Weekly Reading

"I FELT LIKE I WAS BEATING PEOPLE UP at the end of their life. I would be doing the CPR with tears coming down sometimes, and saying, 'I'm sorry, goodbye," says Kendra Fleagle Gorlitsky, M.D., in an NPR piece pointing out how the vast majority of physicians say they hope to die "gently," but go to sometimes brutal and futile lengths to keep their patients alive. Reporter Stephanie O'Neill cites a Stanford study showing that nearly 90 percent of doctors "would forgo resuscitation and aggressive treatment if facing a terminal illness." Ken Murray, M.D., tells her he fits "with the vast majority of physicians who want a gentle death and don't want extraordinary measures taken when they have no meaning." Nevertheless, only about one in 10 physicians say they talk with patients about death. Such conversations would allow individuals to understand that they have options for care at end of life and make decisions that meet their personal wishes. One widow describes how her husband went through an arduous regimen of chemotherapy and radiation that left him bedridden in his final weeks. "And at no point did any doctor say to us, 'You know, what about not treating?'"

"THE DIGITIZATION OF HUMAN BEINGS will make a parody of 'doctor knows best,'" says Scripps Health's Eric Topol in a Harvard Business Review article about how personalized technology will "upend" the provider-patient relationship. The authors describe two emerging business models that they call Goldminers and Bartenders. "Goldminers" are traditional health care players — hospitals, insurers and physician groups — that must better coordinate what they do and find ways to provide more timely, home-based and less costly care. "Bartenders" will come from outside health care — retail, technology, and even apparel — to develop and sell innovations like smartphone apps that give people ownership of their medical data. That, the HBR article asserts, will force providers to "add greater value through relationship-building and deeper understanding of patient needs." As we've reported in H&HN, "disrupters," are hungry to grab a piece of the health care pie, and the HBR article offers terrific insights on how they'll do just that.

"MANY [SURGEONS] STILL DO GREAT WORK" in their 70s, but others should not be practicing anymore." Mark Katlic, a thoracic surgeon at Sinai Hospital in Baltimore, told NPR's Nadia Whitehead last month. "I think the general public would be very interested to know that [surgeons] don't police [themselves] well as a profession." Whitehead's report mentions various efforts afoot in the medical field to change that. For instance, in June, the America Medical Association announced it would convene a group of physicians to develop guidelines for assessing the skills and abilities of older doctors. And last year, Katlic unveiled the Aging Surgeon Program that "invites surgeons from around the world to come to Baltimore to take a two-day test that rates their physical and cognitive abilities." Surgeons can voluntarily choose to take the test or hospitals can request to have their surgeons evaluated. Tellingly, "not a single doctor has stepped forward to take the test," and, Katlic says he's heard that, "a number of physicians have opted to retire when threatened to be put through our program."

"I DON'T WANT TO BE OVERDRAMATIC, but I would use the term, honestly, we're under siege." That's how Bob Krickbaum, CEO of Edwards County Hospital describes the situation facing rural hospitals in Kansas and across the country. Krickbaum was quoted in a Salina Post article that carried the dire headline "Rural Hospitals Search for Ways to Survive." Critical access hospitals usually serve large Medicare populations, and Medicare reimbursements are tightening. Morever, CAHs must provide 24-hour emergency services, a complicated and costly requirement. The Post's BryanThompson reports about a Kansas Hospital Association effort to help small, rural hospitals develop survival plans, including one in which they would give up some or all of their acute care services and become "primary health centers." That's not something Krickbaum and his fellow CAH leaders relish, "but," he says, "the time is coming when it's something a lot of these small community hospitals will have to consider."