"When people are free to do as they please, they usually imitate each other."
- Eric Hoffer, The True Believer
At least have the decency to be vague.
Cancer is Like Cable Television
"Cancer is like cable television. Thirty years ago you had three channels. Now you have 500."
- George Sledge, MD, president, American Society of Clinical Oncology
Picture yourself stuck in a hole that's ten feet deep. A person appears at the top of the hole and offers a six-foot high ladder. What good is it?
When it comes to Arizona's deep revenue hole, Proposition 100 is that shorter ladder. But its approval tells us that we all can act together to get the rest of the way out of the hole and back onto solid ground.
Proposition 100 signals that a majority of Arizonans want the right decisions made to honor our state's values and priorities. We need to continue to call on elected officials and community leaders for renewed creativity and leadership to climb the rest of the way toward a successful and sustainable future for our state. Most of all, we must be directly involved in that effort ourselves.
The image of Arizona has taken a hit lately in the national media. But there is more to our state than distorted perceptions of fear and intimidation. The passage of Proposition 100 is a ladder in the right direction. We need to stop whining and start climbing.
If Proposition 100 had failed, the Arizona legislature had a contingency plan to cut nearly $900 million from the budget. They may get an opportunity to resurrect it if the state doesn't get $400 million out of a total of $24 billion earmarked for a six-month extension of a temporary higher rate of federal Medicaid funding.
Arizona and many other states were counting on the extra dollars to deal with massive budget deficits. The U.S. House recently approved a spending bill that omitted the health care spending because of concerns about the federal deficit itself. With Dems running for reelection in a climate of worldwide deficit spending by government and calls for fiscal responsibility, they don’t want to be tagged as runaway spenders.
The world has been on a collision course between seemingly unlimited needs and limited resources for some time now. We're perilously close to the crash point, if we haven't reached the critical intersection already. One recent analysis, Comeback America, makes a compelling case for both raising revenue and cutting spending if we are ever to get our fiscal house in order. Others, like many associated with the Tea Party movement, believe we should simply slash taxes and get government off our backs.
Except for programs older voters have come to depend on like Medicare and Social Security. Collision course, indeed.
At a recent panel presentation on the Patient Protection and Affordable Care Act (PPACA) before medical students at the University of Arizona's College of Medicine campus in Phoenix, the moderator asked the students how many of them intended to open their own practice or work in a small group practice upon graduation and residency. One or two hands went up. He then asked how many planned to work in large groups, or for a hospital or some other specialty organization. All of the rest of the students raised their hands.
One of the physicians on the panel remarked that this illustrated the principle of Pavlov's Dog: Condition students on the dismal state of solo- or small-group private practice in medicine long enough, and eventually they all will be salivating for regular, salaried jobs in large groups and institutions.
There's some truth to this conclusion. The grass may well be greener for physicians in solo practice or small groups who practice concierge, boutique or retainer medicine, and you don't always hear about those opportunities in medical training today. We suspect, however, that the trend to practice in larger, more integrated groups and settings will continue.
Economics is the driver. Medicine will become a team sport, framed by payer and provider consolidation, integration and emerging methods of payment based on the quality, and not quantity alone, of care. Solo- and small-group practices won't disappear, but they will increasingly be consigned to the margins, and not the mainstream, of care.
We could be wrong, but that's the beauty of not knowing the future. If we could predict it, there would be nothing to learn.
In this period of worldwide political and economic turmoil, one of the hottest topics out there is happiness. Hardly a day goes by when someone isn't releasing a book, publishing a study, blogging or lecturing on this most elusive of subjects: what happiness is, what it isn't, why we want it, how to get it, who has it, and who doesn't.
It hardly stops there. There are those who explain why we should forget happiness and pursue melancholy instead, how happiness is nothing but neurochemical reactions, how it's not okay to be a happy suicide bomber, and so on. An entire happiness industry is evolving before our screen-blurred eyes. Soon you will be able to major in Happiness Studies in college, if you can't already. If you are unhappy, you can hire a Happiness coach.
Where does it end? Somewhere, I hope. Read more in The Drift.
Finally, a way to encourage ethical behavior and improve quality of life in Arizona. Researchers have demonstrated that people are more likely to promote social reciprocity and be charitable when they are in a clean scented room. They compared the behavior of subjects in a room spritzed with lemon-scented Windex and a room with no scent added. Some 22 percent of the subjects in the “clean” room were willing to donate funds to Habitat for Humanity, compared to just six percent in the unscented room.
The reason, researchers say, is that smell is part of the limbic system - the emotional brain. The quickest way to change somebody's mood state or behavior is with smell.
Think about this the next time you're visiting with your legislator about investing in the health and welfare of your community. Carry some air freshener with you. Can't hurt.
Don't check into a hospital in July. That's according to a recent study by California researchers, who studied over 62 million death certificates from 1979 to 2006. They found a 10 percent increase in deaths linked to medication errors in counties with teaching hospitals.
This has long been referred to by physicians as the "July effect:" a spike in medical errors when new residents join hospitals. Residents can put in long hours - 30-hour shifts, for example. According to a professor of sleep medicine who did a survey of public's attitudes toward medical residents' work hours, "one in five resident physicians admits to making a fatigue-related error that has injured a patient, and one in 20 admits to making a fatigue-related error that has resulted in the death of a patient." He said that "Working for 24 hours without sleep impairs performance to a degree that is comparable to being legally drunk."
The Institute of Medicine has concluded that residents should work no more than 16 hours straight. Of course, that would drive up costs - $1.7 billion annually, according to the IOM. The Accreditation Council for Graduate Medical Education is expected to issue its own recommendations later this month.
June 2010
