by GABRIEL H. TENINBAUM in the 20 November edition of KevidMD.com
To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in “medical apology programs.” The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, at least in terms of providing an emotional outlet for patients, they are.
The evidence also suggests that they are about something else: money. Every aspect of how they operate – from who risk managers involve, to what those involved are told to say – suggests a key goal is to dissuade patients from seeking compensation by creating an emotional connection with them. …
- We’re Only Human, Even Our Doctors and Nurses (hcfama.org)
- Patient Safety Must Be Improved (medicalnewstoday.com)
- In Touch With Patients (1 Letter) (nytimes.com)
- Medical Error Prompts Doctor to Push for Safety Measures (prweb.com)
- Health IT May Be Cause Of Patient Errors (baravaida.wordpress.com)
- How much physician guidance do patients want with medical decisions? (kevinmd.com)
From the 18th November posting by DOMINIC A. CARONE, PHDat KevinMD.com
- Useful tips when looking for a new doctor (kevinmd.com)
- Beware Picking Your Dentist (evelyngarone.wordpress.com)
- The impact of unnecessary testing and treatment on patients (jflahiff.wordpress.com)
The art of medicine, the most important part of medicine, involves several components:
- Caring for patients, showing honest concern and compassion
- Giving patient’s time, not rushing in and out of the exam clinic room, being patient with them, having a great bedside manner
- Using the evidence based medicine algorithms as a guideline, as we apply them to each and every patient we see. Understanding that every patient is an individual who has individual circumstances that affect their lives
- Helping every patient to acquire the best outcome they can for themselves by working with them, educating them, coming up with a mutually agreed upon plan of action
Evidence based medicine does not teach us how to apply them to the patients we see, only the art of medicine does that. [Flahiff's emphasis] Much unlike evidence based medicine we don’t learn the art of medicine in a classroom. We learn the art of medicine by seeing patients, one by one, year after year. As new research comes out and the evidence based medicine algorithms change, hopefully we have refined our art of medicine skills to such a fine point that we have attained the stature of a wise mentor….
- Evidence based medicine removes a physician’s autonomy (kevinmd.com)
- Compassionate care is a crucial component of care (kevinmd.com)
- Using Social Media For Practicing Evidence Based Medicine (drneel.wordpress.com)
- Substitutes for evidence based (and science based) medicine (doctorrw.blogspot.com)
- 5 tips to evaluate medical websites (kevinmd.com)
Dr. Mohammodieza Hojat and a multidisciplinary team at Jefferson Medical College in Philadelphia have previously published 5 articles validating an objective and reproducible measure of empathy exhibited by physicians in the context of medical education and patient care. They hypothesized that a physician’s empathy would positively effect clinical outcome, not just patient satisfaction.
To test their theory, they chose patients with diabetes, a chronic disease that requires frequent engagement between patient and doctor, much patient education and communication as well as strict compliance to designated treatment protocols. Moreover, there are definable and easily measurable indicators of improved clinical outcomes. Appropriate statistical controls were used to separate the effect of empathy from other know determinants of outcome such as gender, age and socioeconomic status.
They followed 891 diabetic patients for 3 years and conclusively showed that physicians’ empathy itself resulted in a 40-50% improvement in the measured results. Finally, in their concluding remarks, the researchers acknowledged any limitations to their methodology, but stated that their results do provide sufficient evidence warranting replication of this line of investigation at other institutions and with a variety of diseases….
- Doctors can learn empathy through a computer-based tutorial (eurekalert.org)
- Is medical school an empathotoxin? (mindhacks.com)
- We need to talk about Kevin’s lack of empathy (guardian.co.uk)
- ¿Do you have empathy? (vae20.wordpress.com)
The American Board of Medical Specialties (ABMS) has begun publicly reporting whether specialists are meeting the continuing education requirements necessary for maintaining board certification.
Seven member boards — the American Boards of Dermatology, Family Medicine, Nuclear Medicine, Otolaryngology, Physical Medicine and Rehabilitation, Plastic Surgery, and Surgery — are the first to report via the ABMS.
Information is available on physicians certified by those boards at www.certificationmatters.org.
Search results show the name of the certifying board, and a “yes” or “no” as to whether the physician is meeting the maintenance of certification (MOC) requirements for that board. A link will take the searcher to the certifying board’s explanation of its specific requirements.
The remaining 17 member specialty boards will make maintenance of certification status available through the ABMS by August 2012.
- Clinical Informatics Wins Official Recognition (informationweek.com)
- Physicians Oppose Increased Certification Requirements (bsurgmed.wordpress.com)
- National Medical Society Advises How to Choose a Pain Specialist (prweb.com)
- Universal board certification can solve the Doctor Nurse controversy (kevinmd.com)
(CNN) – As much as she would like to, Dr. Lissa Rankin, a gynecologist, will never forget the woman who planned her wedding while lying naked on her examining table.
“Every 15 seconds, her cell phone was going off, and she was answering it!” Rankin recalls. “It was like, ‘That’s not the cake I ordered,’ and, ‘No, it’s the other gown,’ and I said to her, ‘Is this a bad time? Should I come back later?’ “
From the Hospitals and Health Networks summary (at
House calls have arrived
Sue Paone, Executive IT Director at University of Pittsburgh Medical Center, talks to H&HN senior editor Suzanna Hoppszallern about UPMC’s use of e-visits, which patients use to connect with physicians online on more than 20 conditions and earned UPMC a 2011 Most Wired Innovator Award. Video running time: 4:47.
- Doctors Screen for Cervical Cancer Too Often (nlm.nih.gov)
- Why is it so difficult for doctors to stay on time? (kevinmd.com)
- iPads used for diagnosis and treatment in Texas hospital (tuaw.com)
- The value of time in medicine (medrants.com)
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
- Medication questions and requests for a prescriptions change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009. (Kaiser Family Foundation calculations using data from IMS Health,
.) Because it is not easy to access prescription cost by payer in the exam room, medical practices get lots of callbacks from patients asking to change their prescriptions once they arrive at the pharmacy and find out how much the prescription costs. Related issue: Many national-chain pharmacies have electronic systems that automatically request a new prescription when the patient is out of refills. Also related: Patients calling to ask for additional medication samples.
- Patients are delaying coming to the physician’s office by calling the practice with questions. Patients want to forestall paying their co-pay or their high-deductible by getting their care questions answered without coming to the doctor’s office.
- Patients call back with questions about what they heard or didn’t hear in the exam room.They may not remember what the physician told them, they may not have understood the medical jargon, or they may have a hearing problem and were not comfortable asking the physician to repeat something….
- Implications of a Technology-Based Medical Encounter (medicineandtechnology.com)
- How to Save on Prescription Drug Costs (savings.com)
- Medication Dispensing is Now Available to Patients Before They Leave the Office (prweb.com)
- Medical Docotors Will Issue You A Prescription With No Prescription Ahead Of Time (bigsexymedia.com)
- Pharmacists’ role could expand (cbc.ca)
- Doctors’ use of e-prescriptions soars (seattletimes.nwsource.com)
There are multiple costs to non-compliance, including financial, both personal and societal, and physical-emotional. When patients fail to comply with treatment protocols, fail to get prescribed tests, or fail to stop destructive behaviors, there is a societal cost.
Today, I want to address the physical and emotional costs of non-compliance. I just read a brilliant article by Roxanne Sukol, MD. Dr. Sukol’s article discussed the fact that diabetes starts 10 years prior to your doctor making a diagnosis and, if addressed early, often can be avoided. In her article, Dr. Sukol states, “I like my patient vertical. Not horizontal.” Most doctors have favorite sayings. My favorite is, “May you be so blessed as to never know what disease you prevented.” I’ll add Dr. Sukol’s to my favorite list.
Another one of my favorite sayings is “There is no such thing as pre-diabetes. Pre-diabetes is like being pre-pregnant.” …
(readers responses here, along with responses to other cases)