Protecting patients from medical apology programs

Protecting patients from medical apology programs

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. …

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• 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)

Useful tips when looking for a new doctor

Useful tips when looking for a new doctor.

From the 18th November posting by DOMINIC A. CARONE, PHDat KevinMD.com

These days, it is not uncommon for people to need to find a new doctor. The most common reasons include a) moving to a new city, b) dissatisfaction with your former doctor, c) your old doctor no longer accepts your new or old insurance, or d) you were diagnosed with a new medical condition and need specialized treatment.

Often, people go to their insurance company website or provider book, search for a doctor, and see a list of names in their area with contact information (and perhaps a brief biographical sketch). This narrows the choices down more than the phone book would, but now what? If insurance is not a limitation, the list of doctors to choose from will be even longer.

There is an old saying that word of mouth is the best form of advertising. This is one of the best ways to find a new doctor, provided you are getting the information from a source you know and trust. While friends and family can be good sources to ask about which doctors they use and like, it is also a very good idea to ask a friend (or friend of a friend) who works in a local hospital or health care setting. Here’s why.

First, healthcare providers know who provides good healthcare in their area. They know this because they read the reports of doctors they refer patients to, hear patient feedback on their experiences with the doctor, and may work in the same setting which allows them to have inside knowledge as to whether there are any problems with the doctor that may not be more commonly known to others.

When I needed to find an endodontist to perform a root canal last year, I first asked my regular dentist for a list of names. He gave me a list of endodontists who accepted my insurance and said all were good. Still, I wanted to base my choice on something more specific than using eenie-meenine-miney-mo. Problem is, I don’t have any friends or family members who are dentists. But I did know someone who had a relative who was a dentist in the area. I asked the person I knew about the names on the list, he asked the relative for me, and later he told me who I should see based on reputation in the dental community. The root canal worked out very well and I could not have been happier.

Another thing to do is look at the doctor’s credentials. First, check if the doctor is board certified since this gives you the highest probability that you will be provided competent specialized services. The best place to check is the website for the American Board of Medical Specialists (ABMS) which contains board certification status in 24 specialty areas. For psychology, see the American Board of Professional Psychology(ABPP), which contains board certification status in 14 different areas of psychology. Please note that there are good doctors who are not board certified and bad doctors who are board certified but you increase your chance of finding the former by choosing one who is board certified. Other credentials to look at are where the doctor went to school and completed training. This can be found by either calling the doctor’s office or doing an internet search.

An internet search is another good way to research a new doctor as you may discover news articles that a doctor was interviewed for, which may give you more confidence in the doctor’s expertise. Be careful, however, of doctor review websites because they tend to be skewed towards people who had a negative experience versus a positive experience and thus may not tell the entire story. Be sure to check the website for your state’s licensing board as this can tell you if there are any disciplinary complaints pending against the doctor.

One other idea some people have is to “interview” your potential doctor. Basically, this involves asking the doctor some important questions during an initial consultation such as how are emergencies handled, what are the after-hours policies, how can you get a prescription refill, do you actually see the doctor or a nurse practitioner, etc. Based on the answers to these types of questions and the personal feel you get based on interacting with the doctor, you can get a sense of the doctor is a right fit for you. While good rapport with the doctor is important, also consider how the office staff treats the patients. Are they friendly and courteous or do they seem to be rude and cut people short? Does there seem to be frequent infighting amongst the staff and is the doctor yelling at staff in front of patients. If so, these are bad signs. You need to deal with a competent office staff as well as a competent doctor to manage your health care needs.

One last point: If you get a letter from your doctor saying they will no longer be participating with your insurance as of a certain date due to a contract dispute, see this as a call to action. Contact the insurance company to complain and have others you know do the same who see the particular doctor. If enough pressure is brought to bear, you may not have to make a switch at all as the insurance company and doctor may then make a new agreement. This just happened to me recently, actually.

Related articles

• Useful tips when looking for a new doctor (kevinmd.com)
• Beware Picking Your Dentist (evelyngarone.wordpress.com)
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What happened to the art of medicine?

Image via Wikipedia

by SHARON BAHRYCH, PA-C, MPH at a November posting at KevinMD.com

The art of medicine, the most important part of medicine, involves several components:

1. Caring for patients, showing honest concern and compassion
2. Giving patient’s time, not rushing in and out of the exam clinic room, being patient with them, having a great bedside manner
3. 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
4. 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….

Read the entire article

Related articles

• Evidence based medicine removes a physician’s autonomy (kevinmd.com)
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The ability to quantify empathy

From a November entry at KevinMD.com by NORMAN SILVERMAN, MD

 

..

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….

Read the entire article

Related articles

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Public Gets More Access to Docs’ Certification Info

From the 13 October 2011 issue of MedPage Today

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.

Read the entire article

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10 dumb things you do at the doc’s office

From the 26 May 2011 CNN article

 

(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?’ “

 

Read the article (with the list of 10 don’ts)

 

 

The Power of Patient e-Visits

From the  Hospitals and Health Networks summary (at
http://www.hhnmag.com
)

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.

Video at
http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=3780005706

Most patients don’t need extra tests for diagnosis

A technician performs an electrocardiogram on a patient in the hallway of the emergency room at a hospital in Houston, Texas, July 27, 2009.

Credit: Reuters/Jessica Rinaldi

 

(Reuters Health) – Examining patients and taking a medical history are more useful to hospital doctors in diagnosing patients than high-tech scans, suggests a new study from Israel.

Doctors said that when tests such as CT scans and ultrasounds were given to patients right after they showed up at the ER, the imaging only helped in making a diagnosis in about one in three cases…..

Read the article

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6 reasons why doctors won’t call patients (with possible solutions)

Image via Wikipedia

From the 6 August posting by MARY PAT WHALEY at KevinMD.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.

 

1. 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, 
   http://www.imshealth.com
   .) 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.
2. 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.
3. 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….

Read article and the responses

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The physical and emotional costs of non-compliance

From the 8 August 2011 posting by STEWART SEGAL, MD in KevinMD.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.” …

Read the article

Related article

A 76-Year-Old Man With Multiple Medical Problems and Limited Health Literacy

(readers responses here, along with responses to other cases)