findcancerexperts.com (“Offers names of three expert pathologists to review
results”)Some charge hundreds of dollars, some make no charge.
The Wall Street Journal‘s Tara Parker-Pope found the “virtual second
opinions” to be “surprisingly comprehensive” and sometimes better than seeking
another local opinion face-to-face. She presents evidence from the institutions
mentioned above that “most virtual second opinions — like the traditional kind
— confirm the initial diagnosis,” but most also suggest different
treatment approaches.
Insurance may not cover virtual second opinions, which also take considerable
paperwork and the mailing of medical records. But patients who use them seem to
like them, and they equalize some of the differences in medical care known to
exist in different parts of the country.
Reference: Parker-Pope, Tara (2003). “When the
Web Can Serve Better Than a Local Doctor: Some Virtual Second Opinions Are
Surprisingly Comprehensive.” Wall Street Journal, August 12.
Managed Self-care
Supported SelfCare’s LifeMasters remote disease management technology
enables doctors and nurses to help chronically ill patients manage their own
care, using the Internet or the telephone to take telemetry and provide advice.
The doctor determines blood pressure, glucose level, weight and breathing
patterns, and other parameters for the individual patient. Patients take daily
readings of those items and transmit them to the LifeMaster system. A
reading beyond the set parameters — or no reading at all — alerts a nurse to
call the patient to find out what is going on.
If patients are engaging in behaviors likely to be causing the abnormal
readings, not only can nurses advise them about the correlation, but they can
see it for themselves at first hand and are more likely to make the needed
behavioral adjustments.
Supported SelfCare is profitable and a recipient of venture capital.
This is a telling example of how technology can improve the quality of care,
and of how the practice of medicine is changing to incorporate the patient as an
active member of the caregiving team.
Reference: Friedman, Josh (2003). “Where Tech and Medicine Meet: Venture investors see opportunities in
Southland start-ups melding health care with technology.” LA Times, August
27.
Changing the Practice of Medicine — and
Careers
A dispute between a small group of heart surgeons and a bigger group of
cardiologists highlights one effect of medical technology on practice. The
surgeons had refused to merge with the cardiologists, who retaliated by hiring
their own surgeons and halting referrals to the small group. As a result, the
surgeons say, they lost a lot of business, and are in litigation. “Physicians
who once treated each other and golfed together now don’t speak . . . Patients
complain of being misled about referrals . . . , [and] Veteran nurses have quit
cardiac-care units, citing the poisonous atmosphere among feuding doctors,”
report the Wall Street Journal‘s Anand and Winslow.
Similar disputes are happening around the country, and it’s not all about
revenge. Much of it is about technology; specifically, stents. It takes a
cardiac surgeon to perform invasive and difficult heart bypass procedures, but a
cardiologist can, relatively non-invasively, insert a stent, delaying or
eliminating the need for bypass surgery.
Cardiologists now perform almost a million stent procedures annually, while
bypass surgeries have fallen by more than 20 percent and are likely to fall
further with the success of the drug eluting stents approved in April.
“As technology favors one subspecialty over another, you get very, very large
turf battles” over who treats patients, one expert told the reporters, adding:
“We’re going to see more of these battles where you can literally put some
doctors out of business, and very quickly.”
Said one of the surgeons in the Baltimore group: “My practice that grew for
18 years is dying in two. This is a devastating development in a mature
surgeon’s career. They didn’t teach me about it in medical school.”
Health Futures Digest is published to help redress this predictive
failure, which will only grow more acute as medical technology accelerates. Left
un-addressed, no-one will enjoy the luxury of 18 years of stable growth.
Reference: Anand, Geeta; and Ron Winslow (2003).
“Transformation
of Heart Care Is Putting Specialists at Odds.” Wall Street Journal,
September 10.
Traveling Surgical Training Simulator
A bus outfitted with an operating table, computers, and a simulated patient
called Simantha, is touring cities giving heart surgeons training in the
new FilterWire EX Embolic Protection System, which uses a tiny basket to
trap and remove debris in blood vessels.
Putting technology on wheels helps solve the problem of limited
technical-medical training facilities disc ussed
in the August issue. It is also evidence of the trends to smallness and
portability of medical technology.
Reference: Cobbs, Chris (2003). “Virtual
patient trains doctors: A computerized dummy aboard a training bus helps
cardiologists master a new surgical technique.” Orlando Sentinel, August
27.
Language Interpretation
About 21 million people in the United States speak limited or no English —
50 percent more than a decade ago. Hospitals “are reeling from the major change
in the number and diversity of languages they’re encountering,” says an American
Hospital Association official.
Many providers is to rely on family members — often children — and friends,
because they are convenient and free. The result is significant medical error.
Only a quarter of hospitals train interpreters; how much varies widely.
Articles in previous issues of HFD show that automatic language translation
and interpretation is just about ready to solve this problem, if hospitals will
adopt it.
Reference: Neergaard, Lauran. “Hospitals Look to
Overcome Language Gaps.” Associated Press, September 1.
