Posts by Brad Flansbaum

VIP Syndrome

I was reading a nice piece eulogizing David Bowie.  If you are a fan of his you know what a towering figure he was in the music world.  Given he died of cancer, I was also thinking about the docs involved in his care and their absolute pledge to him to guard his celebrity.  HIPPA aside, if you know the man or like his music, you must be in awe and most certainly, aimed to satisfy his expectations. If you work in a big town, you have probably seen your share of VIPs come and go into your facilities as well.  And you have also witnessed or partaken in the privileges accorded to them by request from above or out of your reverence. By VIPs, of course, I mean starting quarterbacks, lead singers, chairs of the board, and local luminaries and donors with deep pockets. I was curious about the…

You May Have The Killer Med App. But My Hand Still Beats Yours.

Think about how many times per week you pull out your medical calculator to plug and play a Wells or CHADS-VASc score.  Twice?  Three times?  Now think about how many times you get pestered about readmissions--be it through case managers, hospital leaders, or through your paycheck.  Probably daily. You can use an app every day and think it's useful.  But it's the regs and invisible stuff that trumps what you got.  That's my "hand." I have written in the past about high impact readmission publications.  They may seem far removed from what you do in your everyday lives.  Maybe so.  But sometimes the audience for these articles are not frontline clinicians--even though their ability to transform your practice life may be more potent than what you would absorb and use from a familiar journal. Many of us have been carping for years about the post-discharge responsibility period for hospitals as…

Assumptions About Your Hospital Remaining In The Black Are Wrong. And You Better Listen To Who Is Saying So.

What does it mean to decrease the length of stay?  Perhaps you see it as your raison d'etre or a maybe checkbox on the To Do list. To your hospital, it implies efficiency, so they save money and get more with less.  Period. However, even if you achieve a level of increasing efficiency year after year, the hospital you work in, regrettably, will still have a margin (profit) problem.  I will tell you why. My concern stems from something I read published by the CBO.  Hospital-based providers will find it compelling. First, if you do not know what the CBO is or what they do, it is hard to grasp why what they say carries so much weight.  Once you are aware of the acronym, you will be amazed how frequent their name pops up in the news. (more…)

Want To Keep Your Patient Out of the Hospital? Here Is Your Crystal Ball.

If I told you I planned to close a quarter of the country's cardiac catheterization labs, how would you react? You would probably express outrage and accuse me of mismanagement of our entire health system.  And that is to say nothing of all the harm that would come to patients.  But as docs, we reason in a prejudiced fashion.  We do medicine.  We write prescriptions.  We look at blood test results.  That is our profession after all.  It is how we extend lives and improve people’s well-being.  If we can measure, see, or manipulate a variable, anything attached to it must have value.  We have been trained to infer from that ethos with everything else taking a back seat. However, what if I then said I would reinvest every dime saved from those closures above and direct them towards all the people in our communities.  How many more lives might…

Your Career Path. Did You Get Pushed or Pulled?

I recently read the following written by Daniel Ofri, MD in the NYT: The stereotype of specialists handling the more complex and intellectually challenging cases makes many generalists fume. Generalists observe that specialists get the “simplicity” of handling very narrow slivers of medicine. It’s much easier to be an expert when you only have a handful of diseases to worry about. And any issue that a specialist doesn’t want to deal with can be permissibly kicked back to the generalist. The generalist, however, gets no dispensation. Every issue that the patient raises must be addressed. Every symptom from any organ has to be acknowledged. Plus, every medication prescribed by every specialist must be accounted for. Every competing interest between the many medical cooks in today’s fragmented health care environment must be integrated. It brought to mind something else I saw of late--Modern Healthcare's physician compensation survey.  The publication obtained data from…
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