The last mile in Healthcare

This is not a medical blog, but Gabe is recovering from surgery and two weeks with him at the UCSF Hospital brewed much that has to be said. Jonathan is Gabe's doctor. Harold is my mechanic. They are both so good that I will not share their names. Paraphrasing Ben, get your own.

Medicine pooh poohs knowledge acquired without controlled experiments as "anecdotal". Harold can fix any car. Harold has never conducted a random controlled double blind experiment, and unlike doctors he never said that I imagine wheel bearing noises, nor put a placebo in my engine.

The last two weeks I saw that hospital practice is flexible and doctors do admit using trial and error, just like in Harold's shop. Good. Now if doctors were as accessible as Harold's shop... I mean in Who, how, and when to contact for medical help.

That is the last mile of health care, and Jonathan has solved it. Some doctors call you back within a week, or have a nurse call you back in a week, or put you through their answering service Q&A, that is fine if you have a skin rash but not a good thing for chronic or accute care. Jonathan put Al Gore and Steve Jobs together by using the Internet and an iPhone for patient communications, and the outcome is timely, direct, and precise.

Email is not a billable event for profit minded practicioners and insurers, but that thinking is so pre-iTunes, it is vinyl record mentality. Remember the medical equipment telemedicine commercials? Those with doctor-to-doctor sessions and a grateful smiling patient in the background? Get real, patients in pain don't smile, and the only telecommunication that matters in real life is patient-to-doctor, like Jonathan does.

Healthcare change is slow, sick people face the system alone, at a time of weakness, so how can they drive change in the last mile. Answer: Laughing.

That loud sarcastic laughter I use on ridiculous people and ridiculous arguments. Laugh at any doctor unwilling to use the internet to help you. Laugh so loud until it is uncomfortable for the laugher and the laughee. Ridicule them, shame them into retirement until we get a crop of smart multi-taskers like Jonathan. If a browser is good enough to manage their portfolios it should be good enough to ask a question and request a prescription. If Skype is good enough to connect with their college children, it is good enough for a patient followup.

Gabe is recovering and hopefully will be home in a few days, thanks for asking. But fear not, there is pent up laughter and sarcasm waiting to be posted right here, stay tuned.