Hodge Podge

Today is a grab bag of newsworthy citations:

1. Marketers say words matter.  They do.  How you present the facts have a great impact on decision-making.  For example, tell a patient they have a 10% chance of dying OR a 90% chance of survival, and you will note different reactions.

Behavioral science is a burgeoning field, and as in business, healthcare does not escape its grasp.   On the business end of things, an environment tailored to capture our attention surrounds us.  There is not a sound, smell, or inch of space that your local merchant does not preconceive in order to extract a monetized piece of flesh… on our plastic or from our wallet.  Likewise, a hospital and its name convey a similar sentiment.

It was with interest that I came across this poll.  If we as physicians asked ourselves to answer the same question, the result would reverse.  I am certain.  Again, words and perceptions matter.

I cannot vouch for the firm or the methods beyond what the wire service reports in the release.  However, sample size and demographic strata are robust enough to infer that health professionals and patients may view the world differently.  I never would have guessed:

For no reason other than cachet, take me, a doctor, to a Medical Center.  Perhaps Hospital connotes a Marcus Welby-ish warm and fuzzy feel that is appealing to the lay public—their preferred venue.  I cannot say.

Regardless, it is a potential example of a marketing communique, if influenced by physician estimations (big assumption), that might convey a weakened message.

2. You know the sheet you sign when picking up a prescription at the pharmacy—the one you trust offers the pharmacist confirmation that you, the patron, actually purchased the medication.  No dice:

When you sign you are affirming that you have been offered personal counseling by the pharmacist and are documenting that you do not want his or her guidance about how to take your drug, possible side effects and contraindications.

This is a notable post, and it affirms again, that regardless of existing statutes, if the work force or funding is not available, laws go unheeded.  This occurs within the FDA, hospitals, the immigration service, and even recently with worthwhile, but dormant public health and prevention programs.

The take home is, even though a law exists, it does not imply it will or can operate.  Whether it is inadequate funding or unworkable statutory demands (you pick), the fall back position of, “we already have a something on the books,” in response to accusations of inadequate execution fails.  As we know, this is a major problem in our institutions, and without resources or salutary market signals, progress is far afoot.

3. Readmissions persist, and we search for solutions.  This study caught my eye, as did this WIHI broadcast (6/23).  When you read the critics of hospitals and the dysfunction they allege, one would think we are casting our patients to the streets without any community, ancillary, or safety net support.  “Penalize for readmissions,” that is the rallying cry—without consideration of the complexity of this undertaking.  Yes, we must improve, but guess what; we do not have the tools or the needed competence in 2011.

Can physicians or risk prediction models forecast who will recurrently present to the emergency room?  As of this writing, no we cannot.  Can hospitals utilize their current armamentarium of fixes to keep the high utilizers in the community away from our wards?  No, and listen to the podcast if you want personal accounts of the impenetrability of this predicament.  With funding, grit, and creative vision, even motivated programs are having difficulty.  This is hard work, and we, hospitalists, invite those that criticize our efforts to offer their talents to augment what we know currently—an incomplete instruction manual is on our desks waiting for the next chapter in the mail.

4. Finally, the Internet offers many neat tools, utilizing data sets of all stripes.  Most are like toys you purchase for the three-year-old next door: fun for five minutes, but then never looked at again.  However, CMS nails this one, and I bookmarked it in my browser with the intent of a future revisit.  Powerful and helpful, it is a great benchmarking tool for your hospital and program.  Have fun!

Have a great Fourth of July, and for those of you welcoming new housestaff, keep one eye open, and an ear to the ground!

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

1 Comment

  1. Leslie Flores on July 8, 2011 at 1:24 pm

    Regarding your first item, it would be interesting to know where the survey was conducted. Many of the for-profit hospital chains have embraced the term “Medical Center” because of its perceived cachet; California is full of 99-bed “medical centers”, for example. I suspect this sort of deceptive branding may have impacted the perception of a medical center by consumers in some markets.

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