The Two Faces of Physician Shortage

A medical residency is not easy.  Part of the coping mechanism involves complaining among your fellow residents about everything from the work hours to the deteriorating quality of vanilla pudding parfait in the cafeteria.  Generally the discussion goes something like this:

Resident A: “The vanilla pudding parfait has too much whip cream and not enough pudding.”
Resident B: “We get paid fifty-thousand dollars a year for working eighty hours a week, and they can’t even have a respectable dessert in the cafeteria.”
Residenc A: “I am going to go have a chocolate parfait.  That one comes with an Oreo.”

While Resident A is probably just partial to chocolate, Resident B’s observation begs for an obvious non-dessert-related question.  If medical residents create such immense value at a low cost to hospitals, then increasing the size of the residency program must also be highly desirable.  But the truth is even in the face of increasing demand for physicians, America is not making many more doctors to match the demand. Continue reading

Great Storytellers of Our Moral Decisions

Not long ago, I had the opportunity to participate in a medical research project.  In broad terms, the researchers developed a virtual tool to evaluate the skills of doctors on a particular procedure without performing on a real patient, and they needed people at various stages of proficiency to test the training program.  Since I was a total novice, it made me an ideal subject – I was expected to stumble and burn.  In fact, I was so clueless that I had to ask the experimenter to repeat the instructions for the simulation.  Then, through either sheer luck or innate talent (ha), I scored near the top of the chart.

Shortly after the study concluded, I was notified that after discussing with the co-researchers, the research team has decided to discard my data-point because “the instructions were given twice, which gave an unfair advantage over the other participants.”  I wanted to reply, “But if a complete novice can score like this without knowing how to do the actual procedure, doesn’t that say something about the quality of the virtual evaluation?”

More interestingly, if I had scored much lower than the average novice – making the results look even better – would the research team have thrown out my data-point all the same? Continue reading

On Habits, Good Ones and Bad

At work I routinely saw patients who suffered from substance addiction.  Addiction is a powerful motivator – it is heart-breaking to see patients forgo buying life-sustaining food, water, and medications to “save up” for the next cocaine fix.  Traditionally science has pinned the mechanism of addiction to biological molecules.  However, over the past few decades, scientific studies began to show that behavioral neuropsychology – the intermingling of biological molecules, behaviors, and how the brain ties everything together into an experience – is a far more complete way to think about addiction.  This intermingling of different fields also shed light on addiction as a disease of a general, even beneficial, motivation pathway. Continue reading

Why Can’t Hospitals Stop Over-Billing Us? (Part 1/2)

Update: On January 5, 2015, Stephen Brill published America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System, expanding on his popular Time article.

It is an interesting book, not because I agree with Mr. Brill’s data but because it happens to be a useful exercise in how data sometimes can be applied/misapplied to streamline a compelling narrative.

Below is a shameless self-reblog from my response to the original Brill article focusing on how data from a sub-sub-sub-specialized hospital should not be used to comment on an entire set of hospitals, some of which struggle to serve as the safety net for a vulnerable population.

 


 

In an article titled “Bitter Pill: Why Medical Bills are Killing Us,” Stephen Brill outlines a well-researched investigation on hospital over-billing.  In the article, Brill begins by highlighting the unreasonable mark-up MD Anderson places on every medication, service, and imaging that it provides.  He argues that this “hard-nosed approach pays off,” earning MD Anderson $531 million operating profit in 2010, and that this comprises a 26% operating margin.  $1.8 million of that went to the pockets of Ronald DePinho, the president of the cancer center.

Although Brill never outright states the connection, his implication is clear: general hospitals are the oft ignored mammoth in the health care debate, operating under the veil of legitimate non-profit business.  A general hospital funds its astounding operating income by making the uninsured and under-insured suffering patients an offer they cannot refuse – a markedly inflated bill.  It then funnels this unfairly earned profit into the pockets to the Godfather of the organization.

The logic is sensational, if only it were correct.

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On Choices, Decisions, and Happiness

The fable of Buridan’s donkey tells of a donkey who is profoundly hungry.  When put in the exact midpoint between a two identical piles of hay, the donkey was unable to choose which one it wanted and eventually dies of hunger.  Ironically, if the donkey had only one and not two piles of hay to choose from, its life would have been easier (and longer).  Obviously, people are smarter than Buridan’s donkey – are we?   Continue reading

Why Can’t Hospitals Stop Over-Billing Us? (Part 2/2)

In a prior post, I read Steven Brill’s story on health care hospital bills and offered a brief analysis of the “average hospital” in contrast with MD Anderson (spoilers: sub-specialty cancer treatment is profitable, the average hospital is not).  The data show that average hospitals are low-margin organizations.

Below, I argue that although the data disagrees with the vilification of general hospitals in “Bitter Pill,” the article is spot-on that medical bills are incredibly over-priced.

Then, I offer a hypothesis on why.
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On Brainstorming and Group Work

[I]t was the curious power of electronic collaboration that contributed to the New Groupthink in the first place. What created Linux, or Wikipedia, if not a gigantic electronic brainstorming session? But we’re so impressed by the power of online collaboration that we’ve come to overvalue all group work at the expense of solo thought. We fail to realize that participating in an online working group is a form of solitude all its own.

Susan Cain, Author, Quiet: The Power of Introverts in a World That Can’t Stop Talking

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Take a Break, Make a Breakthrough

Most people realize that they tend to perform best when they’re feeling positive energy. What they find surprising is that they’re not able to perform well or to lead effectively when they’re feeling any other way.  Unfortunately, without intermittent recovery, we’re not physiologically capable of sustaining highly positive emotions for long periods.

Tony Schwartz and Catherine McCarthy, Harvard Business Review, as cited.

Can Dr. Watson Practice Medicine?

“Mathematical reasoning may be regarded rather schematically as the exercise of a combination of two facilities, which we may call intuition and ingenuity.” – Alan Turing

Sherlock Holmes is fictional expert in what he calls the “exact science of detection” (A Study in Scarlet). Despite his genius in deductive reasoning and intuition is unparalleled, much of the detective success relies upon the calm and composed guidance of his trusty sidekick Dr. Watson. In most of the canonical novels, Watson acts as the sanity check for Holmes’ storm of ideas and, of course, the meticulous chronicler of their adventures together.

After defeating its human opponents on Jeopardy, the supercomputer Watson by IBM will attempt to learn medicine. Despite its terabytes of storage and raw processing horsepower, Watson’s ability to make medical decisions remains unclear. Can IBM’s Watson truly understand the complex human body and make medical decisions, or will it – like Dr. Watson attempting deduction – prove to be an helpful sounding board but falling short of achieving true intuition?
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Why Everyone Should Chill Out

Any as­pect of life to which at­ten­tion is di­rected will loom large in a global eval­u­a­tion. This is the essence of the fo­cus­ing il­lu­sion, which can be de­scribed in a sin­gle sen­tence:

Noth­ing in life is as im­por­tant as you think it is when you are think­ing about it.

Daniel Kahneman, Nobel Prize-winning Economist, in Thinking, Fast and Slow