How many patients should a hospitalist average on any given day? What do you think? The Hospitalist asked that question to hospitalists and 421 of them responded. They were given responses in quintiles of 10 or fewer, 11-15, 16-20, 21-25, and more than 25 total patient encounters per day.
Go check out their results. I’m not surprised. But, as they say, there is no right answer. The right number is the number that brings WIN-WIN-WIN-WIN to the patient-doctor-hospital-insurance quadrangle. WIN-WIN-WIN-WIN is possible. It just takes a great understanding of removing the barriers to efficiency. Efficiency and quality of care can move in the same direction. They don’t have to be opposing forces. You can be better and faster if given the tools, whether those tools are driven by IT support, systems process changes, communication enhancement, physical and structural hospital layout changes or documentation support tools. There are many others. Read more »
*This blog post was originally published at The Happy Hospitalist*
Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine. It is called de-skilling. De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things. Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), Pay for Performance (P4P), Patient Centered Medical Home (PCMH) requirements and so on.
Examples of physician de-skilling were revealed in a recent study which consisted of in-depth interviews with 78 primary care physicians regarding EMR use. EMRs are all about standardization – what data is captured and recorded, how data is reported, how data is used, and so on.
Over the course of the interviews, physicians in the study described significant examples of de-skilling behavior. Most indicated that Read more »
*This blog post was originally published at Mind The Gap*
News of the World wasn’t read by 15 percent of the British public because it told people what they should know. It got there by giving them what they wanted: stories about the peccadilloes of the rich and famous, accounts of the gross incompetence of government and of course, pictures of naked ladies.
Setting aside the fact that News of the World is no more, its publishers and editors knew how to sell the “news.” As free online news replaces print, every click, every page view, every second of viewing per page is tracked in the fierce competition for ad dollars, and so the selling of news increasingly influences its reporting. Titles, format and content are tweaked by editors to “optimize the metrics.” Reporters succeed and fail based on their ability to write articles that attract eyeballs, not Pulitzer prizes.
In the health domain, the effects of these demands were described in a series of conversations the Center for Advancing Health hosted with health care journalists over the past month.* The themes that emerged were that journalists are often encouraged to: Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
On the NPR Shots blog, Scott Hensley writes, “Quality Prescription For Primary Care Doctors: Do Less,” about an article in the Archives of Internal Medicine. Excerpt:
“A group of docs who want to improve the quality and cost-effectiveness of primary care tinkered with some Top 5 lists for of dos and don’ts for pediatricians, family doctors and internists.
After testing them a bit, they published online by the Archives of Internal Medicine. Most of the advice falls in the category of less is more.
So what should family doctors not be doing? The Top 5 list for them goes like this:
1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weeks or there are red flags, such as neurological problems.
2. No antibiotics for mild to moderate sinusitis, unless it has lasted a week or longer. Or the condition worsens after first getting better.
3. No annual electrocardiograms for low-risk patients without cardiac symptoms.
4. No Pap tests in patients under 21, or women who’ve had hysterectomies for non-malignant disease.
5. No bone scans for women under 65 or men under 70, unless they have specific risk factors.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
Last week I had some blood tests taken before a doctor’s appointment. I went to a commercial lab facility, one of several dozen centers for collecting specimens have opened up in otherwise-unrented Manhattan office spaces lately.
I have to say I really like getting my blood work done at this place, if and when I need blood tests. And it’s gotten better over the past few years.
First, pretty much all they do in the lab center is draw blood and collect other samples based on a doctor’s orders. So the people who work there are practiced at phlebotomy, because it’s what they do most of the time. The guy who drew my blood last week did the same a year or two ago, and he was good at it back then. He used a butterfly needle and I didn’t feel a thing.
Second, they seem organized and careful about matching specimens to patients. The man who drew my blood didn’t just confirm my name and date of birth, but he had me sign a form, upon my inspecting the labels that he immediately applied to the tubes of blood he drew from my right arm, that those were indeed my samples and that I was the patient named Elaine Schattner with that date of birth and other particulars. Read more »
*This blog post was originally published at Medical Lessons*