“Back to the Future” Part 2

In the second part of my three-part vodcast interview with Henry Ford Health System CEO Nancy Schlichting, we continue our discussion about the history of Henry Ford by taking a closer look the first physicians and nurses at Henry Ford Hospital.

Nancy and I talk about the formation of the Henry Ford Medical Group and the evolution of physician education and training, as well as our first physicians at Henry Ford Hospital – Physician-in-Chief Dr. Frank Sladen and Surgeon-in-Chief Dr. Roy McClure.

We again highlight Clara Ford’s important influence during the hospital’s formative years, and her great belief in the caring nature of nursing and its pivotal role in the medical care provided to patients.

She was a driving force in developing the School of Nursing on the hospital campus in 1925. Continue reading

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IDEAL: Advancing Surgical Innovation

Advances in health care happen in a variety of ways.

Sometimes they occur as a matter of necessity – the desperate attempt to save a life.

Sometimes they occur as a matter of luck – the “eureka” moment of discovery.

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Robotic kidney surgery at Henry Ford Hospital.

Most of the time they occur as a result of thoughtful innovation, development and assessment, and then tested for reliability and safety.

When you take a prescription or an over-the-counter drug, you probably don’t give very much thought as to how that particular medication came to be; you know what it does, potential side-effects and why you’re taking it.

But there’s a strong process in place for developing new drugs and making them available to the masses, to ensure quality, safety and effectiveness:

  • The drug manufacturer tests it and submits evidence through a “new drug application” to the FDA’s Center for Drug Evaluation and Research (CDER).
  • A team of CDER physicians, statisticians, chemists, pharmacologists, and other scientists then review the data provided in the application and propose labeling, should it be approved for use.
  • After that a clinical research process continues to test the validity of the studies and role of the medication in the treatment process.

Clear. Effective. Tested.

Ever wonder how the tracheostomy came to be a surgical method of treating an obstruction in the trachea?

The technique was clearly an innovation at the time. But it was not required to go through a randomized controlled trial or other strictures required of new prescription drugs and medical procedures.

You can take a drug “off label” for other uses – there’s a clear method for researching alternative uses and effectiveness as such.

Shouldn’t we have something similar in place for new surgical techniques? For surgical and procedural cases, the “off label” uses are not as clearly understood or often as rigorously scrutinized.

Once the “off label” procedure is proven to work, how do we ensure that it is safely performed by other surgeons and proceduralists? Continue reading

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The Tradition of National Doctors’ Day

National Doctors’ Day dates back to March 30, 1933 in Winder, Georgia, when Eudora Brown Almond, the wife of Dr. Charles B. Almond, decided to set a day aside to honor physicians.

Dr. Gaetano Paone performing a TAVR (transcatheter aortic valve replacement) procedure.

Dr. Gaetano Paone performing a TAVR (transcatheter aortic valve replacement) procedure.

It wasn’t until 60 years later that President George H.W. Bush signed Proclamation 6253, establishing National Doctors’ Day to “recognize our Nation’s physicians for their leadership in the prevention and treatment of illness and injury…”

Like the first observance in 1933, National Doctors’ day is still marked by patients thanking their physicians, mailing greeting cards, or sending flowers.

I want to take time to honor Dr. Hillier.  He delivered me and was our family physician when I was growing up in Troy in the 50’s.

In those days, Troy was a rural community and there were not a lot of doctors or health facilities there.  So, when we were sick, we went miles south on Rochester Road to the Palmer Woods area on Woodward to see Dr. Hillier.

I was very sick with tonsillitis.

My mom waited for my dad to come home from work, which was after 6 p.m. He took a look at me and said to call Dr. Hillier. Continue reading

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Doc in the “HS”

Some of you know I have dual roles – that of “Doc in the D” and “Doc in the HS,” as the Chief Medical Officer of Henry Ford Health System.

In that role, we are making some great strides in linking our physicians and clinicians in a more integrated sense.

This is by no means a solo effort.

Dr. Joanna Pease, the Assistant System Chief Medical Officer and Chief Medical Officer of Henry Ford Macomb, has been an amazing partner in moving forward these efforts. She is a warrior for extraordinary care, quality and support of our clinical work in the System.

A major goal is to get all of our programs and services working together throughout the System.

This is called clinical program integration.

And, as challenging as it is, it offers us tremendous opportunity to capitalize on the strengths of the Henry Ford Medical Group, employed physicians, and private practice physicians working together with the care teams, as well as the potential for seamlessness of care within our System.

Dr. Steven Harrington, the cardiovascular lead surgeon at Henry Ford Macomb Hospital, is now an affiliate staff at Henry Ford Hospital.

Dr. Steven Harrington, the cardiovascular lead surgeon at Henry Ford Macomb Hospital, is now an affiliate staff at Henry Ford Hospital.

Some of these activities are occurring right now. 

For example, Dr. Steven Harrington, the lead cardiovascular surgeon at Henry Ford Macomb Hospital, is now an affiliate staff at Henry Ford Hospital, bringing his most complex cases to Detroit; a great surgeon and a great story.

It is wonderful to hear Steve talk about the expertise of the Henry Ford Hospital cardiovascular team — from pre-op to the OR to the ICU.

We’re very glad to have him on the team. He brings innovation and a way of thinking about quality that is priceless.

Don’t worry: The “Doc in the D” team has been at work on the Boulevard as well.  Continue reading

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The History Behind the Henry Ford Medical Group Insignia

Henry Ford Medical Group InsigniaYou see it every day at Henry Ford Hospital – on lab coats, hanging in the clinic building lobby or on a business card.

But what do you really know about the Henry Ford Medical Group Insignia, a symbol of our heritage and continuing mission of research, education and exemplary patient care?

While the Medical Group was established nearly 100 years ago, the insignia is a relatively new addition, having only been created within the past decade.

The insignia also is composed of several meaningful elements:

  • Shield: Truth and loyalty
  • Banner: Reward for valiant service
  • The word Invenio: Discovery and innovation
  • The word Committo: To unite, collaborate and work as a team
  • Branches with leaves: Symbolizes the reward of saving lives
  • Henry Ford Hospital and Model T Ambulance: Symbolizes the rich heritage of innovation represented by its founder.
  • Microscope: Symbolizes innovations in medical research and education.
  • Caduceus: Represents the medical profession and its commitment to healing. The snake symbolizes knowledge and wisdom.

There’s even a bit of controversy behind the creation of the Medical Group insignia.  Continue reading

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Dr. Abouljoud Named Arab American of the Year

This past weekend, I attended the 42nd ACCESS (Arab Community Center for Economic and Social Services) Anniversary Dinner, honoring Marwan Abouljoud, M.D., director of the Transplant Institute at Henry Ford Hospital, as Arab American of the Year.

ACCESS presents the Arab American of the Year Award to individuals or groups that exemplify the organization’s mission to empower and engage Arab Americans. This year’s other awardee was National Public Radio journalist Diane Rehm.

ACCESS – an organization that focuses on empowering and enabling individuals, families and communities to lead informed, productive, culturally sensitive and fulfilling lives – has a long-standing partnership with Henry Ford. We’ve worked together to provide free health screenings and education, and so much more, in the community. And, its executive director, Hassan Jaber, is a member of the Henry Ford Hospital and Health Network Board of Trustees.

As Arab American of the Year, Dr. Abouljoud will take his place among a distinguished group of past honorees that includes former White House correspondent Helen Thomas; U.S. Sen. Spencer Abraham; entertainers Casey Kasem and Tony Shalhoub; U.A.W. International President Stephen Yokich; U.S. Congressman Nick Rahall; the Arab American Anti-Discrimination Committee; and St. Jude Hospital.

Dr. Abouljoud has led transplant surgery at Henry Ford to national and international recognition. He performed the first split liver transplant in Michigan in 1996, and in 2000 developed the first adult-to-adult living donor liver transplant program in Michigan. Continue reading

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Celebrating National Doctors’ Day

“Whether you think you can or you think you can’t, you’re right.”
– Henry Ford

This Saturday, March 30, we’ll honor and celebrate the work of physicians who serve our communities as part of National Doctors’ Day.

While it officially became a day of national recognition in 1991, the observance of National Doctors’ Day dates back to March 30, 1933 in Winder, Georgia, when Eudora Brown Almond, the wife of Dr. Charles B. Almond, decided to set a day aside to honor physicians.

Nearly 60 years later, President George H.W. Bush signed Proclamation 6253, establishing National Doctors’ Day to “recognize our Nation’s physicians for their leadership in the prevention and treatment of illness and injury…”

Traditionally, people celebrate the day by thanking their physicians, mailing greeting cards, or sending flowers.

The red carnation is commonly associated with the National Doctors’ Day. The first observance in 1933 included the mailing greeting cards and placing flowers on graves of deceased doctors. Continue reading

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The Annual Quality Expo

This week marked Henry Ford Health System’s 21st Annual Quality Expo.

The Quality Expo, hosted at Henry Ford Hospital, offers an opportunity for all of Henry Ford Health System to showcase the innovations and improvements made by our employees, departments and hospitals in the areas of health care quality, patient safety and care delivery.

Leo, a therapy dog at Henry Ford Wyandotte Hospital, is one of the most remarkable therapists that I have ever encountered. Leo and HFWH’s Pet Therapy Program were featured at the Quality Expo.

Henry Ford is the only health care provider in southeast Michigan to host such an event.

The Quality Expo’s features 70 projects, all of which are aimed at reducing medical errors and improving patient safety, quality and satisfaction.

As always at this event, I was truly impressed, as I walked through the poster presentations and spoke with colleagues, by the tremendous work being done by our health care teams to continuously enhance quality and safety throughout the system.

I did stop to see one of our employees, Leo, a therapy dog at Henry Ford Wyandotte Hospital.

Leo is one of the most remarkable therapists that I have ever encountered.  He is calm, friendly, and extraordinarily soothing, and part of a great program of pet therapy throughout our System.  Within minutes of being with him, all of my concerns and anxieties were gone.

(Of course, my own dog, Co Co, previously feature in Doc In the D, continues to be the one I confide in the most.  Co Co’s colleague, Mr. Mo, aka Uncle Mo, provides coverage as needed. Sometimes both are needed to “treat” me.)  Continue reading

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The Affordable Care Act & Henry Ford

What does the U.S. Supreme Court’s ruling on the Affordable Care Act mean to Henry Ford Hospital and Henry Ford Health System, and our patients?

The law has been in effect for two years and Henry Ford has been meeting the necessary steps to comply with the provisions of the law affecting us and our patients.

Doc in the “DIV.” The end of this post includes links to my local news interviews about ACA.

The ruling on Thusday supported the constitutionality of the ACA.

Some of the most controversial aspects of the law are scheduled to be implemented in 2014. Two of these components, mandated insurance and extension of Medicaid, were major subjects of the Court’s ruling.

Mandated insurance was supported as part of the tax provision, that is, failure to adhere to obtaining or providing insurance will be subject to tax penalties.

Without the insurance mandate, the insurance exchanges or pools would likely have fewer healthier enrollees, meaning insurance rates for policies purchased through the exchange would need to be much higher to support costs.

Expansion of Medicaid was left to states wtihout Federal threat of withholding all Medicaid dollars for not extending.

The ruling has brought some “certainty” to the constituionality of the law. This is a certainty that must be looked at through the lens of continued political polarization, the fall elections, threats of repeal of the law in the 2013 Congress, business and personal reaction, and implementation at the state and delivery system level.

But, importantly, this ruling allows Henry Ford to continue to make positive reforms to the country’s health care system, through our efforts to integrate care, reduce costs, increase access and make advances in medical technology, treatment and hospital care.

The ACA means the possibility of extending Medicaid to the nearly 500,000 uninsured people in Michigan, as well as extending additional benefits to lower income familes through insurance exchanges.

The implementation in 2014 also strikes denial of insurance to those patients with pre-exisiting illness. Families will continue to cover their adult children on family policies up to the age of 26.

By expanded coverage for uninsured and low-income patients, the act may help to provide economic relief to Henry Ford’s growing burden of uncompensated care.  In the past eight years uncompensated care at Henry Ford has doubled, from $111 million in 2003 to $210 million in 2011. Continue reading

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Planning a “Good” Death

Dr. Ken Murray, a retired clinical assistant professor of family medicine at the University of California, wrote a thought-provoking article earlier this year in the Wall Street Journal entitled, “Why Doctors Die Differently.”

The essential point of the paper was captured in the sub-headline, noting that doctors’ experiences throughout their careers teach the limits of treatment and reinforces the importance of the need to plan for the end.

In essence, physicians – and I would add other clinical care providers to that list – know all-too-well that medicine cannot fix all, especially at the end of life.

Murray quotes nursing professor Karen Kehl, who in the article called “Moving Toward Peace:  An Analysis of the Concept of a Good Death,” noted features of a graceful death, such as:

  • Being comfortable
  • Being in control
  • Having a sense of closure
  • Making the most of relationships, and
  • Having family involved in their care.

Unfortunately, in today’s world, many patients experience a death without these attributes. Physicians have seen this so frequently that it influences how they think about the end if their lives too.

Why the disconnect? 

To avoid what may be considered undo influence, physicians try not to impose their own views on the situation.

Providing hard clinical data to enable a patient to make a decision is generally believed to be the extent of the information a physician or care provider should offer.

When asked directly what they would do for themselves, physicians often deflect the question to ensure patients are not overly influenced by their answer:

“It is what you would want to do, not what I would do.” 

This is adherence to the medical ethical principle of autonomy, making sure that patients or their decision-makers make decisions for themselves and without coercion.

But perhaps we have lost something by the answer we provide.  Continue reading

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