Healthcare Facts & Ideas from the 2013 Mayo Clinic Conference

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During the two days of the Transform 2013 conference in Rochester, Minnesota, sponsored by the Mayo Clinic, I took notes during the series of eighteen-minute talks on a wide variety of healthcare subjects.  There were too many points made to communicate all of them in this brief blog.  I will attempt to briefly summarize as many of them as possible.  They were just too good not to share!

  1. One percent of American patients consume 25% of healthcare costs.  20% of patients consume 78% of healthcare costs!
  2. $6.5 trillion spent overall (worldwide) on healthcare.
  3. Your zipcode is more indicative of your potential health than your genetic code.  That is, where you live is very important for your lifelong health prospects.
  4. Merchants of Doubt” – title of book about how tobacco companies for many years exploited the fact that there was not 100% agreement on the harmful effects of tobacco to discredit the majority of evidence and block reform.  The same strategies have been used by the petroleum industry to discredit the evidence of global warming and promote continued fossil fuel dependency.
  5. Because of fear of costs, people put off interacting with the healthcare system until they absolutely must.  Postponed care = more expensive care.
  6. Worldwide: 6.6 billion telephone connections worldwide; 2.2 billion have broadband!  One billion computers.  There are more cellphones worldwide than there are toilets and toothbrushes!
  7. 50% of the population of India will never see a doctor their whole lives.
  8. Qualcomm, a multi-billion-dollar corporation, is sponsoring a $10million prize contest, for the design of a Star Trek-like “tricorder” device.  To win, the device must be able to diagnose fifteen common medical conditions better than a committee of five physicians.  This technical solution is more possible than ever because physicians don’t know their patient’s history/experience, and there is no multiple drug reconciliation among various physicians treating common patients.
  9. Doctors’ “house-calls” are becoming common again, because care delivered at home is cheaper than in the hospital.  All records are available electronically.  Through cellphones and electronic monitoring, patients are able to be diagnosed remotely.

10. “Alert overload” = when too many machines broadcast too many alarms.  Doctors and nurses end up ignoring all of them.  Patients die.

11. The “doctor shortage” is a perception problem.  The healthcare system cannot be victim to one chokepoint (physicians).  Care will be administered by nurses, physicians’ assistants, home care, clinics, and wearable electronic sensors, etc.

12. Violence in society exhibits characteristics similar to disease epidemics, and can be treated with the same approaches.

  1. Transmission:  exposure to violence/disease leads to more violence/disease
  2. Geographic clustering/mapping is similar
  3. Prevent disease/violence relapse (i.e. retaliation)
  4. Disease & violence are both contagious
  5. Violence could be reduced by treating it through scientific understanding instead of simply regarding it as a moral issue (cf. epidemics/plagues = acts of god)
  6. Violence is the number one cause of death in young people in cities; number two overall in the country
  7. 13.  Health journalists, e.g. Dr. Phil, Dr. Oz, Dr. Sanjay Gupta, deliver “infotainment” which reaches many more people than other healthcare education methods.

14. Emergency Room, aka Emergency Department (ED) care is expensive and not as good as primary care.

  1. 83% of ED visits are not acute emergencies
  2. 63% of ED patients don’t pay
  3. 22% come to ED for trauma, but only 3% get stitches and 0.3% are treated for broken bones
  4. More than 120 million ED visits in US in 2010
  5. Conclusions:  ED visits are not just for emergencies; thus it’s necessary to increase the value of ED usage by decreasing the cost of care, improving visit outcomes.

15. 70% of people say they want to die at home, but 70% die in hospitals.

16. The medical article claiming that vaccinations cause autism was thoroughly discredited.  Yet, many people cling to the false/fabricated premise.  This is unfortunately the manifestation of societal scientific ignorance.  It mirrors the false belief in some Moslem countries, e.g. Pakistan, that vaccinations are a Western plot against Islam.  The result is the resurgence of polio, previously thought to have been eradicated via universal vaccination.

17. The retail store chains Target and Walmart are exploring the limits of healthcare delivered in a retail setting.   They are applying retail research results to the healthcare choices offered.  For example, it’s been shown that when a customer is offered more than ten choices for a particular item, they are less likely to choose any of them.  They are overwhelmed.  The ideal number of choices (as determined by market research) is six.  Look on the shelves at Target:  There will rarely be more than six different choices for a particular item.  The same psychology applies to healthcare choices.

18. One doctor spoke about the experience of experiencing the deaths of patients on a daily basis.  Life is fragile.  A 1800’s Japanese haiku embodies this sentiment as witnessed on a typical humid morning:

 

A world of dew

A world of dew indeed

and yet…and yet…           

Comments (0)

  1. Jeffrey Leep

    September 19, 2013 at 12:59 am

    Dallas, your blog needs to go viral. You are amazing. Thanks for doing what you do. Jeff

  2. David Friedman

    September 19, 2013 at 6:57 am

    Dallas, with regard to point #8: Qualcomm would be better off spending 10 million dollars to fund projects which improve physicians’ universal access to, and the interconnectivity of, medical records, so that said 5 physicians would be able to diagnose “15 common medical conditions”. Medicine is an art, just as music is an art. Replacing 5 musicians with a computer program which can generate pleasant (common?) melodies is technically possible, but there is more to diagnosis than the ability to come up with computer generated solutions, as I am sure you would agree. The art of medicine is in finding the unexpected or the unusual. Naturally, a powerful “Big Blue” type of computer can list thousands of possible connections between disparate symptoms and signs, but it is the physician (artist?) who is capable of crafting a unique diagnosis for the unique individual. Computers are tools, not artists. Keep the excellent blogs coming.

    • Dallas Smith Blog

      September 19, 2013 at 8:59 pm

      This contest is good publicity for Qualcomm. I agree totally about the “art” of medicine. This futuristic computer tool is intended to extend the capabilities of doctors by “pre-analyzing” the symptoms and vital signs, while augmenting caregivers practicing in areas beyond their expertise, as in underserved areas or third world countries.

  3. David Friedman

    September 19, 2013 at 7:21 am

    Point # 11: The doctor shortage is a real problem, not a perceived one. Doctors don’t just “administer care”. Patients have been sold a bill of goods when they are encouraged to believe that a nurse (practitioner), a physicians assistant, a clinic (?) or a sensor (!) can replace a physician. I understand that administrators of healthcare would have us believe that the care is equal, but they are clearly foisting this on the public because they perceive it as being cheaper. As an ER physician, I cannot begin to tell you how many patients are told to “go to the ER”, by PAs and NPs, when they could have been cared for, far more inexpensively, by a competent physician. Moreover, even competent physicians are prone to sending patients my way because they are overworked, not in small part because of the onus of poorly devised electronic health records, incompatibilities between systems, etc. An efficiently constructed universal health care system might help to alleviate some of the burden which physicians face. More efficient and affordable medical education would be helpful for training more physicians. Alternative pathways for nurses to attain the competencies of physicians might allow them to become physicians, rather than “nurse practitioners”, etc.

    • Dallas Smith Blog

      September 19, 2013 at 9:06 pm

      My posting of the statement about the doctor shortage being a perceptual problem was meant as a part of the conference report as opposed to implying agreement. I had heard previously that the number of US-trained physicians had been restrained by the AMA and the existing medical schools which oppose the establishment of additional new medical schools. Again, I personally can’t substantiate or refute these claims. The larger context of the “perception” comment was that care is delivered on a continuum, starting with immediate family members and passing through friends, colleagues, nurses, and finally to physicians. The intention was expressed that care all along the continuum would take some of the burden off doctors who are the last resort and not the first resort for most people when they start along the road to care.

  4. David Friedman

    September 19, 2013 at 7:30 am

    #14: ER care is certainly expensive. As I noted above, however, everything rolls downhill to the ER, when primary care offices, nursing homes, urgent care clinics all advise patients to “go to the ER” because they are “too busy” or because they are not able to triage their own patients competently. Not to mention the number of people who have no concept of what an emergency room really ought to be used for. It was never intended to be a “convenient care” facility, a “medication renewal” facility or a “replacement dental office”. It most certainly should not be used for “primary care”, but it all too often is. The entire medical system in the U.S. needs to be seriously overhauled. We have had quite a few discussions about this in the past, Dallas. I am sure you are acutely aware of the challenges our system faces. Thanks again for blogging about them.

    • Dallas Smith Blog

      September 19, 2013 at 9:12 pm

      Certainly, ER care is overused by patients who ideally would have access to primary care. The hospital CEO who spoke about the ER crisis said that people will continue to swamp the ER as long as that’s the only place for them to receive immediate, comprehensive, and affordable care. Thus, he called for hospitals to expand their ER’s to accommodate this reality, to use the ER as the conduit for more types of care than just emergencies. In other words, healthcare is best delivered “where the patients go already for their healthcare.”

      • David Friedman

        September 20, 2013 at 7:02 am

        It has been my experience that expanding the ER to accommodate the crush of patients who utilize the ER as their “primary care provider” has led to more expensive and fragmented care, which may, in fact not even be more immediate (think: hours’ long waits in the ER for uncomplicated and chronic problems which could have been handled in a more efficient, less costly and timely manner, had they been “slipped into” a 5 minute, “walk-in” appointment with the PCP, or even handled over the phone by a competent triage nurse—I’m speaking about medication refills, toothache, chronic back pain, medication side effects, unreasonable expectations of “insta-cure” for problems already addressed by the PCP, ofttimes the same day (!), etc.). True, the care might be delivered “where the patients go already”, but it is, as I contend, NOT where “healthcare is best delivered”. This ties in to the whole issue of planning for the future by encouraging and incentivizing primary care and devising a universal health care system which would employ a universal electronic medical record, with universal access; which would avail itself of collective bargaining with pharmaceutical companies and medical device suppliers; which would provide for many additional entry points into the system (primary care offices) and which could, with proper oversight, reduce the cost of medical care, in the long run. This would need to be paired with re-educating the populace (possibly the most challenging issue) as to what constitutes health, disease and “an emergency”. A $900 ambulance ride to the ER, combined with a $400 visit for a diaper rash, runny nose, farting, an ingrown toe-nail, dandruff, sneezing, a pregnancy test, a mosquito bite, etc., etc. (I have seen “it all”) is not an efficient or cost-effective use of the ER, where “patients go already for their healthcare”.

        Forgive my rant, but there seems to often be a disconnect between administrators/hospital CEOs and those of us on the front lines, when it comes to evaluating what needs to occur with U.S. healthcare, in the future. Those of us who actually care for the patients are infrequently asked for our input, and less frequently yet, are we heard.

        • Dallas Smith Blog

          September 20, 2013 at 10:52 am

          Dr. David Friedman is an ER doctor (and personal friend) working “in the trenches.” Thank you David for your informed perspective on this complex issue of healthcare in America.

  5. Kelly

    September 23, 2013 at 11:26 am

    Seriously powerful morsels to ponder; thanks for sharing Dallas!

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