The band is back in stunning form with new contemplative, yet accessible music. Well, not exactly new — but sorely needed in an age of slick, manufactured pop that seems to be characterized by personality-driven artifice than by stable songwriting, uncomplicated lo-fi riffs, and a WYSIWYG ethic. Enter Arcade Fire and their excellent The Suburbs. First track from the album, “Ready to Start” is probably the best place to dive in to this conceptual collection of songs  – a track in which the listener is confronted with the stark imagery of fractured cities and dropped bombs. Okay, just a tad morose, but, given the rather plaintively expansive structures of many of the arrangements on the album, it sets the tone for its16-track, 1+ hr runtime. Listening to the sprawling album’s interpretation of exurban sentiment, one gets a taste of hopelessness — yet promise of societal redemption noticeable by its conclusion. Fall ’10 tour kicks off right here in St. Paul.

Oh, and yeah, it really makes for great running and/or studying music. | LINK

What do you get when old-fashioned community activism meets 21st century social media tech? Perhaps the best politics-is-local example of reforming healthcare access so far after its passage on a national scale. Howard County, Md. – approx pop. 250 000 — is partnering with a tech firm with one simple goal in mind: to guarantee access to healthcare for its uninsured.

Its mechanism looks to be a harbinger for reform-based enterprises such as local healthcare exchanges/cooperatives (whether subsidized or not) within which members pay a monthly fee for basic services. These services may run the gamut of primary care — as acute hospitalizations, preventive medical treatments and screenings, and emergency medical access would be covered.

Perhaps even more important, the utilization of concierge providers as healthcare “coaches” as both an empowerment mechanism and compliance tool, ensures continued healthcare access, sound preventive care, and decreased future healthcare costs. Will it serve as a model for state-based healthcare exchanges under reform? Looks like it’s on its way. | LINK

Sad to hear today of the death of Dr. Robert Butler from complications of leukemia. The appellation “father of modern gerontology” is a well-deserved one, as I referenced his research and teachings throughout much of my training as a  resident and fellow. Many of the I principles incorporate into my daily practice have come from what this pioneer so dutifully studied in over 300 scholarly articles and publications. Although he was a psychiatrist by training, his contributions to geriatric medicine virtually created the discipline itself.

Butler was the first clinician who coined the term “ageism”, the result of such forward-thinking approaches to the geriatric patient that was characterized by the medical practice free of biased attitudes and treatment assumptions that, if employed today, would cause harm to many elderly patients receiving chronic medical care. Indeed, many of his sound principles so sacrosanct to the practice of geriatrics and study of gerontology sprang forth from his diligence, inquisitiveness, and yearning for the dignified treatment of the elderly patient. He will be missed. | LINK

Some headlines prior to the Independence Day holiday. Normal posting resumes here at Doctor Pundit on July 6. Have a happy and safe holiday weekend!

• Veterans Admin admits to the debacle surrounding dirty dental instruments placing hundreds of patients at risk of HIV transmission. [LINK]
• Minnesota nursing strike may be averted, but time will tell if threat to strike was more of a bluff. Hospitals and nurses pledged to work within the constraints of internal governance. [LINK]
• How’s healthcare reform going? Just fine, according to some. [LINK]
• How influential will states’ insurance commissions be when regulating insurers’ medical loss ratios in the age of reform?
  

  The medical-loss ratio measures how much of premiums insurers pay out for medical care versus administrative costs. The new law requires that insurers use at least 80% of the premiums from individuals and small businesses to pay for medical care and profit-taking, and 85% of premiums from larger employers. Health insurers are waiting for regulators to clarify how companies must account for the numbers—whether they can average the MLRs of their subsidiaries, for instance.

  [LINK]

• Study: Genes key to longevity. [LINK]

Most attending physicians well out of training know of the continued discussions on local, regional, and national levels regarding the most “acceptable” amount of hours residents in training are able to work in any given week. I trained in New York state (Syracuse) in the mid-1990s, fresh off of statewide regulations limiting overage due to some high-profile cases out of NYC involving adverse patient outcomes at the hands of fatigued physicians in training. However, no matter how well enforced many of these statutes are by states, training hospitals have always seemed to have the final say — citing financial and training constraints.

This week’s NEJM includes guidelines (still in an advisory period before final recommendations are proposed) put forth by the residency programs’ accrediting body. Among other things, a tiered system of hours is offered for first year residents (interns) to cap hours at no more than 16h/day, as opposed to more senior residents who may be in a better position to supervise and prevent error. These proposals may not go far enough, though, as oftentimes there are a host of other factors at play in overall patient care delivery by residents in an academic hospital setting — qualitative measures that are difficult to quantify for the purpose of making simple preventive interventions. | LINK [PDF]

A new twist on old news. While practically everyone with a vague association to healthcare delivery in this country knows that there is a primary care shortage, it is always refreshing to see fresh innovation to lure more talented docs to the specialty on the part of some medical schools and educational entities (…even hospitals):

[Johns Hopkins] has launched programs to bring cheap specialty care to the uninsured and primary care to those who tend to go to the emergency room. And [John ]Feldman’s [director of the school's Urban Health Residency Program] six-year residency program aims to annually produce four primary care physicians who eventually could become leaders in the field by opening a federally backed health center, directing a primary care clinic or becoming a city health commissioner.

LINK

One look at the infographic below, and you’ll see that alrazolam (Xanax) was the most prescribed psychotropic in the U.S. last year. Interesting, but not surprising. Via GOOD. | LINK

Prescription Psychotropic Infographic via GOOD

The three-volume Oxford Textbook of Medicine, coming in at a staggering 6000+ pages, is officially and completely online. Its publisher, the Oxford University (UK) Press, is leading the way of e-reference for any interested party by aggressively placing much of its library on the online space (not free, however). What makes this event more compelling is that the text, referenced by everyone — from medical students to journalists — will be following a wiki-style constant update and renewal strategy. The medical reference is apparently also source for international evidence-based medical information, making its updates and revisions all the more timely. | LINK | LINK2

Enjoying Wikipedia (if you’re really into that kind of thing) just got a little cooler. Previously only available to logged-in members and admin, the option to create a physical paperback of one’s own editing is now open to anyone. The collaborative encyclopedia has a history of content delivery via third-party hardware devicers, but this is the first time the online giant has made such a decidedly retro approach to content delivery available to the masses. And it’s all possible as a result of its partnership with PediaPress. Check out the very interesting how-to below.

Becoming your own editor of your own specialized content. Talk about a sterling endorsement for narcissism…

Schools of medicine have largely remained timid about the introduction of courses on the business of medicine or any topics related to issues of medical economics. I graduated medical school in 1994, right around the time I first heard the term “HMO”. Physicians were set free after graduating from undergraduate education to fend for themselves and the postgraduate training programs which had no guarantee of preparing those new doctors for anything remotely resembling the financial aspects of the field which would define them for the rest of their professional lives. That’s slowly changing, however. You can credit the national debate on health reform for that.

[E]scalating costs and the national debate over the health care overhaul are forcing medical schools and residency programs to grapple with teaching about the financial side of their profession. Accrediting organizations now require such teaching, and students and residents recognize that they need to understand finances as well as blood tests.

Although physician employees may not have direct control over the day-to-day costs of providing care, there is nothing negative about keeping them in the dark about it until after formal training. They’ve gotta learn sometime. | LINK

Although I have a week to wait to get one (the 3G-enabled + WiFi), the iPad WiFis are starting to encroach upon e-health as a realm of future dominance.

A hospital district in Visalia, California, has ordered 100 iPads to provide staff with access to rudimentary applications like e-mail, as well as X-ray images, EKG results and patient monitoring programs around its five sites.

Nick Volosin, the hospital’s director of technical services, thinks the iPad is a superior alternative to both laptops and the specialized touchscreen tablets often used by hospitals — it’s portable, has a 10-hour battery life and costs merely $500 (other devices can fetch close to $3,000).

Many training programs and health systems have incorporated the iPhone (by virtue of its rich app interface) into the traditional medical-administrative workflow for quite a while now; who’s to say that an oversized 3G-enabled iPhone (that just happens be an iPad) couldn’t do the trick? | LINK

The morning after the historic vote on healthcare brings the realization which no one can take away: that the healthcare delivery system has been changed at its fundamental core. President Barack Obama set out to define his presidency in some way, for better or worse, with a nod toward progressivism — a designation that shouldn’t carry the partisan political definition, but rather one which denotes movement in an entirely different direction. As healthcare delivery was redefined midway in the 20th century to acknowledge the evolving sociopolitical demographics occurring its midst (formation of Medicare and Medicaid), the entrenchment of these legislative steps forward practically ensured their essential nature within the fabric of public policy as it relates to healthcare. That is, one cannot imagine health policy without the delivery of healthcare financed or influenced in some part by these federal guarantees. Ironically, it was the presence of such entitlements which the GOP felt compelled to defend as part of its antipathy for any movement or evolution toward sustainable healthcare delivery in the rapidly changing sociopolitical environment of the nascent 21st century.

Barack Obama understood this and tried to take control and possession of the movement. Yesterday’s historic vote by the House underscored his desire to do so, again — for better or worse. The coming days, weeks, and months will bring punditry on either side of the issue which — at the very least — will make for stimulating and educational discourse. And, perhaps that is a good development. Social legislation such as this requires national discussion, as change of this import will probably not take place quietly — nor should it.