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Grand Rounds 5:12 — Healthcare Reform Q&A

If Dr. Rob can inter­view Santa, why can’t I inter­view a select group of health & med­ical blog­gers? They will have some good ideas to share”.

So did President-elect Obama came to real­ize a few days ago. After his peo­ple kindly con­tacted our peo­ple, we felt com­pelled to grant him open access to our col­lec­tive wis­dom. With­out fur­ther ado, below you have Grand Rounds 5:12 — a Q&A ses­sion led by the incom­ing Pres­i­dent on how to reform (for the bet­ter, we hope) healthcare.

On Health Insurance

Q:  How does the blo­gos­phere per­ceive the prob­lem of hav­ing a sig­nif­i­cant group of peo­ple uninsured?

Health Insur­ance Col­orado: a grow­ing eco­nomic bur­den, which may lead to emer­gency rooms turn­ing peo­ple away if they are unable to pro­vide proof of health insurance.

Dr Rich: well, a recent arti­cle in the Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion showed how over­crowd­ing in Amer­i­can emer­gency rooms is NOT due to the unin­sured. Rather, it is due to insured Amer­i­cans who can­not get in to see their pri­mary care physi­cians. We may need improved care both for the insured and unin­sured groups.

Insure­Blog: I’d sec­ond that. Lack of health insur­ance is a major prob­lem but is it really our Biggest Problem?

It’s All about Attitude

Q: You may have heard my cam­paign mantra, “Yes We Can”. Can I count on your support?

ButY­ouDont­Look­Sick: Yes. If Leslie Hunt can talk so openly about her chronic ill­ness (Lupus) yet ful­fill her Amer­i­can Idol dreams, we can ful­fill our dreams too.

Notes of an Anes­the­sioboist: you are talk­ing to the group of pro­fes­sion­als will­ing to self-experiment with our own body for the ben­e­fit of sci­ence and our patients.

Med­views: My wife, son, and I signed up to work as med­ical vol­un­teers for your upcom­ing inauguration.

Emergi­Blog: I am on board too. But, please, remem­ber that car­ing is the essence of nurs­ing. And that is why my patients will always be my patients and never my  clients.

Neu­roan­thro­pol­ogy: Mr. President-elect, it seems to me that, despite all our good inten­tions, bal­anc­ing the bud­get and mul­ti­ple com­pet­ing pri­or­i­ties will be a chal­lenge. May I sug­gest you start prac­tic­ing some capoeira for equi­lib­rium training?

Shrink Rap: Happy to help. Now, we will need to pro­tect some time for qual­ity sleep time.


Q: I am encour­aged by your words. How can my team and I bet­ter sup­port you in your daily activities?

Aequa­nim­i­tas: we need more role mod­els for us to “learn to think, observe, and com­pare” and that the patient is our “first, last, and only teacher”.

Mud­phud­der: Couldn’t agree more. We need bet­ter men­tors (and to learn how to select and appre­ci­ate them).

New York Pub­lic Library: also, help us main­tain our brains in top shape. We need more sardines.

Other things Amanzi: and clear stan­dards of excel­lence.

Allergy Notes:  hav­ing more free video lec­tures would help pro­fes­sional devel­op­ment on-the-go.

Degran­u­lated: above all, please help us clean the sys­tem from abra­sive clinicians.

Men­tal Health

Q: The Men­tal Health Par­ity Act just passed into law. What are our major risks and opportunities?

Cana­dian Med­i­cine: our coun­try just went through a com­pre­hen­sive, system-wide review of the most com­mon men­tal health prob­lem, depres­sion, and found out that the health­care sys­tem hasn’t been effec­tive in deliv­er­ing on non-pharmacological treat­ments. We need to change this. Med­i­cine does not equal drugs.

Cock­roach­Catcher: I have come to the rather unpleas­ant con­clu­sion myself that par­ents nowa­days may not have been told the full story about Antipsy­chotics. How many of them have been made aware of their range of side effects when it is sug­gested that their very young child should go on such medication?

Dr Deb: we need to break old stig­mas. When peo­ple need help, they should con­sider seek­ing pro­fes­sional med­ical and psy­cho­log­i­cal help.

Sharp­Brains: plus, why would one wait to care about our brains until prob­lems like depres­sion have snow­balled. Let’s encour­age the wider use of side-effect-free tools such as med­i­ta­tion to help peo­ple learn how to cope with stress.

Patient Out­reach

Q: How can we empower every­one in this coun­try to make informed deci­sions about his or her health?

Health­Busi­ness­Blog: let me start by say­ing that maybe we aren’t all as dumb as we look. True, a recent Kaiser Fam­ily Foun­da­tion sur­vey shows that not as many peo­ple as expected use web sites that rate health ser­vices when select­ing insur­ance plans, hos­pi­tals or physi­cians.

Dun­can­Cross: Hav­ing said that, search­ing through trusted social net­works, instead of rat­ing web­sites, is an entirely ratio­nal way to go about find­ing care.

Jolie (no, not that one): I see too many peo­ple fol­low­ing ran­dom web advice. A lit­tle knowl­edge is a dan­ger­ous thing. Per­haps, in fact, what we need is a rat­ings sys­tem for the qual­ity of the infor­ma­tion avail­able in the web?.

Out­doorHealth: we also need to pro­vide more clear infor­ma­tion on the side effects of drugs –and how to man­age them.

The Happy Hos­pi­tal­ist: and to man­age the expec­ta­tions of fam­i­lies in the care of end stage ill­ness. It makes no sense to me to things just because we can do them. We need to pro­tect the dig­nity of each person.

In Sick­ness and In Health: we can also encour­age patients in gen­eral –and breast can­cer ones in par­tic­u­lar– to have a pos­i­tive out­look and a sup­port­ive part­ner.

Tech­nol­ogy and Inno­va­tion

Q: What would you add to the agenda of my new Chief Tech­nol­ogy Officer?

Life in the Fast Lane: wide­spread train­ing in med­i­cine 2.0 tools will be a must. Here I have pre­pared an in-depth review try­ing to reach out to the less com­puter lit­er­ate of the physi­cian fraternity.

Clin­i­cal Cases and Images: we hope the rev­o­lu­tion will be Twit­tered . Even hos­pi­tals are doing so already.

ACPin­ternist: please con­sider the poten­tial to aggre­gate online infor­ma­tion and ana­lyze pat­terns to track the spread of dis­eases like flu.

Health­Blawg: focus on inno­va­tions are either directed at, or have the effect of, ame­lio­rat­ing the pri­mary care physi­cian short­age.


Q:  Talk­ing with all of you has been a won­der­ful expe­ri­ence. Thank you. I need to go now to my next appoint­ment, with finan­cial blog­gers. Any depart­ing pearls of wisdom?

Six­Un­tilMe: above all, give me a good den­tist.

RebuidY­our­Back: now that you and your team will be lift­ing the whole econ­omy, remem­ber that lift­ing belts have not been shown to be effec­tive at pre­vent­ing back injuries. And they’d look funny on you.

Teen Health 411: please encour­age teenagers to exer­cise.

Dia­betesMine: and reckon the things a dia­betic has to live with.

Adven­ture­Health: this may look a bit pedestrian…but here are some tips to deal with marine and salt­wa­ter infec­tions .

DocGur­ley: Mr. President-Elect, it has been a plea­sure to chat with you. We wish you a happy National Stress-Free Fam­ily Hol­i­day Month!


That’s it for this edi­tion. A Chronic Dose will host next Grand Rounds. Happy hol­i­days!

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