Guest Post: I’m donating my kidney, I hope you do too!

September 10th, 2009

About a month ago I was exchanging emails with my long-time friend and former business colleague George Taniwaki. During the course of the digital conversation gtaniwakiGeorge mentioned that he had made the decision to donate a kidney to an undesignated recipient as a living donor. This is a particularly selfless act – George does not know the potential recipient, who will be identified through a tissue match. Sailing in uncharted waters, George found the donation process to be both extremely interesting and amazingly challenging.

At this time more than 80,000 people are on the official Organ Procurement and Transplantation Network (OPTN) kidney waiting list. One study estimated that there are an additional 80,000 people in this country who are not on the list who are good transplant candidates. Last year just 15,517 people received transplants. More than 4,000 of those on the list died waiting for a kidney transplant – an average of 11 individuals each day.

Dialysis can save a life, but the quality of that life is impaired. Patients must spend up to four hours three times a week connected to a dialysis machine. They may develop health problems such as anemia, they can suffer from weight gain and bloating, and because they eventually lose the ability to urinate they must severely restrict fluid intake. In comparison, kidney transplant recipients must take immunosuppresants, but can otherwise lead near-normal lives.

When George offered to tell his story, I jumped at the chance to share it here. Over the next several weeks, you will learn the “back story”, which began in November 2007 when George made his decision to become a living kidney donor. After that series of posts is complete, he will continue to provide regular updates as he continues the process.

George hopes that by sharing his personal journey with others it will raise awareness of the urgent need for kidney donations and encourage another person to consider donating a kidney to help someone in need. Here is George’s first post; please read on to learn how he decided to become a living kidney donor and make a real difference in someone’s life.

George Taniwaki: I’m donating my kidney, I hope you do too!

It’s Nov 25, 2007 and I’ve decided to donate one of my kidneys to a person who needs it. Unlike most people who make this decision, I’m not helping a relative, a friend, or a neighbor. Instead, I’m going to donate it through a charity that will match me with a recipient.

It’s a big decision and not one I’ve taken lightly. However, I’ve done my research and feel confident that the benefits vastly outweigh the risks. The recipient of the kidney will probably be able to stop dialysis, which will greatly improve his quality of life and quite possible will save his life. Meanwhile, the risks to my own health are minimal.

I’ve just signed up with two organizations, the National Kidney Registry and the Alliance for Paired Donation, that will coordinate with participating hospitals to match donors with recipients.

Two factors have led me to my decision to donate a kidney. First, I’ve known several people who have donated a kidney, who have needed a kidney, or have worked for the National Kidney Foundation.

Second, I’ve been a blood donor, and more recently a plasma donor, for most of my adult life. I’m comfortable with donating a part of my body to a stranger to save their life. I’m not concerned about the discomfort or pain caused by having surgery. And I’m not worried about the loss of income (I don’t get paid sick time) while I stay home during my recovery.

(To be continued next week.)

George Taniwaki is a software program manager living in Bellevue, Washington.

Editor’s note: Over the next several months, Mr. Taniwaki will be writing about his experiences on the path to becoming a living kidney donor for an undesignated recipient. Please note that the opinions expressed are those of Mr. Taniwaki and do not represent medical or legal advice.

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Ten Questions: Linda Burke-Galloway

July 15th, 2009

Galloway_ blog
We are pleased to introduce this week’s medical thought leader, Dr. Linda Burke-Galloway, a board-certified obstetrician-gynecologist and author of The Smart Mother’s Guide to a Better Pregnancy
How to Minimize Risks, Avoid Complications, and Have a Healthy Baby.

Dr. Burke-Galloway has a very unique perspective because of her background in social work and her devotion to patient safety and public health. Her passion for administering quality health care to women in medically underserved communities led her to Harlem (NY), Lake Charles (LA) and the Lakota Native American Reservation in Pine Ridge, South Dakota, where she delivered babies and managed high-risk pregnancies.

Dr. Burke-Galloway also serves as a medical consultant reviewing medical malpractice cases for the Federal Government and works for the State of Florida Department of Health. She holds a Doctorate of Medicine from the Boston University School of Medicine.

1. You have a master’s degree in social work and a doctor of medicine degree in obstetrics and gynecology. What led you down this path and how does it influence your approach to helping patients?

I’ve always had the desire to help people and selected social work as a career path. However, after graduating from Columbia University’s graduate school of Social Work, I realized that the school was light years ahead of the actual profession. Columbia raised the bar regarding my expectations and confidence.

I realized that I had to do something “more” and that “more” was ultimately medicine. Ironically, I actually come from a family that was always entrenched in medicine. My great-great grandmother and her mother were midwives in Virginia; my cousin was a second year ob/gyn resident and half of the women in my family were either nurses or nursing assistants. In one of my first blog entries, entitled “Love at First Sight”, I describe the awe I felt when I witnessed my first delivery in a New York City hospital as a volunteer. I had found my calling and there was no turning back.

In order to be an effective physician, one has to be willing to advocate for the patient. Social work has taught me that everyone is accountable to someone, and I’m very adept at finding out whom that “someone” is.

2. Why did you decide to write The Smart Mother’s Guide to a Better Pregnancyand how is it different from other books on pregnancy?

I wrote The Smart Mother’s Guide to a Better Pregnancyto prevent pregnant women from falling through the cracks of our very imperfect and complex healthcare system. Because healthcare has become a business, everyone is extremely busy. Physicians see more patients and nurses have more responsibilities, which leaves less time to pay attention to the details of a patient’s condition. Increased patient volume means a greater chance of making a mistake or missing something crucial.

Unlike most prenatal books that discuss the experience of being pregnant, my book teaches the reader how to recognize potential red flags, both regarding their own condition and external conditions within a hospital that could compromise their pregnancy and delivery. A low risk pregnancy can become high risk in the blink of an eye, especially in the labor room. My book is the only one that addresses potential labor room problems and solutions to these problems.

3. For every 1,000 women giving birth, there are 17 fetal deaths and 6 – 8 birth injuries. What are the most important things an expectant mother can do to minimize the risk to herself and her baby?

1) Make certain that her physician or midwife does not have seven-figure law suit settlements.

2) Ask how many patients are scheduled to see her physician or midwife in a day and how much time will be allotted for their visit. If they have more than 30 patients a day, that’s a red flag. This will assure that a patient receives quality time during her prenatal visit.

3) Make certain that they always feel the baby move after 22 weeks to document the well being of the unborn child. Stillbirths usually occur after prolonged absence of fetal movement. Kick charts are helpful to document this.

4) Shoulder dystocia (or a “stuck” baby) occurs because the baby is too big to be born vaginally. During labor, if a patient has reached a certain dilatation (say 6 or 7 centimeters, or any number for that matter) for more than two hours, without any further progress, it is quite possible she will need a C-section because the baby is too big. Most lawsuits occur because of shoulder dystocia and a missed diagnosis of fetal distress. My book is also the only one on the market that gives illustrations of “normal” and “abnormal” fetal tracings. The ability to recognize these patterns empowers the patient and her family to question her management when the tracing looks bad and no one is addressing the issue.

5) Make certain she has access to a high-risk specialist for an in-person or phone consultation. What I recommend in my book is a little out of the box. If you have insurance and you have the ability to have a high risk consultation I would obtain one and I would approach the insurance company in this manner: “If for some reason my pregnancy becomes high risk, if I develop hypertension, if I develop gestational diabetes, would I be able to have a consultation from a maternal fetal medicine specialist?” More than likely the insurance company will say yes, although the primary provider physician or midwife would more than likely have to do the referral.

6) The other recommendation is something a little bit unusual, but I think it’s necessary. In the event that you are in labor and your labor doesn’t appear to be progressing, if there’s some concern about the fetal monitor and the physician or the midwife doesn’t seem to be responding in a way that you’re comfortable with, it would be helpful to have a second opinion. This is where what I’m recommending is a little unusual because the patient would under normal circumstances feel that the physician has control of the delivery and of the labor progress and you would want to have confidence in that person. But in my experience reviewing medical malpractice cases, sometimes the nurse will contact the physician and the physician will not respond. There’s a difference in terms of communication, one group is leaving and one group is coming on, and there is a difference in terms of delivery management.

So you want an expert in those situations where the progress of the labor doesn’t appear to be going smoothly. Basically what they’re going to do is look at your chart, they’re going to look at the fetal monitor strip and say, “I think she needs to have a C-section” or “she’s fine.” That is thinking outside of the box, but I think in terms of medical malpractice and also the healthcare issues at present, it’s always nice to have a second and even possibly a third pair of eyes to render an opinion if things don’t appear to be going in a normal fashion.

4. With these tough economic times, many families are trying to save money wherever they can. What are some ways an expectant mom could pare costs, and where is it dangerous to cut corners?

A very good question. She should ask for generic medication if it’s available. If it’s a question of a name brand antibiotic, or an antibiotic that’s been around forever and is effective, I would definitely recommend generic. And that also applies to prenatal vitamins.

I don’t think I would cut corners in terms of nutrition. I would definitely eat fresh fruits and fresh vegetables. I would stay away from processed foods, fried foods and fast foods. Processed foods have a lot of sodium in them and that could inadvertently cause high blood pressure. Fried foods have a lot of fat that can complicate the pregnancy by increasing your chances of developing gallstones and of course gaining weight and having an enlarged baby. I wouldn’t cut corners in terms of nutrition and food.

5. What are the most important things a woman’s doctor can do to ensure a safe pregnancy and delivery?

Be well versed with the patient’s history. Know what her lab values are. Be present or available while she’s in labor to evaluate her progress or lack thereof. Communicate to all members of her healthcare team so that everyone has a consistent plan of management.

6. What kinds of changes that will directly impact patients do you see coming to the field of obstetrics and gynecology in the next five years, both positive and negative?

Genetic testing is going to become more prominent in the future, thereby alerting both mother and fetus of their risk factors for potential medical disorders.

More cord blood banking will be done along with stem cell therapy.

There will be more intrauterine surgery on the fetus before it’s born, particularly for problems such as spina bifida.

A very exciting new method is used to reduce the incidence of brain damaged babies right after birth. Hypothermia, or a “cooling blanket” was first used in San Francisco and is now becoming more widespread. By reducing the temperature of critically ill newborns for two to three days, there has been documented evidence of less permanent brain damage, particularly in babies who have low APGAR scores.

On the negative side, the present healthcare system is in flux, as we all know, and the future might not be kind if the present insurance situation remains the same. I think people are going to look for ways to cut costs. It might even develop into a situation where an insurance company would say “you are obese and a lot of your medical problems are due to your obesity. Therefore we’re not going to pay for any services until you lose weight.” I think they are going to use obesity as a means of exclusion. This form of future discrimination by insurance companies might make it more difficult to obtain quality care. Also, because of increased risk for complications, some physicians and midwives might refuse to accept obese individuals as a patients.

As more insurance companies reduce the amount of reimbursement for professional services, procedures such as newborn circumcisions and dilatation and curettage will be performed less.

7. You are a practicing physician for the Florida Department of Health and a medical malpractice consultant for the U.S. Department of Health and Human Services (HHS). What does a medical malpractice consultant do?

I review obstetrical malpractice cases, as a second opinion, that were paid under the Federal Torts Claims Act, and determine whether the standard of care was met or breached. Any community health organization that receives federal funding is covered under this umbrella. These cases are then presented to a panel of health policy leaders from all branches of HHS, who then determine whether the physician or healthcare provider should be reported to the National Practitioner Data Bank and who also make risk management recommendations for quality care improvement.

8. How would you describe the current medical malpractice environment and how do you see it changing during the next ten years?

The present medical malpractice environment is strained. Some states have a limit or cap on the amount of damages a plaintiff can receive, but it still doesn’t help the average ob/gyn physician whose premiums have tripled in the past five years. The costs of premiums are so exorbitant that many obstetricians have retired or eliminated obstetrics. In the next ten years you will see more midlevel providers such as nurse practitioners and physician assistants practicing direct patient care as physicians move into other areas such as business, entrepreneurship and technology.

9. If you were to describe yourself in 3 separate words, what would they be?

  • Passionate… about babies
  • Compassionate… about the underserved
  • Dedicated


10. Is there anything else you’d like to share with our readers?

People need to become very literate about their health conditions. They need to focus on wellness. I think we have to become proactive about being healthy.

ADDITIONAL INFORMATION

If you would like to purchase Dr. Burke-Galloway’s book, The Smart Mother’s Guide to a Better Pregnancy, you can click on the link to the right. Your purchase of this book through the links on this page helps support this blog – thank you!

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Ten Questions: Margo Corbett

May 20th, 2009

margo_corbet_v2This week’s medical thought leader is Margo Corbett, author of The Savvy Patient’s Toolkit. Ms. Corbett has created a new method that enables patients to prevent medical errors, manage their own health care and make effective use of the doctor’s time before, during and after an appointment.

Margo is also the founder of The Savvy Patient School, a program that teaches people how to fully engage in their own health care. An experienced patient advocate, medical technologist and researcher, and the survivor of three nearly fatal medical errors, Margo has a compelling story to tell.

1. You have a master’s degree in storytelling and a background in medical technology and research. How has this influenced your work on the Savvy Patient’s Toolkit?

It’s been an interesting journey. I did my internship at Mary Hitchcock Hospital, with classes at Dartmouth Medical School with the second year medical students, attended classes at MIT in systems thinking, worked as a medical technologist, worked in the virus research program at Yale, and have worked as a total quality & knowledge management trainer & consultant. When I retired from the workforce in 2000, I decided to get a master’s degree in storytelling. Medicine has been an interest all my life.

Over the years, I’ve survived three medical errors and cancer. My medical background plus the health issues I’ve had to deal with kept me involved in the field. In 2003 my husband was diagnosed with kidney failure and due to missed diagnoses we were told he might not live through the night. The first form for the book came into my head that night. If I’d been advocating for him at his appointments he probably wouldn’t have ended up in kidney failure. I continued to develop forms as I advocated for him and an elderly neighbor and the book evolved from there.

I was just finishing the storytelling degree and it occurred to me that every time we go to the doctor we’re telling a story. How we tell that story and what we include has a major impact on the health care we receive. Studies show that the doctor will interrupt us in the first 18 seconds of our appointment because they are used to getting information from patients in a way that’s not useful, so they start asking their basic seven questions.

Studies show in the first 20 seconds 85% of diagnoses are made. The first words to come out of the patient’s mouth and the way they present themselves make all the difference in the world. We found over time that we were actually changing the way our doctors were interacting with us – they weren’t interrupting anymore and we could tell our stories in the right order with most of information they needed. They were then able to think more and look at more options regarding the diagnosis. They were asking us better questions and we in turn were able to give them better information because we had it all at our fingertips.

What we’ve done is created a system to help the patient connect the different parts of their story, tell their story more effectively, prevent the interruptions, and present that information back to the doctor in a way that he can really help the patient more effectively.

2. What are the greatest challenges facing patients in the health care environment that we have today?

We all know the whole system is broken and we know that different people are doing different things to try to fix it. One challenge is if everybody suddenly becomes insured there’s going to be a doctor shortage because we’re going to have so many more patients seeking care.

I think one of the biggest challenges that people have that they don’t realize is the challenge of becoming a savvy patient. If they don’t manage their own care, their care will be substandard regardless of what is coming down the road regarding insurance.

People don’t have the awareness of the importance of being involved in their care in order get the care they need. Until people realize that they’re part of the system and they have a part to play, the system will always remain broken for them.

Doctors can only do what they can do with the information that they’re given. Lots of time the patient has the missing pieces that would lead to a timely diagnosis and they don’t even realize that a particular symptom that they or another family member has is even related to what they’ve got, so they don’t tell the doctor about it. They don’t have the knowledge to be able to connect things.

3. A recent CDC study found that the average amount of time a patient spends with a doctor is 22 minutes. How can the patient and the doctor make the most effective use of that time?

The patient deciding to get involved in their healthcare, being very knowledgeable and learning how to tell their story will make a huge difference from the patient’s side. They have the capability to set the tone for the appointment. Patients don’t realize that the doctor is a paid consultant and that we should be leading that appointment. The doctor is there to diagnose and act as an educator and consultant to us but we need to learn to be the leaders and coordinators of our healthcare team.

On the doctor’s side they need to be very good listeners and some aren’t. They should not assume that the patient doesn’t want to learn. In the past, doctors have been put upon a pedestal and looked at their patients as if they don’t know anything about medicine, so they assumed that there were a lot of things they didn’t need to tell them.

If doctors would meet people as equals with equal respect and put themselves in more of a role as an educator, they would find that a lot of patients would get a lot more engaged in their care. I know the doctors get very frustrated because a lot of patients seem not to care; it seems all they want is a pill and to go home. But they could reach more people by the way they interact with the patient.

4. If someone were about to undergo a complicated procedure like a heart bypass, what advice would you give that person?

I have a critical question series that I’ve developed so that patients have most of the questions they should ask at their fingertips. If the doctor tells them something, they can flip open to the page and have the questions right in front of them.

Examples of questions to ask when told you need surgery are: what are the risks and benefits? Is it a short-term fix and do the benefits outweigh the risks? How will my other health conditions affect my surgery, the anesthesia, the recovery time or the overall risk? How do the risks of the surgery compared to the risk of any potential alternatives?

When you are asking your questions in the context of the surgery the doctor usually is willing to answer the questions. If the doctor is not willing to answer the questions, I wouldn’t want them to do the surgery on me.

5. How does your system fit in with the new electronic medical record systems being developed?

I see them interacting very well. Having just moved here to North Carolina, every doctor that we have met with since we came here is just blown away. When we leave our first appointments they have our complete medical history – the details they need to know about our chronic conditions, our family medical history, medications and more- they have everything they need to know about us and they say, “I wish all my patients would come with this kind of information.”

I’ve been involved with the nonprofit CareSpark, as well as a national team providing the customer’s perspective on a medical record system. So, I have a very good insight into what is being done and what the challenges are with electronic medical record systems.

One of my biggest concerns is that the patients are going to think that everything the doctor needs to know about them is going to be in that system, so they’re going to be more likely to think that they can be less involved with their care. Going to the doctor even less prepared than they are now – to me that’s the biggest disadvantage.

The medical record system is going to be as good as the information that’s put into it and as good as the way the doctors use it. All of a patient’s information will not be right in front of the doctor when he comes in to see you. Is he going to have time to go through your entire medical records before your appointment? Of course not. Is he going to have time during the appointment to be able to access all the details of your information? Absolutely not. The onus is still going to be on the patient to remind the doctor of their medical history, their family medical history, the medications they take and so on and be knowledgeable enough to help tie the pieces of his story.

It’s going to be a double-edged sword. The biggest benefit is that it’s going to give the doctors the basic information they need and provide missing items such as test results ordered by other physicians. It is not going to be the panacea that will fix all the problems of the medical system, which is what it’s being touted as.

6. Do you see any changes in terms of education in the way doctors and nurses are going to be trained with respect to patient care?

It’s my understanding that the medical schools now have gone toward more effective communication and listening skills than they did when I was younger and the medical schools trained the doctors more as technicians, like a car mechanic, in the technical aspects of being a doctor. They didn’t worry too much about interpersonal relationships but I know there’s been a lot more emphasis on that.

7. What kind of changes do you see that will directly impact patients during the next couple years?

As mentioned before, the biggest one that I see is the impact if we have some type of universal health care. If everybody is covered by insurance we’re going to have a tremendous shortage of doctors and difficulties getting appointments and tests. We just don’t have the infrastructure to support a flood of people who haven’t been in the mainstream system. The good part of that is that people will be insured.

8. If you could use just three words to describe yourself, what would they be?

Ambitious, tenacious and passionate.

9. If you could wave a magic wand what would you wish for?

When I meet people and show them this [the Savvy Patient Toolkit], they say, “This is unbelievable, this is great, this is exactly what we need.” I would really like to spread the word.

The second edition of the Savvy Patient Toolkit came out last year. Last fall I also developed the Savvy Patient School, and this January I started offering audio recordings of the class. They are on my website. It’s about an 8-hour audio course with eight modules. People pay and have lifetime access to the course; they can go in and listen at their convenience.

10. Is there anything else you would like to share with our readers?

I wrote this book for people with chronic conditions and for those who are caregivers either for children or for an elderly parent who really is having difficulty with Alzheimer’s or just can no longer care for themselves.

The one thing that most people don’t do is take someone to their doctor’s appointments with them. An advocate is one who accompanies people to their doctors’ appointments, helps them and is with them when they’re in the hospital.

One of the most useful forms in the book is the Provider Consultation Form. The advocate would have that form on in their lap and would be prepped so they would know what the patient wants to talk about, the questions they want to ask. They can act as a prompter during the appointment if the patient forgets. This frees the patient to totally concentrate on interacting effectively with the doctor. The advocate takes notes. My husband and I do this for each other and it’s been very very effective. Studies show that you forget 50% of everything that was said in an appointment the minute you walk out the door. With appropriate documentation, the patient will be able to access details of appointments to refresh their memory and answer questions from other caregivers.

Additional Information

Learn more about the Savvy Patient’s Toolkit and the Savvy Patient School by clicking on the links below. Your purchase through the links below helps to support this blog.

• The Savvy Patient’s Toolkit

• The Savvy Patient School

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Google health search: caveat interretiarius

May 15th, 2009

tn_johnny_deeper I’ve always had a soft spot in my heart for Google. After all, co-founder Larry Page was a fellow University of Michigan grad. And Google freed me from what, at the time, seemed like an endless quest for an effective search engine (remember the early days of Lycos, Alta Vista, or HotBot?)

On May 13, 2009 Google posted an announcement to its blog regarding its plan to gather additional information from a random sampling of health-related searches. Characterized as a “short-term experiment,” Google will ask some users if they are searching because they or someone they know has a condition or is using a drug mentioned as a keyword in that particular search.

For example, at the end of the search results for “headache”, some users may see something similar to the following:

“Help Google improve search results and estimate public health trends.
Did you search because you or someone you know has a headache? Yes No”

Google’s blog states that the purpose of the research is to collect aggregated statistical data that will help the company better understand user intent. They hope that this in turn will help Google deliver more relevant search results. Rather than guess if someone is searching for potential treatments or writing a research paper, Google says it will have real data to help make that call. This information could also be used to update features like Google Flu Trends.

The poll is opt-in and some terms will be excluded if they pertain to issues that are deemed “excessively embarrassing, immediately life-threatening, involve mental health, may involve illegal behavior, or pertain to sexual behavior.”

Google says that responses are not associated with the user’s Google account, Gmail address or other personally identifiable information.

However, Google’s servers do record page requests and additional information, including a cookie, the user’s IP address, browser type and language. Responses are “anonymized” in accordance with Google’s log retention policy, which anonymizes IP addresses after 9 months and cookies after 18 months.

Google revised its privacy policy on September 8, 2008, in response to privacy concerns expressed by regulators in Europe and the U.S. This was preceded by a copyright infringement lawsuit Viacom Inc., a media conglomerate, filed in March 2007 in which Google was ordered to turn over log-in IDs and names of YouTube users, IP addresses (online identifier) and video clip details. A subsequent agreement allowed Google to anonymize user data and IP addresses prior to the handoff to Viacom.

I’m a data junkie, and my research side appreciates efforts to improve the search algorithms to deliver better results. But because there is a significant time interval between data collection and data anonymization, the potential for leakage of personally identifiable information is very real. To illustrate, if a cancer patient searches for information on medical marijuana, it may not be the wisest decision to respond to Google’s survey question.

In addition, companies often reserve the right to change their privacy policies at any time. And data such as this would be very valuable to some companies. Marketing uses are the obvious ones, but health insurance companies could conceivably use the data in ways that go beyond marketing. And don’t forget that Viacom lawsuit.

A conjoint analysis of one – I’m thinking that I’d much rather wade through a few more search pages than reveal that I had a headache last Tuesday. Tell me what you think.

Thanks to William Whitaker’s Latin to English translator: interretiarius

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The product development saboteur

May 1st, 2009

Beware the product development saboteur. wooden-shoes-2

These are the people who may knowingly or unconsciously stifle innovation. In the worst cases, they inflict varying degrees of pain on others in the organization and suck the energy out of product development efforts.

The word sabotage comes from the old French “sabot” or wooden shoe. Its meaning evolved to refer to bungling, playing a piece of music badly or deliberately destroying an employer’s property. There are several theories regarding the actual derivation of the word, but the symbolism is exquisite and the damage is very real.

Here are some warning signs that you’re in the presence of a product development saboteur. Even one of the behaviors listed below is a warning sign, expecially if seen on a recurring basis.

  • Creates barriers instead of clearing them away.
  • Withholds information.
  • Insists that there is only one “right” way.
  • Favorite phrase is “yes, but.”
  • Engages in unprofessional behavior such head shakes, eye rolls, or frequent sidebar conversations.
  • Comes to meetings unprepared.
  • Monopolizes the conversation (or at the other extreme, doesn’t participate).
  • Ignores agreed-upon team processes and protocols.
  • Agrees to something in public; disses it behind the scenes.
  • Has trouble managing priorities.
  • Only wants to work on his or her pet project.
  • Lets co-workers do the heavy lifting.
  • Takes credit for the work of others.

What’s a product developer to do?

Sometimes the problem stems from a sloppy product development process that developed organically and took on a life of its own. Or, it can reflect an unhealthy imbalance of power residing in one or two departments or resting with a few individuals.

One solution is to create a better process with well-defined steps, evaluation gates and milestones. Encouragement to improve the process needs to come from the top, but the process itself needs to be developed with input from a broad cross-section within the organization.

Care should be taken in selecting people to work on the team. In addition, the product development team needs to be managed by someone with proven project management and people skills.

Organizations can also act as product development saboteurs. We’ll look at the top ways organizations sabotage their own product development efforts in our next posting.

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NIDAMED Screening: Will it help?

April 20th, 2009

nidamedlogo1On April 20, 2009 The National Institute on Drug Abuse (NIDA) announced a new outreach program to help primary care clinicians screen patients for alcohol, tobacco, illegal and nonmedical prescription drug use.  The initiative, called NIDAMED, consists of an online screening tool, a companion quick reference guide, and a detailed reference guide. 

According to a 2007 National Institutes of Health (NIH) study, an estimated 19.9 million Americans aged 12 or older (~8 percent of the population) were current (past month) users of illlegal drugs, and even more were tobacco and/or binge alcohol users.  Only a fraction of people with addiction issues are in treatment.

According to a media release, the NIDA initiative “stresses the importance of the patient-doctor relationship in identifying unhealthy behaviors before they evolve into life threatening conditions.” 

The quotation did not include the word “confidential” with regard to the patient-doctor relationship, which leaves one wondering if it was simply assumed, or was the omission intentional?

On the one hand, treatment for drug, alcohol and tobacco abuse could save many lives. On the other hand, while the online form does not ask for information that identifies the patient, there is no information or disclaimer on the web page that explains exactly what the NIH does with the data entered in the form. At minimum it is stored temporarily while the form is in use, since the information persists through to the diagnostic page, but does it go any further than this?

It raises an interesting dilemma for the medical practitioner. Screening standardization is a plus, but some patients might be concerned that their information is being entered into a database, expecially if the practitioner’s legacy system or even a PC is linked to a government database. The move toward digital storage of personally identifiable information and medical histories is happening, but erosion of personal privacy, data piracy and security breaches are still of major concern.

What do you think? Will the clinician tell the patient that they are using this tool? How will they handle any questions that may arise? Should we be concerned about the potential for misuse, or relieved that more people will get the help they need?

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Marketing: permission to experiment

April 16th, 2009

Dr. Tal Ben-Shahar, author, lecturer and consultant, teaches a wildly popular course on optimisim at Harvard University. One of the exercises he firmly believes in and employs in his own life is called PRP, described in the April 6, 2009 issue of Time magazine.

The P stands for permission to be human. We can’t be perfect all the time.

The R is for reconstruction. How can we learn from a mistake or a less than desirable experience?

The final P represents perspective. Taking a broader view of life, does one bad experience really matter?

I believe the PRP model can also be applied to marketing. Unless your crystal ball is particularly reliable, marketing is always an iterative process of trial and error. Some things work better than you expected, some meet your objectives, and a few fail miserably. It’s a given that no amount of wishful thinking can change.

In some ways, medical marketers face steeper challenges than marketing departments in other industries. Regulatory and legal demands regarding medical claims must be adequately addressed. The marketer often has to shift back and forth between B2B and B2C perspectives. Public scrutiny is intense. Precision and accuracy are ingrained in the medical corporate culture. Right-brain logic and analysis rules. Perfectionism is rewarded. Experimentation may be okay in the context of new product development, but marketing? Fuggedaboutit!
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These challenges can create significant collateral damage when they bump up against the creative process. This may partially explain why a certain degree of “sameness” has infected medical marketing efforts, and it may not be the marketing department that’s responsible.

New thinking is in order. And it has to start at the top. This is true whether you’re a start-up, corporate alpha dog, or somewhere in between.

Another approach to marketing:

  • experimentation is good
  • mistakes create learning
  • keep an open mind, success will follow


The pursuit of perfectionism may have its place – just not in marketing.

If you’re looking for a good read on the trap of perfectionism, check out Dr. Ben-Shahar’s book The Pursuit of Perfect. Your life may be perfect, but you may not be happy – find out why and what you can do about it. (The link to the right is provided as a service to QEAN Medical readers and helps support this website.)

 

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Twitter medical marketing basics

April 15th, 2009

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I have been sitting in the Beachwood Cleveland Clinic waiting room for over 45 minutes. My time must not be important. @CleveClinicNews
about 11 hours ago, sent by a user on Twitter.

Unless you’ve been napping lately, you’re either on Twitter or trying to figure out how you might use it effectively for your company or organization.

Twitter can be a fabulous tool for connecting with people, establishing a dialog, listening and fostering growth. Even if you don’t quite see the value yet, you can’t afford to ignore it.

If you’re just getting involved with Twitter the first thing you need to do is create a personal account . This will give you a chance to learn how Twitter works without worrying about making mistakes and potentially trashing your brand equity.

Basic tips on selecting your Twitter name can be found here. I also recommend that even if you decide not to use your full name that you still register it to protect your personal brand. If you decide to go this route, simply leave a “tweet” or message on the account that uses your full name to direct people to the personal account you plan to use most often.

There are some excellent beginner’s guides to Twitter, including those found on Michael Hyatt’s and Darren Rouse’s blogs. David Pogue of The New York Times wrote a helpful article from a beginner’s standpoint.

There is an etiquette to Twitter that has evolved since it went live in July 2006. Authenticity is valued. Let some of your personality come through, even if your Twitter account represents your business, because it can forge an emotional connection and that is a good thing.

On the other hand, shameless self-promotion can get tiresome. I remember one of the first people I met on Twitter aggressively tried to sell me accounting software. It was relentless and annoying, and felt like online telemarketing. For some good common sense tips on what not to do, check out Corvida Raven’s blog.

And be aware that Google indexes Twitter. With the exception of direct messages, your tweets will be preserved and searchable long after you have forgotten about them. Don’t use Twitter for anything you wouldn’t want released to the general public.

Communities are forming around hashtags, which are Twitter search terms such as #healthcare, #medical and #medical device. You can add a relevant hashtag to your “tweet” and your tweet will appear when someone searches for that hashtag.

Not only are hashtags a good way to find people or organizations in your field or industry whom you might want to follow, but you can start tracking mentions of your own organization. For example, a Twitter hashtag search for Parker Hannifin produced four mentions during the last six days, while a search for the Mayo Clinic generated over a 100 tweet results over the past two days. Incidentally, the Mayo Clinic has a Twitter account and has issued social networking guidelines for its employees. (Check back at QEAN Medical for an upcoming blog post on social networking guidelines for companies.)

One metric that bears mentioning is the ratio of those following you relative to the number you are following. A large number of followers without some degree of reciprocation is considered a form of Twitter snobbery. While some have argued that those who amass large numbers of followers can’t possibly have quality Twitter relationships, my feeling is that businesses can’t really afford to offend people by not reciprocating.

This is an opportunity in disguise. Some organizations in the medical and health care professions are using Twitter as a one-way communication tool and are leaving at least half, if not more, of its value on the table.

Let’s look at two world famous clinics currently active on Twitter. The Cleveland Clinic has two Twitter identities: The Cleveland Clinic Center for Continuing Medical Education (@cleveclinic_cme) with 869 followers and just 90 people it is following, and the Cleveland Clinic News (@CleveClinicNews) with 33 followers and zero people it is following (as of April 15, 2009). Communication is primarily one way.

The Mayo Clinic (@mayoclinic), as of this post, has 2,088 followers and 1,134 “followees”, indicating some degree of reciprocation. However, most, but not all of the communication is outward directed.

The foregoing is a simple analysis that shows that both organizations are actively using Twitter, but may be missing opportunities to listen to and dialog with their constituents, be they patients, customers, employees, physicians, students, vendors, investors and the media.

One last point about Twitter. If you decide to create an account, you need to make sure you have the resources to maintain it on an ongoing basis. Twitter is a commitment for life, or at least until the next major social networking tool comes along.

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A leading global supplier of medical blog posts

April 14th, 2009

The standard marketing tool kit bulges with superlatives such as leading, unique, proven, best-in-class, industry standard and so on. new-improvedMost of these words and phrases are harmless enough, but watch out when they’re used in place of meaningful communication that resonates with readers.

Some examples with the incriminating information removed:

[Name] is the leading global supplier of orthopedic surgical instruments.
This is a common superlative that usually means…nothing. In fact, some potential customers actually may view it as a negative if they think you’re so big that they will get abandoned in a sea of larger accounts.

A second cousin is XYZ Company is one of the leading suppliers of laboratory diagnostic equipment. This immediately moves XYZ one notch down the credibility scale. If there are 20 companies in your niche and 19 make this claim, is it really credible? Extending this logic to the rest of your product claims, why should I believe anything you’re telling me?

[Name] has developed a unique technology which provides accurate three-dimensional images of cardiac structures…. Unique is probably the least unique and most over-used word in marketing today. And yesterday. In all fairness, “unique” is often used as a lead in to set the stage for additional detail. If you use words like “unique” you’re going to need to tell the reader why your volumetric pipette is different from all the other volumetric pipettes on the market. And don’t put them to sleep while you’re telling them.

[Name's] new current-to-digital converter is setting a new performance benchmark…. Use of the word benchmark gets my attention, but not necessarily in a good way. Whose benchmark? Did you test the product and validate the testing process? Are the results subjective or objective? What kind of performance? If it’s a component, are we talking manufacturing or end user?

The phrase state of the art is another marketing favorite, especially in the medical technology field. According to an entry in Wikipedia, the earliest documented usage of the term occured in 1910 in an engineering manual published by H.H. Surplee titled Gas Turbine. This marketing chestnut is approaching its 100th birthday – ’nuff said.

Sample your competitors’ marketing copy – website, brochures, slip sheets, ads, presentations, directory listings and so on – and then ask yourself if your approach is any different. If your products and services are truly superior then clearly communicate the advantages. Differentiation is key. Otherwise, before too long you’ll find yourself competing on price and potential customers will view you as a commodity.

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Who is responsible for health literacy?

April 2nd, 2009

In an April 2, 2009 New York Times article, Dr. Pauline Chen discusses a concept called “health literacy.” blood-pressure-1

A patient with low health literacy may not understand the implications or severity of his illness, may not follow the prescribed treatment plan, and in general doesn’t take care of himself.

A five-year study of 2,412 elderly patients who exhibited the characteristics of limited health literacy were twice as likely to die.

Whose responsiblity is it to make sure that the patient understands his or her condition, treatment and ongoing care?

In order to gain acceptance to med school, applicants are expected to have high grades. The expectation continues through the next four years of instruction as med students are evaluated on general and specific medical knowledge and practice area expertise, and continues beyond into the internship experience.

The culture is highly competitive, from the top down and peer to peer. A doctor’s place in his or her milieu is in part established by the superiority of his knowledge (or the perception of superiority) over that of others. This is not an environment that is conducive to the development of effective, productive relationships with patients.

Fortunately, some individuals have inherently better “people skills” than others. As in all occupations, there are high performers and others are just average. For those who don’t come by these traits naturally, additional training both during medical school and beyond would help raise self-awareness.

Patients can also be held partly responsible for the communication breakdown, but in all fairness, few people wish to specialize in being a “high-performing” patient. Furthermore, many people view a visit to the doctor as stressful, and studies have shown that stress can inhibit information retention. Or perhaps the patient uses denial as a coping mechanism, and needs extra time to process.

Thus, the burden of responsibility rests with the doctor and staff to develop creative, effective, patient-focused ways to ensure that each patient understands his or her condition, the “whys” of the treatment options, and the implications of following or not following the recommendations.

The patient is, after all, the customer.

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