August 26th, 2007 by Dr. Val Jones in Opinion
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The Wall Street Journal’s Health Blog recently featured a heated
debate about the utility of online physician ratings. On the one hand, some physicians are worried
that their reputations will be harmed by poor ratings given by a select minority
of disgruntled patients. Some have gone
so far as to ask that their patients sign an agreement not to participate in
online physician ratings. On the other
hand, many physicians view online ratings as a welcome form of constructive feedback
– believing that the ratings will further showcase their already good work.
I believe that physician ratings are not a perfect measure of
quality care, but they can offer a legitimate and enlightening patient
perspective on bedside manner, office efficiency, and communication skills. Many patients have nothing more than a health
insurance company’s list of “in network professionals” from which to choose a
provider. Online physician ratings sites
now give them a little bit more information to guide their selection process.
The potential for inappropriate or libelous postings depends
upon how carefully the ratings company reviews the comments. Open message boards may degenerate into gripe
sessions, but closely monitored ratings like those at Revolution Health, are much less risky. Even more valuable will
be the fusion of consumer ratings, peer reviews, hospital, and health
plan ratings of an individual physician all in one place. This kind of rating system is not far off.
The bottom line is that online physician ratings are here to
stay – and the best way for the ratings to fairly reflect the average patient’s
experience is to have physicians encourage all their patients to rate them
online. In that way, the rare
disgruntled patient’s review will be seen in the context of the majority of
satisfied customers. If the majority of
comments are still cautionary, then it becomes more likely that the physician
him or herself has some work to do.
Since the American Board of Medical Specialties is now
recommending demonstration of patient satisfaction as part of the recertification
process for many specialties, online physician rating sites may actually become
a great (and cost effective) way for physicians to collect such qualitative
data. So my advice to physicians is to
embrace physician ratings and make them work for you and for the benefit of
your future patients. Give the audience
some credit – they won’t judge you on one outlier comment… unless perhaps that’s
the only comment they see.
Your views and dissenting opinions are welcome.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 24th, 2007 by Dr. Val Jones in Opinion
1 Comment »
A new study in the American Journal of Public Health reports that teens can expect a 50% reduced risk of developing chlamydia and gonorrhea if they use condoms from their very first sexual experience. Starting to use condoms later on can certainly protect against disease – but it seems that there is something important about using them from the beginning. In other words, people who use condoms from day 1 are more likely to keep using them regularly, and are therefore less likely to contract sexually transmitted infections (STIs).
I could enter into some awkward speculation about why this is true (maybe it’s easier to get used to the sensation of wearing a condom if it’s all you’ve ever known? Maybe using condoms from the start is more likely to make it a habit?) but more importantly, a 50% reduction in sexually transmitted infections is an incredibly huge margin of success. Sadly, sex education programs for youth have had mixed success in increasing consistent condom use. This study seems to suggest that for those students who receive the message, and use condoms from their first experience, there is a much greater chance of avoiding STIs. Early sex education, therefore, may have more benefit than sex education offered after an adolescent is sexually active.
Of course, like Dr. Stryer, I feel a bit concerned about over-exposing elementary school kids to sexual messaging. But since kids are already exposed via TV, the Internet, and various other media, it behooves us to arm them with age-appropriate information at the earliest point possible. Abstinence is the only 100% guarantee of an STI-free adolescence – but since ~50% of teens are sexually active (regardless of beliefs, sex education, or parental controls) it might be best to teach them that condoms are an inextricable part of all sexual intercourse. Sexually transmitted diseases can mean the difference between fertility and infertility, long life, or earlier death for our kids. With stakes this high, consistent condom use should be our mantra.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 23rd, 2007 by Dr. Val Jones in News
1 Comment »
I’ve always thought that bats got a bad rap. Just because one type of bat sucks blood from unsuspecting cattle, a whole vampire legend has unfolded, spun by Hollywood executives looking to feed upon a new movie blockbuster. But what about the other 700 species of bats who are vegetarian or eat mosquitoes and other bug pests?
Well, it’s getting harder and harder to defend these cuties, especially since two very incriminating reports were released recently. Apparently, rabid bats are turning up in Illinois, and certain fruit bats are carrying an ebola-like virus in Africa. So what’s a human to do? Basically, you should avoid bats – don’t touch them or play with them. And if you encounter one in your attic, it’s best to presume that it could carry the rabies virus and call in professionals to remove it. I would be especially wary of bats in sub-saharan Africa (for all those of you who frequent that part of the globe) since the Marburg virus they carry is quite lethal.
There have been recent cases of bat-bourn rabies in Canada so although it’s really rare – it’s something to keep in mind.
Here’s to bat free living…
Addendum: just today a woman in Chicago was bitten by a rabid bat when trying to remove it from her home. Guess she didn’t read my blog. 
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 22nd, 2007 by Dr. Val Jones in True Stories
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Dr. Sid Schwab recently wrote a wonderful blog post about what doctors feel when they treat patients who remind them of their own kids. For example, he describes how it makes the physician want to run home and hug his/her kids out of gratitude that they’re ok. His post reminded me of an experience I had in the pediatric Emergency Department where I came face to face with memories of my own childhood trauma.
I was bitten in the face by a neighbor’s dog when I was about 4 years old. It was unprovoked and completely unexpected. The dog had no history of viciousness and I had no history of tormenting the creature. I was standing in the hallway, eye to eye with the dog (we were the same height) and I reached out to gently pet him when he attacked me. My parents freaked out, blood was pouring out of my face, and apparently it initially looked as if he’d gotten my left eyes since it was covered in blood. I was rushed to the local hospital where a family physician cleaned me up and put stitches in my cheek, eyebrow, and corner of my eye. It was hard to sit still for the numbing medicine and I was crying softly through it all. I don’t remember the details of the event, but I do still have the scars on my face – scars, I am told, that would be less noticeable if a plastic surgeon had closed the wounds.
Flash forward 30 years and I’m working a night shift in the pediatric ED. A father carries in his young daughter, crying and bloody. She had been mauled by a dog – and had sustained injuries to her face only. I escort the little girl to an examining room and begin flushing her wounds with saline to get a sense of how extensive they are. Dad goes to fill out paperwork while mom holds the girl’s hand.
It was eerie – her injuries were very similar to my own. I figured she’d need a total of 15 stitches or so, all on the left side of her face. There was no missing flesh so I knew that the cosmetic result would be good. I explained to her mom that we would be able to stitch her up nicely – and that she’d likely have minimal scarring. The mom asked for a plastic surgeon – and I agreed to call one for her right away.
That night I had a new appreciation for what my parents must have felt when I was bitten. I could see these strangers’ concern – how they hoped that their little girl wouldn’t be permanently disfigured, how they wanted the most experienced doctor to do the suturing, how they held her hand as she cried. It was really tough – but we were all grateful that the injuries weren’t more severe… and I was glad that I didn’t have to do the suturing. I showed the girl my scars and she seemed comforted by how they had turned out. This experience reminded me how personal experience can add a special dimension to caring for others, and that sometimes having been a patient can make you a better doctor.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 21st, 2007 by Dr. Val Jones in Uncategorized
3 Comments »
I had an interesting dialog with Dr. Bruce Campbell recently. In his blog he described a patient who lost about 60 pounds after losing his sense of taste. The patient had undergone radiation therapy for throat cancer, and in the process lost his ability to taste food. He soon lost interest in eating, and eventually dropped 60 pounds – not from the cancer, but from the side effect of radiation therapy. In this case there was a happy ending (his sense of taste eventually returned and he regained some of his weight) but it made me think about the relationship of flavor to obesity.
Just as I was musing on this very fact, a new research study was published in the journal Neurology. It suggested that unexplained weight loss was an early warning sign of dementia. They speculate that this could be linked to another early sign of dementia: loss of the sense of smell. Of course taste is largely a function of smell, so we can easily understand how people lose interest in eating when they can’t enjoy the flavor of food.
Wouldn’t it be interesting if we could temporarily alter a person’s sense of taste in order to affect weight loss? I doubt I’m the first to think of this… has anyone else heard of such a strategy? Surely this would be a little bit less invasive and dangerous than bariatric surgery.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
