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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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13 Responses

  1. rlbates says:

    I love your “inter­view”!

  2. hgstern says:

    Out­stand­ing job!

    Thanks for host­ing, and for includ­ing our post (esp near the top)!

  3. Barbara K. says:

    Love the inter­view for­mat. Great job. And thanks for includ­ing my post.

  4. Deb says:

    Clever and so infor­ma­tive!!!

  5. Dean Moyer says:

    Great line-up, lots to read. Thanks for host­ing and for includ­ing my post.

  6. Love that you kept your style. Great inter­views.

  7. Shrink Rapper says:

    Neat for­mat, thanks for includ­ing Shrink Rap!

  8. Thank you all for par­tic­i­pat­ing in a great dis­cus­sion 🙂

  9. Clever, yes, and impres­sive that you got cov­ered at Huff­in­g­ton, but vac­u­ous. Not a sin­gle word about the fun­da­men­tal impor­tance of elim­i­nat­ing the waste in the sys­tem cre­at­ed by our depen­dence upon pri­vate health insur­ance. We need more fun­da­men­tal change.

  10. Hel­lo Aaron,

    Thanks for the vis­it. I agree on the impor­tance of revis­it­ing the basic archi­tec­ture of our sys­tem.

    As you know, blog car­ni­vals are bot­tom-up ini­tia­tives. The solu­tion to that gap you men­tion is sim­ple: why don’t you sub­mit a good post on the top­ic to the next Grand Rounds?

    If you do, I will also be hap­py to point to it both from here and from the Huff­Po post.

  11. Are we on the verge of “Med­i­cine 2.0”?

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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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