Tag Archives: Disparities in care

Big Ben, Covent Garden and The Thames: Lessons Learned from a Visit to London—Collaboration Improves Outcomes

This past week I had the honor and pleasure of introducing my book on Women and Cardiovascular Disease in London. During the book-signing event, I was able to meet with many of my European colleagues from both the media as well as the healthcare space. As the evening’s discussions continued into the night, I once again realized just how much we have left to do in addressing gender disparities in care—it is not just a problem of a single country, it is truly a global issue.   More importantly, I once again became aware of just how small the world really is—and how many problems we share as a world community of healthcare providers. While we are separated by oceans and answer to different governments, healthcare systems and regulations, one thing remains constant—our devotion to the care of our patients as well as our desire to improve care and outcomes for all patients.

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In the US, we have worked diligently over the last ten years to raise awareness for women and cardiovascular disease. We have made great strides in the identification and treatment of women with occult heart disease. While the numbers are improving, disparities in care remain. The American Heart Association and the annual Go Red Campaigns have made a remarkable difference in promoting awareness, advocacy and research. We cannot, however, rest on our accomplishments—we must do more in the US to continue to close the gap. In Great Britain, I think that we can and must do even more. After my discussions during the book signing I realized that the level of awareness in the UK among women, media and healthcare providers is even less than in the US. During the event, I was able to chat with numerous bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women throughout the UK. We identified many ways in which we may be able to improve education and awareness of women and heart disease in Britain and throughout Europe.   Even though the event lasted a little more than 2 hours, we were able to brainstorm numerous ideas and made plans for future discussions. It struck me that through collaboration and cooperation across oceans and among different nationalities that we can not only make an impact in our own countries–We make even bigger impacts (both at home and abroad) through a more global approach. When we work together towards a common goal we are able to tap ideas and harness the potential of larger numbers of professionals with disparate academic and social backgrounds. This can lead to novel solutions.

Collaboration is a way in which individuals or groups can work together to generate solutions. However, collaboration is a complex process where people from different backgrounds must come together to effect change.

But how can we be effective and make the biggest impact?

  1. Collaboration is a Journey: Collaboration does not happen overnight. Relationships develop over time. Some of the most important keys to success are communication, mutual respect and compromise as well as a commitment and “buy in” from all invested parties. There are always initial periods of brainstorming and conversation that lead to even bigger ideas. As we work together to solve global issues such as disparities of care for women with heart disease, we must pursue a common goal. Teaming up with others is a powerful way to improve outcomes and improve success.
  2. Collaboration may be best when spontaneous: Collaboration cannot be forced. We must learn to appreciate the talents of others and leverage those talents in a way that produces successful ideas. Working sessions followed by dinner or other gatherings in social settings often produce the most important breakthroughs. Amazing ideas commonly result when we least expect them.
  3. Collaboration requires that we Know Ourselves and Manage Diversity Effectively: The benefit of collaboration is the ability to bring together a diverse group of people with different backgrounds. Collaboration requires that we have cooperation both horizontally and vertically—there must be mutual respect and while maintaining structure and leadership within the group. The diversity of opinions allows us to attack issues from unique angles. The most important factor in producing measurable results for patients is the assimilation of ideas into a new and coherent way of thinking about common problems.

I am excited about the opportunity to collaborate with others throughout the world in order to improve care for women. I believe there is a great opportunity to raise awareness of disparities in care in the UK and throughout Europe. It is my hope that through cooperation and collaboration with my European colleagues, we will be able to improve cardiac care for women all over the world.

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Healthcare Law Rollout “Delays”: Primum Non Nocere

Recently, President Obama’s healthcare law has been met with more challenges and “delays” than when it was rapidly pushed through Congress during his first term.  Many critics of the legislation argued that the rush to produce a product (predictably in time for the re-election campaign) would result in poorly thought out, overly-complex law that would be nearly impossible to understand and implement.  Four years ago, there was insufficient infrastructure at both the Federal and State levels to roll out such a piece of legislation–not surprisingly, things are no different today.  Rather than focusing on preparing for the implementation of sweeping reform, court battles have been fought, billions of tax dollars spent and complex decisions have been rendered by the Supreme Court.

Now, we are beginning to see that many of these critic’s concerns were in fact quite valid.  A few weeks ago, it was announced that the Obama administration would “delay” until 2015 the mandate that business provide healthcare insurance or pay a fine.  As I recall, this was one of the cornerstones of the healthcare law–statements from the White House indicate that it was “delayed” because there was insufficient infrastructure to provide more than one choice of insurance in the October premier of the Healthcare marketplace–the law promised multiple choices for small businesses. (surprised? C’mon,not really)

Today, the New York Times reported that yet another provision in the healthcare law is going to be “delayed” due to the fact that those that must comply need “more time”.  Interestingly, this provision was another one of Obama’s cornerstone promises–there will be limits set for individual out of pocket expenses.  Today, buried deep within other unrelated legislation, it was discovered that this particular consumer protection provision has been “delayed” until 2015 due to the fact that the poor, over-burdened insurance companies need “more time” to work on readying their computer systems to handle these particular co-pay limits.  (yea, right).  In my experience, insurance companies seem to be able to deny claims and disapprove treatments, drugs and procedures for my patients at an alarmingly quick pace.  It’s all a matter of priorities I guess.

What’s my take on all of this?  It’s the patient (or potential patient) that ultimately suffers….

The government and the healthcare law is playing favorites.  The law was supposedly passed in order to protect the individual American from escalating healthcare costs.  The law was created to provide affordable, sustainable healthcare to every American citizen.  The law was created in order to ensure quality care and contain costs.  All of these goals are extremely important and certainly worthy of our nation’s leaders time, resources and focus.  However, as is often the case in politics, much of this law is about partisan politics, re-election aspirations, campaign support and legacy. Forgotten in the midst of all of the debate is the patient.  The patient is the reason healthcare exists in the first place.  The patient is the reason most physicians and other healthcare providers go to work early each day.  In the latest “delay” in the healthcare law, consumers (and hence, the patient) will now have no protection from insurance company charges and co-pays.  By allowing the out of pocket limits to go unenforced, the Obama administration and Congress are effectively providing the insurance companies with a license to charge as much as they can–make as much profit as they can–until the legislated limits are actually enforced.  Many potential patients may not seek care because of the burden of cost.  Many of these patients will suffer with devastating but curable disease.  Many will die.

That’s capitalism right?  But should it be allowed to function at the expense of human lives?

For too long, the debate over healthcare costs and reform has centered around physicians, physician payments and hospital costs.  Isn’t it time we considered holding insurers responsible for years of abuse?–charges to consumers for insurance are far in excess to claims paid.  Most insurance companies that I deal with on behalf of my patients have lots of people trained to “deny” requested medically indicated treatments and procedures.  It is time for government to step up and advocate for the patient.  We must hold all players accountable for healthcare reform–physicians, hospitals, lawyers as well as insurers.  Lets stop playing favorites.  Lets focus on the patient.  Primum non nocere should apply to government, insurance companies, lawyers as well as physicians.  Primum non nocere…Primum non nocere…

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