March 27th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Research
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When nurses sign out during the end of shift, it’s done so in a quiet setting. Contrast that to medical residents — at least when I was a resident 8 years ago — where pager interruptions during sign out were the norm.
PookieMD compares the situation to the “sterile cockpit” that airline pilots enjoy:
“Pilots have the sterile cockpit–a situation in which, if the plane is below 10,000 feet, only conversation directly relevant to flying is allowed. The rule was developed because take offs and landings are the most likely time a crash will occur, and take offs and landings occur below 10,000 feet. Simple enough, and it saves lives.”
Physicians enjoy no such luxury. Patient discussions with other doctors often take place in distracted settings, under the threat of a pager going off at any time.
Changing this, PookieMD argues, requires a cultural shift. As mentioned earlier, when nurses sign out, it’s sacred time. Doctors need something similar. Studies show that medical errors can arise during the patient hand-off to another physician. Signing out patients in an undisturbed setting may minimize the risk of poor communication, and subsequently, potential mistakes. “Page early and often needs to be replaced with ‘page urgently when appropriate,’” writes PookieMD.
Let’s see if hospital administrators have the courage to make this happen.
*This blog post was originally published at KevinMD.com*
March 25th, 2010 by KevinMD in Better Health Network, News, Opinion
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It’s well known that the use of imaging scans, like CTs, MRIs and PET scans, have been growing at an alarming rate. But a recent study provides some stark numbers. According to a recent CDC report, “MRI, CT or PET scans were done or ordered in 14 percent of ER visits in 2007.” That’s four times as often as in 1996. Although a physician called that growth “astounding,” it’s really no surprise.
Emergency departments are becoming more crowded, and with patient satisfaction scores becoming more influential in financial incentives for physicians, sometimes just ordering a test is the path of least resistance. Factor in the spector of defensive medicine which, according to a survey from the Massachusetts Medical Society, accounts for up to 28 percent of tests ordered, it’s a wonder that more scans weren’t ordered.
Imaging scans are a clear cost driver in healthcare, contributing $12 billion to Medicare’s bill. But costs won’t resonate with patients requesting the tests or the doctors ordering them. One encouraging sign is the recent trend of publicizing the harms of scans, like radiation from CTs. I’m finding that patients are becoming increasingly aware of the risk, and making a more informed decision after I explain it to them. It’s a small step forward.
*This blog post was originally published at KevinMD.com*
March 21st, 2010 by KevinMD in Better Health Network, Book Reviews, Health Tips, True Stories
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By Susan Biali, M.D.
Ten years ago, I was an emergency medicine resident and wanted to die. Today, I’m a general practitioner in part-time practice and in love with life. What made the difference? I signed up for a dance class.
Reports on physician burnout list the personality traits that set us up for trouble: we’re excessively conscientious, feel overly responsible, want to please everyone, and function on an extremely high level –- even if we’re overloaded, exhausted, or our personal life is falling apart. We burn out because we bend over backwards to help others, until something (like our minds or our health or our marriages) finally snaps. Now imagine this: what if we took some of that deep caring and hyper-responsibility, and turned it on ourselves?
When my depression hit bottom and I became a serious risk to myself and my patients, my chief resident asked me to take a stress leave. On impulse I went on a solo tropical vacation and one night at the resort, as I watched an exuberant group of salsa dancers burning up the stage, my eyes filled with tears. I suddenly remembered that when I was a little girl, I practiced incessantly in the basement to my ABBA records, preparing myself for the moment that I would live my dream and finally become a “Solid Gold Dancer.” That night, in that darkened tropical theater, I knew how I would save my life. Read more »
*This blog post was originally published at KevinMD.com*
March 17th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion
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I’ve often given doctors too little credit when it comes to business decisions.
But, in an op-ed published at Reuters, physician Ford Vox argues otherwise.
He notes that doctors, indeed, have tremendous business sense:
How can anybody say that doctors don’t have business sense, when not only do most American physicians forge their way in small private practices, but new doctors lay their cards on the table every year? The competitiveness of residencies, where doctors train to become a pediatrician or a cardiologist, correlates strongly with the field’s earnings potential. Read more »
*This blog post was originally published at KevinMD.com*
February 20th, 2010 by KevinMD in Better Health Network, Opinion
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Most medical schools do a reasonably good job clinically preparing medical students to be future physicians.
But they can do better, especially in our fragmented health system where millions of Americans have to contend with costs as much as they have to with their medical conditions.
In her recent New York Times column, Pauline Chen cites a study showing that students exposed to more non-clinical topics, like medical economics, health policy, and the “business” of medicine, were more satisfied with their education. Read more »
*This blog post was originally published at KevinMD.com*
