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Medical Errors Reduced By 30% When Doctors Required To Speak To One Another At Shift Change

I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal “hand off” process at shift change resulted in a 30% reduction of medical errors.

What was the intervention exactly? Details are available via mail order from the folks at Boston Children’s Hospital. It may take me a few weeks to get my hands on the curriculum (which was supported by a grant from the Department of Health and Human Services). I’m not sure how complex the new handoff initiative is in practice (or if it’s something that could be replicated without government-approved formality) but one thing is certain: disciplined physician communication saves lives.

I myself (without a grant from HHS or a NEJM study to back my assertions – ahem) proposed a set of comprehensive communication practices that can help to reduce medical errors in the hospital. My list involves more than peer hand-offs, but also nursing communication, EMR documentation strategies, and reliance on pharmacists for medication reconciliation and review. It is more than just an information exchange protocol for shift-changes, it is a lifestyle choice.

I applaud the I-PASS Handoff Study for its rigorous, evidence-based approach to implementing communication interventions among pediatric residents in children’s hospitals. I am stunned by how effective this one intervention has been – but a part of me is saddened that we practically had to mandate the obvious before it got done. What will it take for physicians to adopt safer communications strategies for inpatient care? I’m guessing that for many of us, it will involve enrollment in a workshop with hospital administration-driven requirements for participation.

For others of us – regular communication with staff, patients, and peers already defines our medical practice. But because (apparently?) we are not in the majority, we’ll just carry on our instinctual carefulness and wait for the rest to catch up. At least now we know that there is a path forward regarding improving communication skills and transfer of patient information. If we have to force doctors to look up from their iPhones and sit around a table and speak to one another – then so be it. The process may improve our lives while it saves those of our patients.

Talk Therapy And The American Resident Project: How Can The Next Generation Of Physicians Improve The Healthcare System?

I have been an outspoken, and often times exasperated, patient advocate and student of healthcare reform. There is no doubt that the U.S. healthcare system is operating far below its potential in terms of efficiency, effectiveness, and affordability. In fact, an entire industry of policy wonks and consultants have sprung up in both the public and private sectors – all with recommendations about how to “fix” our system. In my opinion, the most insightful suggestions will come from those who are currently doing the work of healthcare (i.e. clinicians) and change will be adopted and promoted most fervently by the young and freshly minted among them.

Medical students, residents, and physicians newly in practice now have a place to voice their opinions – The American Resident Project is an ambitious movement to promote fresh thinking from tomorrow’s physician-leaders. I am pleased to be supporting this effort here on my blog and in face-to-face meetings with fellows at medical centers across the country. I hope you’ll bookmark the website and join in the community conversation about how to innovate  in the midst of a broken system. This is more than a think-tank for change – the ideas and opinions of young doctors may be our best hope for a brighter tomorrow.

Stay tuned for some fresh ideas in the setting of some healthy talk therapy!

Family Medicine Residents And Students Discuss Leadership And Advocacy

Just wanted to get some initial thoughts down following the Family Medicine Summit organized by the California Academy of Family Physicians. I’ll have some more developed thoughts in a later post. These initial thoughts were from the plane going from that meeting to the Mayo Clinic Social Media Summit – the meeting I’m at right now.

First of all, thanks again to the California Academy of Family Physicians for the invitation to speak. The audience was mainly Family Medicine Residents and medical students. From my understanding, the registration numbers exceeded expectations (I take full credit for that – Hehe). It’s always energizing to me to present to residents & students.

The opening keynote was from CAFP President Dr. Carol Havens. She asked the audience for words that they think of when you hear “Family Physician.” And, as you can see from this twitpic, the audience came up with a huge list of Family Physician qualities. My favorites are “comprehensive care,” “revolution,” and, of course, “Love.”

My leadership & advocacy sessions Read more »

*This blog post was originally published at Family Medicine Rocks Blog*

Many Newly Minted Physicians Regret Going Into Medicine

Sometimes having no end of job prospects, more than one in four new doctors regret going into medicine by their graduation, according to a recruitment firm survey.

Recruiters Merritt, Hawkins asked new doctors if they would study medicine if they had it all to do over again, and 28% said they would select another field, up from 18% in a similar survey in 2008.

Still, the newly minted physicians have plenty to do while they mull other options. About 78% of newly minted physicians received at least 50 job solicitations during their training, and 47% received 100 or more contacts from recruiters.

Despite the heavy rotation of recruiters, residents Read more »

*This blog post was originally published at ACP Internist*

Improving Surgical Residents’ Bedside Manner

I was alerted to this Archives of Surgery article (full reference below) by MedPage Today:  Role Playing Boosts Surgical Residents’ Bedside Manner.

I find it intriguing.  Role playing gives you a chance for a “do-over” when you make a social or communication faux pas.

So much of medicine is communication.  Those of us who have been at it for years, deliver bad news differently (learned the hard way) now than we did previously.  You choose your words more carefully (though I still occasionally screw up).  Some words are more emotionally charged than others.  Some patients want more information than others.

The University of Connecticut Health Center conducted a prospective study  of a pilot project designed to  teach surgical residents patient-centered communication skills.

The study offered Read more »

*This blog post was originally published at Suture for a Living*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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