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Medical Economics is proud to unveil the honorable mention entries in our 2015 Physician Writing Contest. We believe the essays exemplify what connecting with your patients is truly about, and demonstrate the levels of heart, determination, and empathy you strive to bring into every exam room, every day. Thanks for reading.

The Difficult Patient: Physician writing contest honorable mention

There is no doubt that American health care is in crisis. Tens of millions of Americans are in medical debt. Hundreds of thousands are injured or die each year from avoidable health care errors and hospital-acquired conditions. Insurers categorically deny patients the appropriate treatment and medications in a misguided approach called “prior authorizations.” Employers have been asleep at the wheel for decades, allowing the system to unnecessarily jack up the costs of health care.

The U.S. is the only developed nation in which life span is decreasing, and we have, by far, the worst disparities in health care and health outcomes. Burnout and demoralization amongst clinicians and staff now adversely impact nearly half of the American health care workforce.

If we are to solve the dire dilemma in American health care, it is clear that the approach will have to be radically different from those we’ve taken to date. Over the past decade I’ve been studying visionary leaders who are thinking and acting differently. There are replicable lessons we can learn from these divergent leaders – approaches that we can adapt and scale. Below are three foundational principles and three examples we can learn from to humanize healthcare.

If you’re not actively and intentionally 

, then you're fostering distrust. When people talk about trust, I ask (1) How are you defining it? (2) How are you measuring it? (3) How are you operationalizing it?

Address health inequities and disparities. 

The immediate goal is to eliminate inequities in health care and disparities in health outcomes. What we must do is replace all of the systemic ‘ism’s: racism, sexism, ageism, ableism, classicism – with humanism - and again, operationalize and systematize it.

The evidence is overwhelmingly clear. More preventive primary care in a community leads to greater health and lower costs. 

 is fundamental to achieving any effective and sustainable health care system. This also includes attending to the emotional, relational, and psychosocial aspects of an individual’s life.

There are several examples of these principles in action. Unbeknownst to most, the Veterans Administration (VA) has become one of the most innovative and transformative epicenters leading the way in humanizing health care delivery. It’s also the largest health care system in the US – with approximately 150 hospital centers, 1,400 ambulatory care centers, and over 400,000 employees providing care to over nine million veterans annually.

In 2016 the VA instituted a “Trust Index.” Quarterly, they send out a survey to measure veterans’ perception of the value being delivered to them by the VA. The survey has three statements – each measured on a five-point Likert scale – that address ease, effectiveness, and emotion, plus an overall trust statement.

Ease - “It was easy to get the care or service I needed.”

Effectiveness - ”I got the care or service I needed.”

Emotion - ”I felt like a valued customer.”

Overall trust - “I trust VA to fulfill our country’s commitment to veterans.”

The VA publicly reports their trust index results quarterly (

), breaking down results by gender, race and other demographics. This transparency clearly adds to the trust they’re building with their employees and patients.

When they first began the survey in 2016, they discovered that only 55% of veterans trusted the VA, which they felt was unacceptable. In response, they used the insights they gained from this and other surveys, and launched numerous patient-facing initiatives as well as efforts amongst clinicians and staff to improve trust. As of Q4 2023, their score had improved to over 79% – best in class compared to other public and private sector healthcare delivery systems in the U.S. Their goal is over 90%. In order to reach that percentage, they have already begun mapping out veteran patient journeys and creating personas that capture the pain points, challenges, and bright spots for veterans as they utilize the VA.

The VA has also launched a national Whole Health Initiative (

), which has been extensively studied. Its goal is to provide more holistic wellness care, complementing traditional clinical and social care. The program is based on decades of research demonstrating that non-clinical factors play a significant role in the health outcomes of individuals. These factors include issues such as housing, financial stability, employment, education, transportation, nutrition, sleep, stress, relationships, and neighborhood and environmental safety. What’s fascinating is that this program also addresses issues such as loneliness and an overall sense of purpose in one’s life – factors now known to contribute not only to emotional and mental health but also to physical health and longevity.

The VA Whole Health program is multi-faceted and operationally complex, but it boils down to two essential questions which, I believe, other organizations can adapt and apply immediately. First: “What is most important to you in your life right now?” And second: “What can you and we do to assist you in achieving or attaining what’s most important to you in your life?”

The final example comes from a provider organization called ChenMed, whose focus is to provide VIP care to older patients who have either Medicare Advantage or are dually eligible for Medicare and Medicaid. ChenMed has been recognized as one of the best provider organizations in the country, with demonstrably superior quality, safety, health outcomes and experience scores.

Dr. Faisel Syed is a practicing internal medicine physician and clinical leader at ChenMed. One day he noticed the way he and his team were describing some of their patients. For those who work within provider practices, you’ll be familiar with the term “walk-ins.” The term has a negative connotation because patients who walk in without an appointment disrupt the schedule. It’s a term that does not elicit a lot of warm, fuzzy feelings from providers or staff in a clinic setting.

Syed recognized that it was also a somewhat dehumanizing term, not in keeping with the overall mission and culture at ChenMed. He reminded himself, his colleagues, and his staff that these patients were calling or coming in for an immediate appointment because they had an urgent medical need. So he asked his staff to change the term “walk-in” to “person in need.” It was nothing more than that, but that subtle shift changed everything for the team. It established a renewed sense of empathy, compassion, and kindness.

I applaud anyone who is asking themselves, “What can I do to humanize health care?” I would suggest that rather than trying to boil the ocean, start small. Start by talking about it. Start by asking questions that challenge the status quo and the incrementalism that has taken over healthcare delivery. Start by sharing examples of humanism in your practice and organization. Start by making your workplace more humane for clinicians and staff. Start by noticing the words you use.

The most important thing is not to allow the system to overwhelm, dismiss or demoralize us. Each of us is a leader – no matter what our role is – and we all need to be leading a humanistic transformation in American health care delivery.

) is a health care executive, author and nationally-recognized thought leader. His second book,

Beyond The Walls: Megatrends, Movements, and Market Disruptors Transforming American Healthcare

 was published in September 2023. He has over 15 years of experience in leading enterprise-wide programs and developing innovative, forward-thinking strategies. Dr. Neuwirth produces and hosts the popular podcast series 

 He speaks and consults to healthcare systems, boards, medical societies and national associations.

If we are to solve the dire dilemma in American health care, our approach will have to be radically different from those we’ve taken to date.

Topics

What can I do to humanize health care?

One visit to an emergency department, or even an annual checkup, can leave patients with a lot of information to process, including diagnoses, treatment decisions, prescriptions, instructions for care, and critical steps that need to happen between visits. Following their appointment, patients may feel overwhelmed, confused, or simply unable to remember what needs to be done to continue managing their care. 

 don’t remember their physicians’ recommendations and treatments unless prompted.

But this interval between appointments is an important part of care management and contributes greatly to positive outcomes. When patients wait long periods between appointments and don’t track and report their health measurements, they and their providers are forced to fill in the gaps, often guessing what caused changes—or trying to remember what happened—between visits.

Without a window into ongoing patient health, physicians must wait until they see the patient again weeks or months later, leaving them with a blind spot in disease management and potential medical issues. These blind spots can quickly snowball into poorer 

, particularly when worsening symptoms aren't quickly addressed.

The importance of patient self-monitoring

 the impact of self-monitoring comes into focus. Most chronic disease and illness management is performed 

 by patients themselves. Patients need to be able to identify symptoms, manage medications and/or equipment, and know when to call or go to their care provider. In theory, they should be actively self-monitoring between appointments and working with their physicians as needs arise.

We know that patients who track their health and communicate data with providers are 

. Patient self-monitoring also helps physicians 

, but in a system based on health management through appointments (whether virtual or in-person), even if a patient is regularly self-monitoring, they often 

lack a way to communicate data with their provider

Fortunately, digital health advances make it easier for patients to self-monitor, manage medications, and share this information directly with providers. When patients use technology to track and share their health data between visits, providers have the insights they need to manage and better understand the patient's care journey so they can help improve outcomes and experiences.

Data tracking and sharing between visits is a powerful practice for all stakeholders, leading to better everything:

 Routine provider-patient communication, made easy by platforms designed to streamline this information flow, saves time to discuss drivers of health, as providers already have progress notes and can be better prepared for the appointment. In-between-visit communication can also expedite time to diagnosis and the right treatment path.

 and increase economic burdens for both the patient and health system. Routine tracking can assure providers that patients are adhering to their treatment plans and 

 to health management approaches. Those who track their health information and communicate these updates with providers are more likely to have 

Self-monitoring and data sharing also results in significant 

 and hospital readmissions, also reducing the burden on emergency care services.

Self-monitoring between visits also increases patient awareness and engagement, helping ensure they understand their condition and medications and are equipped to detect fluctuations and side effects that need immediate attention.

Using technology to connect patients and providers

Previously, patients often would be relied on to remember to record health updates on their own, sometimes using a paper journal to share those notes at the time of the next appointments. Even when data recording software or programs became available, they provided no direct connectivity with providers, continuing to ignore the component of care between visits.

Now, both patients and care providers can use technology that has the ability to track specific patient conditions, prompt patients to record timely health measures and share this data with their care provider, as well as alerting patients to contact their provider if there is an anomaly or potential emergency. This technology is key not only to enabling patients to better understand and engage with their health, but helping to build a bridge between patients and physicians.

Such communication is vital to effective care. If patients are diagnosed early and adhere to treatments, they have better outcomes. If patients and care providers have a better connection and more time to speak, there is better engagement and flow of communication. Engaged patients are more likely to participate actively in their care and better understand how to manage outcomes.

To succeed, the technology used to self-monitor and report needs to have two components: connectivity, which is foundational for ensuring the transfer of information, and AI, which is becoming a force in symptom identification and monitoring for specific health issues against existing patient data. On the physician’s side, technology should assist by speeding up the analysis of information, presenting primarily what they need to make rapid and appropriate decisions.

The easier it is for patients to report their information directly to their providers' systems, the faster we can achieve better outcomes and experiences that impact the entire health care system.

Ongoing communication with care providers enables earlier detection and treatment of health problems 

How self-monitoring and data sharing produce better patient outcomes

Physician and patient perception: What doctors think about patients

Patients are not the only people who develop perceptions about other patients. Physicians do too. Patients and physicians both have 

 about patients who provide incorrect medical information in their discussions with doctors. Here is an explanation from Jessecae K. Marsh, PhD, co-author of the 

, “Perceived Penalties for Sharing Patient Believes with Health Care Providers.” Additional authors are Onur Asan, PhD, and Samantha Kleinberg, PhD, both of the 

A cognitive psychologist discusses causal beliefs, patient decisions and disclosures, and how those affect health care.

A study led by a multi-institutional team of researchers from the UNC School of Medicine, Duke University, Oxford University, Columbia University, and the University of Miami illustrates the need for rigorous clinical validation of AI medical devices. Published in 

, their research reveals that nearly half of the 

 authorized by the U.S. Food and Drug Administration lack reported clinical validation data, raising concerns about their effectiveness and safety.

Sammy Chouffani El Fassi, an MD candidate at the UNC School of Medicine and research scholar at Duke Heart Center, along with Gail E. Henderson, PhD, professor at the UNC Department of Social Medicine, led an analysis examining over 500 AI medical devices approved by the FDA, finding that 226 of these devices—approximately 43%—did not have publicly available clinical validation data.

"Although AI device manufacturers often highlight FDA authorization as a mark of credibility, clearance doesn't necessarily mean that these devices have been thoroughly evaluated for clinical effectiveness using real patient data," said Chouffani El Fassi in a statement. "Our findings underscore the need for the FDA and the industry to enhance the credibility of AI devices by conducting and publicly sharing clinical validation studies."

 authorizations by the FDA has increased from two to 69, reflecting the rapid commercialization of AI technologies in health care. Most of these devices are designed to assist physicians in diagnosing abnormalities in radiological imaging, analyzing pathological slides, dosing medications, and predicting disease progression.

AI technologies rely on complex algorithms trained on vast datasets to perform tasks that traditionally require human expertise. However, ensuring that these technologies can accurately process and analyze new, unseen data is critical.

The researchers found that the latest draft guidance from the FDA, published in September 2023, lacks clarity in distinguishing between different types of clinical validation studies. This ambiguity, they argue, could lead to inconsistencies in the evaluation and approval process.

Of the devices analyzed, 144 were retrospectively validated, 148 were prospectively validated, and only 22 underwent validation through randomized controlled trials, the gold standard in clinical research. Notably, some devices used "phantom images"—computer-generated rather than real patient data—which do not meet the criteria for clinical validation.

In response to these findings, the researchers have called for clearer standards in clinical validation. They emphasize the need for the FDA to differentiate between retrospective studies, prospective studies, and RCTs, given the varying levels of scientific evidence these methods provide.

"We've shared our findings with FDA directors overseeing medical device regulation, and we hope our work will inform their regulatory decisions," Chouffani El Fassi said. "We also aim to inspire researchers and institutions worldwide to conduct more rigorous clinical validation studies to ensure the safety and effectiveness of AI in healthcare."

Researchers say the lack of reported clinical validation data raises concerns about their effectiveness and safety



Nearly half of FDA-authorized AI tools may be ineffective

Once a novel idea, concierge medicine has now been mainstream for over a decade and is widely accepted by both physicians and patients. Learn how a membership-based model can help improve your independent practice professionally, personally, and financially.

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The time is now for concierge medicine

Remote monitoring holds promise to improve the health of patients and the financial health of physicians’ medical practices.

How does it actually work? Daniel Tashnek, JD, is the author of “2024 Remote patient monitoring guide.” 

Click on the cover of the guide at right to view it as a PDF file.

Industry analyst outlines care management programs for physicians.

Jihan Akhtar, MD

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