arnold relman

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Must-Read: Dr. Arnold Relman On Lessons From Breaking His Neck

Dr. Arnold Relman on YouTube in 2009.

Dr. Arnold Relman on YouTube in 2009.

Dr. Arnold Relman, former editor of the New England Journal of Medicine, has long played a rare role in the health care sphere: He’s an exceedingly senior and authoritative Harvard figure willing to speak out about what’s wrong in American medicine, from financial conflicts to the need for health care reform.

Now, unfortunately, Dr. Relman has new, first-person lessons to share. In a powerful and compelling piece in The New York Review of Books — On Breaking One’s Neck — he describes the stairway fall that nearly killed him at age 90, and offers his assessment of the care he received at Massachusetts General Hospital and Spaulding Rehabilitation Hospital in Cambridge during his time as a desperately ill patient.  Among the lessons he shares:

What did this experience teach me about the current state of medical care in the US? Quite a lot, as it turns out. I always knew that the treatment of the critically ill in our best teaching hospitals was excellent. That was certainly confirmed by the life-saving treatment I received in the Massachusetts General emergency room. Physicians there simply refused to let me die (try as hard as I might). But what I hadn’t appreciated was the extent to which, when there is no emergency, new technologies and electronic record-keeping affect how doctors do their work. Attention to the masses of data generated by laboratory and imaging studies has shifted their focus away from the patient. Doctors now spend more time with their computers than at the bedside. That seemed true at both the ICU and Spaulding. Reading the physicians’ notes in the MGH and Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices. Conversations with my physicians were infrequent, brief, and hardly ever reported.

What personal care hospitalized patients now get is mostly from nurses. In the MGH ICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.

Read Dr. Relman’s full piece here. One personal reaction: I felt a bit defensive for Spaulding; my late mother received excellent care at their Boston facility. But then I thought: If every patient — particularly patients with as much authority as Dr. Relman — routinely reported publicly on where the nursing care was great and where it was inconsistent, that could help lead to constructive change at the places where it’s needed. We often talk about care that falls short in personal chats, but hospitals need that feedback — and perhaps some of it should be public — to help them improve.

Readers, thoughts, reactions?

Hopeful Thoughts On How Doctors’ Groups Could Save Health Care

Dr. Arnold Relman on Youtube

“Multispecialty Groups Could Stem The Growth In Health Care Costs.”

That’s how the New York Review of Books could have headlined its new piece by Dr. Arnold S. Relman, former editor of the New England Journal of Medicine. But what normal person is going to read an article about “multi-specialty groups” — aside from maybe health care staffers who already know what they are?

Even with the nicely enticing headline the Review did choose — “How Doctors Could Rescue Health Care’ — the article may lose many readers through the lengthy wind-up to its main point. Which would be a pity, because how often do we get positive news about the ever-rising, economy-sinking costs of health care?

So let me cut to my take: The national political situation bodes ill for any prospect of cost-cutting health reform originating from the top. But there are signs of a bottom-up movement in medicine that could do the trick: The recent rapid growth of  “multispecialty practices” — heavy on primary care, owned by doctors or hospitals, often not for profit, tending to pay doctors base salaries.

Dr. Relman roughly estimates that such multi-specialty groups may employ as many as one-quarter of the country’s doctors by now. They appeal to young doctors loath to take on more debt to open a solo practice, he writes, and to doctors who want more flexible schedules to spend time with their families.

Why is this good news? The evidence suggests that multi-specialty groups provide good care with the potential to save money, Dr. Relman writes.

There is much reason to believe that such a reformed system could deliver good care for all at considerably less cost and could also control cost inflation—although such a system does not have the remotest chance of being legislated by our national government anytime soon. But what if, as seems likely, the rapid trend toward group practice that I have described were to continue, and almost all medical care were ultimately to be provided through multispecialty group practices? Despite the limitations imposed by the existing health care market, the advantages of organized care might become obvious not only to patients but to business employers and even to legislators and policymakers in Washington.

 

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Heart Med Study Cited As Example Of Problematic Financial Ties

Alison Bass

Alison Bass’s past as a crack Globe reporter is showing. Now an author and journalism teacher, she shows on her blog today that she can still do a bang-up super-fast write-up. She reports on a Harvard event last night titled “Dollars For Doctors: Who Owns Your Physician?” and pointed remarks at the forum by Dr. Arnold Relman, former editor of The New England Journal of Medicine.

The issue: how conflict of interest in medicine drives up costs by increasing the use of expensive new drugs when cheaper generics would do. Alison writes:

It was left to Dr. Arnold Relman, professor emeritus at Harvard Medical School, to showcase a fresh-off-the-page example of how studies that are funded by drug makers and conducted by researchers who have financial ties to the industry present skewed research results that favor expensive new drugs over generics.

His case in point: The New England Journal of Medicine published a study last week concluding that a new anticoagulant known as apixiban (brand name: Eliquis) was superior to the generic drug warfarin in preventing stroke and deaths in patients with atrial fibrillation (abnormal heart rhythm). The study was funded by Bristol Myers Squibb and Pfizer, which jointly manufacture Eliquis, and featured a lengthy roster of authors, many of whom have extensive financial ties to the drug industry (in the form of speaking and consulting fees). At least three of the authors were Bristol Myers Squibb employees, as the fine print at the end of the study disclosed. Continue reading