Should businesses be required to post COVID-19 case counts?

In January 2021, the Los Angeles Times reported alarming numbers of positive COVID-19 tests from popular businesses including Home Depot, Target, and Costco, with hundreds of staff members infected. Seven Costcos in the area had at least 15 infected staff, according to the Times.

The infected workplaces highlight a troubling fact: Despite social distancing messages outside and long lines to get in, simply going to get a bag of dog food or a new faucet could be a deadly exercise in Los Angeles.

Walking out of the ICU: Dr. X, Patient Safety, and the Battle Between Coronavirus Common Sense and the Hospital Bottom Line

As American hospitals struggle to admit waves of coughing, feverish patients to medical wards and intensive care units, physicians are finding themselves at war with the competing interests of other hospital employees.

Did the Artists Den Succeed in Bringing Soundgarden Back ?

When I first learned the PBS-concert-supplier outfit Artists Den was putting on an immersive Soundgarden concert experience, a full film of the band’s 2013 Los Angeles stop on the King Animal tour, I brimmed with anticipation.

Did Daenerys Targaryen have PTSD?

The penultimate episode of Game of Thrones, “The Bells”, featured a neat victory — thrown completely awry when Queen Daenerys incinerated huge swaths of already-surrendered King’s Landing. This led to heartbreaking choices viewers saw in the finale, when those who loved the queen most had to act in the best interests of those she had not already killed.

The Big Sick: Best Film To Tell The Truth About Having a Sick Loved One

1*iFT57mrZL_oZ5sZUfxCJ-g.jpeg

The Big Sick, the film comedian Kumail Nanjiani delivered with his wife, Emily V. Gordon, did not win Best Original Screenplay at the 90th Academy Awards. That honor went to the searing and timely Get Out, and rightfully so, given the award is meant for stories that spring from the mind fully-formed, like the goddess Athena. The Big Sick is a more dramatic retelling of real life — Gordon’s battle with adult Still’s disease (also known as the scariest thing I saw in medical residency) — and Nanjiani’s awkward bonding with her parents — difficult enough without the object of your affection in a coma. But the film deserves recognition as an extremely rare portrait of life as the loved ones of the ailing.

Happy Thanksgiving: Setting and Maintaining Family Boundaries [Especially for Asian and South Asian Families]

IMG_1893

Boundaries, according to Raymond Richmond, a psychologist in San Francisco, are conscious and healthy ways to protect oneself from emotional harm. When people establish boundaries, the second parties in the relationships have a clear roadmap and guidelines for productive communication.

13 Reasons Why A Young Doctor Will Die By Suicide

1.       She has slept for 3 hours in the last 48.

2.       On his first day of residency, a vindictive doctor sent him on
an errand to a nonexistent department just to watch him suffer.
On many days after, the same doctor called him an idiot in the operating room.

3.       He had to pronounce three people dead in a week; the
gentleman with the poker tricks, the stillborn baby, the 17-year- old with alcoholic liver failure who wrote poetry. There was no counseling afterward and no place to process his grief. Later, he learns that his supervising doctor will not write him a letter of recommendation for fellowship because he was “slow”, meaning he spent too much time talking to dying patients.

4.       She does not have time to call her family, pay bills, go to the
grocery store, change a tampon, get an annual physical, get a haircut, or study, even though she is supposed to study every day.
She feels guilty for urinating while on call because her pager is ringing.

5.       The last home-cooked meal he had was three weeks ago.
After the cafeteria closes, his meals consist of graham crackers and Doritos until sunup. He has gained 30 pounds from stress and bad food. Women do not even look at him anymore; his youth is slipping away while his finance and law friends send photos of their new homes and children.

6.       He was called “weak” for hesitating while being pummeled
with medical minutiae questions about his patient while he was exhausted and sicker than the actual patient. This is called “pimping”. Before he knew it, he was required to repeat a year of residency, ensuring he would lose a year of income-earning potential as a doctor and saving the hospital tens of thousands on a nurse practitioner.

7.       She had a family emergency and called out for an on-call
shift. Her chief resident told the whole hospital that she just skipped out, and ruined her reputation. The chief puts her on call for more weekends than anyone else as a yearlong punishment.

8.       He went to the hospital psychiatrist for help, only to learn
that the visit was placed in his “file” and his every move is being watched.

9.       She miscarried while on duty in the ER and her co-resident
would not come in to take over, nor would her attending see patients, letting her writhe in pain for hours as she ordered morphine for the ER patients.

10.   Her psychiatry patients adore her but she knows that
disclosing her anxiety will brand her as “weak” in the hospital, so she does not go to therapist appointments and drinks vodka every day after work instead.

11.   His girlfriend of five years broke up with him over text for
“never being around”.

12.   Her attending physician in family medicine failed her on a
rotation for “lack of clinical skills” after she refused his sexual advances.

13.   He was a resident bullied by a racist doctor and made
mistakes from stress; now he’s unemployed with $600,000 in debt and every regular job tells him he’s “overqualified” for retail, but not qualified enough to get a job as a doctor.

400 doctors kill themselves every year. Who will be next

American medical trainees dog-paddle every day and night through a swamp filled with bullying, sexism, racism, fatigue, tiny computer screen checkboxes, loneliness, hunger, penury, and unmet spiritual and emotional needs. At the other end, their patients wait for them, dismayed as the residents’ and students’ faces fall from excited to fearful, as they run back to their computers and call rooms instead of spending that extra time at the bedside. Sometimes, the patients receive the wrong medicine. Sometimes, the wrong leg gets amputated.  Sometimes, a residency program mysteriously advertises an “unexpected opening”, and the patient in Room 109 asks, “Where is that nice young doctor who has been seeing me?”

Their supervisors, scarred from being forced to stay up for hours on end themselves, crow that no medical training can be complete without work shifts that tear one’s circadian rhythms apart and that there is no such thing as a good doctor who was not bullied. But a system that produces one of the highest professional suicide rates in the nation cannot remain; we are lying too far to the right of the bell curve. There are other options. Whether this includes improving handoff procedures in the hospital, quickly firing the racist attending doctor or the lecherous surgeon, lengthening residencies to reduce weekly work hours, adding more residents to help with the patient loads (and facilitate actual taking of breaks and naps), or requiring teaching hospitals to provide free and unbiased counseling along with a morning off to actually use it, programs that purport teaching and education should follow the lead of those already working to face the problem of young physician suicide head-on.

For patients worrying about their safety under the care of depressed doctors on little sleep, supporting lawmakers like Rep. Kathy Castor (D-Fla.), who has presented bills in favor of expanding funding to increase residency positions, is a start. At the hospital level, speaking to the residency and medical student rotation leaders about the trainees seeming overworked or overwhelmed can be a start to a healthier training program, giving a voice to the voiceless. Demanding happy doctors may be exactly how to save a life.

Support the upcoming film ‘Do No Harm” http://www.donoharmfilm.com and raise awareness of physician suicide.

Obamacare, Louis Vuitton, and a Crisis of Marketing

Sixty-and-Me_Things-You-Are-Paying-For-that-Should-Be-Free-740x417

One of the saddest outcomes of the Republican moves against the Affordable Care act was that revelation that many ACA enrollees didn’t know Obamacare was the same thing. Patients tweeted things like “Down with Obamacare! I’m on an Affordable Care Act plan!” The same patients may well have voted for the current president and for anti-ACA Republicans, not realizing that they themselves would lose their health insurance.

How did this branding mishap happen, in a world where everyone knows that Luxottica makes every single pair of machine-made sunglasses in the country and Lancome mascara comes from the L’Oreal people?

The Affordable Care Act missed key opportunities to market itself effectively. Because President Obama was so tightly linked with Obamacare, the Republicans had extra motivation to kill it, while anti-Obama patients have decided to hate the concept of a mandate for insurance with penalties.  Let’s take a look at the core principles of marketing, contrasting the Affordable Care Act/Obamacare with another big brand, Louis Vuitton (maker of handbags and clothes), and see what ACA planners could have done better.

  1. Product

Health insurance is a service, while Louis Vuitton might sell a carryon bag, but the principles are the same. A product has to satisfy a perceived need and offer features and accessories that fit the terms the customer group demands. Name and packaging are major considerations.

Who needs a LV bag? Exactly no one—they can cost thousands of dollars. The key is that the need is perceived—because celebrities carry the bag in real life and in magazines. The actual need is not a bag. It’s the wealth, beauty and status of the celebrity.

Millions of people did sign up for health insurance under the ACA, but millions of eligibles didn’t, as well. The ACA created a perceived need of avoiding a penalty and getting health insurance. However, these have negative connotations in most people’s minds. Few people adore their health insurer, and who wants to be reminded of a financial penalty imposed by the government? Instead, the product could have been sold as a perceived need to save money. The website certainly made it easy to see whether insurance premiums would be cheaper using healthcare.gov, but case studies showing how real or imaginary people would have saved money on the overall cost of care had they had insurance drive the point home harder.

People love free things, and the free aspects of care under the ACA could have been sold more, especially to young, healthy patients. I would envision a marketing plan less “get your health insurance today” and more “Your friends have free birth control pills…do you?”2

Allowing the ACA to be referred to as Obamacare in the press and popularly also created negative consequences, as seen by the confusion on Twitter. A concerted effort should have been made to shut down the use of the name, in order to focus attention on affordable care, not President Obama.

 

 

  1. Price

Louis Vuitton prices seem astronomical—but not to women with a little money in the bank and a copy of Vogue magazine. The price is set by demand and perceived value. For many bags in the luxury market, there is also low supply—they are limited-edition, driving up their prices and especially their secondary market prices (see: women who make an entire living reselling purses in China).

 

Because insurance isn’t a tangible good apart from a little white card, pricing needs to not be a barrier. While formulas calculated premiums for families that were affordable on paper, the formulas didn’t account for recent depletions of savings due to a car accident, spouses with credit card problems, needing to pay for Grandmother’s surgery in another country, child care expenses, or outstanding loans. Because of this, the ACA would have benefited from an even more inexpensive option (with correspondingly limited coverage) so that financially strapped patients could feel like they chose to pay instead of being forced to pay, and still see the benefits of free mammograms and physicals. Also missing were tools to remind patients to set up a savings account to pay off potential deductible costs. Yes, health savings accounts exist; and virtually no one knows how to use them properly. Making it easy and integrated to set up a health savings account along with a high-deductible health plan would have alleviated much of the backlash about out-of-pocket costs associated with the ACA.

 

  1. c) Place

Where will you sell your product? What’s the distribution channel? Louis Vuitton often pays for the most expensive real estate to make itself easy to shop for—the first boutique as you walk into an upscale mall, or a prominent location on a fancy shopping boulevard. N

Countless clinics received funding due to Medicaid expansions. This should have been obvious to anyone walking into those clinics. Quick, what’s the logo of the ACA? I don’t know either. Just like Yelp.com sends a sticker to each business doing well on its website, clinics should have a prominently displayed indicator of their funding. Patients—who are also voters—aren’t mind readers. Clinics running in part due to the ACA are operating more like unmarked bars—without the cool-kid buzz.  Similarly, doctors and nurse practitioners who accept the insurance should  have something to display as well, especially to counteract the negative association of the ACA with poor pay. There’s an opportunity to turn taking ACA insurance into a point of pride.

 

 

  1. d) Promotion
    Promotion requires an understanding of the media and of the priorities of potential buyers. Why does LV spend so much money on Vogue ads, runway shows, fancy events, and Jaden Smith? http://people.com/style/jaden-smith-is-the-new-face-of-louis-vuitton-womenswear-wearing-a-skirt-comes-naturally-to-him/ Because it leads to purchases and profit!

The Affordable Care Act, via the healthcare.gov website, did a good job of sending out emails with signup deadline reminders, putting up billboards, ad engaging community centers to sign people up for health insurance. An even more comprehensive strategy could have been to provide signup and marketing materials free of charge to doctors and to create ways to sign up in post offices, grocery stores, and banks. Louis Vuitton is a completely unavoidable brand. The ACA should have had a goal to be unavoidable as well.

You can bet that LV executives were smiling when Sarah Jessica Parker gifted Jennifer Hudson a LV bag in the “Sex and the City” film. Product placement is key. Where were the Victoria’s Secret models advocating for mammograms while selling bras?  Good promotion leads to great branding. A good brand is desirable, aspirational, and feels worth it. Some celebrities were indeed enlisted to sell patients on the ACA, but their message was intangible. Their hashtag of choice was #getcovered. “Coverage” sounds a lot less exciting than a purse. Instead, the messaging could have been directed toward getting a physical exam free of cost, getting your refills, getting free flu shots, or protecting your savings. Even #gethealthy is more interesting than #getcovered.

Policymakers and promoters of health care coverage should think long and hard about how to sell their product.

Could Marijuana Help Our Health in 2017?

179032829_xs

Now that half the country is able to legally smoke marijuana to treat their ailments, does that mean it’s time for you to finally consider it yourself? A hard look at the actual evidence for marijuana as a viable medical treatment for epilepsy and other diseases.

Why I’ll Be Watching Dr. Ken

drken08-e1460761641216

A few weeks ago, I visited the set of ABC’s “Dr. Ken”, the show heralded as the proof that ABC is winning the TV diversity game by a mile. Briefly, the show features a Korean-American family helmed by a cranky HMO doctor, played by Ken Jeong. The show (I saw the Halloween episode) was sweet and funny, with a deep, experienced and lovably nutty gaggle of actors.