Is Anyone's Time Valuable?

Cross-posting from my work at the SGIM Forum, page 4 & 14.  Here I take at look at a recent article from CNN looking at waiting times in doctor's offices.

Dinner out!

Well, I survived my meals out, difficult after my new dietary restrictions.  Thank you both to Zander and Allan for your kindness today.  A special thanks to Roger Berkowitz of Legal Seafood fame for sending us this delicious (and healthy!) dessert!

Need, Want & Would Like

In many discussions over what is ideal primary care, it occurs to me that there is a bit of a definition problem worth certain words people throw around.  I am not taking about Patient Centered Medical Home, Care Cycle, and Quality measures.  Rather, I am referring to three very simple words:  Need, Want & Would like.  I would like to propose operational definitions for each of these words, to better guide solution design for health care.  And perhaps other things about which I am less qualified and therefore less apt to comment.

1.  Need.  Cannot do without; Necessary (in the Necessary/Sufficient paradigm).  An example:  Someone with a new Drug Eluting Stent in their coronary arteries NEEDS dual anti-platelet therapy (perhaps Aspirin and clopidogrel).  Without, chances of death are unreasonably high.  That is a need.  People NEED health care over their lifetime.

2.  Want.  Desiring something enough to give something up for it (or pay for it).  This falls under the common law doctrine of no consideration, no contract.  If you want something, you are willing to pay for it, in money, time, trade, opportunity cost.  For example:  Last year I wanted an iPad, so I bought it.  Wants are not needs, although sometimes it feels like a want has to approach need status before one will pay for it.

3.  Would like:  Desiring something, but not enough to pay for it.  I would like an iPad 2.  But I am not willing to by one yet.  If someone gave it to me free, I wouldn't throw it away.  The difference between Would Likes and Wants comes at payment time.  If you'd rather walk away without paying, it is a Would Like.  You don't value Would Likes enough to pay for them.  Remember that.

There is definite confusion of terms.  I have noticed in health care, and in most situations in which a government is handing things out seemingly for free (whether it is your parents and an iPhone or the Federal Government and Medicare dollars, Really big Wants often get upgraded to Needs, and almost every Would Like is considered a Want.  It is a way of getting things without paying for them.  In this environment, showing weakness is a strategy for gain.

In the world of the marketplace, of producers and negotiation (aka the real world), the opposite is true. Needs get dressed down as Wants, Wants as Would Likes, and I Wouldn't touch that with a 10 foot pole!  This too is a way of paying less for things.  In this environment, hiding weakness is a strategy for gain.

So when deciding on things in your life, first figure out if you are in the government world in the real world, and categorize your priorities accordingly.  But even more so, when designing solutions (for healthcare in this case) really figure out what everyone means, and agree upon the definitions above (or some other standardize set).  Enough with the grandstanding and positioning, just figure out how to get what you need, pay for what you want, and accept what you would like.

Games, a solution for health?

In this week's New England Journal of Medicine, Volpp and colleagues (article linked through the title of this post) comment on the use of immediate incentives to improve employee health through redesigned health benefits plan.  This space has fascinated as it combines two of my areas of interest: health, specifically the delivery of superior health care, and games, specifically PC games.  How did I draw this conclusion?

In the article, the authors comment that adding immediate upside incentives will cause behavior change toward the incentive.  This is what I have tried to explain to the non-gamers around me... you keep pushing the button, ultimately because there is a reward for what you do.  In my preferred case, completion of some task which is fun in its own right, leads to the continuation of a narrative which better be interesting!  Games that lack either a fun mechanic or a decent story tend not to make it into that "classic" realm.

Similarly, benefit design has historically been designed with no incentives (no game mechanic) or worse, perverse incentives (a truly evil game).  The narrative reward--better health, has theoretically always been there, but not quite as explicit as it could be.  One interesting company, Redbrick Health has been doing just what is described in the article, adding a game layer to the world, a brilliant line I have borrowed from Seth Priestbach.

Writer's Block

This is an interesting blog post idea, I know, but I have been experiencing some serious writer's block recently and I hoping to baby step my way out of it.  Currently on my To-Do list I have several pieces to write, some past deadline, some in collaboration with heavy hitters in my field, and some I just find fascinating.  However, between switching from Residency to "real" life, with its attendant risks, intervening vacations, rewards and change of pace; having homework again in the form of board studying sucking up my creative time; and attempting to return my body to a state of pre-residency vitality, has really sapped my ability to create written words.

There is another possibility which is far more terrifying to me.  I am concerned that in my transition to my new careers, both inpatient nocturnist work and outpatient entrepreneurship/start-up work with Iora Health, has made me too happy.  I am actually quite content with my work, excited to do it every day, with a firm belief in both what I am doing in the short term, and its possibility for long term positive effects.  In short, I have lost the strong emotional trigger in the form of frustration that led to so much previous writing.

I hope that I can mature a little and find a new muse which allows me to write.  I am hoping that my enthusiasm for a better world, separated from my frustration from living in the current world, will be enough to keep me writing.  Because I do NOT want to have to go through residency again just to stay in the game!

Resident Night Perks

I received this in the mail unexpectedly from the "Drew Crew" a group of very motivated high school students from around the country who traveled up to Framingham to learn about becoming a physician.  Through National Youth Leadership Forum's Resident Night Program, I was given the opportunity to talk with them for 90 minutes or so.

Drew Crew- you are the best!

Day 3 on the Juice Fast

"Hey Andrew, you want to go to Birch Creek on a Juice Fast with me?" started a conversation with may dad a few weeks ago. It is now day 3 without solid food and about 4 hours of daily exercise. The most surprising thing, I am not hungry. Each day begins with a Barley drink, five mile "walk" (to the top of some high point in the catskills), breakfast juice (two for men!), 2 hours of exercise with a protein smoothie in between, a lunch juice, more exercise and a lecture, a cup of bouillon, then a dinner juice. The even more surprising thing, is that I cannot stop thing about Corned beef. All the foods in the world I am not eating, and it is the salted cured meats that my brain desires.... Watch out Michael's, here I come!