Category Archives: Uncategorized

Calling A Code Blue on the US Healthcare Reform Initiative:  My Visit to Capitol Hill

Kevin R. Campbell, MD, FACC

 

In the past month, I made yet another trip to Washington DC in order to make the case for meaningful healthcare reform.  While Congress continues to play partisan politics, patients and doctors continue to suffer. According to the Mayo Clinic, physician burnout is at an all-time high with nearly 50% of all US physicians reporting experiencing the symptoms of burnout in the last 3 years.  The Journal of the American Medical Association (JAMA) reported in 2015 that 30% of young physicians had symptoms of depression or suicidal ideations.  In fact, Suicide accounts for 26% of deaths in physicians ages 25-39 as compared to 11% of deaths in individuals of the same age in the general population.  Physicians are leaving practice at an alarming rate, with a shortage of over 100K physicians expected in the next decade. For patients, frustrations continue to mount.  Rising premiums, diminished choice (only one choice in nearly 23% of counties in the US and only 1 or 2 choices in 41%), and limited access have patients scrambling for their basic healthcare needs.  Medicaid expansion has not happened in over 1/3 of the States and many are left uninsured—millions more are underinsured.  Medicine continues to focus on the treatment of disease rather than on prevention. Patients are not getting proven screening therapies and many cannot afford necessary medication due to rising costs.   Clearly, something MUST be done.  Healthcare in the US is on the verge of a major collapse—poor care, poor access and likely physician shortages are looming.

Dr. Campbell Goes to Washington

I began making phone calls about a month before my visit in order to set up meetings with key Congressional influencers and leaders.  I was able to secure a few meetings and set off for DC.  On arrival on Capitol Hill, I was amazed by the general lack of interest in the healthcare debate (other than when cameras are rolling for the mainstream media).  On the day I entered the Rayburn Building (which houses most of the House of Representatives offices), there was a long line of people and politicians were buzzing around in the hallways—all due to more hearings on Russia and our election as well as President Trump’s tax proposal announcement—almost no one was interested in discussing healthcare.  I was able to secure meetings with a few Congressional offices and staff, including the Deputy Whip, Patrick McHenry from North Carolina.  I was able to meet with Congressman McHenry’s team and spent nearly an hour going over issues with healthcare.  They listened, took notes, and promised to follow up in the coming weeks.  They seemed truly interested and empathized with the plight of patients throughout the United States.  I also met with staff from Vern Buchanan’s (R-Florida) office and shared more of my concerns. Mr Buchannan sits on the Ways and Means Committee and is influential in discussions concerning healthcare expenditures and funding of healthcare related programs.   Interestingly, both of the Congressional staffs that I met with seemed genuinely surprised about my report of the “real” state of healthcare, particularly when I discussed issues of billing, reimbursement for physicians and the cost of drugs and medical devices.  I really think that many of our Congressmen and women are not adequately informed about healthcare related issues because they do not have to deal with the system in the same way that doctors and the average American patient have to on a daily basis.

Healthcare and Congress, On Life Support

I really believe that there is little hope for saving the US healthcare system during the next 4 years.  After more than 7 years of criticizing the ACA and campaigning on promises to repeal and replace, the Republicans have little to offer.  One would think that during the two Obama terms, the Republicans could have been working on a viable replacement plan—but clearly they have not.  In Medicine, we are always taught to be prepared, to be able to be flexible, and respond to unforeseen circumstances.  We meticulously plan our treatment, or surgical approach and our next steps.  Congress, after winning majorities in both Houses and also taking the White House, has shown a lack of preparation to actually govern—particularly when it comes to healthcare.  The Democrats, always simply satisfied with the status quo, refuse to admit that Obamacare is not viable in the long term and have not put forward ANY plans to address its failings.  Most of their energy has been put in to thwarting any legislation put forward by the opposition.  The Republicans, due to bitter infighting within the party, have crafted piecemeal replacement plans that are likely to show no real improvement—in short, these plans simply “rearrange deck chairs on the Titanic”.

What MUST Happen Now?

In the hospital, when a CODE BLUE is called, all available staff rush to the bedside of a patient who is in distress.  In most cases this means the initiation of CPR of cardio pulmonary resuscitation and any necessary heroic measures are employed in order to save the patient’s life. Any indecision or any delay in treatment can result in death for the patient.  However, if the CODE team works in concert, with a single goal (of saving the patient’s life), comes together quickly and effectively, a positive outcome is far more likely.   It is now time to call a CODE BLUE on healthcare in Washington DC.  We must demand that both Houses of Congress focus on real, meaningful healthcare reform.  Any delay, much like with a patient who is in distress, will lead to disaster and ultimately, death.  Not only for healthcare as we know it, but ultiamtely for doctors and patients as well.

 

Lessons Learned from The South Pacific: Implications for US Healthcare

Kevin R. Campbell, MD, FACC

For the last several weeks I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki.  Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power).  The inhabitants are subsistence fishermen and farmers and are filled with joy and a real sense of community.  While on the island, I found extremely high rates of high blood pressure and moderate rates of type 2 diabetes, but overall, I found a very happy and healthy indigenous population.  Previous research has shown that the South Pacific islands have the second highest rates of type 2 diabetes in the world–but there were fewer cases on Batiki than I expected.  My time on Batiki has led me to reflect on the beauty and passion of its people and how we, as Americans, can learn so much from them when it comes to living a happy and healthy life…

 

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(Image with permission, courtesy of Sea Mercy)

Life on Batiki: Back to Basics

I traveled to the South Pacific as the medical director of a charitable organization known as Sea Mercy.  This organization was formed by businessman Richard Hackett as a way to respond to the devastation caused by tropical cyclones over the last several years.  Many islanders lost everything—homes, families, possessions and many still struggle to survive. Yet they are incredibly resilient and continue to enjoy the simple lives that they have

During my time on the island, I was fortunate enough to spend two weeks living with the villagers in Mua (one of four villages on Batiki) as a guest in the home of the island Chief.  I was able to learn a great deal about the culture and values of the Fijians and I gained a great deal of insight into what really makes us healthy—its not always expensive healthcare plans and pricey name brand medications.  In the case of the villagers of Batiki, much of what makes them healthy is their ability to do so much with so little.  They live off of the land around them and they do not seek care for routine aches and pains.  It was not uncommon for me to see patients in my makeshift clinic that were suffering from orthopedic injuries for months or years.  Many had sprains, healed bone breaks and old cuts—but all continued to work and play.

In addition, the focus on family and community—on supporting one another—seems to result in an increased emphasis on group activities and family meals.  For example, almost every night, the men of the village—both young and old—played rugby games for hours.  The girls played a game called “net ball” and also enjoyed volleyball.  The children loved to swim and run up and down the beach.  Dinners are family events and everyone gathers around a tablecloth placed on the floor to eat together.  While the meals are NOT well balanced—far too carbohydrate heavy and lacking in proteins and vegetables—they are family events.

In the clinic on Batiki, a government paid nurse provides healthcare services for the entire island (four villages) with very limited supplies.  She has no running water or power in the clinic and has a variable stock of diabetes medications, Blood pressure medications, anti inflammatory medications and vaccines.  Due to cultural stigma with seeing a doctor or nurse, it is often difficult to get villagers to come to the clinic and many diseases go undiagnosed and untreated.  In order to overcome this when I was on the island, I made house calls to protect patient privacy.  Rather than use imaging tools and expensive tests, I made complex diagnoses such as Lupus, Neurofibromatosis and others, simply by history and physical examination.  I spent more time talking to patients and their families and did not spend any time imputing data into a medical record or filling out billing forms.  The focus was on the PATIENT.  Imperical treatment and follow up helped confirm most diagnosis and also resulted in a refinement of a patient’s therapy.  In the US, we are far too obsessed on testing and often forget about the power of the patient interaction.

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(Batiki nurses station–photo courtesy of Dr Kevin Campbell)

So, What Can We Learn from Healthcare on Batiki?

One of the founders of modern medicine, Sir William Osler once said that “if you listen to the patient long enough, he will tell you what he has”.  This has been proven to be very true over the years and has been the basis for the doctor patient relationship for decades in the US healthcare system.  Unfortunately, we no longer value the doctor-patient relationship in the US.  Those that mandate the way in which healthcare is delivered (not doctors, mind you), value billing and coding documentation via electronic medical records far more than they value the time a physician spends with a patient connecting on an interpersonal and very human level.  On Batiki, healthcare is both more complicated and actually a lot simpler, all at the same time.  While resources are scarce and you must carefully choose when to use antibiotics or other drugs that are common in the US (and in short supply there), you also are not weighed down by bureaucratic paperwork, rules and regulations.  The patient is the focus of the interaction, not the computer.  There are no practice or hospital administrators—only a team of nurses and doctors who want to get a job done.  On the island, medicine returns to its purest form—listening to symptoms, observing the patient and making a best guess as to the diagnosis based on available data.  Patients heed the advice of the physician and actually WANT to follow the treatment plan.  They do not come in to the clinic as the “worried well” or looking for pain medications—they seek care for problems that they cannot manage any other way.  Both doctors and patients benefit from every single interaction because each and every interaction is unique and unrushed.  Doctors are not stressed due to unmanageable patient volumes and patients are not upset at wait times.  Everyone is happy to be alive and everyone is working towards a common goal—better health and a happy life.  Those in power in Washington DC could learn a lot about healthcare from my friends in Batiki.  Rather than catering to special interests and allowing costs to spiral out of control, focus on what matters most—THE WELLNESS of the PATIENT and the PREVENTION of disease.  If we shift gears and change our paradigm, we all be better for it.  I expect that healthcare costs will stabilize and that outcomes may even improve.  Currently we spend more money per capita on healthcare than any other industrialized nation yet our outcomes are not nearly the best in the world—so, in my mind, something has to change.  I think we must look to the far away parts of the world for guidance.

How Has Batiki Changed Me?

After my experience on the island, I am forever changed—I like to believe that I am now a better physician, a better person as well as a better husband and father.  My brothers on the island of Batiki have taught me many valuable lessons—most importantly, I have learned to live in the moment and to appreciate the little things in life.  I am grateful for many things that I once took for granted—a warm shower, a soft bed, a healthy meal and time spent with family and friends.  For now, it is my hope that my “Batiki transformation” will allow me to do a better job advocating for my patients and will allow me to  inspire others to continue to fight for a better healthcare system in the US today.

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(Photo of Batiki, Courtesy Dr Kevin Campbell)

 

 

 

 

Nothing Really Changes: David Bowie was Right…..

Kevin R. Campbell, MD, FACC

CEO, K-Roc HealthCare Consulting, LLC

In one of his famous songs, “Changes”, David Bowie wrote: “where’s your shame, you’ve left us up to our necks in it” This lyric seems just as appropriate today as it did when he first published the lyric in 1971. Our leaders in Washington have done little this year other than bicker, obstruct the legislative process and stir controversy via twitter. All this is happening as the world is becoming an even more dangerous place—North Korea has ICBM capabilities, Syria continues to murder its own people and millions of Americans are suffering without adequate healthcare. Both parties are to blame. When I study history, there are always inspiring leaders that become the icons of their time—today there are NO heroes in DC.

The last week has been particularly disappointing. After 8 years of criticizing Obamacare and even putting legislation on Obama’s desk to repeal the ACA (which was promptly vetoed), a now Republican controlled Congress has not fulfilled its most central promise—reform healthcare. In addition, President Trump, who promised to protect the LBGTQ community when on the campaign trail, has now unilaterally banned transgender Americans from serving in the military. Infighting and leaks within Trump’s White House staff have created even larger distractions—and unparalleled provided fodder for light night television. All the while, our nation’s problems continue to grow without ANY real solutions on the horizon.

Just when I thought Washington could not get any worse, our elected officials have found a way to sink even lower.

As a lifelong conservative and registered Republican, I made a difficult decision this past week. I revised my party affiliation.

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(Photo courtesy of Dr Kevin Campbell)

My disgust crosses party lines—Democrats such as Hilary Clinton, Nancy Pelosi and Chuck Schumer represent all that is wrong with politics. Self-serving, out of touch long time politicians who care more about their own personal gain than those who the supposedly represent. The Republicans—who promised immediate action if they were given the power to pass legislation—have provided the American people with the biggest “bait and switch” in history. Rather than focus on moving on important legislative matters, both Republican controlled houses of Congress have simply stalled any progress due to intra party disagreements.

Ultimately, those in Washington need to be held accountable for their inaction. No longer should we, as voters, focus on a two party system and work towards protecting a majority or voting along party lines. I believe that each of us must carefully evaluate the job our leaders are doing and clearly call them out on any missteps. When Senators and Congressmen and women are up for re-election in our districts—and it is clear that they have not worked to move our country forward—we MUST vote them out. WE, as AMERICANS, can impose our own term limits. No longer do we have to tolerate the same disgusting politicians every single year. WE have the ability to invoke CHANGE—and, as David Bowie writes, “Time may change me, but I can’t trace time…” Simply put, we don’t have to retrace the past in Washington year after year—vote for change.

 

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(Screenshot via Wikipedia)

Wake UP Congress: America is WAITING for Healthcare Certainty

Kevin R. Campbell, MD, FACC

Cardiologist and CEO, K-Roc Consulting LLC

In the last week, the Senate has failed to produce a viable bill to reform healthcare in the US. BOTH parties are to blame. The Democrats, led by Chuck Schumer have made it clear that they are focused on obstruction of ANY legislation. The Republicans, who own a majority in both houses, cannot seem to come to any consensus—infighting has crippled Republican leadership and severely limited their ability to pass any significant legislation. Sound bites are dominating the news with each side of the aisle pointing fingers at the other. Political posturing is consuming the time of our Congress and very little cooperation and progress is apparent. Democrats accuse the Republican majority of secrecy and a lack of transparency during the development of the healthcare bill—the exact same behavior exhibited by the Democratic majority during the creation of Obamacare more than eight years ago. All of the men and women in Congress were elected to do a job—unfortunately, most are spending more time championing individual causes and playing to cameras than they are actually working to negotiate solutions to legislative problems. As we celebrate the 4th of July holiday this week, I expect better from those who are elected to represent the people of this great country.

 

The Current Issues:

  1. Obamacare is no longer viable. While the ACA legislation does insure large numbers of Americans on paper, the reality is that many of the newly insured have been left with minimal access, high costs (that continue to rise) and very limited choice. If Congress chooses to do nothing, it is likely that more insurers will abandon the exchanges and leave even more Americans will be left without any insurance choices—AND, under current law, be fined for not having insurance (even though there may be nowhere to purchase a plan). Moreover, the uncertainty in the insurance market has resulted not only in a mass exodus of insurers but has also driven up premiums to levels that prohibit many from affording anything more than “catastrophic” type plans with high deductibles and minimal coverage. There is no focus on preventative care and many Americans continue to go without any care at all.

 

  1. The current Republican proposal in the Senate does some—but not nearly enough– to fix the problems with the ACA. While the Senate bill does eliminate the individual mandate and many of the taxes associated with Obamacare, it does not address many of the core issues that both doctors and patients consider vital to any meaningful reform. For instance, there is nothing that addresses the rising prices of pharmaceuticals (and price gouging by pharma CEOs). Americans pay more than any other country in the world for drugs—Why can’t Medicare negotiate prices with pharma? In addition, there is no provision to allow for the purchase of drugs from foreign pharmacies such as those in Canada. Allowing foreign competition will certainly lead to lower prices within the US. Additionally, the plan does little to limit insurance costs—we were promised legislation that would provide for free competition among insurance companies across state lines—in order to allow free market forces to lower prices and improve services. This has not occurred and is not part of any Republican proposal in the Senate. Most significantly, there is no attempt to address tort reform in order to lower healthcare costs. Doctors continue to drive costs by ordering unnecessary tests in order to avoid frivolous litigation by trial lawyers.

 

My “4th of July” Take

It is clear that neither Democrats nor Republicans are ready to come to the table to work together towards meaningful reform. The President has offered little leadership of substance in the healthcare debate other than making vague statements such as “we are going to get this [healthcare] deal done and its going to be great”. Both sides are to blame for the rising cost of insurance and the runaway prices of pharmaceuticals. While the Democrats are unified on a plan of ‘legislative resistance’, Republicans continue to bicker about whether or not the healthcare bill is ‘too moderate’ or too conservative’. At this point, I do not believe the Republican proposal goes far enough to fix the pending healthcare crisis in our country today. Ultimately, doctors want to be able to take care of patients without government interference and patients want the freedom to choose their healthcare and purchase an affordable insurance plan that best meets their individual needs. We must get Congress to act—we need transparency in healthcare pricing and we need to hold both pharma and insurers accountable. We must also hold lawmakers accountable in November—either get the job done, or get out. America can no longer tolerate the status quo in Washington. The 4th of July symbolizes our right as Americans to determine our own destiny. Remember, the election of 2016 was all about disruption and a rejection of business as usual—Wake Up Congress, you have been put on notice. Fix healthcare or the voters will once again speak loudly during the next election cycle.

 

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The VA System Should Address the Physician Shortage By Hiring More Physicians, NOT by replacing them with NPs.

Kevin R. Campbell, MD, FACC

Cardiologist and CEO, K-Roc Consulting LLC

Contributor, Washington Examiner

 

In January of this year, the Veteran’s Administration (VA) made the decision to allow Nurse Practitioners (NP) to practice without any physician supervision. While NPs have a vital role to play within the healthcare system, they are NOT doctors and they are not qualified to replace physicians—even in a primary care environment. Those in leadership within the VA system argue that the physician shortage has left them with no choice but to allow NPs to practice unsupervised. However, I believe that we should be addressing the physician shortage by actually recruiting more physicians to care for primary care in the VA system. Our veterans deserve the very best care—and while NPs are caring, competent members of the healthcare team, they do not have the same training as physicians and are not equipped to fill the role of an independent physician. According to current VA statistics, there are roughly 93,500 nurses employed by the VA—of these 5,700 of them are advanced practice, meaning they have a master’s or doctoral degree in a nursing specialty. In the past, individual states are able to determine whether or not NPs are able to practice independently and 22 states already allow unsupervised practice.

How are NPs and Physicians Different?

Nurse practitioners and physicians are trained in very different ways. Physicians first must obtain a four-year undergraduate degree and then attend a four year medical school. Following medical school, physicians must complete an Internship and Residency with more than 21,000 hours of a standardized educational and training process. The minimum residency program is three years, and some specialties require almost 10 years of post-graduate training—all before ANY independent and unsupervised practice is allowed. By contrast, advanced practice nurses obtain around range from 3,500 to 6,600 hours of coursework and formal training—including Master’s or Doctoral degrees.

Physicians complete endless years of “in house” training in hospitals (taking overnight call as frequently as every third night). During these overnight shifts, physicians learn—while being supervised by an endless hierarchy of medical professionals—how to diagnose and manage very complex diseases. Nurse practitioners do perform time training in a clinical setting but they do not have the same responsibilities nor autonomy. Residency and other practical on the job training teaches young doctors judgment and improves clinical acumen—and this takes years of practice. Nurse practitioners simply do not have the same opportunity to gain these insights.

Before The Angry Response Begins—Everyone Has an Important Role to Play on the Healthcare Team

When I write articles such as this, I am often met with harsh criticism from professional organizations that represent advance practice nurses. Let me say at the outset that this is not a turf war—it is about making sure that every patient has access to BOTH a competent caring and well trained physician as well as an exceptional advance practice nurse. Rather I am arguing that we should continue to develop the idea of a TEAM approach to healthcare. Advance practice nurses are very good at developing meaningful relationships with patients and they are very good at treating common ailments and disease. Patients enjoy the time that NPs are able to devote to them in the office or hospital. Physicians are often rushed from patient to patient and procedure-to-procedure and do not have the same luxury of time to spend with the patients who need us. Physicians are exceptional at recognizing clues and symptoms and DIAGNOSING disease. Advance practice nurses, while exceptional in their role as caregivers and in the treatment of common primary care ailments, they simply do not have the experience needed to make complex diagnoses. While many NPs will argue that there are data from 2014 to show similar outcomes in patients managed by NPs versus physicians, the devil is in the details. The studies did not report whether or not the NPs were consulting with physicians in the management of their patients or whether they were practicing alone. In addition, none of these studies actually looked at DIAGNOSITC accuracy. Making the correct diagnosis and choosing the most appropriate treatment is the most important job of primary care physicians. As diseases do not always present as they do in a textbook, this is where experience and extensive training can make all the difference in the life of a patient. Physicians are used to working in packs—different doctors have different specialties and areas of expertise—we refer to others when we are outside of our specialties. Nurse Practitioners are asked to work with a wide variety of patients and often, in my experience, they do not know when to refer for a higher level of care or for more advanced treatments by a specialist physician—these instincts come from years of experience—like the experience gained during post graduate residency training.

The Bottom Line—Don’t Replace Physicians, Augment the TEAM

The VA and other states that are allowing independent NP practice are looking for a quick fix for the doctor shortage. However, those in charge are not putting the best interests of patients first—they are simply “filling coverage holes”. Rather than allowing NPs to practice outside of their scope of training (ie without MD supervision) we should be working to figure out why doctors are leaving the healthcare industry. We need to examine quality of life and burnout and we need to begin to listen to the needs of our healthcare providers. We must recruit more young dedicated primary care doctors AND, at the same time, expand the role and significance of NPs on the healthcare team. Until we do this, doctor shortages will continue to mount. Inadequacies in the VA system such as long wait times, fraud and abuse are more about the VA leadership and administration than they are about physician shortages.

 

We must also work to promote more understanding between physicians and advanced practice nurses. We must all work with a single goal in mind—providing patients with outstanding care and improved health outcomes.

So, for now, I must strongly object to the decision made by the VA system. Patients definitely need nurses—and advance practice nurses—BUT they also deserve access to a licensed, board certified, residency trained Doctor as well.

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(image via screenshot of VA.gov website)

 

 

Wake Up Call to the ADA (American Diabetes Association): Medicine (and Medical Meetings) are Now Digital….A Cautionary Tale

Kevin R. Campbell, MD, FACC

@DrKevinCampbell

Cardiologist

CEO, K-Roc Consulting LLC

Over the last 48 hours, Twitter has exploded with angry commentary directed at the American Diabetes Association (ADA) after the organization actively attempted to censor what was posted on twitter during their annual sessions this past weekend in San Diego. The fiasco began when an attendee posted a picture of slides on twitter—in an attempt to “LIVE Tweet” during a session on the recommended #ADA2017 Hashtag. The @AmDiabetesAssn twitter feed then began to post tweets instructing individual attendees to take down specific tweets that involved photography. In fact, the ADA twitter feed at one point was dominated by their repeated requests for attendees to delete tweets. Quickly, the censorship became the focus of the hashtag—not the science. Comparisons to George Orwell’s “thought police” from his novel 1984 were made on social media platforms including twitter.

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What followed was nothing short of “twitter outrage”. Twitter has become one of the most important tools in scientific information sharing in modern medicine. For many, meeting attendance is not always possible—some physicians have to stay back at their respective institutions and care for patients. Others who are based in another country may not be able to afford the time and cost associated with travel to the United States. There has been a huge push by most academic societies within my specialty of cardiovascular medicine to actively participate in the meetings from a virtual platform and guidelines for virtual participation have been published in Forbes magazine. Many of us in cardiology are very active on twitter and we began to debate the merits of such an outdated and restrictive policy. After a matter of hours, numerous leaders in the cross section of Social media and medicine, such as Dr. Michael Gibson (@CMichaelGibson) became the most influential members of the #ADA2017 hashtag.

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(Screenshot image via Symplur.com Healthcare Hashtag Project)

Most societies have worked diligently to engage members online and have promoted “LIVE Tweeting” at their respective Annual Scientific Sessions. In fact, at the Heart Rhythm Society (@HRSonline), we actually provided attendees with a special “Social Media Guru” ribbon to add to their name badges to recognize active engagement. Next year, we plan to add twitter handles to the registration process so that they appear on badges along with the attendees’ name and institution.   The American Heart Association, the Society for Angiography and Intervention (@SCAI ) as well as the American College of Cardiology (@ACCinTouchall actively promote LIVE tweeting from their annual scientific sessions and have seen increased engagement online as a result of these policies.

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HRS 2017 Analytics via Screenshot from Symplur

What are the Benefits of LIVE Tweeting?

  1. Immediate and widespread dissemination of information

The average twitter user expects a response in less than 15 minutes. When new findings and ideas are tweeted LIVE from a meeting, a wider swath of clinicians will have access to new and potentially impactful information right away. Rather than only having 300 attendees hear Late Breaking Clinical Trials presentations, hundreds of thousands more can benefit from new treatment insights in real time when LIVE tweeting is promoted.

  1. Collaboration and engagement

When we actively discuss newly presented data and treatment applications, we often begin to debate the merits and validity of new research. This process can sometime take years—In the digital age, the debate can occur in “real time” and clinicians from all around the world can participate in the discussion. These discussions often become mini “think tanks” and can lead to new applications and treatments for patients. At the very least, these collaborations and new online engagements lead to new (and in some cases) lifelong friendships.

  1. Spur discussion that may lead to new research questions

When we discuss new data with a larger group of physicians, many perspectives and opinions can be considered. In many cases there are differing opinions as to how best to apply research findings in the clinical arena. When there is disagreement and debate, new research questions and ideas are created. By engaging online around a particular subject, experts from around the world can build new studies and work together to solve clinical problems.

  1. Sharing data may lead to faster advancement of therapies

One of the biggest problems with medicine today is that we all seem to live in our own silos—many scientists remain resistant to data sharing. Now that we are in an age of digital innovation and real time data generation and dissemination, there is no reason we should not be sharing data. Rather than duplicating success and failures, if we foster cooperation, we will certainly significantly decrease the time it takes to produce new (potentially live saving) treatments for our patients. Social media and digital can play a huge role in data sharing and should be ENCOURAGED rather than censored. There is no longer a role for data hoarding in modern medicine.

What Can We Learn from the #ADA2017 fiasco 

  1. Medicine is now Digital and any effort to change that will be poorly received:

After years of gaining momentum, the digital world is now intertwined with medicine. As Dr Eric Topol (@EricTopol ) has said in his book The Creative Destruction of Medicine, “The digital world has been in a separate orbit from our medical cocoon, and it’s time the boundaries be taken down… The problem is that it takes physicians so long to accept a radical change. And the lag is unacceptable.” No longer can we work an live in separate academic silos—the digital world IS a part of medicine and this will NOT change—out patients’ LIVES depend on it.

  1. Societies and their leadership MUST be flexible and respond to changes in membership needs and priorities—IN SHORT, LISTEN TO YOUR MEMBERS

The way societies are functioning is changing. Physicians and researchers have a choice when it comes to WHERE and HOW to present their findings and novel research. Societies that are restrictive and put forward Draconian policies will see their numbers dwindle. No longer can an academic society survive solely on their previous reputation. Physician members are increasingly digitally engaged and expect innovation and forward thinking from their societies. It is vital that the “old guard” who has led our societies for decades makes way for the new digital physician—in short “adapt or get out of our way”.

The American Diabetes Association has had a difficult weekend. Due to the lack of preparedness for a digital audience and a lack of connection with their members who are engaged in Social media, the society’s academic sessions and all of the presented science has been overshadowed by a “Twitter Controversy”. This has been a disservice to physicians, attendees and most importantly, the patients the society and its members tirelessly serve.

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Changes in Latitudes, Changes in Lifespan: How Much Longer Will We Tolerate Disparities In Healthcare in the US?

Dr Kevin R. Campbell, MD, FACC

CEO, K-Roc Consulting, LLC

While Thomas Jefferson may have written that “All Men are Created Equal” in our Declaration of Independence, nothing could be further from the truth when it comes to healthcare in the United States. As a physician, I have pledged to ease suffering and heal those who are sick. However, I find that my job has become increasingly difficult over the last several years. The Affordable Care Act (ACA) has limited access for my patients, increased the administrative burden on healthcare providers and created a market that favors those who “have” over the “have-nots”. I am also deeply concerned about the impact of the “so called” replacement passed by the US House of Representatives last week.

Problems (and questions) remain after the latest repeal efforts—how will we cover those Americans who need healthcare the most—the chronically ill, the poor, and the marginalized? Why is there STILL no tort reform? Why did we not address the issue of competition among insurers across state lines? What about limiting drug costs by holding big pharma accountable?

Now, there is more evidence that healthcare in the US remains broken….This week, a new study published in the Journal of the American Medical Association shows that WHERE you live within the United States may have a significant impact on your longevity.   IN fact, in 2014 there was a spread of nearly 20 years in life expectancy based solely on which county in the United States in which you lived. Counties where residents are more educated and more affluent had the longest lifespan and, as you might expect, those counties where residents are poorer and have no post secondary education have the shortest.

Those that are educated and have more financial options are able to focus on prevention and healthy lifestyle habits.  Those that “have not” do not have the access to preventative care and cannot afford quality insurance.  While they remain insured “on paper” they are effectively uninsured due to issues with access and cost.

Until we focus on prevention for ALL, we will continue to see such disparities and we will continue to have the most expensive healthcare in the world.  

The new Republican plan leaves me with little hope.  Those that are already marginalized will remain marginalized.  Those who need preventative care will be placed into high-risk pools and could be “priced out.” While the House Bill does say that pre existing conditions will be covered, I fear that by leaving much of this to the States, we will likely create a system in which many are left out. Alternatively, if we were to create a system where we address chronic disease EARLY in the process and focus on prevention of complications and the proper management of the condition, we are likely to be able to close the ever increasing “lifespan gap” that is demonstrated by this most recent study.

Any real reform must include things that will lower cost, increase access, improve choice and care AND expect engagement and individual responsibility from patients.

  1. Tort Reform—We can no longer allow for frivolous and predatory lawsuits against physicians. Fear of litigation increases costs by forcing doctors to practice “defensive medicine” and results in the ordering of costly and often unnecessary diagnostic tests.
  2. Allow insurers to compete across state lines-Many counties across the US have either 1 or NO choices for ACA exchange insurers. This lack of choice results in a limited network of physicians and may create significant issues with access to care. We MUST allow patients to choose the doctor that is right for him/her. We must force insurers to compete with one another for our business and allowing them to cross state lines is likely to lower costs, improve care and improve choice. By providing better access in ALL areas of the country, we may be able to lower the life expectancy gap.
  3. Place limits on drug prices-Currently, many patients cannot afford the drugs they need. Lack of compliance with treatments for common diseases may be a major contributor to the life expectancy gap. How can we expect patients to improve their health status if they cannot follow their treatment plan due to a lack of financial resources? We can no longer allow drug makers to charge US consumers far more than is charged elsewhere in the world. We must hold big pharma accountable if they are found to be price gouging.
  4. Individual responsibility. I do firmly believe that patients can play a role in improving their own life expectancies as well. Patients must engage with their healthcare providers and must participate in their own treatment plan. The treatment of a disease is a team effort. Doctor and patient must work together—BUT we must be allowed to collaborate without government interference in the exam room.

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