and more time on healthcare issues, as many know. At or near the top of the list is hospital errors. Much of the fix requires driving "garden variety" quality improvement systems through our acute-care hospitals and clinics. One blanches—I did yesterday—to read a news bulletin reporting that there are about 1.5 million miscues per year in the administration of drugs; that's apparently one per day per patient. Then, if you dare, add in the number attendant to doctors' office visits. And yet so many players continue to balk at widespread use of tools and techniques that could make a profound difference.

But those statistics didn't come close to upsetting my applecart as much as the _______ (disgusting? tragic?) picture above. Our HHS secretary tells us that obesity, especially childhood obesity, is a bigger problem than terrorism. What you see above looks pretty much to me like a clogged artery (but what do I know?). Instead, it's a close-up, taken with my garden-variety Sony, of a tiny section of a KFC photo-poster on the window of a shop near me here in Singapore. What can I say (sorry) other than: Holy shit!

I am, I suppose, not surprised—but I am wholly disgusted.

Alternatives, Please?

KFC/Yum Brands were sued over trans fat yesterday. I am unalterably opposed to regulating the dickens out of the food-fast food industry.

But ...

We literally can't live with trans fat. (Trans fat + high-fructose corn syrup USA = HIV/AIDS Africa?) So what the hell are we supposed to do-going to do?

On the Right Track

Our medically uninsured are a big problem—and, at least to me, a global embarrassment. But what if the care, once you do get in the system, is questionable? As readers of this Blog know, I've been on a tear about quality of care in acute-care facilities, emphasis on prevention & wellness & chronic care, erratic application of medical "knowledge," obesity, H5N1 preparedness, and the like. (See my recent healthcare "report card" PPT attached.)

Nonetheless I am delighted to report that my "right stuff" healthcare FILE is bulging from recent reportage. E.g.: "Medical Guesswork: From Heart Surgery to Prostate Care, the Medical Industry Knows Little about Which Common Treatments Really Work" (cover, BusinessWeek, 0529). "What Doctors Hate about Hospitals: An Insider's View of What Can Go Wrong—and How You Can Improve Your Odds of Getting the Right Treatment" (cover, Time, 0501). "Pushing Pills: How Big Pharma Got Addicted to Marketing" (cover, Forbes, 0508). "Hey, You Don't Look So Good: As Diagnoses of Once-rare Illnesses Soar, Doctors Say Drugmakers Are 'Disease-mongering' to Boost Sales" (BusinessWeek, 0508). "Teaching Doctors to Care: The Problem With Most Medical Students Is That They've Never Been Really Sick. Now Some Are Learning What It's Like to Be Chronically Ill." (Headline, Time, 0529). "The Politics of Fat" (Time, 0327). "Obesity Tests: Every Four-year-old in the Country to Be Officially Screened" (The Independent on Sunday, UK, 0521*). (Later in the same paper there was a story about McDonald's new XL burger.) "Call for Switch to Preventive Measures as 29 Billion Pound Cost of Heart Disease Is Revealed" (The Independent, UK, 0515).

Great, more or less! At least these issues are beginning to work their way into the consciousness of our citizenry. And hacking at Big Pharma is way overdue, as I see it; the recently retired CEO of a giant med devices company told me last week that for last year's roughly $15 billion in pharmaceutical research among the U.S. Giants, we got exactly ZERO approved drugs. I haven't checked the accuracy of that statement, but given the source I'm assuming it's right on or damn (damningly?) close.

Healthcare Report Card

Attached as a one-slide PPT you'll find my healthcare Report Card, created for a recent presentation.

AirX. (Airport Exercise.)

Sometimes, all too often, my schedule makes it difficult to get in my 5-mile-daily-minimum exercise (power walking). Why it occurred to me at this late date I don't know. Since many of us, post 9/11, get to the airport early, there is a matchless opportunity to log an easy mile or so of decent, borderline aerobic exercise.

Many of you have been to the Atlanta airport, I suspect. You ride an underground tram to your gate. You can, in Atlanta and several other airports, walk if you wish. Yesterday I left from the B concourse, but I walked from security out to the end, the E concourse I think, and then back to B. As I casually measured it, I logged about 1.25 miles ... at a very brisk pace further enhanced by carrying a heavy backpack and pulling a roller bag. Even in smaller airports (e.g., Nashville, recently) I've discovered that if you "do" every concourse from end to end, and maybe but no more than twice, it's pretty easy to log a mile while receiving only a few odd glances. You get in some pretty effective exercise, relax pretty effectively from a perhaps stressful day ... and the only price I've found is being a little sweaty for a few minutes when you're done.

(To state the obvious, on longer flights I am a big, big advocate of the in-seat stretches! Most airline mags offer rather complete suggestions—and hats off to British Airways for the best "program," in my opinion.)

Breakthrough!!! (For me.)

Thanks to my noodling prior to my Dubai speech last week ("Arab Health Conference 2006"), I have come to a "definitive" conclusion:

STOP ... using the term "healthcare."
START ... using the term "health."

Better HEALTH is the goal—and if we did "it" (focus on "health"), then "healthcare" would be far, far, far less necessary. (Understatement.)

"HOW YESTERDAY" OBSESSION: healthcare.
"HOW NOW/TOMORROW" OBSESSION: health.

H5N1: More Sunday New York Times

I recommend "Why Revive a Deadly Flu Virus?" in the magazine section of yesterday's Times.

HC21.J1

I am becoming "health-obsessed." No. Not (just) my own, but the centrality of health-writ-large to our "survival of civilization" concerns today and in the years ahead. Concerns range from ... H5N1; to the acute-care quality catastrophe; to wellness M.I.A. (e.g., the diabetes, obesity plague in developed countries); to man-machine genetic re-engineering; to more-or-less near term, accelerating environmental degradation; to the aftermath of a WMD event. These are, mostly, multiplicative problems. (Also, from a crude business sense, incredible market opportunities—witness Immelt at GE.) Am I late to the party on most of this? Yes, alarmingly and embarrassingly so! Nonetheless, I do believe heartily in "better late than never." The following, in absurdly shorthand form, is my "starter list." (It's also attached, what else from me, as a 2-slide PP.) I've titled it "Health: Century 21, Job #1," or "HC21.J1":

HC21.J1

Quality
"Evidence/Outcomes-based" medicine
Prevention
Wellness
Med-school re-orientation
"Public health" emphasis
Mind-boggling 15-(20-?) year social-moral-technological impact of life sciences ("the Singularity"?)
H5N1
WMDs
Environmental degradation
Risk assessment (private, public)
Public vs/+ Private responsibilities & partnerships
Africa!

TP's Healthcare Twenty-seven/December 2005

In preparation for a healthcare client conference call, I hastily jotted down this list of my more or less "beliefs" about healthcare (no particular order, not in order of importance—but main points are BOLD):

1. Fully utilize Physician's Assistants to do routine work in a timely fashion. ("Doc in a Kiosk" at Wal*Mart is great!)
2. Maximize Outpatient Services!
3. Short hospital stays work!
4. Support home care to the max. (E.g., "Declaration of Independents"—Beacon Hill/Boston)
5. STOP THE 100K+ NEEDLESS DEATHS—much/most of the "quality stuff" is eminently fixable. (Don Berwick for President! AHA for Hall of Shame!) (Strong, vicious insurer incentives!!!)
6. FLIP HC 177 DEGREES TO EMPHASIZE PREVENTION & WELLNESS. ("Steps" are being taken but not enough. Med schools: Awful! Insurers: Little better. Support for appropriate-proven alternative therapies is an important part.) (HUGE INCENTIVES FOR EFFECTIVE WELLNESS-PREVENTION PROGRAMS-MEASURABLE SUCCESSES.)
7. "Boomers" will determine HC's (very different?) future. (They are from a different & demanding planet compared to yesterday's Oldsters.)
8. "Focus on Women." (It's my generic—and correct—rallying cry, and it applies to HC in spades, women-as-patients-with different-woes-than-men; women-as-HC decision makers at the "consumer"—and commercial—level.)
9. "Patient/Consumer-driven" may be a buzz phrase bandied about all to easily ... but it is true. (And changes the game.)
10. Reduce incentives for unnecessary tests. (Malpractice caps would help, though the issue is complex. Insurers-HMOs doing so-so on this.)
11. OUTCOME-BASED MEDICINE IS A MUST! (There is a long, long way to go!) (Measure until you're blue in the face!)
12. Science-based medicine is a terrific idea!! (Many-most "therapies" unproven scientifically, uneven in application when proven.)
13. Over the next 5-25 years, the Life Sciences Revolution will make the likes of the "info revolution" look like small beer. (Get ready.)
14. Radical increase in "best practices" utilization—inculcate in Med school!
15. Med school "revolution" imperative—outcome-based medicine, abiding emphasis on Wellness & Prevention, etc.
16. Get info to Patients! (HIPAA mostly good.—"I wanna see my records!") (Detailed hospital-by-hospital, disease-by-disease, doc-by-doc success records a must—despite controversy.)
17. Upgrade IS-IT in the entire system, starting with acute-care institutions. (Current grade: D-.) (Winners include: Indiana Heart Hospital; Inova Fairfax Heart Institute.)
18. Healtheon WebMD-like (if it had worked) mega-, integrated-info network will-should emerge. (A healthcare Google+?)
19. MOVE HEAVEN & EARTH TO IMPLEMENT ELECTRONIC MEDICAL RECORDS. NOW.
20. By hook or by crook, something approximating basic universal care, starting with kids—50 state partial experiments is a help; some are quite far along. ("Market-based" as much as possible—but this is far from a "perfect market.")
21. Deal with the enormous HMO "I want my doc" perception problem. (Fact: MARCUS WELBY, STATISTICALLY, AIN'T THAT GREAT A HEALER IN TODAY'S "HIGH SCIENCE" WORLD! Incidentally, same perception problem re Congress, schools. "My Congressman is great, Congress has 434 other crook-clowns." "My kids' school is good, the system is awful.")
22. Blitzkrieg of Patient/Customer/Citizen education (e.g., re "outcomes-based HC," "Get the most for your HC dollar"). (Corporate cuts should motivate this.)
23. "Healing-centric" care supported. (E.g., Planetree model—reduces future problems.)
24. Emphasize front-to-back "customer care" practices—cuts waaaaay down on malpractice claims among other things.
25. Specialization in acute care works wonders, regardless of howls! (E.g., Shouldice/hernia repair.)
26. Shorten the FDA approval process. (Tom, age 63, wants the good new stuff and will accept associated risk; so will most boomers-geezers.)
27. DON'T MESS AROUND WITH H5N1/AVIAN FLU!

No Comment

Wall Street Journal, p.1, Section B, 12.19.2005:

Para #2: "US Airways Group eliminated health coverage for 28,000 employees and 10,800 retirees late last year. But the financially ailing airline had already guaranteed departing CEO David Siegel and his family medical coverage for life."

Para #4: "Health care is essential for our employees, and I live with the same plan as everyone."—Tom Wolf, CEO, STS Consulting (600 employees in 14 states)

Wish I Hadn't Read This Today

"When I climb Mount Rainier, I face less risk of death than I'll face on the operating table."—Don Berwick, M.D. Newsweek/12.12.2005/"Six Keys to Safer Hospitals: A Set of Simple Precautions Could Prevent 100,000 Needless Deaths Every Year"

Yikes, I've got to spend an outpatient day in the hospital next week—think I'll wear Kevlar.

(To my mind, Don Berwick is the Mother Theresa of health safety.)

About Time!

Docs with crappy bedside manner are getting whacked, big time, according to the November 30 New York Times. About time, I say.

More and more group-practice compensation plans are docking docs—or rewarding them—based on patient satisfaction measures. For instance: Rochester Independent Practice Association ... 20% of docs' pay (3,000 docs) is based on patient satisfaction measures. Tufts Health Plan ... 3K to 4K docs lost all or part of their bonuses last year because of low C.Sat. #s. California Medical Association ... a $30,000,000 pot will be divvied up among 35K docs based on C.Sat. scores—the consequences could run $5,000 per doc.

Typical statements patients respond to: "Is easy to talk with"; "Is very familiar with my medical history"; "Takes time to answer my questions"; "Listens carefully to me"; "Is someone I feel I can trust."

Bravo!

(NB: This ties in nicely with my recent rant on the applicability of "business" thinking to the world of non-profits.)

Vioxx Makes Me Feel Better!

It's damned hard to love a Big Pharmaceutical company—especially if you viewed John LeCarré's latest, The Constant Gardener. Moreover, I don't know the details of the Vioxx lawsuit which Merck effectively won today.

What I can say is that with Great Gain comes some Pain. I do not take lightly the death of a single human being from Vioxx, if indeed that were the case. I do believe that if a drug dramatically helps millions, one must, for better or worse, expect a little downside. I do not want to see clinical trials for new drugs extended forever and ever. And subsequent approval extended forever and ever. Perhaps it's a function of age, but I want demonstrated good stuff available even if there is a minute chance of attendant harm. As in: Welcome to Life 101. Right now I have a couple of docs fighting about a drug that might help me with a minor problem. One is conservative. One is aggressive. The med that the aggressive one wants to use has a few low-odds side effects. I don't know how I'll decide, but I damn well appreciate having the two options.

(Truth in lending: I was a temporary Vioxx user, following a bout of knee pain a few years ago. It worked.)

Wal*Mart + Memorial

The Marriage of Wal*Mart and Memorial Hospital of South Bend

There is another marriage on the scene, and, at first, it may seem like an odd couple. What do our friends at Memorial Hospital in South Bend, Indiana, have to do with Wal*Mart. Well, it seems that health care is walking down the aisles of Wal*Mart!! Memorial is first to put a quick medical center in a Wal*Mart store.

Inspired by the menus found at McDonald's, they created a medical menu board, so that you can 'order up' just what you need and know the price before you partake. They borrowed another idea from restaurants and give you a hand-held vibrating disk, so that when it's your turn you can stop shopping and swing by the health center. The device also has a pleasant voice telling you that the nurse practitioner is ready for you.

Health care continues to evolve, and innovative health services will continue to break through the barriers. To find out more, visit http://www.medpointexpress.com/.

Now, are there any objections to this marriage? If not, forever hold your peace! AND go get your flu shot while shopping at Wal*Mart in South Bend.

H5N1

Confirmed.
Today.
Europe.
(Turkey.)

H5N1 Moves Another Step Closer

I'm sure you are reading the news of belated Federal actions in preparing for bird flu. Sunday's news reported the first probable European outbreak in birds, in Romania. As I am headed there in late November, my antennae are quivering. Beyond physiological concerns, this is the first, direct, tip-of-the-iceberg personal warning of the economic consequences of an approaching pandemic. While short of panicking (I have not cancelled my Romanian trip, for instance), I am dramatically accelerating my and my family and friends' preparations—e.g., working on self-sufficiency on our Farm, laying by a 6-month supply of normal prescription medications, procuring appropriate masks, dealing with possible short-term financial issues, etc. Surely Katrina has taught us all that "You're on your own," at least for a while, is "good management practice" for friends and family.

(And, obviously, businesses. For instance I talked on Friday to members of the tanning salon industry. Most are "mom & pop" entrepreneurs, hardly sporting very deep pockets. Their industry would doubtless be hit hard and fast at the slightest hint of H5N1 in or near America. Hence 100% of their revenue stream could evaporate on a week's notice; there are, literally, millions of small entrepreneurial businesses in much the same boat. I'm not by disposition an alarmist, but I am unable to conjure a scenario under which pandemic would not lead to a sudden, wholesale economic crash. Not to mention the likes of the riots the Feds modestly project at places of vaccine storage and delivery.)

H5N1 Redux Redux

Mentioned H5N1 in Santiago. There was a senior public health M.D. in the audience. I aked him if my tone was "alarmist." His terse answer: "No. Keep talking."

I will.

H5N1 Redux Redux (Again)

Worst scenario yet. The October National Geographic, hardly a rad rag, in its October cover story ("The Next Killer Flu: Can we stop it?") surfaces a plausible estimate of 180 million to 360 million worldwide deaths. [audio on ng.com]

My only mission: Get this to the/near the top of our agenda—these numbers outpace Al Quaeda, at its worst, by a country mile.

H5N1 Redux. New Orleans Redux?

The avian flu reportage volume is increasing exponentially, with WHO releasing on Friday some grim probable death #s, as high as 150 million worldwide. Personally (and professionally), I think it's appropriate to more or less scare the shit out of people—the expected timeframe in the U.S. is roughly a year from now. (Incidentally, the 1919 pandemic was unexpectedly as brutal to the 18-40 demographic as to the old and young.) Susan said she listened to a brief H5N1 interview with the new FDA chief, whom she described as "sounding as clueless as [former FEMA Director] Brown." That's encouraging.

H5N1

Presumably the designator H5N1 is already deeply imbedded in your memory. If not, it damn well should be! Today alone, the Financial Times had three articles on avian flu. I talked to someone close to the main CDC deliberations recently, and he informs me that the time has come to engage in modest panic. The odds of a pandemic, apparently, are edging up to 100% over the next couple of years. Deaths could easily be in the millions, or deca-millions, in the U.S.A. alone. Vaccine apparently simply will not cover all bets. He was talking practicalities—and suggesting that one's financial planning move into high gear. The world economy could come to a virtual (whoops, make that real) stop. Travel will be truncated. Public gatherings could be curtailed. Markets will doubtless plunge. Activities such as my speaking stuff will likely evaporate in a flash. Should we horde gold, buy concertina, and work on our epitaphs? Maybe not. But there is nothing modest about the problem, its vast implications, or the odds of it comin' on.

NB: The current (July/August 2005) issue of Foreign Affairs has a set of exceptionally thoughtful articles (here's one) on the topic, organized under the headline "The Next Pandemic?"

Barking Back at the Black Dog

For the first time in memory I've come across a "sure fire" (WRONG! NO SUCH THING!) way to deal with the Black Dog, a/k/a depression. Meds help. But my new (three months old) "miracle" "med" is body-punishing, mind-short-circuiting exercise. I've been pretty consistently speed walking/aerobic walking for 16 years. Good stuff. But about three months ago I decided, for a host of reasons, to up the ante. Speed walking is now the centerpiece of my day, and I've increased my distance from a "good for you" level of 2.5-3.5 miles per day (less on the road) to 5-7 hilly miles (a lot in "walking world"). Particularly in the heat (90+!), it beats the living hell out of me. All other things, including that Black Dog, are erased from the system! And it sticks! I love it, I'm also doing it on the road, and I plan to turn it into an addiction! (Of course it's also good for every other damn malady you can name—unless one pushes to sunstroke, which I almost did on Sunday along the C&O Canal Towpath in D.C.) I know this is not "news" for many of you, but it's a big deal for me; moreover, it suggests that Old Dogs (speaking of which) can indeed learn new tricks.

One-Stop Shopping

for Health Care Services!

When I was growing up, there was a neighborhood grocery store and everyone walked there. I remember dragging a little red wagon, and we would put the groceries in the wagon and go home. At that time a grocery store carried groceries, paper products, and cleaning supplies.

In an article in the Cleveland Plain Dealer, we see a new type of grocery store, one where you not only can buy food and every other item you can think of, but you can now get a health check-up as well.

These mini clinics are starting to pop up in grocery stores and other retail outlets.

What do you think? Bag of groceries, case of beer, and oh yeah, my annual physical!

Breathe Deep

I've had a strange month of next to NO exercise after a painful fall on my coccyx in early June thanks to rollerblading. I was forced to rest and be off my feet during the first few weeks (very difficult for me) and even then, in the weeks that followed, I was going through a lot of pain every day and had to take it easy. Today for the first time in more than a month, I did my Rodney Yee AM Yoga class and started back on a routine of working out ... every day ... I hope. I've done his yoga class on my living room floor for a few years, and I'm always glad to start the day with it.

In the meantime, Rodney Yee's been a lot busier than I have, doing yoga, teaching yoga and now ... he's blogging! He's just launched a new blog over at Yahoo Health Expert Blogs. I think healthcare and blogs go hand-in-hand and that we will see many more communities of wellness using blogging as a natural way to connect.

This morning as I unrolled my mat and got down on the floor (something I could barely do a month ago), I was so grateful that I'm well enough to work out again, glad I had the time to think about my life, and optimistic that I can rebuild my strength to where I was before I fell.

When you do a regular workout practice every day, you quickly notice which parts of your body are tense, which muscles are strained or injured, and where you need to focus. Today, I expected a lot of pain and tightness in my coccyx, pelvis, glutes.

What surprised me more than anything was how injured MY BREATHING was. This may sound strange, but I noticed I was breathing very unevenly and in a shallow, fearful way, as if each breath might result in a sharp new pain. If you've done even a small amount of yoga, you know the ability to breathe deeply matters a lot. And you know that excellence in your life is helped immeasurably by a foundation of physical wellness. So I'm truly back at ZERO, as I start today up the ladder towards physical wellness by simply remembering how to breathe.

Read It!

There is a fabulous "must read" six-part article in this week's (07.18) U.S. News & World Report, titled "Saving Lives: Hospitals Have Signed on to a Six-part Plan to Avoid a Multitude of Unnecessary Deaths." (Many of the Rx's are quite simple, amazingly enough.)

Hospitals can respond to the 100,000 or more people they murder annually! This article describes how. It is long ... LONG LONG ... overdue.

Hats Waaaaay Off to Patron Saint & Mt Rushmore candidate Dr Donald Berwick, who gets an enormous share of the credit for hammering away at this issue. The "hear no evil, see no evil" AMA and various hospital associations join GM's Rick Wagoner in the Bozos Hall of Shame on this one.

More "hats off' to Pennsylvania for becoming the first state to, according to USA Today (07.13), "publicly report the toll hospital infections take." (Numbering 11,600 in PA last year, and killing 1,500 people—or 4 full 747s as I like to translate it.) Again, the industry's stalwarts have fought like the NRA to derail such transparency. (Of course fatal gun accidents—including murders?—pale by comparison to hospital malfeasance.)

Action item: Demand action—Radical Action—from your doctor & hospital.

Damn!

Many/most of you perhaps think of me as a Ranting Maniac. And I occasionally am ... at the keyboard. But I am the soul of non-confrontation in person. (Byproduct of my Southern Mom's tutelage.)

Sometimes my aversion to contention goes too far. It did recently.

I was on a panel that included a hospital association senior director. I'd made a public remark about the 100,000 (100,000+?) people U.S. hospitals unnecessarily kill each year. He responded with, "Whether it's one or one-hundred thousand, it's too much." Reasonable enough, you might say.

No!
No!
No!

In effect it was a standard hospital association denial, that I've heard a dozen dozen times. Fact: There is a huge difference between 1 and 100,000 thousand. Of course every death is "too much." But 1 is a fully excusable statistical anomaly when millions of patients pass through the system; 100,000 is an epidemic, a tragedy, a travesty, shameful, pathetic ...

A few years ago there was controversy over the CDC's estimate of 98,000 deaths due to error. Now some number like that (I've seen as high as 193,000 per year) is more or less accepted wisdom ... except by state and national hospital associations. (And as one nationally prominent ER doc pal said to me, "And, hey, Tom that doesn't include the thousands more we kill or maim in doctors' offices.")

Consider two articles in national papers that appeared on the same day, June 6th. New York Times: "Hospital infections kill an estimated 103,000 people in the United States a year, as many as AIDS, breast cancer and auto accidents combined." (While we stagger under this burden, countries such as Denmark and the Netherlands have it essentially licked.) USA Today: "As many as 98,000 Americans still die each year because of medical errors despite an unprecedented focus on patient safety over the last five years, according to a study released today [by the Journal of the American Medical Association]."

At any rate I'm furious at myself for letting the hospital association exec's remark pass quietly. I should have arched my shoulders and shot back in no uncertain terms. I should have, in fact, Southern Mom or no ... RANTED.

Damn!

e-Health

What's going on here? New technologies are sprouting up all over the place. You can't swing a dead cat in the media without hitting a story about a new Google feature launch or television coming to cell phones. People are innovating left and right.

Why is healthcare not keeping up with these advances in technology? Look at these three recently published articles related to the lack of electronic medical records: NY Newsday, AlwaysOn Network, and USAToday. Apparently funding is the biggest barrier.

But if there are small armies out there scanning old books in libraries (that can't be very lucrative), there must be people who could figure out a way to make a buck from creating a simple, beautiful system to get our medical records online. The USAToday story spotlights an entrepreneurial healthcare-by-phone business that would be a whole lot safer if the doctor at the other end of the line could diagnose you while looking at your medical records. On the other hand, how worried would you be that someone could hack into your health history once it's online?

Stalled Mobility

Some people are born great,
Some achieve greatness,
And some have greatness thrust upon them.

I've written previously on tompeters.com about how our modern take on these lines from Shakespeare's Twelfth Night is so different from that of the Elizabethan audiences who originally heard them. They believed you had to be born into greatness, we believe that people can pull themselves up by their bootstraps to a higher station in life.

A fascinating—and somewhat disheartening—series this week in the New York Times challenges our current beliefs about "Class in America." Class is defined as the combination of education, income, occupation and wealth. The first installment, published Sunday, told how, in the last three decades, there is far less movement up and down the economic ladder than economists once thought. People of all economic strata, including those less fortunate, believe that it's possible to rise to a higher station in life through your own initiative, but the fact is that it has become less common in our society. Why? Well, it may be that the most important choice you ever don't get to make is who your parents are, and what kind of opportunities they make possible for you. What does this say about the "American Dream?"

Monday's article showed how healthcare is not distributed equally by class, but in fact has become a good that is disproportionately distributed to the wealthy, similar to "BMWs and goat cheese." The story follows 3 New York heart attack victims, a wealthy architect, a Con Ed worker, and a cleaning woman, describing the astounding differences in their experiences.

Do these findings surprise you? Is there a gap between perceived and real equal opportunity in our society?

The next installment is tomorrow (Thursday).