Unlearning 101

Doctor Heal Thyself ... By Unlearning

When physicians are asked to state the relative risks of classical predictors of heart disease (such as smoking or diabetes) many, according to this article, are likely to cite a figure of between "10 to 15 times."

This is not only wrong, it is dangerously wide of the mark. Most of the predictors have only relative risks of around 1.8 to 2-fold.

Too many people it might seem that the danger of over-assessing the relative risk of, say, smoking to heart disease is a good thing -- or, at least, it doesn't do any harm. This may be true but I'd argue it can have a dangerous side-effect by causing physicians to under-assess other risks.

For example, due to the accelerating rate of genomic information (which I have written about before), physicians have a better ability to use genetic information to more effectively treat disease. In many cases, in fact, this genetic information is just as predictive of health as the more classical predictors.

Unfortunately, most doctors aren't aware of this reality. They, therefore, mistakenly continue to believe other risk factors are more important.

To understand the magnitude of the problem consider this statement from Felix Frueh, president and head of genomics initiatives at Medco: "Less than 1 percent of all opportunities are being realized with respect to genetic testing."

Put another way, 99% of all patients are receiving less-than-optimal care due to physicians under-estimating the predictive power of genetic information!*

I am convinced that before new learning can take place, often, unlearning must first take place. In this case, physicians need to unlearn their misunderstanding of the relative risks of classical predictors (e.g. smoking, diabetes, etc.) before they can learn the new powers of genetic testing.

(*At the present time, there are more than 1,200 genetic tests for more than 1,000 different diseases and yet only 13% of 10,000 doctors surveyed had ordered a genetic test for a patient in the preceding 6 months.)

Related Posts

The Future of Healthcare is Accelerating

Why the Healthcare Industry Must Be Prepared to Unlearn

Bite the Hand That Feeds You

 

Paris, Big Mamma and Ineffective Advertising

I recently had the pleasure of going to Paris on vacation and happened to use the city's fine subway system on a daily basis. One of the things that struck me as odd was the large number of advertising posters for Martin Lawrence's new "Big Mamma" movie. Now, to be honest, I can't imagine why anyone would want to see the movie in English, let alone French. This, however, is not the point of this post. Rather, it is to question why Hollywood continues to take such a wasteful, shotgun approach to advertising.

We live in an era of targeting advertising. With little effort, Hollywood could find out that I am more likely to enjoy the "King's Speech" or "Waiting for Superman" than "Big Mamma" and then find a way to pitch me on the Internet or, perhaps, my smartphone.

Alas, before businesses and industries can learn a new and better approach, often they must first unlearn the old, ineffective way.

I know Hollywood can grasp this message. After all, we are no longer watching silent, black-and-white movies. Why then is Hollywood still advertising as though it -- and its customers -- are living in the past?

Related Posts

Unlearning Hollywood

 

I've Got a Secret and I'll Kiss & Tell

Am I -- and Your CFO -- to Blame for Spiraling Health Care Costs?

Earlier today I had the opportunity to deliver the closing keynote presentation at the Alabama Hospitals Associations' Annual Leadership Conference. Before my talk, I had the great pleasure of listening to Bill Ward, the director of the Master Health Administration Degree at the Johns Hopkins University's Bloomberg School of Public Health.

At one point, Bill brought up a slide and asked the audience which drug a hospital should buy: Drug A, at a cost $1.80 per dose; or Drug B, at a cost of $11.50 per dose.

At this point, I thought to myself, "Yes! This is exactly the problem with healthcare. Many people continue to prescribe brand name drugs when a cheaper but equally effective generic version is available."

While this is undoubtedly a real issue and many generic drugs should be prescribed, this was not the point Bill was trying to make. As a result of his next slide, I found myself unlearning.

The initial cost of the drug is only one of the variables which must be considered. Review the following:

Drug A Drug B

Drug cost/dose $1.80 $11.50

Administration cost/dose $15.oo $1.00

Nurse intervention/dose $3.00 $3.00

Total cost per dose $19.80 $15.50

Drug A is actually more expensive. The point, of course, is that all of us need to view healthcare costs from a broader perspective -- myself included. (Ed. Obviously, the effectiveness of the drug and the length it must be administered must also be considered.)

Related Posts

Unlearning & the Health Care Debate

Unlearning the Hospital

For the past two days I have been in California working with a well-known construction company and architectural firm designing the hospital of the future. Due to the proprietary nature of project, I can't go into specifics with this post but I always begin such projects from the premise: What must we unlearn?  

For example, perhaps, we should unlearn the idea of who the customer is. Every hospital claims it wants to "serve the community." If they are serious about this idea than they must also focus on non-customers. in other words, a true community hospital needs to continuously look for ways to "push" preventative information medicine out into the broader community so that its citizens never need to visit the hospital in the first place.

Hospitals must also unlearn the idea of the doctor-patient relationship. Today, patients and their social networking often know just as much -- if not a lot more -- about their disease than the doctor. The hospital of the future must acknowledge this reality and be designed in such a way that information can flow freely between all parties.

Another thing hospitals must unlearn is the waiting room. One strategy to think differently about the hospital of the future is to focus on the "exit" room. What information does the patient need so that he or she doesn't need to return to the hospital?

I have a lot more ideas but I'd love to hear your thoughts on this subject.

Related Posts

Unlearning & the Health Care Debate

Unlearn the Doctor/Patient Realtionship

Unlearning Surgery

Unlearning Disease

Unlearning the Hospital Gown