Saturday, April 02, 2011

Off to the Land of Make Believe

Tomorrow I head off to Land of Make-Believe: The 2011 American College of Cardiology Scientific Sessions in New Orleans, Louisiana.

I say this not out of spite for the organizers who have toiled to streamline the registration process and prepare the display hall, nor because I have anything against the presenters who have spent hours perfecting their talks and preparing their slides, nor because I won't learn anything there, nor because I don't have faith in the incredible will and wonder of the people of New Orleans. Seriously, it's a huge, fun, informative conference in a warm, welcoming, and conference-friendly city.

Rather, I say this because I fear these meetings will have less and less influence on how health care delivery will occur going forward as limits to how and how much care is delivered - at least as far as technology and innovation are to be used in the years ahead.

The sands are shifting beneath our feet. Every doctor I speak to knows it - some with more foreboding an outlook than others - but no one dares to show it lest they not appear to be a "team player." Instead, most of us act on the outside as though we are stalwart stewards of the status quo marching ahead to our future Land of Make Believe.

As such, we’re elated at the prospect that percutaneous aortic valve replacement will be available to all of our patients over eighty years of age with multiple severe co-morbidities soon (at least those are the only patients studied so far) and that all us who are fantastic interventionalists will soon be able to perform the procedure for all of our patients to meet the overwhelming demand. After all, the data at this meeting will show how safe the procedure is for them, right? Surely CMS would never drag it's feet toward approval of this expensive technology, would they?

Make Believe.

We watch the Stent Wars between companies and clinical investigators like a good Ultimate Fighter match: each company sparing for the right to claim a hair-thin victory over their competitor. And those bio-absorbing stents? Rock on! Surely the winner hear will take the sales prize, right? Especially since doctors have such influence over purchase orders these days. Everyone will be watching when a p value gets low enough and the legions of Press Corps spring to action as willing sycophants to the marketing hype so critical to promotion and adoption by the cardiovascular community at these meetings. As if it will soon really matter.

Make Believe.

We urge our medical students, residents, and fellows to attend these meetings and offer cash rewards to our best and brightest Young Investigators as if to suggest that most of them can still become entrepreneurs in the medical device arena in the years ahead. After all, regulatory approval hurdles for new technology aren't prohibitive, right? And those fees to the FDA, they're not too high, are they? Profits surely will be showered upon our young employee-inventors, too, right?

Make Believe.

And then there will be the transparency about how much all this stuff displayed costs, like the hybrid cath-lab/operating rooms (being developed now to install all those percutaneous valves in our elderly patients). Better to ignore this in favor of the bright, the shiny, and the new. Never mind that doctors and hospitals will soon be paid in lump sum payments from Medicare. Never mind that those payment amounts will be about 20% of where they are now. The sky's the limit for these purchase orders, right? Hospitals will get their return on investment quickly and doctors will still get their fare share of those bundled payments. Finally, look for these issues to be discussed front and center every single day at these Scientific Sessions.

Make Believe.

But I still can’t stay away. It will be a welcome respite from the cold to enjoy some nice warm weather. There’ll be nice people from all over the country and all over the world there. I enjoy speaking at these events, too: you realize the depth and breadth of commitment of today's doctors despite the forces that are changing. There’s a unique camaraderie that's developing, I feel, despite all of these changes. No matter what happens ahead, so far we are still afforded the luxury of meeting face-to-face to share our stories of patient care – both good and bad. And once in a while those stories can sometimes be shared nice glass of self-bought wine.

Better yet: it’ll be my excuse to leave those insidious Electronic Medical Record communications, office and patient e-mails, and results-reviewing behind for a few days.

Oops, I forgot.

Make Believe.


P.S.: Anyone who wants to share some stories and a good glass of wine between e-mails at the ACC 2011 Meeting can reach me via Twitter at @doctorwes. If you're still not on Twitter, here's how and why you should consider signing up.


Dr. Dean Brandon said...

Ok, I did my residency in N.O. Basically, every restaurant in town is great....Brennan's in the quarter---Also, go to Ralph's on the Park (if you are with your wife)--very nice for lunch, and Commander's Palace for dinner--it's is a must!

Andrew_M_Garland said...

Soon our government will arrange for the US to have the benefits of a fair, universal health care system patterned after Cuba, the famous example of implemented Hope and Change.

Congresswoman Watson Likes Cuban Health Care
=== ===
Cuba’s so called universal healthcare system has been a private embarrassment for the communist country as most of the nation’s patients are denied even the most rudimentary access to safe and modern healthcare.

Yet, yesterday in a town hall meeting, Congresswoman Watson praised Cuba’s healthcare. She admired a system where access to simple everyday medications is often an epic struggle. She praised Cuba’s former dictator Fidel Castro as “one of the brightest leaders I have ever met”.

Castro has murdered, tortured and exiled his own countrymen. It is no surprise that journalists and citizens alike have responded to the Congresswoman’s remarks with shock and trepidation.
=== ===

President Carter Praises Cuban Health Care System
=== ===
For more than a quarter century, we have struggled unsuccessfully to guarantee the basic right of universal health care for our people. But, Cuba has superb systems of health care and universal education.
=== ===

Doctors must find a way to organize and speak out. If "no one dares to show it, lest they not appear to be a 'team player' ", then most US doctors will end up employed by the government in an underfunded "Cuban" system. Fighting that is worth some risk.

Keith said...

If only these wonderful advances could be created without breaking the Medicare bank!

In most areas of endeavor, progress must be subject to the marketplace. Yes you can build a car that would get great gas mileage and perform exceptionally on the road, but nobody would be able to afford it. You seem to want a sort of fantsay land where medical breakthroughs are not subject ot the laws of eeconomics, and medical device manufaturers and creators simply need to show that their new creation works, with no consideration of the cost.

Meanwhile, we shortchange our educational system, let our roads and highways crumble, and frankly don't provide adequate investment in our human capital. What we need is a balancing of all these needs in a bigger picture look. We can't continue to spend gobs of money on new medical interventions that offer minimal improvements in health and longevity if they mean spending more money on health care.

Anonymous said...

Thank g_d for Keith! Mr. Garland sounds like he is still checking under his bed each night. But Dr. Brandon is absolutely correct about Commander's Palace. It's been years and I wonder if they still serve that Bread for the gods!

jimbino said...

I can't spare myself some schadenfreude contemplating the future of doctors. They've been hiding the ball, acting like gods, voting to maintain their cartel and engaging in wallet biopsies for so long that they deserve to be condemned to the status of government employee.

I've spent hour upon hour calling doctors and dentists trying to find out what they charge for a simple, routine procedure. A waste of time!

The more we can outsource their labor to India and practice medical tourism in Thailand, Mexico, Brazil and Argenting, the better. Amerikan docs need to be taken down quite a few notches.