A Country Doctor Reads: August 31, 2019 – Polypill for CVD risk reduction; Assisted living is a money-making fantasy; Why doctors should read business journals

The Polypill is Back – The Lancet

One of my first posts on “A Country Doctor Reads”, in 2011, was about a Polypill study that promised dramatic reductions in cardiovascular disease rates from a combination of inexpensive generic ingredients. In the past few weeks another such study reported similar results in The Lancet. When will we be able to prescribe something like this? So far, I’ve only seen Caduet, a combination of atorvastatin (Lipitor) and amlodipine (Norvasc), which was an expensive brand name for many years…

— Read on acountrydoctorreads.wordpress.com/2011/02/26/trial-begins-of-another-polypill-for-stroke-and-heart-attack-prevention/

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Assisted Living is a Money-making Fantasy – The New York Times

There are nursing homes, boarding homes and assisted living facilities. I have certainly seen patients who are unsafe on their own at home who themselves or whose families are hoping they “don’t have to go to a nursing home”. But assisted living facilities, just like their advertisements often suggest, are really only for people who want an extra level of support available in case they need it, but not right now.

“Assisted living seems like the solution to everyone’s worries about old age. It’s built on the dream that we can grow old while being self-reliant and live that way until we die. That all you need is a tiny bit of help. That you would never want to be warehoused in a nursing home with round-the-clock caregivers. This is a powerful concept in a country built on independence and self-reliance.

The problem is that for most of us, it’s a lie. And we are all complicit in keeping this dream alive.

The assisted living industry, for one, has a financial interest in sustaining a belief in this old-age nirvana. Originally designed for people who were mostly independent, the number of assisted living facilities has nearly tripled in the past 20 years to about 30,000 today. It’s a lucrative business: Investors in these facilities have enjoyed annual returns of nearly 15 percent over the past five years — higher than for hotels, office, retail and apartments, according to the National Investment Center for Seniors Housing & Care.

The children of seniors need to believe it, too. Many are working full time while also raising a family. Adding the care of elderly parents would be a crushing burden.”

“We need to let go of the ideal of being self-sufficient until death. Just as we don’t demand that our toddlers be self-reliant, Americans need to allow the reality of ourselves as dependent in our old age to percolate into our psyches and our nation’s social policies. Unless we face up to the reality of the needs of our aging population, the longevity we as a society have gained is going to be lived out miserably.”

www.nytimes.com/2019/08/29/opinion/sunday/dementia-assisted-living.html

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Why Doctors Should Read Business Journals and Books (Like HBR)

Hey, Doc – read this and tell me if it makes you think of anything that’s happening in your organization. I can, off the top of my head, think of at least one post I have written that totally resonates with the front page story of this month’s Harvard Business Review. That post is about taking advantage of, if not exactly rigging, the numbers, titled “Don’t do Chronic Care in December“.

Quoting from HBR:

Idea in brief

THE PROBLEM

Companies that work hard on their strategies and carefully monitor their progress often run into spectacular trouble.

WHY IT HAPPENS

People have a behavioral tendency – known as surrogation – to confuse what’s being measured with the metric being used.

HOW TO FIX IT

To reduce the risk of surrogation, make sure that the people executing your strategy have a role in formulating it, don’t link incentives too tightly to strategy metrics, and use multiple metrics to assess performance.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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