Ask Not For Whom the Web Tolls – It Tolls For Thee

There is a significant push in the US toward tiered internet service.  US telecommunications companies who supply the lines and hardware that comprise the backbone of the internet are lobbying Congress for the ability to charge clients for premium, high-speed delivery of data, according to a May 25th CNN report Coming Soon, The Web Toll.

Some foresee the end result being much like cable TV – with basic channels and premium channels offered. Congress may vote on the matter before the year is out, and it is quite possible that the days of open cyberspace are numbered.

A tiered system would give companies with deep pockets a huge competitive edge over start-ups.  Small web sites, including many blogs, would no doubt disappear.

BBC News reports that Sir Tim Berners-Lee, the developer of the web, has stepped forward to state that he believes the web should remain neutral and resist attempts to fragment it into different services.  He warned that if the US decided to go ahead with a two-tier internet, the network would enter “a dark period”.

I can hardly claim to be objective since I am the owner of a minimally funded web site and blog. but one of the features I’ve always liked best about the internet is that in many ways it levels the playing field among the small and the great. It gives a voice to what Glenn Reynolds (Instapundit) refers to as “An Army of Davids.”

Other than making money for the telecommunications companies, at this point at least, I have a hard time seeing a positive side to this development.

Plaintiff Granted Access to Hospital Peer Review Records

The peer review process is once again under fire in court.  The Texas case cited below is a reminder that hospital peer review committees must provide and document consistent, fair, legally defensible peer review, as US courts seem increasingly inclined to grant access to confidential peer review records.

On May 1, 2006, a federal district court in Houston, Texas held that disparate treatment of a physician in peer review was relevant to the physician’s antitrust case, via the Holland & Hart Health Care Law Blog.

The Court ordered the hospital to produce all of the underlying cases in the hospital peer review of other physicians in order to permit Dr. Benson to do a comparative analysis of peer review of others compared to his own.

In Royal Benson, M.D. v. St. Joseph Regional Medical Center, ( C.A. H-04-04323), Judge Keith P. Ellison ruled that Dr. Benson was entitled to pursue discovery of discriminatory treatment of him in peer review by sustaining his request that St. Joseph Regional Medical Center produce peer review cases of physician’s other than himself who went through peer review proceedings at St. Joseph.

More information:

Avian Flu – How Will It Affect Us?

With the concern over apparent human-to-human transmission of avian flu in Indonesia, and the experts predicting the spread of H5N1, what remains in question among scientists is the severity of the expected outbreak.

Since many readers of this blog work on the front lines of healthcare, we know that there is  considerable concern over the effect on hospitals and health care workers if avian flu becomes a pandemic illness. 

Hospitals engage in disaster planning, and so should we as individuals. We all tend to rely on the continual availability of goods and services, yet we know that disasters occur, and the normal rhythms of life can be disrupted. It’s good to consider what items you might really need if you found yourself unable to get to a grocery, pharmacy, or hardware store, or if those stores were closed and empty. 

The ABC News article How Will Bird Flu Change Your Life? advises everyone to "stock up on essential items in case you get stuck at home for extended periods because of your own illness or quarantines."  The author also advises having a supply of high-quality HEPA, or high efficiency particulate air filter, masks and "a lot of soap."

More information is available in the ABC News Report – Bird Flu: Fears, Facts and Fiction.

Crying Wolf

Kerry Patterson, co-author of Cruicial Conversations: Tools for Talking When Stakes Are High, reminds us that setting up rules and regulations that aren’t actually followed creates a culture of unpredictability and cynicism.

He relates the following example about visiting a family member in the hospital.

Outside my mother-in-law’s hospital room you can find a device that nobody cares about all that much. It’s a plastic pump bottle filled with antiseptic. A sign next to each door clearly states that employees are supposed to use the antiseptic—both entering and exiting the room.

I’ve watched for hours on end as healthcare employees walked by the bottle without giving it so much as a glance. Occasionally someone would pump the bottle and rub his or her hands together for a second or two. The preferred method seems to be to treat the bottle as a religious icon. People just pat the top of it as if mere contact passes on some mystical healing power. Nobody applied the antiseptic and rubbed it in for the required fifteen seconds. Nobody.

Aside from infection control issues, Mr. Kerry concludes that the takeaway is simple. Routinely examine rules, regulations, and policies. Which ones need to be followed religiously? There should be few if any. If you have any such important strictures, make sure people follow them all the time or you create a culture of wolf-crying alarmists and raging cynics.

Horty Springer & Mattern Comment on Proposed NPDB Changes

As you may know, the March 21, 2006 Federal Register outlined several proposed changes to the National Practitioner Data Bank. The public comment period closed on May 22nd.  Charlotte Jefferies, a partner in the national healthcare law firm of Horty Springer & Mattern forwarded a summary to me in response, and kindly gave me permission to reprint it here.

While the proposed regulations seem significant, they don’t really pose any additional responsibilities on hospitals or exclude hospitals from obtaining information concerning actions taken by others to address "unfit health care practitioners" or "acts of fraud".  Our summary

1) The addition of new reporters and new queriers does not allow those reporters and queriers to gain access to actions taken by hospitals and others to resolve issues of clinical competence and/or professional conduct.  Those who must query and must report  (or may query and may report) to the NPDB remain the same.

2) Hospitals will receive Section 1921 information when they query; however, new queriers that are granted access through Section 1921 may only receive Section 1921 information.

3) Section 1921 was intended (among other things) to capture adverse licensure actions taken against health care entities, like hospitals, and maybe that’s not such a bad thing.

4)  The same types of licensure actions currently reported to the Healthcare Integrity and Protection Bank (HIPDB) are now going to be reported to the NPDB under Section 1921. However, the subjects of the reports are different.

5)  Section 1921 does not collect clinical privileges actions, medical malpractice payments, other adjudicated actions, health care related criminal convictions or civil judgment, or Medicare or Medicaid exclusions.

Charlotte Jefferies
Horty, Springer & Mattern
4614 Fifth Avenue
Pittsburgh, PA 15213


Teaching Empathy

The May 21, 2006 Time Magazine article Teaching Doctors to Care states that Harvard Medical School now has medical students shadowing patients in order to develop a better understanding of what people with chronic illness deal with.

Claire Brickell, 25, an aspiring neurologist in her third year at Harvard Medical School has a problem: she’s too healthy. Like most of her classmates, she has spent very little time as a patient.

At Harvard and other medical schools across the country, educators are beginning to realize that empathy is as valuable to a doctor as any clinical skill. Whether it’s acknowledging that a patient was inconvenienced by having to wait an hour before being seen or listening when someone explains why he didn’t take his meds, doctors who try to understand their patients may be the best antidote for the widespread dissatisfaction with today’s health-care system.

The article is worth reading, but I think it needs a different title

With some exceptions the problem is not teaching doctors to care, it’s teaching doctors how to balance the demands of their profession with the needs of patients.  It’s reminding both sides that compassion and respect are essential if we’re going to work together. There are adversaries enough to vanquish. Let’s not add each other to the list.

Full text:,9171,1196411,00.html

Grand Rounds 2.35

Dr. Emer, a physician from Manila, Philippines, has posted this week’s well-organized edition of Grand Rounds at Parallel Universes.

Read more abour Dr. Emer in the Medscape PreRounds Index.

I got a chuckle out of his response to this question from Nick:

Dr. Genes: What influenced you to start? If I recall, you began when there were just a handful of blogging docs, and none in your country.

Dr. Emer: For us doctors, I think it was Doogie Howser, MD, who gave us the idea. Remember that TV show? Remember the end parts when he would type his reflections on his PC? I think he was the first doctor-blogger.

Florida Association Conference

I was in West Palm Beach last week as part of the Florida Association Medical Staff Services conference. 

I’ve been able to participate in a number of State Association conferences over the years and am continually impressed by the caliber of the presentations, the attendees, and the programs.  I always learn something new.

Based on location, quite a bit of what I learned at this particular conference came from conversations with attendees who assist their hospitals in planning for and dealing with hurricanes.  Our Florida colleagues are often right in the thick of things when severe weather strikes.

If you’re a member of a NAMSS state affiliate, be sure to recognize and thank your state association leaders and conference planners.  They do a considerable amount of behind the scenes work, on top of demanding and challenging ‘day’ jobs. They accept the added responsibility because they believe in the work we do, and in supporting the people who do it.

Hats off to our State Association leaders!

For those of you in attendance in Florida – a question of attribution came up with regard to my closing quote “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us.”

I did some additional checking and found that it was written by Marianne Williamson as quoted, in a book called Return to Love.  It is sometimes attributed to Nelson Mandella in error. – Rita