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Physician Specialty Silos Can Cause Friendly Fire Casualties

It’s no secret that medicine has become a highly specialized business. While generalists used to be in charge of most patient care 50 years ago, we have now splintered into extraordinarily granular specialties. Each organ system has its own specialty (e.g. gastroenterology, cardiology), and now parts of systems have their own experts (hepatologists, cardiac electrophysiologists)  Even ophthalmologists have subspecialized into groups based on the part of the eye that they treat (retina specialists, neuro-ophthalmologists)!

This all comes as a response to the exponential increase in information and technology, making it impossible to truly master the diagnosis and treatment of all diseases and conditions. A narrowed scope allows for deeper expertise. But unfortunately, some of us forget to pull back from the minutiae to respect and appreciate what our peers are doing.

This became crystal clear to me when I read an interview with a cardiologist on the NPR blog. Dr. Eric Topol was making some enthusiastically sweeping statements about how technology would allow most medical care to take place in patient’s homes. He says,

“The hospital is an edifice we don’t need except for intensive care units and the operating room. [Everything else] can be done more safely, more conveniently, more economically in the patient’s bedroom.”

So with a casual wave of the hand, this physician thought leader has described a world without my specialty (Physical Medicine & Rehabilitation) – and all the good that we do to help patients who are devastated by sudden illness and trauma. I can’t imagine a patient with a high level spinal cord injury being sent from the ER to his bedroom to enjoy all the wonderful smartphone apps “…you can get for $35 now from China.” No, he needs ventilator care and weaning, careful monitoring for life-threatening autonomic dysreflexia, skin breakdown, bowel and bladder management, psychological treatment, and training in the use of all manner of assistive devices, including electronic wheelchairs adapted for movement with a sip and puff drive.

I’m sure that Dr. Topol would blush if he were questioned more closely about his statement regarding the lack of need for hospital-based care outside of the OR, ER and ICU. Surely he didn’t mean to say that inpatient rehab could be accomplished in a patient’s bedroom. That people could simply learn how to walk and talk again after a devastating stroke with the aid of a $35 smartphone?

But the problem is that policy wonks listen to statements like his and adopt the same attitude. It informs their approach to budget cuts and makes it ten times harder for rehab physicians to protect their facilities from financial ruin when the prevailing perception is that they’re a waste of resources because they’re not an ICU. Time and again research has shown that aggressive inpatient rehab programs can reduce hospital readmission rates, decrease the burden of care, improve functional independence and long term quality of life. But that evidence isn’t heeded because perception is nine tenths of reality, and CMS continues to add onerous admissions restrictions and layers of justification documentation for the purpose of decreasing its spend on inpatient rehab, regardless of patient benefit or long term cost savings.

Physician specialists operate in silos. Many are as far removed from the day-to-day work of their peers as are the policy wonks who decide the fate of specialty practices. Physicians who have an influential voice in healthcare must take that honor seriously, and stop causing friendly fire casualties. Because in this day and age of social media where hard news has given way to a cult of personality, an offhanded statement can color the opinion of those who hold the legislative pen. I certainly hope that cuts in hospital budgets will not land me in my bedroom one day, struggling to move and breathe without the hands-on care of hospitalists, nurses, therapists, and physiatrists – but with a very nice, insurance-provided Chinese smartphone.

Health Care Is Stuck In The Past

We respond to certain “Code Blue” situations in our hospital. In the ED, of course, and in the outpatient areas and radiology, and if needed as back-up in the inpatient units. The hospital issues one of those overhead calls when there is a code blue — a cardiac arrest or other collapse, person down, injury, etc., but we also carry a pager in the ER in case we don’t hear the overhead call. The pager also signifies which doc is designated to respond to such a call, since we often have 8 docs working at once. It’s a little ritual we have at change of shift, passing off the pager and the spectralink phone, like the passing of the torch to the oncoming doc.

So of course I took the pager home the other day and had to make an extra trip to the hospital to return it. Ugh.

As I was driving back in, I took a moment to really look at the thing, and it struck me that this pager is the exact same model I used in medical school and residency, way back in the mid nineties. The exact same one: Read more »

*This blog post was originally published at Movin' Meat*

Android, iPhone And iPad Being Tested For Medical Use On The Battlefield

I was always under the impression that medical documentation was reserved for the office and the hospital.  Not necessarily so — even in the battlefield, medics document medical care in real time.

Unfortunately, the tools they use to do this documentation consists of bulky Motorola hand held devices that are four years old.

Four years is an eternity in the tech world.  To put this in perspective, I was still rocking a Motorola RAZR back then.  So it shouldn’t come as a surprise that the Army is field testing the iPhone, iPad, and Android smartphones in the battlefield. Read more »

*This blog post was originally published at iMedicalApps*

Which Generation Of Physicians Uses The Most Mobile Technology?

Smartphones and tablets have reached 80% of physicians across all practice types, locations and years in practice, and 25% of users are “Super Mobile” physicians who use both types of mobile devices. This is far beyond the general population’s 50% adoption of smartphones and 5% adoption of tablets.

QuantiaMd, a free, online learning collaborative, released survey results that showed 44% of physicians who do not yet have a mobile device intend to buy one this year.

While younger physicians have higher adoption rates than older ones, current use of mobile devices by physicians longest in practice is above 60%, the survey showed. Among physicians with 30 years or more of practice, almost 20% already use a tablet device for work, and another 25% say they are extremely likely to do so. Physicians in their second decade of practice use Read more »

*This blog post was originally published at ACP Internist*

Teamwork And Good Communication Make Everything Better

What? Just what am I talking about? Give me a minute.

More and more people are telling me too often they are encountering doctors who 1) don’t look them in the eye 2) don’t listen to them 3) don’t touch them or get anywhere near them and 4) stay focused on their a) computer b) smartphone or c) iPad.

More of us are saying we are “mad as hell and are not going to take it anymore” just like the character in the movie “Network” years ago. We find another doctor.
I am happy to report that an increasing number of the gray haired doctors who run medical schools are agreeing with us. Doctors need to be better communicators. They need to celebrate human contact rather than devote themselves to only technology and leading edge science. The professors also want tomorrow’s doctors to know how to work as part of a team. That’s the core of multi-disciplinary care that we talk about all the time these days. It’s smart minds working together for you and me – and to avoid medical errors – which, by the way are estimated to kill 98,000 U.S. patients a year. The idea is Read more »

*This blog post was originally published at Andrew's Blog*

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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