1.
Featured Article:
The Mayo Clinic's new SPARC lab is driving experimentation
A Prescription for Innovation by
Chuck Salter, a Fast Company senior writer based in Chicago.
The
Mayo Clinic's new SPARC lab is driving experimentation at the frontier of
health care. How? By getting physicians to think more like designers. From
Fast Company: Issue 104 | April
2006 | Page 83 |
. . .The kiosk was getting there. And that was the idea: Put
the earliest version, the rough sketch, in front of patients to see what they
thought. Then use the feedback to tweak and retest. Then do the whole thing
over again.
The Mayo Clinic in Rochester, Minnesota, is no stranger
to innovation. W.W. Mayo and his sons - still known here as Dr. Charlie and Dr.
Will - founded their rural group practice in the late 1800s around a new
concept at the time: integrated medical care, which involved various specialists
working together in the same building, performing comprehensive evaluations,
and administering coordinated treatment. Ever since, innovation has been a
vital part of the clinic's DNA, traditionally in the research lab.
But the approach with the kiosk - rolling out unfinished
ideas to patients - is something new. Last summer, Mayo opened SPARC, a
clinical innovation lab that operates like a design shop and that specializes
in the "patient experience." Doctors, nurses, and other staffers do
what designers do: They interview, shadow, and observe customers (in this case,
patients) to uncover their needs, brainstorm with abandon, and engage in rapid
prototyping - hence, the paper kiosk.
Despite its status as one of the best known and most respected
medical facilities in the world, Mayo is wrestling with the same issues that
designers routinely tackle: In an increasingly competitive field, how do you
differentiate yourself? How do you generate fresh ideas and implement them in a
timely fashion? And how do you make sure those ideas actually benefit
customers?
Mayo's program is "definitely unique, and it has
enormous implications," says Dr. Samantha Collier, vice president of
medical affairs at HealthGrades, which rates the quality of the nation's
hospitals. "Medicine has long been embedded in tradition. But just because
this is what we've done since the days of Marcus Welby doesn't mean it's still
the best way. [Mayo] could find disruptive ways of practicing medicine better.
This isn't just about customer service but about quality."
SPARC is not simply a research lab or a medical clinic.
It's both. Real patients see real doctors and, in doing so, participate in
experiments (they're briefed and asked for permission). Instead of being
shunted off-site, the program is based in the Mayo Building like any other
clinic; it occupies a corridor that used to house urology. The acronym, which
stands for "see, plan, act, refine, and communicate," is meant to
remind participants of the design-oriented methodology so they'll continue to
employ it when they return to their departments.
The idea grew out of the realization that outpatient care
is overdue for fresh ideas. "Medicine has changed, people have changed,
technology has changed, but the exam room isn't so different than it was in the
1800s," says Dr. Michael Brennan, an associate chair in the department of
medicine, where the program originated. Mayo wants its doctors to apply the
same experimental approach to clinical innovation that they apply to scientific
innovation.
Ryan Armbruster, SPARC's director of operations and
design, researched how other organizations, such as Procter & Gamble and
Hewlett-Packard, foster innovation, and was struck by the prominent role of
design. Dr. Alan Duncan, SPARC's medical director, had always thought of design
as merely about aesthetics, but he quickly recognized the parallels to health
care. "Look at how physicians generate a diagnosis," he says.
"You do a history, listen, and think about all possibilities. It's purposefully
broad to avoid locking into an early diagnosis, just as a designer wants to
avoid locking into an early solution."
The inclusion of actual patients is critical.
Understanding user needs, after all, is a tenet of smart design, says
Armbruster. There are three types of needs: those that are explicit and tacit
and can be identified by surveying and interviewing people; those that can't be
articulated but become apparent through observation; and latent needs, the
hardest to root out. "The only way to identify them is to make something
and have people experience it," Armbruster says.
"Just because this is what we've done since the days of Marcus Welby
doesn't mean it's still the best way. Mayo could find disruptive ways of
practicing medicine better."
Dr. Victor Montori, an endocrinologist, brought doctors
and patients to SPARC to experiment with a new way of discussing statins, drugs
that lower high cholesterol. Too often, he says, patients get overwhelmed with
information and let the doctor choose the treatment. Because they didn't decide
for themselves, patients tend to abandon the therapy, which puts them back in
the doctor's office.
Montori tested a one-page guide that gives an
individual's risk of a heart attack, shows how statins affect those odds, and
outlines possible side effects. He's still reviewing the data, which suggests
better adherence to medication, but he already knows that the personalized
guide got patients' attention. "After the fifth or sixth prototype, we
started seeing an emotional and physical response," Montori says.
"They were moved." He knows this because SPARC's exam rooms are
equipped with small cameras that provide rare glimpses into doctor-patient
interactions. "We hear all the time about a clinician being
empathetic," Montori says. "Now we're watching empathy at work. The
eye contact. The listening. We see the whole dance."
In fact, most everyone can see. With the help of office
furniture maker Steelcase, Mayo created a highly transparent environment. The
glass walls reveal SPARC's inner offices and show support staff working at the
front desk; researchers reviewing project videos; and the SPARC team leading
workshops in a central space that functions as an informal lounge and meeting
room. SPARC removes the mystery found in a typical closed-off clinic.
The space is also highly flexible. Much of the corridor,
including the exam rooms, can be reconfigured to accommodate a variety of
experiments. Walls, furniture, and computers can be moved like puzzle pieces.
"People come expecting to see the finished product," says Armbruster.
"But they experience the opposite. They see prototypes in different stages
of evolution."
Mayo's physicians both embrace design principles and
integrate them with traditional medical research - in effect slipping the
doctor's white coat over all-black designer duds. Doctors or managers propose a
problem or a question they want to explore, and the SPARC staff assembles a
cross-functional team, which gets a crash course on design methodology. By "the
second hour, we were out with cameras, notepads, and tape recorders," says
Becky Smith, a manager in patient education. Her team discovered that Mayo's
main education center was confusing. It was intended for patients and family
members to learn more about diagnoses or treatments. But because the space was
open - no walls or doors - patients weren't sure if the computers were for them
or the Mayo staff. When they did venture online, it was mainly to check email.
"We hear all the time about a clinician being empathetic. Now we're
watching empathy at work. The eye contact. The listening. We see the whole
dance."
To read the entire article, please go to www.fastcompany.com/magazine/104/sparc.html.
Chuck Salter (csalter@fastcompany.com) is a Fast Company senior writer based in
Chicago.
Have something to say about this story? Email the editor.
* * * * *
2.
In the News: Selling Generic Drugs by Mail Turns into Lucrative Business
Benefit Managers Say They
Save Employers Money, As Their Own Profits Rise -
Off-Patent Bonanza Ahead; By BARBARA
In many industries, middlemen scrape by on small
margins. Not so in generic drugs.
Documents from 2001 filed in an
Today, Caremark Rx
Inc., another middleman, charges the federal government and employees $96.88
for 90 pills of generic Prozac, according to a Caremark Web site. The same
pills can be bought wholesale for less than $5.
Medco, Caremark and Express
Scripts Inc. are the big three "pharmacy benefit managers," or
PBMs. Employers that offer prescription-drug coverage hire PBMs to do the
paperwork and keep costs down when an employee needs a prescription filled.
More than 100 million Americans carry a card with the logo of one of the big
three, using it at the pharmacy to show they're covered.
It's a hugely lucrative
place in the food chain. Generic drugs are popular because they save money by
offering alternatives to expensive brand-name drugs. But the PBMs have figured
out how to use mail order to turn generics into a bonanza. Buying in bulk, the
PBMs typically pay a few cents per pill, then turn around and bill employers a
quarter, 50 cents or even a dollar a pill. A Medco spokeswoman, Ann Smith, says
final profit is much smaller than that spread because of administrative and
dispensing costs.
For the employers, the
generic prices look like a bargain because they're generally still much lower
than those of brand-name drugs. The employers often don't know the spreads
enjoyed by the PBMs.
The big three PBMs' perch
could grow even more valuable over the next five years as brand-name drugs with
$47 billion in annual sales lose patent protection. Copies of top sellers such
as the cholesterol drug Zocor and antidepressant Zoloft will take a big bite
out of the drug industry's profits, while giving PBMs more chances to sell
high-margin generics.
More than half of Medco's
net income comes from filling generic-drug prescriptions at its mail-order
facilities, although the mail business including brand-name drugs represents
just 37% of revenue. Collectively, the big three recorded net income of nearly
$2 billion last year.
The business has brought
gains for PBM shareholders and made some PBM executives rich, chiefly from
valuable stock options, even as many employers and employees struggle to afford
health insurance. Caremark's chief executive, Edwin M. "Mac"
Crawford, has sold $185 million in stock since November. (See article.) At Express Scripts,
Chairman Barrett Toan has sold $64.8 million in stock since last fall.
It helps the PBMs that many
employers are unfamiliar with the economics of manufacturing pills. While a
brand-name pill such as Lipitor or Prozac may cost employers $2 or more, most
of that goes into marketing, research into future drugs and profit for the drug
company. The cost of actually producing the pills is usually only a few cents
each.
After the patent on a drug
expires, brand-name makers lose the monopoly that allowed them to charge a high
price. But for customers accustomed to the old prices, it may seem like a
bargain to get pills that used to cost $2 for just 50 cents.
The PBMs defend their lofty
margins on generics, saying that they need the profits there to make up for
overhead costs and losses or slim margins on brand-name drugs. They say
employers benefit from their efforts to switch patients to generics. Pharmacies
also add huge markups on generic drugs for some customers, such as uninsured
people who pay for medicines out of pocket . . .
But for now, the generic
mail-order business is booming. It represents the latest evolution of an
industry that has played a key behind-the-scenes role in the $250 billion
The PBMs started out by
promising to liberate employers from the grunt work of offering a
prescription-drug benefit for employees. They could handle the paperwork when
prescriptions were filled at pharmacies and make sure employers paid only for
approved drugs . . .
Today, big facilities like
Medco's can fill prescriptions in minutes and put them in the mail with barely
a human hand intervening. At its Willingboro, N.J., facility, which Medco calls
the world's largest automated pharmacy, trays of bottles get filled from 1,200
bins containing almost every major pill for chronic diseases prescribed in the
U.S. Robots cap and seal the bottles after their two-mile journey and drop them
into plastic mailing bags. The factory churns out more than a million
mail-order prescriptions a week.
When the allergy drug
Flonase lost patent protection this March, Medco says it converted 95% of brand
prescriptions to generics within two days. A similar conversion in 2001 when
Prozac went off-patent took more than six months, it says.
An even bigger opportunity
is coming in June, when Merck's cholesterol fighter Zocor goes off-patent.
Medco vice president Ken Malley says Medco has a "very overt, very
aggressive program" to push generic Zocor. Medco will fax letters to
50,000 doctors urging them to put their patients on the generic pill. The
letters say, "Help keep your patients' benefits affordable."
To read the entire article, please go to (Subscription
required) http://online.wsj.com/article/SB114713546203047327.html?mod=todays_us_page_one.
Write to Barbara Martinez at Barbara.Martinez@wsj.com.
[The only reason that the
Big 3 PBM can charge $25,620 for $766 worth of drugs is that the patient the
primary beneficiary is completely out of the picture. If patients dealt
directly with the Big 3, the PBMs would each have to compete directly for the
patient to continue to sell the drugs. There would be a racing frenzy to reduce
the price of the drugs to attract the most patients. There is nothing more
effective than the free market to reduce health care costs. Editor]
* * * * *
3.
International
Medicine: Canadian Medicare Loses in the Canadian Supreme Court
A
Seismic Shift: How Canada
Executive Summary (www.cato.org/pub_display.php?pub_id=6378)
Early
efforts by Western democracies to restrict freedom of contract were rationalized
on the ground that such restrictions were necessary to prevent the suffering of
ordinary citizens. People who oppose the freedom to opt out of state-run health
insurance schemes turn that rationale on its head: they oppose freedom of
contract even when it is necessary to prevent the suffering of ordinary
citizens. A recent ruling by the Canadian Supreme Court has helped to restore
that freedom and the right of patients to make their own medical decisions.
On
The
ruling in Chaoulli v. Quebec has expanded the right of Canadians to
obtain private medical care and opened the door to a parallel, private health
care system.
Jacques Chaoulli is a physician and a
senior fellow at the Montreal Economic Institute. He successfully argued the
case Chaoulli v.
Introduction
In advanced nations, the
financing of medical care is dominated by state-run insurance schemes. In most cases, governments
limit expenditures by limiting the supply of services in the face of heavy
demand. As a result, many governments force patients to wait for care - often
in pain, and often at the cost of the patient's life.
My adopted home of
The average wait has been
increasing since 1993 (though in 2005 it fell slightly), and these delays seem
impervious to additional funding. When the state pumps more money into
Those imposed waits can have
painful and even fatal consequences. As
The evidence shows that, in
the case of certain surgical procedures, the delays that are the necessary
result of waiting lists increase the patient's risk of mortality or the risk
that his or her injuries will become irreparable. The evidence also shows that
many patients on nonurgent waiting lists are in pain and cannot fully enjoy any
real quality of life . . .
Conclusion
"Social
solidarity" was the justification offered by communist leaders from
[S]ignificant barriers to
market entry have sometimes been created, such as a legal ban on private
practice. This is still the case in
To read the entire report, please go to www.cato.org/pubs/pas/pa568.pdf.
[Medicine, Healthcare, and the peoples of the World
will forever be indebted to Dr Jacques Chaoulli.]
Canadian Medicare does not
give timely access to healthcare but only gives access to a waiting list.
* * * * *
4.
Medicare: For All
as in
HEALTH ISSUES (NCPA):
ROMNEYCARE'S FINE PRINT, WSJ,
What
is the impact on individuals?
- The state will offer subsidies to help low
income residents pay for coverage (Section 19), but most of the uninsured
earn too much to be eligible.
- An individual making $29,000 or more would
probably have to pay the full cost or find a job that provides health
insurance. Individual coverage costs about $3,600 in
- Moreover, under the new law, individuals
purchasing their own insurance must buy HMO policies. Preferred provider
plans (PPOs) -- which give you more ability to choose your own doctors and
treatments -- are not allowed (Section 65).
It's
one thing to criticize, says McCaughey, but there are alternatives to make
health insurance more affordable. State legislators have pushed up prices by
requiring policies to cover chiropractics, acupuncture and other services that
are worthwhile -- if you can afford them. But mandating them is like passing a
law that the only car you can buy is a Lexus, when all you can afford is a Ford
Focus. People should be allowed to buy basic, high deductible insurance without
costly extras.
www.ncpa.org/newdpd/dpdarticle.php?article_id=3288
Source:
Betsy McCaughey, "Romneycare's Fine Print," Wall Street Journal,
For
text (subscription required): http://online.wsj.com/article/SB114679782365744636.html
For
more on Health: www.ncpa.org/iss/hea/
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Patient-Driven Health Care Nips Excessive Health Care at the Source
During the recent World Health Care Congress, a senior
administrator, who now has high deductible health insurance, relayed her own
experience with Patient-Driven Health Care. After she left her gynecologist's
office and was about to start her car, she looked at the laboratory tests that
her OBG physician had ordered. She
noted that the tests were nearly the same as her internist had obtained the
previous month. She returned to the office and explained this to the
receptionist. She was told to have the lab results forwarded to the
gynecologist's office and that would certainly be acceptable.
She commented that in the past she would not have paid
much attention to what was ordered since her previous insurance company paid
the bill and increased her insurance premiums every year or so. Now that she
had a $2,000 deductible on her policy that she paid out of her own pocket, it
became important for her to manage her costs.
It is important to note that, in this instance,
consumer- or patient-driven health care cut the laboratory costs by 50 percent,
a huge savings not appreciated or accepted by those who want to control
individuals by having government control health care costs. It will not be
efficiency that will control costs but denial of access and prolonged waiting
lists, which have not proven effective in reducing costs in any system of
health care. [It just makes the bureaucrats feel that they did some work, even
if it was not useful or beneficial to anyone except themselves by providing job
security.]
Medical Efficiency: Putting the Patient Financially in
Charge Will Eliminate Excessive Health Care Costs Immediately, Without Further
Effort on Anyone's Part.
* * * * *
6.
Medical Myths:
Universal Health Care Using EMR will Nip Excessive Costs at the Source
There is a push by the uninformed in government and in
our industry that the electronic medical record (EMR) will also eliminate such
costs as outlined above. This may not be so since they are unable to integrate
this across a variety of practices. The above 50 percent reduction in cost did
not occur when the internist and OBG physician were already part of a large
managed care system. It occurred only because the patient obtained a
Patient-Directed Health Plan.
The EMR eliminates such duplication only in a totally
integrated system, such as Kaiser-Permanente and the VA. The Mayo Clinic and
other large clinics have EMR, which works inside their clinics across a large
number of services and departments. It does not compare to the total national
integrations achieved in the Kaiser-Permanente system. The VA system has
achieved it for their members that obtain their care exclusively within that
system. However, a large number of their patients continue to have one foot in
private practice and thus have two medical records, sometimes more, that never
interrelate with each other, causing huge duplications. Many of the veterans in
my practice find this duplication a source of great comfort. The usual veteran response is that the VA is
free and thus only their private care is a source of health-care costs.
The EMR is making rapid progress in the free-market
environment. Government involvement in this process can only slow, diminish and
frustrate the progress. We don't need another government bureaucracy to worsen
our patient's health care and then blame private physicians and hospitals for a
patchwork of disintegrated care. This is being used daily as an argument for
the need of a government monopoly such as the disintegrating Canadian system.
Medical Truth: Patient-Driven Health Care, with or
Without the EMR, Is the Only Mechanism for Eliminating Excessive Health-Care
Costs.
* * * * *
7.
Overheard in the
Medical Staff Lounge: Dr Sam Is Beginning to Dislike Uncle Sam's Medicare
Dr Sam has
been having quite an ordeal with Medicare. He reported this week that Medicare
has not paid him for the past four weeks. His billing clerk has been hitting a
stonewall on all attempts to reach Medicare electronically or by phone. She has
been researching the Medicare manuals and has not been able to determine where
the glitch is. Dr Sam isn't sure just what he wants to do. Options he's
considering include becoming a non-participant in Medicare, firing his billing
clerk, leaving the practice of medicine, or drive to the Medicare headquarters
and make an issue of it. But then he thought the Medicare employees would have
a belly laugh at his expense to think that cutting his income in half could
conceivably hurt a doctor. The more heated he became in the lunchtime
discussion, the more he thought it best to just eliminate Medicare from his
practice.
Dr Dave
wasn't much cooler as he came across the article in Opinion Journal about Great Moments in Socialized
Medicine, which quoted from Mike
Hume in the
Edward Atkinson, a
75-year-old anti-abortion activist, was jailed recently for 28 days for sending
photographs of aborted foetuses [sic] to the
Dr
Dave was wondering why the same people who don't trust the government to spy on
terrorists, lest dissenters get caught up in the web, so often also urge giving
government control over our health care?
Dr
Rosen pointed out that some six or eight years ago when Medicare electronic billing
began, the turn around time from billing to payment was supposed to be one week
rather than the three- or four-week delay for paper claims. However, the
government (Medicare & Medicaid) stated that the government coffers were
unable to pay the past four weeks of claim in one week. They put in an
electronic delay - all the claims went into a holding bin for three weeks and
then the first week of claims were paid. When doctors complained, the response
was rather straightforward. We can't be concerned about your lack of income for
three or four weeks when the government does not have the funds to pay one
month of the nations health-care cost in one week.
Dr
Edwards complained about the frequent loss of claims from Medical, another
government program. He actually made a trip to the claims office and was shown
an auditorium with hundreds of desks with clerks processing claims. The
Medicaid administrator told Dr Edwards that he was sure that every day there
were hundreds or more claims lost in that huge auditorium. But there was
nothing that could be done about that.
This
ability of the government to manipulate electronic claims gave experience and
precedent for later abuse and harassment by having data mysteriously disappear,
temporarily or permanently. Of course, there was always an administrative
explanation. Just as in Dr Sam's case above, which Dr Rosen was also
experiencing at the present, Medicare gave the billing clerks an explanation
that seemed to satisfy their billing clerk's questions.
Dr
Rosen handled the present lack of half of his income for four weeks by
borrowing $4,000 to cover the rent and salaries and delaying the payment of
other bills. Dr Rosen has made the decision to no longer accept Medicare
patients and is holding a decision in abeyance on what to do with his present
Medicare patients.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
A Medical Student's Introduction to the Politics of Medicine, by Brian Boone, Medical Student, FSU
School Florida
I
have always had a passion for two things; politics and medicine. On March 15, I
ventured to
In a single day at the capital, I was exposed to the important issues of tort
reform, physician liability, and scope of practice. I visited multiple committees where bills important to the
medical profession were introduced, debated and voted on. I witnessed FMA
President-Elect Dr. Patrick Hutton testify before the Senate Committee on
Health Care, fighting to preserve physician scope of practice by opposing
legislation that would allow pharmacists to give flu shots. I observed the
House floor as our representatives debated the tort reform issue of joint and
several liability. I was introduced to the complicated process of budget
appropriations in the Senate Health and Human Services Appropriations
committee. In one day, I witnessed legislative action on numerous bills that
will have a dramatic influence on my patients, my ability to practice medicine,
and my career. . . .
To
read the entire article, please go to www.fmaonline.org/pubs/quarterly/april06_up.asp.
* * * * *
9.
Book Review: Symptoms of Unknown Origin, by Clifton Meador, MD, 175 pages, Vanderbilt University Press, $15.
Current Books: Biomolecular
Misgivings By Colleen Foy-Sterling, MD, In
A
patient is sharing her deepest pain. We sit across from her, slowly sinking
into one of the most uncomfortable places for a doctor: being completely unable
to empathize and frustratingly unable to offer a cure. As physicians we are
sworn to help, to empathize, to care and care for; but it is sometimes
altogether impossible.
Symptoms of Unknown Origin, by Clifton Meador, MD, is a compact,
folksy remedy for these difficult encounters with a seemingly alien species.
Feeling burned out and too pressured to follow the "15-minute hour"
so strictly? If so, this delightful little book will be a pleasure to read,
providing a slight breeze to your sails.
Meador has been a practicing internist for more than 50 years, and some of his
stories are old-fashioned and politically incorrect. In fact, a few tales told
by his mentors take place in the 1930s, 40s, and 50s. He seems unconcerned that
some of his solutions involve taking a parental or controlling approach to
patients. All is acceptable as long as physicians truly listen to patients and
work to heal them, or at least to move ahead and get on with life.
Meador's freedom and abandon make his strategies thought-provoking and
creative. How many of us would dare to withhold a diagnosis from a patient or
to demand that a patient agree to see only you? (In one story, Meador
recommends that surgeons not inform a married, male patient of the surgical
findings that the patient had the internal organs of a woman.)
Meador
graduated from Vanderbilt in 1955 as a true devotee of the biomolecular model
of medicine. He confesses that his greatest desire as a newly minted MD was to
deduce what was wrong with patients and fix it. He dreamily relates a memory
from medical school that profoundly affected him: A female patient is wheeled
into a deep, classic amphitheater. She is confined to a wheelchair, barely able
to lift her head, and seemingly near death. A white-coated physician brings out
a syringe and, with a dramatic injection, brings the patient "to
life."
This case, of a patient with myasthenia gravis, is etched in Dr. Meador's mind:
"I was amazed. I felt my neck and arms crinkle, as goose bumps rippled
across my skin. Awe, in the truest sense of the word, flooded me." The
power of the scientific method is demonstrated in all its glory. For years,
Meador searches for that rush of amazing, powerful cure bestowed by the kind,
intelligent doctor unto the patient.
That search eventually brings Meador to a polar opposite role. He becomes an
expert in patients without a cure: those challenging, difficult, and downright
annoying patients with "symptoms of unknown origin." Along the way,
he discovers the writings of Michael Balint and works with Carl Rogers at the
Center for the Study of the Person in
In 20 cleverly titled chapters, Meador presents intriguing, personal stories of
patients who confound their physicians. He explains that, after 50 years of
practice, his "overarching thesis
is that the prevailing biomolecular
model of disease is too restricted for medical use." Real patients often
refuse to fit the biomolecular model. Whether they don't want to be saved, or
whether their medical condition is too embedded in a web of psychosocial
modifiers, some patients just defy definitive diagnosis and treatment. In fact,
many patients come to Meador carrying incorrect diagnoses, invited by their own
impossibly long list of symptoms . . .
Dr. Foy-Sterling, a family physician, serves on
the SCMA Editorial Board.
To
read the entire book review, please go to www.scma.org/magazine/scp/sp06/foy_sterling.html.
Why Johnny Can't Comprehend
What He's Reading By DAVID GELERNTER
A review of The Knowledge
Deficit by E. D. Hirsch, Jr. (Houghton Mifflin, 169 pages, $22)
American schools are failing
to teach our children to read intelligently, and "The Knowledge Deficit"
explains why. You cannot be a successful reader, E.D. Hirsch reminds us, unless
you understand the context in which the author is working. Competent readers
depend on a store of shared knowledge that our children must learn -- but are
not being taught.
Our schools are trapped
instead in a nightmare of vacuous bullet-points and double-talk; teachers
present "comprehension strategies" ("predicting, summarizing,
questioning, clarifying") in place of plain, nourishing information.
Students are shown again and again how to "classify, draw conclusions,
make inferences, predict outcomes." But they still can't read
intelligently. No author can possibly spell out the implied context of every
sentence he writes. Children must learn to fill in those blanks -- but our
schools refuse to teach them.
Imagine trying to read
"War and Peace" armed with good "classification skills"
instead of basic knowledge. Who was Napoleon? What do czars do for a living?
Where is
To read the entire review of
our failing public school system, please go to (Subscription require) http://online.wsj.com/article_print/SB114669140622743010.html.
* * * * *
10. Hippocrates & His Kin: Just a Notch above Lawyers
In the public opinion polls concerning who inspires
the most confidence that people trust, the top has always been doctors,
ministers, and Supreme Court justices. Who's on the other end? Well that may be
changing. Congress was always considered a "notch above lawyers"
until someone figured out that Congress is primarily a bunch of lawyers. Now
many respect lawyers more and some have even placed them a "notch above
Congress."
But has that really changed what's down in the cellar
all that much?
Congress is trying to micro manage every aspect of the
practice of medicine: what goes on in the consultation room, how the doctor
records the medical history, what diagnosis the doctor is allowed to use, what
five digit code the doctor has to use to get paid, have all diagnosis been
upgraded every year, how to change the code every year which will confuse most
offices and thus there will not be any urgency to pay the claim until after the
second or third rejection, what laboratory tests the doctor can order, what
procedures are approved by Medicare and Medicaid, who can go to a hospital, who
can go to the emergency room, who has to go to a "doc in a box"
facility, if the wrong decision is made, it's an excellent reason not to pay
that claim, what is recorded in the hospital history and physical examination,
what goes into the hospital summary, who can we discharge the patient to, what
procedures do we have to follow on discharge, what can we order in a skilled
nursing facility, in a custodial facility, in a board and care facility, who
can we release the medical records to, how much of the medical record can we
release and to whom, HIPAA now demands that we release the records to any
governmental agency, but not to a doctor or hospital who are the ones that
really need them without full disclosure. What restriction is next? (Censored!)
What other professions or business would allow
someone to destroy them and their product?
Where are our professional
medical organizations? What are they doing? Are they on our team in protecting
us from the harassment and destruction of government? Are they trying to
protect the interest of our patients and keep the doctor-patient relationship
sacrosanct? Or are they politicians with their own agenda and thus part of the
problem? Should we subject our leadership to a "confidence/no
confidence" vote? Don't we have enough physician-lawyers that we can start
to micromanage the legal profession? Can we tell them how long their
appointments are allowed to be, how they have to record their records, whether
electronically or be allowed to write, how they have to make them available to
any government agency, to any court, to any party in a legal action?
Wouldn't that get Congress
and the Bar off of our back?
The
Legal Fraternity A BOOK REVIEW, By William Peniston,
MD; How our laws have developed ever more largesse for trial attorneys
while making the acquisition of truth increasingly difficult.
The Fraternity: Lawyers and
Judges in Collusion by John Fitzgerald Molloy,
244 pgs. $22.95, Paragon House, ISBN 1-55778-841-3.
This
is a book you must read. You may not enjoy it, but if you have any concerns
about our legal system, and you surely must, you will learn there are more
problems than you thought.
This
is the story of a trial attorney, and the changes he was privy to, during 46
years of private practice that were interrupted by 12 years serving as a judge
in various capacities, including the Arizona Supreme Court.
He
admits to being a part of this "collusion" for almost all of his
professional life. Admittedly, there were times when he mused about his
"Daddy's" law practice and that of his own mentor, "Judge
Hall." There even were times when he opposed some of the collusion and
sometimes wrote minority opinions contesting some of the changes. To read the
rest of Dr Peniston's book review, please go to www.ssvms.org/articles/0601peniston.asp.
* * * * *
11. Restoring Accountability in HealthCare, Government and
Society: