If you haven’t seen this before, you must check out TBTAM’s photo of a man’s message to his wife (taped on the refrigerator). He had answered the phone and taken down this message for her…
***
“Someone from the Gyna Colleges called. They said the Pabst beer is normal. I didn’t even know you liked beer.”
— Rick
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Less than a year ago, I didn’t even know what a blog was. Many physicians still don’t know about them, and yet (according to Wikipedia’s September ’07 figures) there are over 106 million blogs currently online. A recent article about medical blogs suggests that the number of health professionals blogging may be in the order of 100’s. Therefore, medical blogs are only a tiny drop in the blogosphere bucket.
As with IT initiatives in general, the medical world is sorely lagging behind. However, there is a small group of pioneers who are already making a difference in the lives of patients and colleagues around the world. I have witnessed with my own eyes how cancer patients are being directed towards optimal care through blogs like those of Dr. Heinz Josef Lenz. Although he practices in southern California, his blog has been discovered by colon cancer patients across the country – and he has a loyal following who learn about cutting edge research and clinical trial information three times a week. These patients would never have access to this kind of information without his blog – they would have to wait for research to be published in a peer-reviewed journal, and then hope that the media would faithfully translate the findings into consumer language. (Good luck with that.)
Some blogs are being used to educate peers about surgical techniques. Dr. Bates has a wonderful, detailed blog about how to correct cosmetic defects, and a group blog called Inside Surgery has information for surgeons about difficult or unusual cases.
Dr. Rob, our Grand Rounds host this week, does a wonderful job of educating others about primary care, physical exam basics, and the broken healthcare system. He does it with flair – and a whimsical approach that is very entertaining. Where else can you learn about the healthcare system AND the lifestyle habits of llamas, goats, and accordion players?
If you want to keep up with healthcare news – KevinMD is a one-man news feed of all the most interesting goings on. If you need to keep up with advances in the medical device industry, MedGadget is your one stop shop.
Of course there are many other great medical blogs out there as well (and so many nursing blogs, like Emergiblog are outstanding)- but what excites me the most is when I see patients benefiting from the information they receive directly from healthcare professionals. Blogs can truly improve access to the minds of medicine, and even save lives – Medical blogs have the power to:
1. Educate patients about their health
2. Debunk medical myths
3. Cut through the media spin associated with research and health news
4. Influence health policy
5. Instruct other healthcare professionals
6. Expose dishonest medical schemes
7. Increase awareness of clinical trials and important research
8. Provide emotional support
9. Create a networking opportunity for professionals, advocates, and patients
10. Help people navigate the broken healthcare system
If you haven’t already, I hope you’ll add your voice to the medical blogosphere, and be part of a movement to change healthcare – one blog post at a time.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
I was a bit tired today, thinking about how nice the long weekend will be. A colleague wrote me an email reminder to slow down… he said, “go home and have a nice glass of wine and relax.” I guess research supports drinking in moderation – it’s good for the heart, right?
But then, I noticed this poem in Paul Levy’s blog – and I realized that we docs could all use a little slowing down…
ENCOUNTER ON THE STAIRS
By Warner V. Slack, MD
Next to Children’s Hospital, in a hurry
Down the stairs, two at a time
Slowed down by a family, moving slowly
Blocking the stairway, I’m in a hurry
I stop, annoyed, I’m in a hurry
Seeing me, they move to the side
A woman says softly, “sorry” in Spanish
I look down in passing, there’s a little boy
Unsteady in gait, holding onto an arm
Head shaved, stitches in scalp
Patch over eye, thin and pale
He catches my eye and gives me a smile
My walk is slower for the rest of the dayThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Emergency departments are splitting at the seams, uninsured patients fill the waiting rooms, and Emergency Medicine physicians are crying “uncle” on a national level. We assume that gaps in health insurance coverage force patients to seek treatment in the ED, but the reality is that many insured patients seek treatment there as well. Why? Because the ED is a crowded, but one-stop shop whose convenience cannot be denied. PandaBearMD explains why one well-insured patient (who has a regular PCP) still chose to see him in the ED:
“As my patient related to me, in order to see his doctor he has to
make an appointment which is often weeks to months in the future. On
the day of his appointment, even if he shows up on time he will usually
have to wait an hour or two because the doctor is always running late.
Then he will spend a brief ten to fifteen minutes with his doctor who
will order a slew of tests and imaging studies, many of which will have
to be completed at a different location. He may, for example, have to
drive across town for a CT scan and it is usually scheduled for a
different day, often weeks in the future.
Then, as my patient explained, he must wait several weeks for his
next appointment where his physician will explain the results and
finally initiate either definitive treatment or, as is often the case,
referral to another specialist who will repeat the time consuming
process…
My patient also confided to me that even getting the results of studies
and imaging was not guaranteed. Although we are all quick to relay bad
news, apparently follow-up is not that pressing to many physicians if
the results are normal…
Consider now a visit to the Emergency Department. First, my patient did
not need an appointment. While it is true that he was triaged to a low
acuity and had to wait a while, at certain times of the day the waiting
times are not that much longer than the typical wait for his delayed
primary care physician. Second, the lab tests he needed were drawn on
the spot and the results reported within an hour even though he was a
low acuity patient. Our goal, you understand, is to discharge or admit
as fast as possible. Likewise his imaging studies were obtained, read,
and reported quickly. Finally, if anything serious has been discovered
he would have been admitted within hours. More importantly to my
patient, since everything was all right he knew fairly quickly instead
of biting his nails for a couple of months.”
This is a perfect illustration of how Americans value convenience over cost, and how health insurance can be an enabler for inappropriate ER use. The solution here is in IT. Primary Care Physicians need the tools to automate a lot of what they do, thus making care more convenient for their patients and themselves. A common, secure PHR-EMR, synched with online scheduling, radiology suites and laboratories, health news alerts, care pages and vibrant community, chronic disease management tools, and comprehensive, credible, patient education will go a long way to keeping people out of the ER. Revolution Health is working on such a system, and we have high hopes that the creation of America’s first integrated, digital medical home will improve the quality of life of patients and physicians alike. Achieving this goal will require cooperation and patience from all sectors in healthcare. I hope we’ll find a way to work together as rapidly as possible or else the PCPs and ER docs are going to crack. Hang in there, guys – help is on the way, though it might be a few years out…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
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.
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