Gary Oftedahl: Could I live in a “health care home?”

In the past several weeks, I’ve had occasion to experience two events which have elevated my angst regarding much of the hype around the PCMH (patient-centered medical home) model. Understand, I conceptually get it. It’s totally in line with my philosophies, principles, and beliefs. A team-based approach, with leveling of the hierarchy in which I’ve practiced, the attention to evidence-based medicine, the patient-centered focus all resonate. Indeed, my hopes for some sanity to the payment model are often enhanced by the evolving whole patient approach envisioned in the PCMH model.

Kent Bottles: Archimedes Webinar to Explain Computer Simulation in Evidence-based Medicine

I am writing to invite you to next week’s webinar on the inner workings of the Archimedes Model. This webinar, entitled “How the Archimedes Model Works and is Validated”, will be led by David Eddy, M.D., Ph.D., co-creator of the Model and leading authority in the theory and application of evidence-based medicine and mathematical modeling in health care.

Kent Bottles: My Top Ten Books on Behavioral Economics

Several readers of the ICSI Health Care Blog have asked me about behavioral economics which has been mentioned in some posts (http://bit.ly/4uZNlH) and (http://bit.ly/49q4Uy). I am by no means an expert in this area, but I am happy to share with you an annotated bibliography of the books that have educated me on the topic.

Gary Oftedahl: Are We Done with Dunbar?

I’m all about networking, developing relationships, and maintaining a distance if possible (after all I am Norwegian) in advancing my efforts in collaborating with others. I’m struck that while I’m often compared to an “Energizer Bunny” at work, I tend to more closely resemble a hermit when I walk away from the job. As I reflect, it’s getting less and less frequently that I walk away from the job, but that’s another story.

Kent Bottles: Check Lists & Decision Trees v. Spontaneity & Imagination

The task of health care reform in 21st century America is to decrease per-capita cost of care and to increase the quality of care delivered to patients. It’s complicated. A famous Rand study concluded that Americans only receive 55% of the care that science dictates. Patients intuitively believe that more health care is always beneficial. Medicare reformers would like to do comparative effectiveness research so that CMS and private insurers could wind up paying only for therapy that actually works. Some estimate that 30% of all care delivered in the United States is waste. What some call waste, others label revenue, and Atul Gawande becomes famous for identifying waste/revenue in McAllen, Texas (http://bit.ly/ENlli).

Kent Bottles: Why Smart People Don’t Learn from Failures

My ICSI colleague Claire Neely recently mentioned that the classic Chris Argyris article “Teaching Smart People How to Learn” had been an “aha” moment in her efforts to learn how to better teach and reach physicians. While I don’t think I have ever read that article, I had been impressed with Chris Argyris, especially his work with Donald Schoen. Claire emailed me the article, and it really is a classic that needs to be read. (http://www.velinleadership.com/downloads/chris_argyris_learning.pdf)

Gary Oftedahl: Learning from Aesop

As I was catching up on my readings from Aesop’s fables, several issues came to my mind. First, and foremost, what drives someone to consider the perusal of ancient fables as an exercise worth considering? I have to admit, that may be a question for pondering, causing internal reflection which might lead to valuable insights into my true persona. But let’s leave that for another day. Second, the value of a fable is in it’s application to today’s situations, providing an imagery which simplifies or magnifies our thinking. Such is it with one of Aesop’s less known fables—The Stomach and the Body.

Gary Oftedahl: It’s a Mystery to Me!

The drive to find solutions for the deficiencies in our health care system is accelerating as the issues of cost, poor quality, limited access, poor coordination, disparities, and others become more public. The debates on health care reform, with the recent influx of large amounts of stimulus money, have led to a proliferation of projects and initiatives which will hopefully provide direction in the journey for a transformed health care delivery system.

Kent Bottles: My New Year’s Resolution: To See the World Clearly (Not as I Fear or Wish It to Be)

One of my blog posts (http://icsihealthcareblog.wordpress.com/2009/12/07/kent-bottles-good-evil-niebuhr-buddhism-health-care-reform-and-twitter/) created concern about my mental state. I received a very nice Twitter direct message from @ePatientDave and my colleague at work @jtrevis noted that my dark blog posts seemed to be less popular than the sunnier ones. While I would never want to be in a “normal” mental state, I do think that seeing the world and people clearly for what they are is preferable and more effective than being controlled by our wishes or fears.

Gary Oftedahl: Let’s get rid of hospital discharge summaries

In my 26+ years of practicing internal medicine, a constant thorn in my side in hospital work was the odious task (or so it seemed) of completing a discharge summary upon dismissal of a patient from the hospital. The patient was better, the work had been done, the discharge instructions provided to the patient, or so I thought, and yet, I now had to sit down, and go through the chart, summarizing the hospital episode of care, reiterating many of the facts already present in the existing record.