August 16th, 2007 by Dr. Val Jones in Medblogger Shout Outs
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In an effort to provide round-the-clock emergency care for their patients, physicians often share an on call schedule. The physician on call makes him or herself available for emergency consultation for 24 hours or more at a time. Unfortunately, patients seem to misunderstand the role of the on call physician – believing that being on call is a form of extended office hours for their convenience. Here’s one doctor’s account of the non-emergency services he provides on-call, and the attitudes that drive him crazy:
One of my biggest challenges is
understanding why patients consider an emergency as anything that they
don’t want to wait until Monday, or even daylight. They want lab
reports. They want advice on whether to get a flu shot. They want to
know what that green cough medicine was their doctor recommended 3
years ago. They want their medicines— that they only seem to know by
color—refilled. And, of course, they are not satisfied with a few pills
to get them through the weekend. They’re not going to pay a “full”
copay for less than a “full” prescription.
A related challenge is that, when I call a phone
number after being paged, the person answering the phone is almost
never the person who paged me. Sometimes it is a teen who answers the
phone with a “Yeah” or a “What?” That there is an important call
expected and that there is an emergency going on in the house is beyond
them. Eventually, I persuade them to find the sick person, and from the
amount of time they are gone, the house must be a mansion.
Sometimes a man answers the phone, and says, “Here,
I’ll let you talk to my wife.” Funny, he’s the one with the problem,
but he somehow cannot talk. I imagine him sitting in the background
like a king who cannot be expected to do his own talking, while his
servant/wife explains his symptoms. Sometimes, if the person having the
emergency is a teen, I have to talk to the mother, because the teen
won’t come to the phone (an interesting twist). The teen won’t tell Mom
exactly what the problem is either, so I have to ask the mother my
questions, then she yells them down the hall, listens for the answer,
then relays the answer to me. Example: “My daughter Susie has a cough.”
“Does she have a fever?” “SUSIE, DO YOU HAVE A FEVER?” “NO.” “No,” “Is
she bringing up any sputum?” “SUSIE, ARE YOU BRINGING UP ANY SPUTUM?”
“YES.” “Yes.” Well, I don’t need to go on, but it can, interminably.
Sometimes the person having the problem is not
available at the number when I call. “Hello, this is Dr. Constan.”
“Hello, this is Mrs. Smith, I’m calling about my mother, Mrs. Jones,
and she wants to know what to do about her abdominal pain.” “Could you
please put her on the line so that I can talk to her?”
“She’s not here, she went shopping.”
“Oh.”
Sometimes the person doesn’t answer, at all. I’ve
called back promptly, yet “there’s no one home.” What gives? They call
back later to fill me in on what happened at the ER, like I need to
know. They had called me then decided it wasn’t necessary to talk to
me, they wanted to go to the ER anyway. Then, why did you call?
Sometimes when I call back, I get a busy signal. How does that happen?
You page a doctor then tie up the line so I can’t call back! I imagine
that you figure you should first seek advice from the doctor then seek
advice from all your friends and relatives, whomever you can get on the
line. Later you say to yourself, “I wonder why that darned doctor never
called me back.”
…
The advent of Caller ID has produced its own set of
challenges. The person pages me, leaves their number, but when I call
them, they won’t answer the phone because they don’t recognize the
number displayed by the Caller ID. I imagine them standing by the
phone, staring at the number, and reasoning: “Now, I’m having a serious
emergency here, but I don’t want to take the chance of answering this
call and having to talk to a telemarketer. What do I do? Best not take
the chance.” Later: “I wonder why that darned doctor never called me
back.”
If I talk to an answering machine, I usually offer
that the patient can call me back later if they still need help. One
lady called me back and told me that she was home when I called, heard
me leaving the message on her machine, but couldn’t come to the phone
because she was doing her vacuuming. How has outrageous fortune
relegated my services below those of a vacuum cleaner?
Although all the above challenges tend to wear on me
toward the end of the weekend, I try to be professional and caring
about each call (just ask my family). It’s my job to stay the course
with no laurel wreath expected on Monday morning. It was a surprise and
joy to me recently when, at a party, I was introduced to a nice young
couple. “You’re Dr. Constan! We called you 2 years ago about our sick
child. You were so helpful. We’ve always appreciated what you did for
us.” The challenge of weekend call should have more such awards.
For a complete version of this article, please visit www.PMDLive.comThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 15th, 2007 by Dr. Val Jones in Expert Interviews
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The Washington Post featured an article about how social networking tools like Facebook are influencing student socialization at college. Some say that the frenetic texting, online communications, and iPhone chatter are causing students to lose the ability to socialize normally in-person. Others say that technology levels the social “playing field” for introverts. I interviewed Revolution Health’s psychologist, Dr. Mark Smaller, to get his thoughts on the matter. Feel free to add your perspective in the comments section of this blog.
Dr. Val: The article
suggests that technology can become a social crutch, keeping people from making
new friends. Do you think that the
Internet can isolate students from one another?
Dr. Smaller: I think the long term impact of the Internet in
social interactions is unclear. For now
such technology does allow students to remain in touch with one another
instantly, but that’s not too different from what the telephone did for
previous generations. If anything, I’d
say that technology can interfere with isolation, especially for the new
college student away from home for the first time. If there is a propensity for isolation, any
activity in excess – reading, school work, drinking, etc. will become the means
to continue that isolation.
Dr. Val: Do you think
that social networking and Internet based methods of communication are
particularly healthy for introverts?
Dr. Smaller: Being able to communicate sincerely or
genuinely but indirectly and not in person may help the otherwise shy person. Some of our most brilliant artists and
writers have used their craft as a means to communicate to others in ways they
could not in social situations.
Dr. Val: Overall do
you think that socializing via the Internet is a good thing or a bad thing for
college students?
Dr. Smaller: One things is certain on and off the Internet:
relationships for children, adolescents, and adults can become quite intense
with this way of communicating because of fantasy and anonymity. Previous generations used the art of letter
writing to express intense feelings, followed by the telephone, and now online
communication. What they all have in
common is the essential human need to connect – including the satisfaction of
doing so and the frustration when it chronically does not occur.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 14th, 2007 by Dr. Val Jones in News
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A recent analysis (via KevinMD) of average IQs of individuals in certain professions revealed that doctors have a mean IQ of almost 10 points higher than lawyers. Go ahead and snicker, docs – we may be smarter, but are we more successful?
Social and economic success does not have a 1:1 correlation with IQ. The study authors list several other determinants of success:
Ambition, perseverance, responsibility, personal attractiveness, physical or artistic skills, access to social support and to favorable social and economic networks and resources.
So basically, you can be quite a dim wit – but with perseverance, artistic skills and personal attractiveness, the world is your oyster. Or better yet, you can have no redeeming qualities whatsoever, but be born into a favorable social and economic network and do just fine.
However, in medicine you’re not really going to get by on charm alone. The grueling nature of the educational process (and the vast amount of information that one must master) requires substantial cognitive reserves. So I’m not surprised that doctors do well on IQ tests. However, the sign of a great doctor is not his/her IQ, but a complex interplay of character, compassion, and emotional intelligence. That being said – if I’m wheeled into an ER after being run over by a truck, I’d be pretty glad to know that the man or woman taking care of me is smart. And you can be pretty sure that he/she will be.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 14th, 2007 by Dr. Val Jones in Announcements
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I watched the final episode of “Hell’s Kitchen” last night – a cooking show where a mean chef berates young chef hopefuls in a series of competitive cooking contests. The host of the show was almost as vicious as my vascular surgery preceptor in medical school… you docs out there know what I mean.
Anyway, I had the pleasure of being the sous chef for Chef Rock at a recent charity event for celiac disease awareness. GastroGirl (Jackie Gaulin) and I helped him whip up a delicious, gluten free meal and CNN’s Heidi Collins taste tested our dish. Although our shrimp and grits lost to a rival “coriander encrusted skate” I always thought that chef Rock was a winner.
And here he is: the top chef of Hell’s Kitchen. Congratulations, Rock! I’d be delighted to work as your sous chef in Las Vegas… see you at the B. Smith’s victory party!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 14th, 2007 by Dr. Val Jones in Expert Interviews
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In a recent study conducted by the Agency for Healthcare Research and Quality (AHRQ), it was argued that better primary care could prevent 4 million hospitalizations per year. This staggering potential savings – on the order of tens of billions of dollars – seems like a good place to start in reducing some of the burden on the healthcare system (and reducing unnecessary pain and suffering). I interviewed Dr. Joe Scherger, Clinical Professor of Family & Preventive Medicine at the University of California, San Diego School of Medicine (UCSD) and member of the Institute of Medicine, to get his take on the importance of prevention in reducing health costs.
Dr. Val: What do the AHRQ
statistics tell us about the role of primary care in reducing healthcare
costs?
Volumes!
Primary care works with the
patient early in the course of illness, maybe even before it has developed, such
as with prehypertension and prediabetes. Primary care focused on prevention
with patients keeps people healthier and out of the
hospital.
Dr. Val: What can individual
Americans do to reduce their likelihood of having to be admitted to the
hospital?
Prevention begins with the individual,
not the physician. 60% of disease is related to lifestyle. Bad habits such as
smoking, overeating, not being physically fit, and stress underlie most common
chronic diseases. If Americans choose to be healthy and work at it, we would
save tremendously in medical expenses.
Dr. Val: Are there other studies
to suggest that having a medical home (with a PCP) can improve
health?
The medical home concept is new and lacks
studies, but the work of Barbara Starfield and others have confirmed the
importance of primary care and having a continuity relationship with a primary
care physician. The more primary is available, the healthier the population.
The opposite is true with specialty care.
Dr. Val: Why did the
“gatekeeper” movement (promoted by HMOs) fail, and what is the current role of
the family physician in the healthcare system?
The
“gatekeeper” role failed because it restricted patient choice. Patients need to
be in control of the health care, which is what patient-centered care is all
about. HMOs put the health insurance plan in charge, something which was hated
by patients and their physicians.
Dr. Val: In your work with the
IOM (specifically in Closing the Quality Chasm) did the role of primary care and
preventive medicine come up? If so, what did the IOM think that PCPs would
contribute to quality improvement in healthcare? Did they discuss (perhaps
tangentially) the cost issue (how to reduce costs by increasing preventive
measures?)
Just before the IOM Quality Reports
came out, the IOM did a major report on the importance of primary care. The
importance of primary care and prevention are central to improved quality. In
the “Chasm Report”, the focus was more on the patients taking greater charge of
their health care, and the realization that primary care is a team effort, and
not just a role for physicians. The reduction in costs comes from making health
care more accessible (not dependent on visits) through health information
technology and the internet. Preventing disease, and treating it early when it
comes, are the keys to quality and cost reduction. Revolution Health is a
vehicle for this, consistent with the vision of the “Chasm Report.”
Dr. Val: How can patients be sure that they’re getting the best primary care?
First take charge of your
own primary care. The traditional patient-physician relationship was, “Yes
doctor”, “Whatever you say doctor”. Your care would be limited by the knowledge
and recall (on the spot) of your doctor.
Much better is a “shared care” relationship with your primary care
physician and team. After all, the care is about you. Be informed. Make your
own decisions realizing that the physician and care team are advisors, coaches
in your care. You may agree with them, or disagree and do it your way. By
having your own personal health record and being connected to resources like
Revolution Health, you are empowered to get the care you want and need.
Finally, choose your primary care wisely. Not just anybody will do. Your
primary care physician is as important a choice as your close friends. You need
to like and trust this person. Have a great primary care physician who knows
you and cares about you and your health care is in real good shape. But, no
matter how good she or he is, you still must take responsibility for your care.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
