by Kent Bottles

First posted on Kent Bottles’ Private Views on 12/31/12

Kent Bottles, MD, Host of Kent Bottles’ Private Views

As a self described Information Flaneur who wanders aimlessly around the Internet and my world searching for what I don’t know that I don’t know, I did not expect to find any rhyme or reason to my 2012 blog posts.  And yet when I read them today on New Year’s Eve to select the Best of 2012, I surprised myself by finding six coherent and recurring overarching themes:
·      American physicians have lost their way and need to undergo intense self-scrutiny
·      American health plans need to reinvent themselves or disappear
·      The digital future of medicine is fascinating and largely unknowable
·      There is an urgent need to bridge the gap between the humanities and the sciences
·      The American preoccupation with Happiness is wrongheaded but extremely important
·      Understanding and explaining the Affordable Act takes a lot of time and energy, but it is worth it

American physicians have lost their way and need to undergo intense self-scrutiny
Some of my closest colleagues found it amusing that I of all people wrote passionately about the need for physicians to embrace humility and win the battle for the soul of American Medicine.“Early in life I had to choose between honest arrogance and hypocritical humility. I chose the former and have seen no reason to change” is a Frank Lloyd Wright quotation that I used ironically at the start of one of my diatribes calling for physicians to undergo intense self-scrutiny, and my closest friend said he thought Wright could be speaking for me.
http://www.thedoctorweighsin.com/physicians-humility-and-the-transformation-of-american-healthcare-2/
Nevertheless, there is a battle for the soul of American Medicine; I pontificated about it herehttp://thehealthcareblog.com/blog/2012/12/20/the-battle-for-the-souls-of-american-doctors/  and in a three part essay inspired by the English Olympics Opening Ceremony, which celebrated the National Health Service http://www.thedoctorweighsin.com/the-olympics-doctors-nhs-transformation-and-heroes-why-the-difference-between-usa-and-uk/,http://www.thedoctorweighsin.com/the-olympics-doctors-the-nhs-transformation-and-heroes-why-the-difference-between-the-usa-and-uk-part-ii/http://www.thedoctorweighsin.com/the-olympics-doctors-the-nhs-transformation-and-heroes-why-the-difference-between-the-usa-and-uk-part-iii/   These blogs drew the wrath of many practicing physicians, as did my blog post that attributed much of any personal or professional success to luck http://www.thedoctorweighsin.com/does-luck-contribute-to-personal-success-2/.
American health plans need to reinvent themselves or disappear
The survival of Obama’s Affordable Care Act has demolished the traditional business model of the American health insurance company, and it has been fascinating to watch them scramble to reinvent themselves.  Some are buying bankrupt delivery systems and others are investing in providers and smartphone applications, but none of these tactics will work unless they can transform their corporate cultures.  Read about the challenges herehttp://thehealthcareblog.com/blog/2012/07/22/health-insurers-the-affordable-care-act-extinction-or-reinvention/, here http://www.thedoctorweighsin.com/health-plans-continue-to-struggle-to-reinvent-themselves/, and here http://kentbottles.blogspot.com/2012/03/technology-aetna-itriage-and-future-of.html.
The digital future of medicine is fascinating and largely unknowable
Like everyone else I read Eric Topol’s book and tried to keep track on Twitter of how digitizing a human being will revolutionize medicine.  I reviewed two books on digital medicinehttp://www.thedoctorweighsin.com/the-future-of-medicine-as-envisioned-by-topol-and-agus/, advised hospital executives to get with ithttp://www.hospitalimpact.org/index.php/2012/03/06/p4009#more4009, and wrote a summary of an iMedicine conference organized by medical studentshttp://kentbottles.blogspot.com/2012/04/imedicine-influence-of-social-media-on.html.
There is an urgent need to bridge the gap between the humanities and science
Two of my favorite quotations are the 19th century neurologist Jean Martin Charcot’s “Theory is good, but it doesn’t prevent things from existing” and Albert Einstein’s “In theory, theory and practice are the same. In practice, they are not.”  These two statements summarize the tension between a medical science that thinks it can explain everything and my own experience that an alternative theory of the mind is needed.  I explore these issues in great detail in a five part essay titled Human Understanding, Randomness, Free Will, and Delusions found herehttp://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-i/,http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-ii/,http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-iii/http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-iv/http://www.thedoctorweighsin.com/human-understanding-randomness-free-will-and-delusion-part-v/ and in a two part essay titled The Humanities vs. Science linked herehttp://www.thedoctorweighsin.com/the-humanities-vs-science-part-i/ andhttp://www.thedoctorweighsin.com/the-humanities-vs-science-part-ii/
Siri Hustvedt’s elegant book review of Oliver Sacks’ new book Hallucinations convinces me I need to read more of Sacks and re-read some of Hustvedt’s novels to make better sense of this complex subject. (http://www.nytimes.com/2012/12/30/books/review/hallucinations-by-oliver-sacks.html)
The American preoccupation with Happiness is wrongheaded but extremely important
Even though I have read at last count 19 books on happiness, I am always a little bit skeptical about the whole enterprise.  I do find it fascinating that bronze medal winners are happier than silver medal winners and that winning the lottery often results in misery, but there is something wrongheaded about pursuing happiness as a goal.  Viewing Stefan Sagmeister’s The Happy Show at an art museum at the University of Pennsylvania inspired me to write a four part blog post on happiness: http://www.thedoctorweighsin.com/musings-on-stefan-sagmeisters-the-happy-show/,http://www.thedoctorweighsin.com/musings-on-stefan-sagmeister-the-happy-show-part-ii/,http://www.thedoctorweighsin.com/musings-on-stefan-sagmeister-the-happy-show-part-iii/,http://kentbottles.blogspot.com/2012/05/musings-on-stefan-sagmeister-happy-show_21.html.
My skepticism about the whole subject made me write The Downsides of Trying Too Hard to Be Happy, which can be found here http://www.thedoctorweighsin.com/the-downsides-of-trying-too-hard-to-be-happy-part-i/ and http://www.thedoctorweighsin.com/the-downsides-of-trying-too-hard-to-be-happy-part-ii/. I just finished reading a new book by Oliver Burkeman titled The Antidote:  Happiness for People Who Can’t Stand Positive Thinking, which has reinforced and brought focus to my skepticism.  I recommend it highly.
Understanding and explaining the Affordable Act takes a lot of time and energy, but it is worth
I spent much of 2012 running around the country giving keynotes, retreats, and seminars on the Affordable Care Act.  I also enjoyed teaching another graduate class at the Thomas Jefferson School of Population Health on health policy and the structure of the American delivery system.  My best blogs on this subject were on the demise of fee for service paymentshttp://healthworkscollective.com/kent-bottles/70536/fee-service-really-dead, the Supreme Court decision upholding the individual mandate http://kentbottles.blogspot.com/2012/06/why-did-chief-justice-roberts-do-it.html, and the Medicaid expansion controversyhttp://www.thedoctorweighsin.com/the-scotus-the-ppaca-the-medicaid-expansion-decision/.
At the end of 2012 I was asked to predict what health care journalists should cover in 2013.  My essay can be read here http://www.reportingonhealth.org/2012/11/15/kent-bottles-new-ideas-covering-health-care-2013.  However, I must warn you that a far better way to understand health care in 2013 is to wander around twitter, read books and newspapers, and go to conferences in fields other than medicine.  Join me in becoming an information flaneur.