When Clarissa was 13 she entered Johns Hopkins Hospital to be treated for relapsed acute leukemia knowing full well that she had only a 40% chance of survival. Today she is 16 and in excellent health. But it took 2 1/2 years of incredibly rigorous treatments to get there. Equally importantly it meant riding an emotional roller coaster for her and her parents.Clarissa had ...
Stephen C. Schimpff, MD
What should we expect of a physician leader today?
What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added ...
Are physicians motivated by virtue or are they passive victims?
An interesting article in JAMA by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.”Basically, are we motivated by virtue, by self interest or are we just passive victims? The authors suggest that this is a good question not only for physicians to contemplate but ...
How dietary guidelines can help prevent disease
Most of the illnesses that occur today are chronic like diabetes, heart disease, cancer or kidney disease.These stay with us for the rest of our lives, are debilitating, and are expensive to treat. But in many cases they are not all that difficult to prevent. Unfortunately, our dietary guidelines are of little or no help in this regard but could be.In 1941, following studies that demonstrated ...
A system based on units of activity encourages more units of care
Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare.In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, ...
Insurance does not have incentives to lower costs or improve quality
Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality.In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care ...
America has a disease industry, not a health care system
The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or ...
7 disruptive changes that will affect medicine
Generally we prefer calm seas but often they don’t get us anywhere.We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change.Here a few more disruptive changes or refinements ...
Prevention improves health and lowers healthcare costs
Prevention is the key to both better health and lower healthcare costs over the long haul. This is where the nation — and each of us as individuals — needs to put energy and resources. In the long run, it is more important than addressing the high cost of new technologies and drugs or their inappropriate overuse.Today, the U.S. basically has a medical care system rather than a health ...
