Massachusetts - Bytes and Pieces from Boston

Boston, January 10, 2007 - I’m here to attend a poetry reading by my son, Spencer Reece, a nationally known poet. He recites at academic institutions and poetry festivals across the United States.

I’m here also to observe the health scene. Massachusetts considers itself U.S. health care’s academic hub and the leading state in universal coverage.

What follows are three observations.

1) Information Technology Not What It’s Cracked Up to Be – My host here is a chemist. He works for a national chemical firm. Part of his job is to persuade chemists to use “electronic notebooks,” the analog of EMRs, in the course of their work. Most chemists still prefer old paper notebooks. Next to my bedside sits The Social Life of Information (2000), a book by two information scientists at Stanford, long the hotbed for budding Internet entrepreneurs. Two of these are the Google founders. The book claims Internet information’s sheer outpouring exceeds society’s capacity to process it usefully. As I pondered the usefulness point, I thought of,

• the dot.com collapse of 1999-2000,

• limited successes of EMRs in doctors’ offices,

• disappointing market penetrations of WebMD.com and RevolutionHealth.com

• The trouble consumers are having digesting the massive diet of health misinformation on the Internet

We’re drowning in web growth, measured in trillions of megabytes. The data deluge is growing 50% a year, but our ability to apply is at the 5% to 10% level. This is an example of the old DI-DO (Data-In, Debris-Out) problem, more commonly referred to GI-GO (Garbage In-Garbage Out). You might ask what good is data if it doesn’t relate to human events. Events often move faster than the data. The unreliable polling data of the Clinton-Obama New Hampshire primary is a telling example of what I’m talking about.

2) The Yawning Hole in Medical Education - Sitting next to me at my son’s reading was Rafael Campo, MD, a general internist at Massachusetts General Hospital. He specializes in infectious disease and instructs Harvard medical students. Rafael is a poet and prize winning author of The Healing Art: a Doctor’s Black Bag of Poetry, and the Poetry of Healing: A Doctor’s Education, in Empathy, Identity, and Poetry. Rafael confided there’s a yawning hole in educational and humanistic yearnings of today’s students. ”Soul numbing managed care and mind numbing technology advances seem to have conspired to distant patients from doctors,” he has said. At the reception after the reading, I spoke to a writer and illustrator of children’s books. She said her daughter is an internist at one of Massachusetts General’s suburban outlets. Her daughter believes in taking precise notes and telling patients’ stories as a narrative. But the system, viz, managed care, technological documentation in bytes and dabs, and demands of processing patients quickly, do not lend themselves to narrative medicine and meticulous note taking. The moral to these two tales is simply this: absorbing new technologies and producing digital data doesn’t lend themselves to patient intimacy and to doctors telling patients’ stories as cohesive narratives.

3) Consumer Convenience and Access Trumps Academic Prestige. As I was railroading out of town, I picked up a copy of the Boston Globe and read the front page story, “In-Store Healthcare Wins State Approval.” It announced the Public Health Council and 8 members had approved the entry of CVS Minute-Clinics into the Massachusetts health care market. If things go according to plan, 100 to 120 clinics will open in CVS stores in the next five years. This news shocked the academic establishment, which has long monopolized Massachusetts with its not-for-profit hospitals and large affiliated medical groups. But according to one observer, it was “loud and clear” time-strapped consumer’s preferred quick access to convenient, less costly care, to waiting in line at academic medical centers. . Another Council member noted it was not the fault of CVS but of the system. “My issue,” he said of the clinics,” is what they say about the whole delivery system. The primary care delivery system in this country is dying. The reasons these things have become important is because of this big hole in the delivery system.” Another reason is that Massachusetts is in the process of covering 300,000 uninsured residents. Universal coverage without convenient access doesn’t mean much. The CVS message is that some sort of affordable access, even if less than ideal and less than comprehensive, should complement traditional care before the universal coverage train leaves the station.