Sunday, January 31, 2010

Medical Trends - News Doctors Can Use

Why do I write? Why have I written ten books? Why have I produced 1185 blogs over the last three years at a one/day clip?

Fundamentally, as warty bliggens, a toad in the Archy and Mehitabel stories said, it is because “expression is the need of my soul.” Secondly, I want to put material out there my fellow physicians can use, Thirdly, I want others to understand what makes doctors tick.

Producing material doctors can use isn’t as easy as you might think. I try to be specific . Doctors don’t like generalizing, editorializing, or pontificating. “Just the facts, Mame! “ as Sergeant Joe Friday used to say in the TV series.

Specificity works best when telling stories about successful innovations doctors have brought into the world. These innovations must save time, solve problems, please patients, increase efficiencies, improve care, or generate more revenue, or doctors aren’t really interested. I give a number of specific examples in my book Innovation-Driven Health Care (Jones and Bartlett, 2007), and in my blog series, which is called medinnovationblog for a reason.

But specificity has its limits unless put into a larger context. A physician’s mindset is terribly important too, e.g. whether one wants to be an independent soloist or part of a group effort, whether one wants to put one’s eggs in the office practice basket or hospital-physician joint efforts, or whether one wants to become engaged in practical, philosophical, political issues of health reform.

Drucker Priorities

When it comes to priorities , I invariably fall back on Peter Drucker’s advice on what makes one effective in this crazy-quilt world.

• Pick the future against the past;

• Focus on opportunity rather than problem;

• Choose your own direction.

• Aim high, aim for something that will make a difference, rather than for something that is safe and easy to do;

This is easy to say, hard to do. You have to know your time limits, ask yourself what you can contribute, make your strengths productive, take first things first, and check your biases at the door.

Writing in Context of Trends

Writing In terms of trends adds context. It allows you to present news physicians can use – or at least think about. In this sense, I still find John’s Naisbitt’s ten megatrends useful.

The ten megatrends are,

1. Industrial society to information society - Get used to the computer as your right arm. Here I am not thinking about EHRs, which are overrated, but of broad band access, googling, and search engine use.

2. Forced Technologies to High Tech/High Touch
– Forced EHRs and medical technologies are not your sole salvation. Use the human touch lavishingly. Maximizing those moments of truth in doctor-physician encounters count for more new and loyal customers than technologies.

3. National Economy to World Economy - Some of your patients may go abroad for lower costs, and you may need to compete.

4. Short Term to Long Term
- Consider joining with other doctors in virtual groups, and using telemedicine and monitoring devices. This will be long term trend.

5. Centralization to Decentralization - Mini-practices, concierge practices, and cash-only practices are coming. People will seek more personal and private care.

6. Institutional Help to Self-Help - Don’t fight it. As costs rise, patients will treat themselves with OTC medicine, use home remedies, believe in herbs, antioxididants, and nutritional supplements, and frequent offices of alternative practitioners. Help them choose the right things, even consider offering alternatives yourself.

7. Representative Democracies to Participatory Democracies – This is what the Town Hall and Tea Parties are all about.

8. Heirarchies to Networking - Twittering, Facebooking, social networking, retail and worksite clinics, and office websites are all forms of networking and communicating with patients.

9. North to South - As the recession eases, people and physicians will begin anew to flock to the South, Florida, and Southwest. Since Texas passed tort reform, doctors are flocking to the Lone Star State in record numbers.

10. Either/Or to Multiple Options
- This is why comprehensive national health reform is tanking. People fear losing their plans, having limited options, or having plans forced upon them.

Sources of Information

For credible, timely, topical material, I find it helps to have good, continuing and continuous sources of information. I use health care business sources - WSJ health blog,, ,,, American Medical News, Modern Medicine, – to name a few.

I use medical networking sites -,, ,, The Physiciansfoundation. org – and a few others too.

I also read The New England Journal of Medicine and JAMA.

For general information on the flow of health reform, I use The New York Times, The Wall Street Journal, and to a lesser extent, USA Today.

Lastly, and frankly, I turn to a website called is an American non-partisan political news and polling data aggregator, and conservative-leaning blog based in Chicago, Illinois. The site aggregates columns and news stories as well as election related transcripts and videos. The site also carries the most recent poll data, and compiles averages of major political polls on various elections throughout the United States to give a national view of what's going on.

The site was founded in 2000 by former options trader John McIntyre and former advertising agency account executive Tom Bevan. Forbes Media LLC bought a 51% equity interest in the site in 2007.

I like because it is commonsensical, posts a variety of articles and editorials , 25 or more a day, with a variety of opinions, both left and right, from leading thinkers and columnists, and contains tracking polls, based on averages of national polls. It gives you a sense of where the country is headed.

Here, for example, are its aggregate poll results for today.

RCP Poll Averages

President Obama Job Approval

Spread +2.3

Congressional Job Approval

Spread -40.0

Generic Congressional Vote

Republicans +3.2

Direction of Country

Right Direction
Wrong Track
Spread -20

Because I track this information daily, these poll averages tell me a lot.

• That President Obama still has positive job approval, but that it has dropped rapidly over the last year.

• That the public massively disapproves of Congress’s performance, which may lead to loss of Democrat majorities in November 2010.

• That more people now identify with Republicans than Democrats, a dramatic switch over the last year.

• That there is genuine and deep concern over the direction the country is headed because of such issues as unemployment, a faltering economy, the national debt, and health reform.

These are not trivial matters. This is news I can use. This is news physicians can use as we try to adapt to the new realities that face us and make a positive contributions that make a difference.


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