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To some, he’s a visionary. Others think he’s blowing up a bridge people are still walking on. Truth is, pediatrician Donald Berwick used the bridge metaphor quite powerfully in his presentation at an American Hospital Association health summit in San Diego.
The Choluteca Bridge in Honduras is also called “the bridge to nowhere.” Built in the 1930s by the U.S. Army Corps of Engineers, it survived the devastation of Hurricane Mitch in 1998. Only problem was, the storm destroyed all the surrounding roads and diverted the course of the river that the bridge once spanned.
“It’s time to name our monsters ... our problems,” said Berwick, former head of the Centers for Medicare & Medicaid Services, one of the nation’s most powerful healthcare regulators. His tenure was brief. He was never brought for a final Congressional confirmation hearing, which had promised to be a scathing confrontation between liberal friends and conservative detractors.
“We spend 40% more (on healthcare) than we need to.” Too many stents. Too many coronary artery bypass grafts. We are over-treating. We need more prescription management and fewer invasive procedures. Too many appliance and drug-makers are going way past making a profit to bathing themselves in greed. Care-givers are acting like the guilds of centuries past, doctors/nurses protecting what they do by fighting off those who dare question them. Not everything that’s legal is proper, he said. Large amounts of healthcare often do little more than expose us to greater risks.
Hospitals were the first cathedrals. But they were designed to heal diseases, not prevent them. They let bad things happen so they can fix them.
Berwick’s clearly not afraid of the finger-in-the-eye rhetorical approach.
If it’s possible to keep people home 50% more of the time rather than having them hospitalized, wouldn’t we want to do that? “We need to celebrate empty beds, not full ones,” he said.
Perhaps a bit less shrill but largely in keeping with Berwick’s message was Dr. Eric Topol, cardiologist and author of “The Creative Destruction of Medicine.”
His focus is more on genomic remedies rather than, say, chemotherapy. “The hospital room of the future will not exist,” he said, except for the most acutely ill. It’s time to hit “control, alt, delete on healthcare.”
Stethoscopes are history, said Topol, flashing a video from the Stephen Colbert TV show in which he used what was essentially a smartphone app to examine Colbert’s ear canal for all audiences to see.
“Healthcare is the last frontier of the digital age.” It’s one of the few marketplaces where patients endure hours-long waits for a seven-minute physician visit. Patients usually can’t see their medical records, let alone their physicians’ notes, have no clue how much radiation exposure they’ve had in their lives – meaning they don’t know if they have elevated risks of cancer. The democratization of data – “nothing about me, without me” – will end the paternalism of the current and historical physician culture.
Opening-speaker Berwick and closer Topol made quite the bookends for the 1,900 who attended the three-day event. Hard to know if they bent the curve as folks headed home trying to get their arms around the shakeup that's fully injected into our lives come January 2014.