Digital Exhaust #172

Virtual dandruff clinic, smarter watches, and what I did on my newsletter sabbatical

Good morning and welcome to new readers. I’m typing from the windy Austin Hill Country (to find out why I’m here, see the last section) in the cold. I just realized Substack has comments. Thank you to all who have chimed in — I love hearing your thoughts….

Here are some things I stumbled on this week.

Do patients really want to read their notes?

This Atlantic piece reflects on the 21st Century Cures Rule (the legislation that lets patients see their notes and test results) and raises questions about its impact. The money shot: The debate about open notes can be boiled down to a matter of practicality versus idealism.

I wrote a post in plain English about the rule a couple of years back if you’re interested.

Amazon Clinic tackles the human scourge of dandruff

Amazon’s latest effort to make healthcare like buying a book is Amazon Clinic, a chat-based platform that offers a ‘personalized treatment plans’ for issues like erectile dysfunction and dandruff. But wait, there’s more: You get two weeks of follow up texts with your provider (can we even call them providers?).

I wish human care was this easy.

Smarter watches

A study in Nature Medicine demonstrates a successful AI algorithm for heart failure.“Although smartwatches have previously been tested for the detection of atrial fibrillation, a type of cardiac arrhythmia, this new, early-stage study demonstrates that smartwatches can be used to identify people with diminished heart function.” I think this gets us closer to closing the gap between Apple Watch as ‘consumer play product’ and true clinical applications for these devices.

Speaking of smart things, this study shows that Apple AirPods can serve as a reasonable hearing aid. But of course, every technology comes with a cost. This guy was reported this week to have become hearing impaired from having an AirPod piece wedged in his ear canal for 5 years.

Beyond Apple, Karen DeSalvo dropped a HLTH update on what Google is doing to support health. And Google is continuing to explore a consumer-facing health record.

Smartypants trigger warning: It's time for the 2022 Stat wunderkinds.

Word of the week: Disneyfication

Over the last decade or so, in lieu of building truly humanlike robots, AI creators have outfitted their machines "with cutesy humanoid touches, Disneyfication effects that will enchant and disarm the uninitiated."

— From Megyn O’Gieblyn in God, Human, Animal, Machine - Technology, Metaphor and the Search for Meaning (grrrreat book but super heavy….)

The dream of policy change around telemedicine reimbursement

A solid (but paywalled) Perspective in the New England Journal of Medicine on the next great challenge for telemedicine: Policy change to expand telemedicine . The authors suggest that answering 3 questions would lay the foundation for permanent telemedicine policy. Does telemedicine 1) increase spending, 2) improve patient outcomes, 3) advance health equity? Seems there are answers, but not good ones. A well-referenced piece that lays bare the fact that there’s still work ahead to demonstrate the hard value of telemedicine.

FWIW, the folks at the American Medical Association are still bullish about telemedicine. I found this recent AMA survey with interesting telemedicine stats. And rural Koreans love telemedicine.

The letter of resignation that changed one doctor’s perspective

My friend and 33c subscriber Jay Baruch recently drafted a letter to his boss spelling out his intention to leave medicine. He was feeling “pancaked” by two surges of the pandemic, and burned out. But the simple act of writing the letter transformed his understanding of his work and hooked him back in. Jay is one of medicine’s greatest storytellers. “Stories are more powerful than data,’ he suggests. His story is here on Stat, and in a podcast here.

I owe Jay a review of his amazing new book, Tornado of Life - A Journey Through Constraints and Creativity in the ER. Stay tuned….

Okay, so what was I doing when the newsletter was dark?

Early in 2022 I took the position of Chief Medical Officer for Texas Children’s Hospital North Austin. As a 500 million dollar construction project, I had a lot going so I had to step back and take a break. It felt kind like that moment when Forrest Gump just decides to stop running. But the amount I’m learning is crazy. I’ll try to share some of these lessons going forward.

But after a while I realized that the process of writing is how I understand my world. So I’m back, as much for me as for you. Hoping it works for both of us.

Shameless plug: We’re hiring 129 doctors and almost as many advanced practitioners. We open in February of 2024. If you are a pediatric specialist, surgeon or advanced practitioner and want to work in our new children’s hospital at the edge of the Texas Hill Country, give me a shout. And you get to work with me!

Digital Exhaust

• Anonymous testicle checking booth debuts in New Zealand.

• You might need this: How to download your Twitter Archive.

• Steve Jobs’ nasty sandals sell for $200k at auction.

• Preparing for the next generation of EHRs from Deloitte.

Cool quote

“Russians glory in the past, hate the present and fear the future.” -- Anton Chekhov

He was talking about 19th century Russians but he might as well have been referencing 21st century healthcare administrators and physicians!

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Thanks again for tuning in. I appreciate your support. If you could send this along to a friend with a recommendation to subscribe it would be really appreciated. And have an amazing weekend.

You’ll notice the #172 in the title — this is the 172nd curation letter that I’ve sent since 2018 (formerly 33mail on Mailchimp). Going forward I’m going to drop the date in the title and use the edition number.