Tuesday, July 12, 2011

Grand Rounds: "It's Up To Us" edition

Our theme this week is "Personal Responsibility" - only posts that address this issue have been included. I was quite impressed with the creativity that potential contributors brought to the table to make sure their posts fit the bill.

We like outside-the-bun thinkers.

The concept of personal responsibility (or accountability, if you prefer) has been a consistent meme here at IB since our earliest days some 6+ years ago. So it seemed appropriate to use that as the theme for this edition of the venerable Grand Rounds:

As the Happy Hospitalist notes, "personal responsibility doesn't have to be only about the patient. It can be about doctors and hospitals, too." Here's his take on how to hold providers accountable to their patients.

Ryan DuBosar, the ACP Internist, reports on a new study claiming that "obesity is filling in for smoking as a cause of death in working class women." Doc Ryan observes that "people need to take personal responsibility for their health, even as they drop one bad habit." Picking up a substitute one isn't moving the ball forward.

■ Can interpersonal communication help us understand our relationships and the social world in new ways? Will Meek thinks it can, and makes the case that "when we have this knowledge we can be more responsible in how we interact with others." A potentially great first step towards personal accountability.

■ Continuing the Happy Hospitalist's point that personal responsibility also rests with providers, Bob Coffield avers that "health care providers and staff have a “personal responsibility” under HIPAA to not snoop in the records of patients not under their care." But he goes even further, making a great case that "health care lawyers have a personal responsibility to understand how their health care clients are implementing and using social media tools in health care." These include Twitter and Facebook (and, presumably, blogs and bloggers).

The always entertaining (and enlightening) Dr Roy Daviss asks "should patients take personal responsibility for how their health information is shared and with whom?" In answering the question, he notes the "risks and benefits of your data going through a Health Information Exchange (HIE)." And don't miss the lively conversation in the comments.

Glenn Laffel provocatively suggests that "folks with chronic diseases would tend, all things being equal, to take care of themselves somewhat better than ‘healthy’ folks, since they have been taught the tough lesson that their behavior is indeed linked to poor health outcomes." One would think so, notes Glenn, but "alas, that’s just not the case."

■ Our colleague Louise Norris observes that "health insurance is not where personal responsibility ends." She backs this up by noting that, oftentimes, "a large claim on a health insurance policy can be the result of a chronic condition or one that will need extensive long-term treatment." One might well have coverage at the outset, but what happens if that changes during the course of the condition?

■ So how to avoid (or at least mitigate) such chronic conditions? Dr Ed Pullen suggests that "choosing a healthy hobby is one of the things we can all do to take personal responsibility for our own health," and even offers some helpful suggestions on which ones to consider.

■ Private practice cardiac electrophysiologist [ed: try saying that 10 times fast] Dr John Mandrola believes that "wellness requires more ownership," and laments that this message seems to be (increasingly) falling on deaf ears.

■ I confess to a guilty pleasure: DrRich (not a typo) is my favorite President of the Future Old Farts of America (FOFA). This is a lot more prestigious than it sounds: as of this writing, total membership in the FOFA exceeds zero. In this post, DrRich discusses what other OF's need to know about "Medicare as we know it," and their responsibility to ensure and/or prevent its demise.

Dr Charles offers us this Ode to Dads, and their child-feeding responsibilities.

■ Meanwhile, Dr Paul Aurbach offers this "brief introduction to helping persons with a medical disability safely enjoy an outdoor adventure experience, which may come with more than the "usual" amount of risk." Since assessing and managing risk is most definitely a matter of personal responsibility, this one's spot on.

■ So, should folks in Glass Hospitals stow thrones? Or ban smokers? University of Chicago's general internist and medical educator Dr John Schumann likes the idea that employers have the "right not to hire smokers." He notes that this is already the case at the Cleveland Clinic. But he's also concerned that it's a potential "slippery slope, and that all of us, especially those of us in the health care workplace, have a responsibility to set a good example."

Over at Calling the Shots, breast cancer survivor Beth Gainer knows better than most the value and importance of personal accountability. Her post "focuses on ordinary people who did the extraordinary," helping her through her "medical crisis of breast cancer because they felt a personal responsibility to do so." Talk about True Heroes.

e-Patient Dave [ed: gotta love that handle!] continues the cancer-survivor theme, offering this post that "articulates the best framework I've ever seen for what constitutes patient engagement." It's about 4-time (!!!) cancer survivor Jessie Gruman, whose recent address to the Institute for Clinical Systems Improvement recounts her own struggles and triumphs.

■ From Canada's West Coast, Carolyn Thomas wonders why "some heart attack survivors remain emotionally wounded for life as they relive and re-experience their catastrophic cardiac events again and again." She thinks it has to do with the fact that anyone who's undergone such a traumatic event can't help but be transformed, and then points out ways in which those most successful in moving on are those who understand best their own role in their recovery.

The Health Business Blog's David Williams brings us full circle, noting that providers also need to take a bit more personal responsibility. In this case, it's pretty simple: take the time to find out how much things cost [ed: sing it, brother!].

■ Finally, our own Bob Vineyard has the touching/disturbing story of a gentleman who took personal responsibility (perhaps) a bit too far.

Next week, please stop by Dr. Elaine Schattner's place for another romp through the medblogosphere.
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