The Krafty Librarian

Information sciences meets medical search meets web 2.0 at the Krafty Librarian. I don't know what the future of medical education looks like but the future of scholarship will incorporate much of what is discussed here.

Pennsylvania Health Care Reform

Handing over the reins of my PAFP presidency was painless, though I almost missed the inauguration of my successor. The ceremony (which I mc'd) was to begin at 6 pm and I found myself waking up from a power nap at 5:47 still having to get into my tux and navigate 8 floors in elevators hijacked by teenage band members who acted as if they'd never seen an elevator before.

The big discussion in our house of delegates was about the competing versions of health care reform in play in Pennsylvania. SB 1085 got the most discussion, a full bore universal coverage single payer system that has all the elements to actually work, and therefore all the elements to petrify every stakeholder into opposing it. It's being pushed by a group that includes a lawyer, doctor and businessman (all with progressive leanings) and democratic sponsors in the legislature, making chances of action nearly nil. Reminds me of Star Trek:

Kirk: I take it the odds are against us and the situation is grim.
Picard: You could say that.
Kirk: You know, if Spock were here, he'd say that I was an irrational, illogical human being by taking on a mission like that. Sounds like fun!

Plenty of other blog discussion on SB1085 here and here. A hearing would be nice but seems unlikely at present. Still, the primary is only a few days away and the elections are coming up in November, making for a lame duck sine die session that's already building steam.

Other legislation in play: a Maryland like "make walmart pay their fair share" plan that's pretty white bread to me. A no-brainer "don't let insurers retroactively revoke payment four years after they cut the check", not to mention a few more.

New Mexico - Amazing

I recently went on a road trip with the family to New Mexico to explore the region. Pueblo indian culture at Bandelier, atomic energy museum at Los Alamos, browsing Santa Fe galleries, driving back roads to Roswell, then a side trip through Hondo Valley to White Sands before circling back to Albuquerque via Tularosa and Carrizozo.

Most amazing aha's? The stunning Hondo Valley drive in the spring. White Sands national monument: we never expected it to be that great. A great 2003 Sangiovese (Sangiovese!) at Tularosa Vineyards. And if you're ever in Carrizozo make sure to get a green chile cheesburger at the Outpost. Honest food, honest setting. Great all around.

Marketing Metrics meets Public Health

I listened to David Reibstein of the Wharton School* on this Knowledge@Wharton podcast (free registration required) last night while riding home, and it got me thinking about the Press-Ganey surveys we do in our health system. Do we inflate our satisfaction scores by only surveying people bold enough to stay with our practice? I know how to calculate MDRD-GFR. Why don't I know these common marketing metrics? Aren't they a better predictor of what I'm being paid for?

More importantly, how do the metrics like 'market share' relate to similar public health/epidemiology concepts? If patient satisfaction/practice satisfaction is associated with adherence, and adherence with health outcomes, then it would seem we're not paying enough attention to doing right by the patient. Anyone who's navigated my practice's 'automated voice attendant' probably knows what I'm talking about.

*disclaimer-I'm employed by Penn but don't know Dr. Reibstein and am not getting a cut of his book, but would be happy to : )

AAFP now has RSS feeds for news now

Periodically I send Leigh McKinney (Director, Online and Custom Publishing Division AAFP) an email about AAFP publications and how I'd like to bring them into the 21st century. The academy is already the leader in pushing electronic medical records, and they've won awards for some of their online sites, but as a geek I can't help but consider how the academy can more successfully compete for the attention of its members by using new media tools that take advantage of the social networking that is the strength of the academy.

Today Leigh sent me a message to note that the academy has added an RSS feed to their valuable news service AAFP News Now. wOOTt!

Now how about an AAFP RSS aggregator that pulls feeds of interest to the AAFP into one spot (like David Ross' and Jacob Reider's medlogs.com)?

Contracting resources for residents

Had a nice chat with my residents this morning about looking for a job. Stark ("what's that?"); restrictive covenants; need for lawyers, etc. This is an area where it's important to personalize the advice to the person involved, hence my inclincation to point residents to resources and have them identify their own learning issues and approach. Guided discussion is one way to do this but it's not as active as it could be and doesn't take advantage of the 'teachable moment' that every resident feels when they first get a glimpse of what life could be after residency.

Here's a collection of articles on contracting from FPM for residents seeking employment. Also contracting services and demystifying contract terms. FPM is a good general resource but [small print lawyer disclaimer language here] "can't substitute for legal counsel."

Why quality measures don't work in primary care

I've written in my PAFP Keystone Family Physician column about my dissatisfaction with pay for performance measures in primary care. Now Barbara Starfield weighs in. I couldn't agree with her more.

This isn't the first time I've been impressed with her work this week. She presented a plenary at last weeks society of teachers of family medicine meeting that introduced me to the world health chart website and application.

The world health chart is amazing, but clearly in its infancy with regard to the integration of graphic display of quantitative information as it relates to public health. I'm anxious to see local versions of google-map mashups with useful information like the availability of medical assistance dermatology appointments in the Philadelphia area. Alternate mash-ups: physician by appointment availibility, physician by blog, physician by contribution to neighborhood economy, physician by contribution to community health measured by primary care characteristics - availability, comprehensiveness, coordination of care

Anyone up to the task?

Independent Pharmacies still exist

The version of this pharmacy that still exists here in Philadelphia is Davis Pharmacy on Baltimore Avenue in West Philadelphia. Nice story.

Brain Rain Barrels

Do you use a mind mapping software program? Inspiration is my current dumping ground, and it's fine for my casual use, but something that makes it easier to group and connect similar ideas would be nice, not to mention something a little prettier to look at. Tinderbox, OmniOutliner and some of the opensource programs at the wiki mind mapping page seem to be candidates. I use Mac OS X and am a casual GTD beginner, using a backpack account for my various lists. Quicksilver is gold. Stickybrain doesn't do it for me.

My typical inspiration use: jotting notes directly into the diagram view using rapidfire mode. Outline view doesn't do it for me.

What do you use? Why?

Albuterol and Pharma

So why are albuterol inhalers rapidly disappearing from the market? Are CFC's really to blame or is the market transition to HFA inhalers with their higher cost and higher margins to blame. Call me cynical, but this seems to me to be another failing of the current health care system. It takes doing the right thing (eliminating CFC's) and turns it into a profit making - patient hurting debacle.

What am I missing here?

Hello

No the world doesn't need another doctoring blog, but as you'll see if you read for long it's really for me. A place to brain dump all the otherwise forgotten thoughts that enter my too full head. If I put one more thing in I'll forget how to drive.

OK, I suppose it's also an effort to preserve the patience of my colleagues, who would otherwise have to listen to me rant even more than they already do.