Pretty well, actually.

As predicted last December, there was no big change to health care reform, doctors still didn’t have enough time with their patients, Microsoft made moves to create a “Windows” for electronic health records, and “ACO” became the hot buzzword in health care.  Some state governments started major redesigns of their benefits programs, saving money in the same ways private sector employers do.  Meanwhile, more than ever, private sector employers are penalizing employees who don’t take care of themselves.

Misdiagnosis finally started to be recognized as a public health problem.  At Best Doctors we got a great deal of press coverage in 2011 on this (for a few examples, go here, here, here, here and here).  I will sneak in a 2012 prediction and tell you that you will hear a lot more about this this year, and not just from us.

What did I get wrong?

Well, I said no major employer would drop their health benefits – and none did, so I didn’t really get this wrong.  But I was surprised to hear some very major employers quietly talking about their plans for dropping coverage in 2014.  It’s a bad idea – and I would have thought its badness would have been enough to keep it off the table.  For some employers, apparently not.

I also can’t point you to signs that the health insurance system is starting to take on the bad aspects of the workers compensation system.  Instead, many of the Fortune 100 employers we work with are trying to make their benefits plans simpler and easier to use.  I’m glad to be wrong about that so far.

Here are the two biggest misses.

First, I predicted a doctor would get sued for offering medical advice to a patient on line.  It didn’t happen in 2011.  Interestingly, there was (finally) a lawsuit claiming gag orders on posting reviews of medical providers on-line were unenforceable, something I thought would have happened a long time ago.

Second, I thought that health care reform would be more popular at the end of 2011 than it was at the beginning.  According to the Kaiser Health Tracking Poll for December 2011, in January, 41% of Americans had a “favorable” opinion of health care reform.  In December?  Forty-one percent.  A better prediction would have been that no one’s minds would be changed….

For my 11 predictions for 2011, I got 8 right.  Not bad, but I have to do better in 2012.

So, for 2012, I will make only one prediction – the world won’t end on December 21, 2012.

I feel good about this one- I’m wrong, no one will be here to see.

Sunday’s Milwaukee Journal Sentinel published an op-ed I wrote about how you can avoid misdiagnosis.

Published studies show that rates of misdiagnosis in America are a stunning 1 in 5.The good news is there are several steps you can take to protect yourself. They start with understanding why misdiagnosis happens, how you can work with your doctor to avoid it and, above all, playing an active role in your own health care.

Diagnostic errors happen much more often than most people realize. Even doctors are not immune. According to The New England Journal of Medicine, 35% of doctors have reported errors in their own care or that of a family member.

How can this be happening in a time of such great medical advances?

How indeed.  Go to the Journal Sentinel site and find out how you can protect yourself.

Bill Gates once said:

Success is a lousy teacher. It seduces smart people into thinking they can’t lose.

It’s clever, and it seems right.  Now there is science to prove it.

In a study published last week, scientists studied special imaging scans of doctors brains as they made simulated medical decisions.  Those doctors who paid attention to their mistakes made better decisions than those who were more interested in their successes:

“These findings underscore the dangers of disregarding past failures when making high-stakes decisions,” Montague said in a statement. “‘Success-chasing’ not only can lead doctors to make flawed decisions in diagnosing and treating patients, but it can also distort the thinking of other high-stakes decision-makers, such as military and political strategists, stock market investors and venture capitalists.”

This is just the latest proof of how important it is to interrupt your doctor’s decision-making process.  Leading researchers in the field of medical decision-making have emphasized how easy it is for “overconfidence” to get in the way.  Doctors are neither immune to disease nor the pitfalls of decision-making that plague the rest of us.

Guatemala is a developing country, with great natural beauty, hard-working people and many challenges.  Most Americans look at places like Guatemala and see only the challenges.  Some see opportunity.

I’ve just returned from Guatemala, where I met with our business partners, government officials, and others.   And I can tell you a universal truth.  People across the world want the best medical care they can get.  They aren’t looking for the latest technologies and drugs and treatments – or, rather, they aren’t looking only for those things.  No, what is most important to whoever I meet, no matter where they live, is that they are able to get the right diagnosis, and the right treatment.

It’s a harder thing to get in some places than in others.  Americans don’t realize that one of our great exports is our health care.  Not our system – but our know-how, education, medications, devices, techniques.  In many ways, health care promises to be the economic engine of 21st century America.  And getting access to it doesn’t necessarily mean getting on a plane and coming to the states.  At Best Doctors this is what we do – bring the expertise of the world’s leading doctors to where – and when – it’s needed.

After a speech I gave in Guatemala one of the audience members came to me and said she thought something I said was very important.  “Every person deserves the right diagnosis and treatment,” she said.  It’s a simple concept that is much harder to make reality.  But it should be the basis on which any health care program, health care provider – or health care system – must be built.

What does it mean to be an entrepreneur in health care?

Twice in the last two weeks I had the honor of speaking at Northeastern University’s Health Sciences Entrepreneurs Program. It’s a terrific program, dedicated to fostering the creation of health care businesses by helping the people who build them figure out how to do it. That it exists is a testament to how strong the American spirit of entrepreneurship really is – and how the 21st century economic engine is going to be health care.

But the hundreds of students and alumni who attended the events already knew this. What they wanted to know were the answers to more practical questions – how do I know if it’s a good idea to try something? What happens if I make mistakes, or fail? Do I really need to start a business to be an entrepreneur? What opportunities does the changing world of health care create?

They’re the right questions because they’re hard. Being an entrepreneur means you’re willing to look at the world as it is and want to make it as you think it should be. It means being willing to take risks, try new things, and not being afraid to fail. In fact, if you listened to the panels of highly successful entrepreneurs, you’d think failure was a big part of what entrepreneurs do. You can’t create something new without making mistakes along the way.

At the end, we were all asked to give one piece of advice to the budding entrepreneurs.

Mine was this: Do Something Cool. Always put yourself in a position where you’re doing something that is so cool you want to tell people about it. When you don’t think it’s cool anymore, leave, and find something else that you think is cool. Don’t worry about whether it means starting your own business or working with someone else who has. Put yourself someplace where you think you are changing the world.

If you can do that, you’ll be an entrepreneur.

Atul Gawande says that we’re used to doctors working like “cowboys” – rugged individualists who are responsible for making sure your care gets done right.  We don’t need cowboys, he says.  We need “pit crews” – teams of doctors working together toward a common goal, with each playing their own role.

It’s an appealing idea.  Pit crew-like teams work, and work well, in trauma units across the country.

But there’s a problem: if you haven’t just been airlifted to a hospital after a horrible accident, you’re not going to be treated by a pit crew.  You’re going to be on your own, shuffled from one 15-minute specialist visit to the next, likely with no one person in charge of your care.

Dr. Gawande knows this, and he picks a heck of an example of the problem:

“But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to ‘protocol’ the MRI.”

Why is that such a good example?  Because it’s exactly what happened to my brother at one of the leading medical centers in the country.  He had a person directing the work up of his back pain and all the rest, including deciding on the right treatment for the “unexpected cancer found growing in his spine.”  It all worked well….except that he didn’t have cancer at all.  In fact, had he been treated for cancer, he might not be with us today.

The truth is when you get sick, there is no pit crew rushing out to help you make your way through the system.  There are overburdened, time-pressed doctors making decisions based on fragmented and often incomplete information.  Scientific studies showing diagnoses are inaccurate more than 20% of the time are a clear warning sign and a symptom of this public health crisis.

If you’re sick, you don’t have time for the system to change.  And so while we may not want our doctors to be cowboys, as a patient, you better learn how to be one.  Be self-reliant, demand answers, and, above all, know this:  the person with the greatest stake in getting your care right isn’t your doctor – it’s you.

Health care expenses are hurting businesses and governments around the world.

But why?

There are a lot of reasons, but the most overlooked is this:  people demand life-saving medical care.  There is a basic, human desire to want to live long, healthy lives.  And so, will health care be the engine of the 21st century economy?

Go to the Washington Times to read my op-ed on it.

Billionaire Teddy Forstmann has apparently been diagnosed with a serious form of brain cancer.  There’s a tragic twist to the story: according to Fox Business News, Forstmann believes that for more than a year, he had been misdiagnosed with meningitis.

ABC News wonders:

How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests?

They’re missing the point.  Misdiagnosis happens with shocking regularity – as much as 44% of the time, depending on the illness.

I’m sure that, as with most things, being a billionaire is better.  But as a neurosurgeon quoted by ABC News points out, even for a billionaire, getting the right care is “still a bit of a crap shoot.”

So how can you improve your odds?  Here are 5 tips that work.

1.  Know your family history – and remind your doctor of it. Don’t assume your doctor remembers that time you told him that two of your aunts died of breast cancer, or that your grandfather and father have a history of malformed blood vessels in their brains.  Research studies have shown that a family history may be a better predictor of disease than even genetic testing.  Find out about your family’s medical history, write it down (the Surgeon General has a good on-line tool to help you do this), and make sure your doctor knows about it – especially if you’re sick and they’re trying to decide what’s wrong.

2.  Ask questions.  The typical doctor sees as a many as 40 patients a day, spending 15 minutes or less with each one.  It’s all too easy to be referred to a specialist and start treatment without having all of your questions answered.  But asking questions won’t just make you feel more comfortable – it can disrupt your doctor’s thought process and make him think about your case in a way that may save your life.  Dr. Jerome Groopman, one of the world’s foremost researchers on how doctors think (he’s written the definitive book on it) agrees:

“Doctors desperately need patients and their families and friends to help them think. Without their help, physicians are denied key clues to what is really wrong. I learned this not as a doctor but when I was sick, when I was the patient.”

You can find some useful tips on how to do this at the U.S. government’s web site, called “Questions are the Answer.”

3.  Don’t Assume Technology Will Save You.  The best medical technology ever available is available today.  Still, studies show it is no more effective at getting the right diagnosis than a doctor piecing together your family history along with more traditional, low-tech tests.  If I had to pick between getting a high-tech test and a doctor who will spend an hour talking to me, thinking about my case and putting all of the pieces together, the research says I should pick the doctor.

4.  Don’t Always Trust the Tests. Some tests, like a review of pathology, can be wrong more than 40% of the time.  Why?  Because interpreting these tests is a matter of judgment, and experience.  As Dr. Lisa Sanders, who writes the New York Times’ Diagnosis column puts it:

“There are lots of diseases that can look like something else.  And that’s where clinical judgment and experience are essential.  Doctors see results as coming straight from God.  But just because a test gives you a yes or no answer doesn’t mean it’s right.”

5.  Get a Second Opinion.  But not just any kind of second opinion.  You need the doctor to look at your case from scratch – to hear you talk about your symptoms in your own words, and to think about your case without being influenced by the conclusions of your original doctor.  Don’t say “I was seen by Dr. X and he tells me I have meningitis and need treatment Y, what do you think?”  Instead, describe your symptoms, tell him about your family history, the tests you’ve had done, and help him come to his own conclusions about what’s wrong with you.  Of course, if you have Best Doctors, you can call us, since that’s what we do.  If you’re not satisfied with the answers, get another opinion – you only have one life, and maybe only one chance to get this right.

I’m in Israel, home to some of the most innovative care in the world.  Doctors here wanted to know if the high-tech tests that are an increasing part of their work help.  A couple of weeks ago, they published their results.

It turns out that in about 90% of cases, it didn’t matter.

A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades was almost always all that was needed to get a diagnosis.  As one of the doctors in the study put it, “basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases.”

The conventional wisdom is that doctors – at least in the U.S. – order extra tests to protect themselves from getting sued.  But this study was done in Israel, where the problem of medical malpractice is nothing like it is in the U.S.  American-style defensive medicine can’t be the reason doctors in Israel use so many diagnostic tests.

Instead, the answer is revealed in a comment from a Canadian doctor who wasn’t involved in the study.  According to him, the use of high-tech studies has become so “routine” that doctors need to be reminded that they aren’t a replacement for actually diagnosing the patient.

There is something more fundamental happening – and it’s happening around the world.

To understand it, look to something that is happening in courtrooms across the U.S.  Some call it the “CSI Effect,” after the TV show, CSI.  In that show, a police team uses sophisticated technology to identify criminals with almost complete certainty.  Researchers have found that shows like CSI have changed jurors’ expectations of what kind of evidence the prosecution should be able to present.

Something like this is happening in medicine.

Patients show up with the expectation that the doctor will use sophisticated technology to get a quick diagnosis.  They’re often surprised to see how it really works.  Their doctor is rushed, uses paper files, and it can often take a long time before you get a clear diagnosis.  Doctors often order high-tech tests because patients expect it.

But doctors also do it because they are so pressed for time – because a test is a convenient short-cut that might reveal the answer without having to go through the trouble of asking questions, spending time with the patient, studying their medical history, and thinking about the meaning of more routine test results.

So are doctors lazy?  Do patients have overblown expectations of what doctors can really do?  Maybe.  But there is a more important truth which studies like this help reveal.

The most valuable piece of equipment your doctor has is his or her brain.  High-tech tests may give more information, but they are no replacement for your doctor’s training, judgment, and insight.

Government can be like the weather – everyone complains about it but no one does anything about it.

At Best Doctors we like to look at obstacles as opportunities to make things better.  In this case, I had the chance to help change an old law in Florida that made it hard for companies like ours that serve the international health insurance markets to do business.

It’s exciting to report that we got the law changed.  Now, I can also tell you that a major Florida paper, the St. Petersburg Times, published my story yesterday.

Read the story here, it’s a reminder that government really can work.