JUST RELEASED: #RightCare Series in The Lancet

The Lown Institute has just announced the release of the Right Care Series, a collection of articles on overuse and underuse of medical care around the world, published in The Lancet:

"The full series of papers is available free to read online, along with our authors' commentary, a commentary by Don Berwick, and an editorial by Richard Horton & Sabine Kleinert of The Lancet. [The hops is that] you'll share the papers with your colleagues and others you think might be interested. You can also participate in the ongoing conversation about the papers on social media, by following us on Twitter and using the hashtag #rightcare. . .

The series is also a great opportunity to start a conversation about right care with friends and family. [They] have created a short explainer in non-technical language that lays out the key points from the article, including why it's crucial for patients and community advocates to take a leading role in decisions about how countries allocate their health resources."

(taken from a release by Vikas Saini, President, Lown Institute)

There are two other medical journals featuring similar collections: 

I also collect articles from diverse sources here:

 

 

Source: http://www.thelancet.com/series/right-care

VIDEO: Take Back Health: Join the #RightCare Alliance

Although the USA is a slightly different animal, with more emphasis on health care as a for-profit industry, many of the same problems exist in Canada and other nations with a primarily single-payer, public system.

The solution to health care interventions that are unnecessary, unwanted, or even harmful is: a social movement. That's what the Lown Institute thinks, and the Right Care Alliance is gaining momentum.

Watch this:

Source: https://www.youtube.com/watch?v=mdeH1bwYYD...

Day 2 of Road to #RightCare #Lown2015 Recap

This old photo came to mind as I thought about how people tell their stories:   Some graffiti at the skate park in Inuvik, NWT; Is it a profound statement about the way things are imposed on people without ever asking them or listening to them?  Maybe it's just  some teenagers upset about not having enough weed. 

This old photo came to mind as I thought about how people tell their stories:

Some graffiti at the skate park in Inuvik, NWT; Is it a profound statement about the way things are imposed on people without ever asking them or listening to them?  Maybe it's just some teenagers upset about not having enough weed. 

Today was about people.

What I kept hearing today was that patients are people, people have goals and values, and they need to be asked and heard. 

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We started with Dr Harlan Krumholtz explaining that the right care "is about an informed patient, with an informed choice, based on the right information." Given the real information, a person can decide whether the potential risks or harms of some test or treatment are worth accepting, for the potential benefit of that test or treatment.

Peter Drier, an articulate non-healthcare professional, told his story about being a patient and being the recipient of a (surprise!) $117k bill from a consultant (who he never met) that spent a few hours assisting in the Operating Room. This was in addition to the original agreed upon bill for his surgery. As he told his tale of attempting to navigate a rats-nest of a system that it seems purpose-built designed to bankrupt patients, I was alarmed. Dismayed.

How could you possibly navigate this while also coping with disease? How could vulnerable patients survive in this system? How could doctors ethically accept they were a part of it?

Others in the room thought that getting a patient help to navigate the system would be a good fix. Or maybe publishing prices in a transparent way would help. Wait... what?!

I was shocked to see that people have accepted this system. Rather than challenge the status quo, they seemed resigned to work with it and plan to bodge together some work-arounds and bandaids. Incremental change is sometimes a good solution but when you have a system that toxic, how can you let it persist?

I started really worrying, worrying about the case that surgeon Dr Brian Day has before the BC Supreme Court, which if successful, will pave the way for patients to pay privately for medically necessary procedures. I try to envision a world in which this helps patients, but that future looks like the US of A, and in the US of A, health care is broken, in a far more challenging way than it is in Canada.

But, there are bright spots! In a workshop on designing the future of Primary Care, we learned about the model of the Stanford Coordinated Care Team. It puts patients at the centre and offers them multidisciplinary support to engage them in achieving health, and does so by asking team members to rise within their scope to manage care and build relationships.

Through Beyond Workups and Rule-Outs, we explored the unique drivers of care in the Emergency Room, like time pressures and fear of missing a diagnosis. We brainstormed solutions for the culture and process, and I was pleased to be able to share the (often hated in medical school but valued later in practice) "FIFE" model. This aims to aid patient-centred interviewing, to get at the person rather than the disease or symptoms:

This model forms the backbone of the Family Physician certification exam in Canada.

There were lots of other ideas about helping patients get in and out of the ER "well" and one idea for changing the culture of practice that I really like is "reverse M&M rounds" which may be the same thing as "Right Care Rounds." There was a separate session on this topic I didn't get to go to that session as there was too much simultaneous good stuff; regardless, I am inspired to attempt (time permitting) case rounds back home about inappropriate (unnecessary) care, whether it caused an obvious bad outcome or one that was a bit more subtle.

In the same vein, The Do No Harm Project presented some wonderful 'vignettes' or narratives from residents, highlighting 1) how common medical overuse is and 2) how persuasive a patient's story can be. 

Tomorrow we decide how we will take what we've learned and commit to putting it to work.

The Lown Institute: great Right Care resources, updates

The Lown Institute represents the strongest collective voice of the Right Care movement. They've spearheaded the Right Care Alliance, conferences that have transitioned from "Avoidable Care" to "Right Care," and the Declaration of Principles. The redone website is easy to navigate and has some great new features!

Today they sent a great summary e-mail of their recent work and initiatives. I've updated some Lown Institute details in the Less is More Medicine projects section and I shamelessly endorse them here by sharing some snippets (edited for brevity) from the update I received:


New Website

Our website www.lowninstitute.org has gone through an overhaul, complete with new design and user experience. Added features include Overuse 101 , the Overuse Library, and invitations to Sign the Declaration of PrinciplesTell Your Story, and Join the Right Care Alliance.

Right Care Weekly

We have launched a regular Right Care Blog feature called Right Care Weekly. Right Care Weekly is a round-up newsletter that highlights the most important news of the week as it relates to overuse, underuse, and misuse of medical tests and treatments.

Right Care Regional Events

In partnership with Right Care Alliance members, we are hosting regional conferences to promote right care across the country.  We have confirmed a regional conference in Denver, Colorado on Oct 11, 2014; planning for the Washington, D.C., San Francisco, and San Marcos, California area is underway.  Regional conference updates can be found on our website.

2015 Lown Institute Annual Conference

The third annual Lown Institute conference is slated for March 8-11, 2015 at the Omni Hotel, in San Diego, California. The aim of the conference is to share progress made since the 2013 conference, renew our collective voice for change, and inspire Right Care Alliance organizing efforts. Unlike previous years, the conference is open invitation. Registration will begin this summer.