December 12, 2012 Leave a comment
“Sometimes you want something so much that it slips away from you because you’re holding on too tight. You have to be patient. Even though you want it, you have to understand the best way of going about getting there. You have to stay focused on that. You can’t allow frustration or urgency to kind of choke the process.” – Kobe Bryant
December 10, 2012 Leave a comment
From “There Was No Couch: On Mental Illness and Creativity” by Jalees Rehman.
Before I started my psychiatry rotation in San Diego,
I had been convinced that mental illness fostered creativity. I had never really studied the question in much detail, but there were constant references in popular culture, movies, books and TV shows to the creative minds of patients with mental illness. The supposed link between mental illness and creativity was so engrained in my mind that the word “psychotic” automatically evoked images of van Gogh’s paintings and other geniuses whose creative minds were fueled by the bizarreness of their thoughts. Once I began seeing psychiatric patients who truly suffered from severe disabling mental illnesses, it became very difficult for me to maintain this romanticized view of mental illness. People who truly suffered from severe depression had difficulties even getting out of bed, getting dressed and meeting their basic needs. It was difficult to envision someone suffering from such a disabling condition to be able to write large volumes of poetry or to analyze the data from ground-breaking experiments. The brilliant book “Creativity and Madness: New Findings and Old Stereotypes” by Albert Rothenberg helped me understand that the supposed link between creativity and mental illness was primarily based on myths, anecdotes and a selection bias in which the creative accomplishments of patients with mental illness were glorified and attributed to the illness itself. Geniuses who suffered from schizophrenia or depression were not creative because of their mental illness but in spite of their mental illness.
The whole essay is fascinating and well written, covering hypermedicalization, media bias, sham science, and more.
November 21, 2012 Leave a comment
Rising, he kicked the cat out of the door, and picking up the mouse compassionately put it out of its misery by pulling off its head. Recalled to the bedside by the moans of his patient, the Kind- hearted Physician administered a stimulant, a tonic, and a nutrient, and went away.
November 9, 2012 Leave a comment
…may be shortsighted. Homi K. Bhaba poignantly explains further:
“There is a kind of global cosmopolitanism, widely influential now, that configures the planet as a concentric world of national societies extending to global villages. It is a cosmopolitanism of relative prosperity and privilege founded on ideas of progress that are complicit with neo-liberal forms of governance, and free-market forces of competition. Such a concept of global development has faith in the virtually boundless powers of technological innovation and global communications. It has certainly made useful interventions into stagnant, state-controlled economies and polities and has kick-started many societies which were mired in bureaucratic corruption, inefficiency and nepotism. Global cosmopolitans of this ilk frequently inhabit ‘imagined communities’ that consist of silicon valleys and software campuses; although, increasingly, they have to face up to the carceral world of call-centres, and the sweat-shops of outsourcing. A global cosmopolitanism of this sort readily celebrates a world of plural cultures and peoples located at the periphery, so long as they produce healthy profit margins within metropolitan societies. States that participate in such multicultural multinationalism affirm their commitment to ‘diversity’, at home and abroad, so long as the demography of diversity consists largely of educated economic migrants – computer engineers, medical technicians, and entrepreneurs, rather than refugees, political exiles, or the poor. In celebrating a ‘world culture’ or ‘world markets’ this mode of cosmopolitanism moves swiftly and selectively from one island of prosperity to yet another terrain of technological productivity, paying conspicuously less attention to the persistent inequality and immiseration produced by such unequal and uneven development.”
(from Preface to the Routledge Classics Edition of ‘Location of Culture’)
I was most recently reminded of the one-sidedness of such glorification of ‘world markets’ in reading this article about Bangalore. Think about the last article you read about India. I bet it was either about a lot of people who died in some natural disaster, or about the market potential of the region (or the failure of that potential to actualize).
October 24, 2012 Leave a comment
October 16, 2012 Leave a comment
Here is a trenchant look at one of today’s renowned pundits. Does his intricate web of speaking engagements, honoraria, and written endorsements make him an unfit journalist? Or are our “thought leaders” exempt from scrutiny?
“Intellectual,” however, does not seem the most apt term to apply to Zakaria. His authority seems to be grounded not so much in the power of his intellect (though he is very smart) as in the power of his influence—the simple fact that so many people, especially important people, talk and listen to him. He is what contemporary parlance calls a “thought leader.” And as a thought leader with multiple platforms and rich compensation for airing his perspective, he is also a “brand.” When people pay Zakaria for comment, they are not so much paying him for the intellectual process he has taken to form it, but for the comment itself and the sanction it grants. Zakaria’s opinion is a seal of approval that confirms smart and eminent people—people like Zakaria, who strategize at the Aspen Institute, attend the G8 Summit, or talk shop with CEOs and consultants at conferences on energy security—think one way, and therefore you should too.
(hattip to 3QD)
September 26, 2012 Leave a comment
A recent HealthAffairs articleoutlines the results of a study of Large Multispecialty groups and their readiness for new payment reform. As provider groups prepare themselves to take on new risk models, the success factors for building successful models of accountable care are clear: results-based payment models for physicians, strategic goal setting and effective management (e.g. targeting ED high flyers or reducing readmissions) and of course, effective information management systems.
Look Ma, I’m building an ACO
What was interesting is that even among the ‘advanced groups’ in the study – meaning those who operated on a majority of risk-based contracts (71 percent on average), these success factors are hardly fully implemented. For example, the risk-based groups still doled out about half of their compensation (to both PCP’s and specialists) in volume-based contracts (compared to 85 percent of the FFS group). The management strategy was a little bit better, with 82 percent of those practices having implemented some kind of targeted policies or programs for readmission, compared to 70 percent of the FFS group.
Where did the Risk-based advanced group really blow their FFS counterparts out of the water? Data Management. While both groups fared well in having a shared EMR or a results management system (radiology/lab tests integration), 100 percent of the risk-based groups had a data warehouse and analytic software, 60 percent had disease registry systems, and 70 percent had practice variation analysis software. Only 10, 20, and 10 percent of the FFS practices, respectively, had implemented those systems.
So what does this mean?
Quite simply, advanced data management capabilities are at the heart of an effective accountable care model. Nothing we didn’t know before – but still a green light for the analytics industry and vendors who prove themselves in the space in the coming months.
EDIT – This article just came out. ACO’s are expected to spend $1-4 million depending on their size.
