Death Rating of Doctors Hurting Healthcare? Study highlights complex issue

The statement of purpose for this blog pulls no punches. From my choice of words the reader can easily deduce that I am "mad as hell" and often ask myself how much more I can take. However, I fully recognize that the challenge of improving health care is, like most challenges we face today, complex and far from clear-cut. Sure, there are some things that ARE clear, at least IMHO, starting with television adverts for drugs. They don't help anyone but the shareholders of drug companies. Drug ads on TV should be banned. The laws that prevented them for so many decades should re-applied. Period. Do a little free reading here if you doubt this or dig into some of the scientific papers here.

But other issues are less clear cut. For example, should the public have access to a doctor's 'stats' such as survival rates for individual surgeons. This sounds like it might be a good idea. If I was about to have major surgery I would like to get some assurance that the doctor wielding the knife had a good track record. Indeed, a good friend of mine is facing hip surgery and found a set of stats in USAtoday that gave him pause. He was going to have the surgery done at Flagler Hospital in Saint Augustine, but Flagler only got one star in the ratings he found on the web, versus four stars at the hospital he chose instead. However, these ratings are tricky. Consider this chart. Flagler gets three stars for 2007, an improvement over one star for 2006.

Not knowing who or what stats to believe is only part of the problem. Consider this story in the Boston Globe about death rating doctors. And now consider this comment by Twila Brase, president of the Citizens' Council on Health Care:

"Physician report cards threaten patient access to medical treatment. Doctors who fear that the death of a patient will be a black mark against them have been found to avoid the patients that need them the most. Increasingly, patients may find doctors unwilling to try a risky procedure that could actually save them."

I don't always agree with Twila, but have remained on her mailing list because she often highlights the other side of the coin, so to speak. The CCHC web site is certainly worth a look.

As for the answers, well it seems to me that under a free market system anyone can get a good rating for their product or service, they just have to find the right rating entity, and invent one if there is not a pliant one to be found. Wouldn't a government rating system be better? After all, we get government crash test ratings for our cars. And would it not be better for those ratings to apply to a surgical practice as a whole, rather than single out individual doctors? Further research on the effect that Twila highlights is clearly needed.
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Jimmy Carter and Middle East Politics: You cannot equate criticism of Israel with anti-Semitism

I have just bought Carter's new book, Palestine: Peace Not Apartheid. I have not read it yet, but I plan to review it when I have read it (something that some other "reviewers" have failed to do). Some of the criticism that Carter has drawn is extreme, with reviewers on Amazon calling him "wicked" and "a liar." And I think I can hear mutterings of "anti-Semitism in the air. Clearly, anti-Semitism is wrong (there is a good definition and a very long entry on this topic in Wikipedia). But I see no basis for equating criticism of the government of Israel with anti-Semitism. Take one simple example. Israel has atomic bombs. If you believe it is wrong for countries to possess atomic bombs are you therefore anti-Semitic? I don't think so.

Remembering The Love Man: Otis Redding, 1941-1967

It was 39 years ago today that Otis Redding's plane crashed during a storm en route to a concert in Madison, Wisconsin. He was just 26 when he died, but Otis gave us an enormous body of work, songs that have become part of the soundtrack of our lives, from "Respect" to "Try a Little Tenderness." from "Shake" to "The Dock of the Bay." He gave us dreams to remember and he will always be remembered, with love and respect.

Hoops for Hope: Hope for kids in more ways than one

Very sorry I didn't blog this in time for their December 2 fund-raising event. Hopes for Hope is an organization raising money for children orphaned by HIV/AIDS. In the process the organization is raising awareness of the problem among children and adults in this country. Featured on NBC. And started by a 12-year-old!

This is definitely a hopeful sign that apathy has not completely overtaken our nation's young, something I have talked about before.

Carter Bashing: At least get the facts right

Former president Jimmy Carter has a new book and the old complaints are being echoed again, along with old errors. Consider "He Failed and He Can't Shut Up, Opinion by Allan Saxe, WBAP Political Analyst."

What is it about former President Jimmy Carter? He continually finds faults with the United States and those countries that uphold western civilization and the rule of law.

Presumably those countries include America and Israel and Mr. Saxe thinks former presidents are not allowed to talk about things like Abu Ghraib and conditions in the Palestinian refugee camps. According to his detractors, Carters' sins are numerous:

He has sanctified the elections on the rise of Hamas to rule the Palestinians. On the other hand, he has said that the elections in the United States do not meet up to his standards.

Or is it that years of neocon intoning that democracy will save the Middle East looks dumb when Middle Easterners elect someone neocons don't like? And gosh, everyone knows touch screen voting in America is jolly well accurate, just ask the undervoters in Sarasota, Florida. What's to criticize?

Fortunately, Mr. Saxe understands "why this former President disdains the democracies and inadvertently legitimizes tyrannical societies. And why he is so critical of his own country." Okay, let's hear it:

It is because he lost the presidential election in 1980 to Ronald Reagan. For an incumbent President to lose an election straight away to a single challenger, with no third party taking votes away and scrambling the election like Ross Perot did to President Bush the Elder in 1992 or Ralph Nader’s candidacy affecting Vice-President Gore’s bid for the Presidency in 2000 is very rare.

Hmm, so what about John Anderson, the moderate 1980 Republican turned independent candidate? Close to 6 million people voted for him over Carter or Reagan. Indeed, Anderson took a not insignificant 6.6% of the popular vote. Sure, Reagan won by a landslide. But to claim Carter is a sore loser, and then rewrite history to make his loss look worse than it was? C'mon folks, let's try to stick to the facts.

Smartcar Looks Smart:: We want smart cars now!

Seen here outside Foyles, the largest book shop in London. The sad thing is, that was THREE YEARS AGO! Come on people now, let's sign together: We want fuel efficient cars NOW.

Nothing will cool the tension in the Middle East like a big fat drop in U.S. fuel consumption. Wise old Sheik Yamani figured that out back in the seventies: Jack the price of crude too high too fast and Americans will switch from Caddies and Lincolns to Toyotas and Hondas, cutting demand. Sure enough, gas consumption dropped off at the end of the seventies and didn't rebound until the late eighties.

Believe a former petroleum accountant when I say, there is a nightmare scenario for oil producers: Crude left in the ground. This can happen if price per barrel falls below the per barrel cost of extraction, which rises as an oil field ages. Here is an interesting snippet from Yamani back in early 2005. Note the correctness of his prognostications: oil has fallen off its highs.

And Americans can now buy the 40 mpg Toyota Yaris, the 38 mpg Honda FIT, and 36 mpg Nissan Versa, all introduced in recent months to round out high mileage offerings. Add a bunch of 60 mpg SartCars to the mix and average mpg could drop enough to scare producers into being more amenable to diplomatic negotiation (not to mention the reprise from pollution).

Smartcar for Work: Commercial delivery in Amsterdam

While DaimlerChrysler continues to deny Americans the Smartcar, these superb vehicles are finding many uses in other countries. Here is one I saw in Amsterdam being used for commercial deliveries (with just a driver in the car it can carry a surprising amount of stuff).

Binder Clips to the Rescue: Travel tip for a good night's sleep

I am a big believer in getting a good night's sleep when traveling. This has been made easier by the move to upgrade bedding, led by Marriott if I am not mistaken. But even on a "plush" bed I will have trouble sleeping if the room is not dark. This is especially important when you have shifted time zones and want to acclimate to the new zone.

Of course, most decent hotels provide light-blocking drapes/curtains, but for some reason I have yet to fathom, these often fail to close all the way. The result: the lights from the parking lot keep you awake; or a shaft of blinding sunlight strikes your face at 6:30AM when you really needed to sleep until 8. The answer: binder clips (medium). These are the metal spring clips you get for just pennies a piece at the office supply store. I have had great luck in keeping drapes from drifting apart with just one or two of these clips applied to the inter-folded edges of the fabric. Slip a few into your bag before you head out.

Another room darkening trick is to roll up a surplus part of the bedding (one of those foo-foo decorative cover bits for which I don't even have a vocabulary) and put it across the bottom of the hotel room door, you know, across that yawning gap which doesn't seem too bad when you first turn out the lights, but slowly expands to admit enough light to read by.
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Traveling Light: A good idea gets better

Here's an old travel tip made newly useful by the increase in lost airline luggage, due to the increase in checked luggage, due to the reduced-liquid-in-carry-on rule: travel light. Easier said than done maybe, but think about the last time you flew. Did you wear all of the clothes you took with you? A lot of people will admit that they did not. Next time, take two items out just before you leave. I bet you won't miss them. Repeat each trip until you are down to the bare essentials.

And what about the essentials? Could you have packed fewer items if you had a chance to wash your clothes during the trip? Well you do. Here's what I do when traveling on business in North America, i.e. staying in hotels at night and wearing a shirt and tie during the day. I take just two shirts and wash one every night in the sink in the hotel bathroom. Tepid water and a touch of hotel hand soap. Then I wring them out in a hotel towel (I will post some pictures if this is hard to visualize). Then I hang the towel and the shirt to dry, smoothing out the main wrinkles in the shirt and putting it on a hotel coat hanger in the bathroom (for hotel hanger's that don't have proper hooks just hang the shirt on the rack or use a twist tie--I carry several with me, plus a few rubber bands and binder clips--more on those later).

The typical American hotel is so dry that the shirt is bound to be ready by morning, plus the shirt and towel will have eased, slightly, the humidity in the room, which is good for you. Use the hotel iron to remove any remaining wrinkles (I've noticed a lot of budget hotel chains are now providing irons). To make life easier, chose a good no-wrinkle shirt to start with. I find JCPenney Stafford shirts work great and look great after dozens of washings, but still have the feel of 100% cotton.

Wash-as-you-go helps reduce the amount of stuff you carry on with you, and the impact of misplaced bags. Since I travel in a good shirt, lost luggage won't stop me looking good the next day. I became a believer in this strategy about 20 years ago when I took a day trip down from the home office in San Francisco to a client site in LA for 8 hours of consulting that stretched into two days. The client was delighted that I could stay the extra day and didn't even notice that I had not brought a change of clothes with me. I just washed the essentials overnight.
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Images Abound: Goosing a blogspot blog template

Just a quick word about the images on this page (all Cobb originals). They are, clockwise starting at the top left:

• The nose of the DaimlerChrysler Smartcar, photographed in London. There are over 750,000 on the streets of the world, but they are still not sold in America. How backward is that?
• Aeroflot Tupolev Ty-154M passenger plane, taking off from Moscow airport.
• Maserati Quattroporte, the most elegant four door passenger car design ever (IMHO), photographed outside a showroom in Moscow, then turned into a pencil sketch with PaintShop Pro. See the real thing below.
• TGV high speed train, photographed in the Gard du Nord, Paris, after I arrived there from Amsterdam on the Thalys, another high speed train. The lack of high speed trains in America is testament to the continuing power of oil companies and the trucking/road building lobby (favored by a certain governor turned president).

A train, a plane, and two automobiles. A taste of things to come.

Oh, and the blogspot template that formed the basis of this page? It is called Lighthouse, but it looks a lot different from this when you first install it.
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