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Remember Ebola? How the 24/7 News Cycle Impacts Health Care

Note: This was first published in December 2014 at the Fresh Perspectives blog, but still holds true

Do you remember what a huge news story Ebola was one year ago? For a while, it seemed like the virus was the only story in the news.

In fact, Ebola was likely a top-three — and possibly the biggest — news story of 2014. It certainly was the biggest story in medicine.

Image courtesy NIAID

Produced by the National Institute of Allergy and Infectious Diseases (NIAID), this digitally-colorized scanning electron micrograph depicts numerous filamentous Ebola virus particles (blue) budding from a chronically-infected VERO E6 cell (yellow-green).

The coverage in cable news, print, talk radio and online media illustrated how our health care utilization is influenced by the news. Some hospitals experienced an increase in emergency department visits due to patient concerns about potential Ebola symptoms. At one point, in fact, the CDC was logging 800 calls a day about potential cases of Ebola infection.

None of those calls panned out.

The irony was not lost on physicians who tried to educate concerned patients about Ebola and the need for a vaccine to combat the virus when the same patients then refused a flu shot. For the record, there have been 10 cases of Ebola treated in the United States and two of these patients died last year. By comparison, the CDC reported that as of December 2014, more than 1,000 laboratory-confirmed influenza-associated hospitalizations and seven influenza-associated deaths among children had occurred, despite it still being early in the flu season. During the week ending Dec. 6 alone, the CDC said there were more than 3,400 influenza-positive tests reported to the agency.

So how can physicians — and as educators of future physicians — deal with demand for health care that is influenced by the media?

Well, we shouldn’t trust the “facts” provided in news reports as completely accurate. We’ve all seen stories about new medical studies or other health-related topics presented in the media in an inaccurate way. Oftentimes, the details are misunderstood, or worse, the entire point of the study is misrepresented.

Remember in December 2013, when Katie Couric used a rare side effect of the HPV vaccine to imply that the vaccine was too dangerous and shouldn’t be given? Stories like this are too common. As physicians, it is our responsibility to know the facts so we can properly educate our patients and the public, which means going to appropriate, evidence-based sources for information.

We should be able to put health care concerns into perspective for our patients. As mentioned above, some Americans were mistakenly more worried about Ebola than influenza. We know that even though Ebola is scary and yes, dangerous, we all have a much greater likelihood of facing significant morbidity — and even mortality — from influenza.

It’s critical that we be able to explain these facts to the patients we care for so they can make informed, proper decisions about their health. We can provide information on these topics not only during office visits, but through our local traditional and social media outlets.

If we can work with the media to inform people about real health care concerns and then use that leverage to improve health, we can squelch mass hysteria. For example, we recently learned from the CDC that 2014‘s influenza vaccine was not as effective as we would have liked. Even though the vaccine will still provide some protection, the news reports likely have turned many people off from getting the vaccine.

Before the CDC shared information about the vaccine’s shortcomings, there had been — by comparison — little coverage in the news about why we should be vaccinated against not only the flu but other diseases, as well. Physicians have the expertise and the clout to be able to drive these discussions instead of merely reacting to them. We should all be more involved in steering the conversation toward true health needs that will impact our patients and our communities.

Inaccurate medical information in the mass media can be difficult for patients and physicians to deal with and often causes frustration. Still, as physicians, it is our responsibility to educate and inform people about the realities of media-driven health care utilization.

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Medical Competition: What in the world are we doing?

Note: this originally ran at Physician’s Practice on 4/10/15

As an intern I participated in a rural rotation in central Utah. I worked at a clinic that was one of four in a valley that was approximately 70 miles long. I was amazed at the extent to which the family physicians were able to perform a wide variety of procedures and treat multiple conditions with fewer resources to which accustomed.

Because of the 4 clinics, the physicians at this practice wanted to ensure that they saw as many patients as they needed to keep up their business and avoid losing patients to one of the other practices. One day a 4 year old boy was brought in due to symptoms of an upper respiratory infection (URI). After a bacterial infection was ruled out, my attending offered prednisone as a relieving agent while he healed from the URI. Prednisone, I thought? “It will help dry up his runny nose, give him some energy, and he’ll be back to himself in no time,” he explained to the mother. I was taken aback and asked him later why he would give prednisone, a powerful medication with plenty of significant side effects, to a child for a URI.

“It helps them feel better faster. They came in expecting something for his cold. If I don’t give him anything to help, next time his mother will take him to one of the other clinics down the road and I lose them as patients.”

After returning to my community hospital following this month long rotation, I heard word that the hospital wanted to increase the number of obstetric patients that deliver there. Many providers had stopped referring their patients to deliver at this hospital due to some substantial safety and quality concerns, to the point where there was very little volume of deliveries and the hospital was losing money on the Labor and Delivery floor. If the administration addressed the safety issues, I thought, it would definitely bring back the business.

One week later, the construction of a new floor and overhaul of the delivery rooms began. I wasn’t sure what was going on until I realized that this was the administrations way of competing for more patients; if the area is more attractive, of course more patients will come! The smell of the floor glue and other chemicals quickly became apparent and soon engulfed the entire Labor and Delivery area. But deliveries continued, babies remained in the nursery where the fumes were present, and everyone who worked there had to try to get accustomed to the odors. The administration was fearful of temporarily closing down the unit to avoid losing further patients.

I share these stories to illustrate how competition in medicine often works. Both of these occurrences were before the recent extreme push on patient satisfaction, but they were done in an effort to draw in more patients through satisfying what they thought were critical needs. With our practices and hospitals being business entities, it is not surprising or even wrong to try to draw in more business; this is natural in our current system. The problem comes when patient safety and quality of care is pushed out in order to bring in this business.

As the quality and cost of the care that we provide is becoming more transparent, this will need to become the basis on which we attract new patients. Patients will look for value (quality + patient satisfaction/cost) and will respond to those practices that demonstrate it. We are all aware of some of the pitfalls of this method of evaluation, but the best we can is improve the metrics, not change the principle.

This, however, requires a major change in mindset from all health care entities. We cannot continue to compete on trivial and potentially hazardous grounds; we must start competing on what our patients actually need, which is quality care for as low a price as possible. Though the transition will be difficult, we cannot cover-up the problem with a little prednisone to make us feel better.

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Costco Health Care

I recently published my second piece on what I call “Costco Health Care”. This latest one is at the AAFP’s Fresh Perspectives Blog, whereas the first was at Physician’s Practice. While the two articles are actually quite different in their approach, the common link between them is the waste that we have in our health care system. Unfortunately, a lot of this is unrecognized without hindsight, but the majority of it is known beforehand.

“Every system is perfectly designed to get the results it gets,” and the US health care system is the least-efficient, least consumer-centric industry in the developed world. It’s an extremely convoluted system, with so many superfluous, redundant, confusing, expensive, and deleterious parts, that very few experts/analysts actually understand it! (see Ezekiel Emmanuel’s Reinventing American Health Care for a full explanation of how few people really get it.) To identify such an industry as socialist misunderstands the lack of central organization in it’s structure; to identify it as capitalist ignores the presupposition that the consumer can have full understanding of the implications of their “rational” choices. The system is (and likely ever will be) fully caught in the middle of these two ideologies and can thus never experience the benefits of either, but likely just the harms of both. Hopefully we can at least keep Costco in its intended economic role, instead of permeating our health care system.