Comments on: Long tail, practice time, education time

By: amy

amy — Mon, 14 Aug 2006 02:58:24 +0000

A long tail market is where the conventional solution is only dealing with the high frequency service and what is left unserved is actually a majority of the market. A long tail solution specializes in dealing with those infrequently ordered products and solutions that collectively are the majority of the market. The two classic examples are Amazon for books and Netflix for movies. The corespondent in healthcare does not exist yet, as long tail solutions require an innovative use of technology and medicine lags behind. In medicine, we are punished by lawyers for being innovative. The closest I can come up with would be telemedicine.

By: amy

amy — Mon, 14 Aug 2006 01:26:28 +0000

For academic medicine, what you say is true and fascinating. From the standpoint of a community doctor, I am more interested in making the first 80% of situations work right. Honestly, when people can’t afford a necessary cath or mammogram, that rare disease stops fascinating me. because that mammogram will increase the life expectancy and a 40$ nebulizer machine will increase the quality of life. I know, sometimes I sound like an idiotic socialist but it is frustrating.
You know, I went to a seminar at a big university, about anticoagulation. Everybody was talking about LMWH and I asked them : how good is the regular heparin sq, is it so below the standard of care that nobody even considers it ? I have a lot of cash patient who refuse to go to hospital and can’t pay hundreds of dollars for Lovenox. You know, none of those big teachers could give me an honest answer. They had no clue.
We should chase the white unicorn sometimes but we will do it more for ourselves, like a pleasure for fine and rare chocolate. In the big picture of healthcare, it does not make a big difference.
Now, there are situations where we should embrace more of a detective job : why does the patient refuses the treatment, what is the home situation, how many pills does this person actually take ? These things take time and can make a big difference with little money. I do house calls. It is an eye opener and it makes me realize how far from the real world of our patients we sailed.

By: jetset

jetset — Sun, 13 Aug 2006 18:27:59 +0000

I have to concur with Dr. Rack. If we treated every common symptom commonly we would be doing our training a disservice. What differentiates an MD from NPs and other health care providers is precisely our training that should provide us the ability to tease out uncommon diagnoses from the ‘longtail’.

By: NoAcuteDistress

NoAcuteDistress — Thu, 10 Aug 2006 20:41:47 +0000

I’d also say that it’s what distiguishes a good physician from a mediocre one.

By: Michael Rack, MD

Michael Rack, MD — Thu, 10 Aug 2006 19:56:13 +0000

The ability to make a long tail diagnosis is what separates a good physician from a nurse practitioner.