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Are MDs More Effective At Running Hospitals Than MBAs?

It’s been more than five years since Henry Mintzberg released the enlightening book ‘Managers, not MBAs’, a well-reasoned criticism of prevailing management education that basically revolves around Master in Business Administration (MBA) programs. Financial crisis was not even in sight but Mintzberg, a professor at McGill University in Montreal and one of the most important guiding lights in the questionable field of management, already pointed out that it was a serious danger for modern organizations to rely on professionals that had just finished their MBAs as the prime source for senior managerial positions.

Mintzberg focused his criticism on two essential aspects. First, most programs are aimed at people with no previous experience or knowledge about organizations and how they look like from the inside… and these same people then storm into companies believing that the real world works exactly as business school taught them it does. The second point is that many of these business schools spread a perverted set of values, such as the hunt for short-term profit, the belief that a good aim justifies any means and the urge to translate all human behaviors into accountable figures (the ‘countophrenia’ depicted by Vincent de Gaulejac in his must-read ‘La Société Malade de la Gestion’).

Then the crisis rose, and many CEOs of the biggest organizations had their share of responsibility for it, as they were enjoying multi-million dollar bonuses while taking their companies to the edge of bankrupcy. Most of them came from the most famous business schools in the world. I have outlined in the past the outrageous conflict of interests of many of these institutions, starting with Harvard, as Charles Ferguson perfectly displayed in his brilliant documentary ‘Inside Job’.

‘Social Science and Medicine’ published in its August issue a very interesting work by Amanda Godall, professor at the IZA Institute for the Study of Labor in Bonn, Germany. Godall’s is the first empirical research on the correlation between hospital results and having MDs in their top managerial positions. Read more »

*This blog post was originally published at Diario Medico*

The Beneficial Effect Of Laughter On Your Health

I stumbled upon the article ‘Laughter: gender-specific variations’ in Revista Clínica Española (‘Spanish Clinical Journal’) and I can’t help thinking about the need for taking this into account to improve doctor-patient relationships. The text can actually be read as a guide to understand how every person laughs and how to use it in clinical practice.

Table 1. Laughter effect on health Read more »

*This blog post was originally published at Diario Medico*

Medical Tourism: A Lot Of Sellers But Not Many Buyers?

I must confess that I have a weakness for medical tourism. Patients have always been ready to go on a pilgrimage to find the world’s leading expert (we call it ‘key opinon leader’ now) hoping to find a cure. As long as traditional leaders in the field of Medicine have been the Germans, the French and the English -with some occasional Austrian and Spanish name in the mix- traffic of wealthy patients across Europe is nothing new.

Since we entered the antibiotics era, these leaders started to be located mainly in the United States, the cradle of modern, technology-driven Medicine. Thus hi-tech centers got ready to welcome foreign patients, building strong International Customer Support departments. A random example -by no means the only one- would be the Mayo Clinic. On their website you can see that their wealthy patients speak Arabic or come from Latin America. These healthcare services have a long tradition of client-oriented work because they work for private clients that pay for their treatment (sometimes the client is not the patient himself but his family). The important thing was never the price, but the patient. Read more »

*This blog post was originally published at Diario Medico*

Do You Really Need 6-8 Glasses Of Water Each Day?

“Bueno es saber que los vasos
nos sirven para beber;
lo malo es que no sabemos
para qué sirve la sed”.
Proverbios y cantares.XLI. Antonio Machado

(‘It’s good to know that glasses
are what can help us drink;
The trouble is, we don’t know
What is the purpose of thirst’)

The one thing you can’t afford to have missing when you start a scientific congress or any other professional meeting is not a notepad, a pencil or even an iPad – nowadays, it’s a bottle of water. Offices, airports, handbags and lecture halls, all of them are bursting with all kinds of bottles. It seems they are essential to work and even to stay alive.

Bordering nonsense, some people desperately search for a bottled water vending machine as soon as they arrive at the airport, even if that means gobbling it down in a minute before walking through the security checkpoints.

It is now a common belief that continously drinking water (6 to 8 glasses a day according to NHS, at least two litres -half a gallon- according to other sources) is the healthy thing to do. Read more »

*This blog post was originally published at Diario Medico*

From Spain: Drug Prescription Habits Are Often Emotionally Driven

I recently stumbled upon a very interesting editorial opinion in the ‘European Journal of Clinical Pharmacology’: ‘The use of drugs is not as rational as we believe…but it can’t be! The emotional roots of prescribing’, authored by Albert Figueras, from Fundació Institut Català de Farmacologia (Catalonia Institute of Pharmacology Foundation at Vall d’Hebron Hospital, in Barcelona).

Since more than 40 years ago when Archie Cochrane said that “there must be solid scientific evidence behind any statement, decision and prescription made by medical staff”, and all the way until today’s WHO promotion of rational medicine utilization, both developing and industrialised countries have been striving to increase sound knowledge about prescription and thus spread the kind of rational thinking necessary to foster evidence-based medicine in drug use.

Keeping your skills up to date has never been an easy task but nowadays we have newsletters and other Internet tools that can grant any MD state-of-the-art knowledge on any subject he or she may need, accessible anywhere and for any medical speciality. Nevertheless, drug use in the “real world” is far from this high quality. Not only in Spain: it has been noted in France, Greece and other countries that, despite widespread knowledge of risk factors that may cause gastrointestinal toxicity in patients under nonsteroidal anti-inflammatory drugs (NSAID) treatment, there is a massive use of proton-pump inhibitors in individuals that show no significant risk.

Changing well-established drugs for newer, less-known products is not consistent with the need of a well-grounded comparative evaluation. We are not raising concern on the influence of gifts or invitations from pharmaceutical companies. Many doctors really want to make rational decisions… but can’t. Read more »

*This blog post was originally published at Diario Medico*

Latest Interviews

The Surprising Economic Burden Of ADHD (Attention-Deficit Hyperactivity Disorder)

If you can read this you need to download a more recent browser It is estimated that as many as million U.S. adults have ADHD Attention-Deficit Hyperactivity Disorder A recent research study publication-pending suggests that the economic burden of ADHD on America could be as high as billion annually. I…

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Is The Adderall Shortage A Harbinger Of Future Drug Supply Problems?

If you can read this you need to download a more recent browser Today most- if not all- Doctor’s offices are strained by the shortage of some prescription medication or vaccine. A month ago President Obama signed his executive order directing the FDA to take steps to reduce drug shortages…

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Latest Book Reviews

Book Review: The First Step To Improve Health Care Is A Close Examination Of How It’s Delivered

My friend and former Chair of the CFAH Board of Trustees Doug Kamerow has written a book that I think you will like. Besides being a mensch and witty as heck Doug is a family doctor and a preventive medicine specialist. In his new book Dissecting American Health Care Commentaries…

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“Your Medical Mind” Explores Factors That Influence A Patient’s Medical Decisions

Recently I had a conversation with Shannon Brownlee the widely respected science journalist and acting director of the Health Policy Program at the New America Foundation about whether men should continue to have access to the PSA test for prostate cancer screening despite the overwhelming evidence that it extends few…

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Book Review: Food Truths, Food Lies

Food Truths Food Lies written by family physician Eric Marcotte M.D. may be the most refreshingly evidence-based diet book of the decade. You will not find a single mention of super-foods magical berries or supplement must-haves in the entire book. What you will find is the cold hard truth about…

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