May 16th, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Journalism, Medical Ethics, News
5 Comments »
Superstar medical blogger KevinMD calls today (May 16, 2007) “Black Wednesday” – the day when two of the Internet’s most popular blogs were officially closed. Both Flea and Fat Doctor were forced to shut down their blogs due to privacy concerns. The two bloggers had been posting anonymously – in order to protect themselves and the privacy of the people they wrote about. It seems that Fat Doctor was outed by a co-worker, and Flea… we don’t know what happened exactly, but he was in the middle of a malpractice lawsuit, and was revealing the unsavory details of how the trial was going.
And this news is timely, coming on the heels of an interview I did with USA Today about blogging and patient privacy.
This seems to me like a wake up call for medical bloggers – there is no such thing as true anonymity. Your identity can only be hidden for so long.
I have never blogged anonymously – and I recognize that anything I post can be read by anyone, anytime, anywhere. This knowledge has resulted in extreme caution in posting information that could even remotely be linked to a real patient. And yes, I have also refrained from blogging about issues and events that I sure would have liked to because of the associated risks.
It may be time for us medical bloggers to create and adhere to a code of conduct to protect ourselves and our patients from harm. I had actually proposed this to Dr. Rob a few weeks ago…
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 8th, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Humor
2 Comments »
Many thanks to Dr. Rob at the Musings of a Distractible Mind
blog for tagging me with the 456 billion dollar meme… The idea of this game is to think of the best
way to spend 456 billion dollars. Sam at
BlogMD started this meme when considering how the total amount of money spent
on the war in Iraq may have been better spent (he suggests that we could have
cured cancer by giving that money to the NCI instead). By contrast, Rob’s proposal is rather whimsical, exploring
the number of llamas and goats that could have been purchased for that amount
of cash.
I’m of two minds – part of me wants to be silly, the other
wants to be serious (a tension that is part of Rob’s daily inner struggle)… but
in this case I’m afraid that silly wins.
Silly Val
My apologies to Sam for allowing his noble meme to
deteriorate so rapidly into chaos but what did you expect, tagging a goat loving
guy who blogs about the history of accordions?
It’s not surprising that his pals would wander off into uncharted animal
territory, rather than suggesting solutions that might actually achieve world
peace.
I myself have a special fondness for any animal whose face
bears an expression of astonishment, goofyness, or inquisitiveness. Some animals are just plain cute because of
their whimsical behavior.
Given my recent concern about melamine and pet food tainting
– I suppose the 456 billion could be used to create US regulated, safe, animal
food factories to support the culinary needs of kitties and doggies everywhere…
except in China, of course, where they make pet food but eat pets. There’s some kind of irony in there somewhere…
Of course, humans are people too… and I also worry about the
safety of the food supply for them. The
latest food debacles (salmonella in Cadbury’s chocolate bars and in US
peanut butter, as well as the E. coli/spinach issue) highlight the fact that
even the West’s attempts to regulate and monitor food safety have fallen down
on the job.
So… in honor of the culinary medical blog “The Blog That Ate Manhattan” – our Grand
Rounds host this week – I am voting to use the $456 billion on safe food for
pets and people. Since math isn’t my
forte, I’m not sure exactly how the cost break down will go, but I think it’s
something like:
Cost of creating internationally safe pet food: $50 billion
Cost of creating an air-tight FDA process for ensuring human
food and drug safety: $100 billion
Cost of setting up safe, organic producers of healthy food
all over the world: $306 billion
The cost of a fat, juicy, 100% Salmonella-free wild fish
steak on summer barbeque grill… priceless.
I tag the following bloggers to tell me what they would do
with $456 billion… Dr. Charles, Dr. Joe,
Dr. Charlie, Dr. Jeff, and Mira Kirshenbaum.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 23rd, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Emergency Medicine
No Comments »
An Emergency Medicine physician blogger calls laziness the “cardinal sin of
medicine.”
How did this quality achieve such status?
TrenchDoc explains:
Simple. It is the ONE thing that we as
physicians can control. We cannot prevent patients from smoking and driving
their minivans into light poles. We cannot help that patients have myocardial
infarctions without any symptoms whatsoever. We certainly can not force them to
take medicine or have routine checkups. We CAN however be careful,
double-checking and unassuming diagnosticians. I don’t mean by this that we
should order a whole boatload of tests on each patient… quite the contrary… I
mean we should SPEND THE TIME with the patient to find that one unlikely detail
that is the key to solving the problem.
Honestly though, being lazy, quick and
cheap are the easiest of sins to commit in our vaunted system. We pay
physicians in this country basically upon the number of procedures or the
amount of patients they care for per hour. Eventually, poorly directed
efficiency gives way to poor quality of care and to be honest, I am as guilty
as anyone when it comes to missing important clues from a patient.
In his blog post, TrenchDoc goes on to describe a terrible
case of a mentally disabled woman who fell out of an electric shopping cart at
a Value Mart. She complained of severe back
pain and got every imaging study under the sun (which showed a normal
spine). She was discharged from the
Emergency Department, only to be readmitted to another ED weeks later when her
pain was still too great to bear. This
time she said it was her leg that hurt… take a look at the horrible fracture
she had that was missed at the first ED.
I have argued that one of the major causes of decreased
quality of care is reduced patient-physician interaction time. We are so pressured to rush through our
history and physical that we often miss the diagnosis, furiously documenting
everything without mentally processing what we’re doing.
I agree with TrenchDoc’s call to spend more time with
patients, though time doesn’t come easily.
How do you think we can help physicians find more time to be with their
patients?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 20th, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Family Medicine, News, Parenting, Relationships
4 Comments »
“Be quick to listen, slow to speak.” That’s the old wisdom I was taught growing
up, though it sure is difficult to apply regularly and consistently, isn’t it? Nonetheless I can’t think of a better
principle for practicing good medicine.
I was reading Dr. Smith’s blog and was touched by his
observations:
Patients don’t know
how to put words on their pain, and there is no disease named for the pain that
the patient wants to tell you about. It’s about the inner anguish of this
particular person’s quest for life, their disappointment, the abuse they have
experienced, their feelings of failure and lack of significance, their rage at
the injustices they endure and they don’t have anyone else but you to talk
to. And, by having a relationship with a safe professional, some of their
pain is relieved and, in many cases, they get well or better! In some
cases, they don’t, but that begins to matter less than the fact that you begin
to understand that “getting better” is not the goal here. And,
if you keep trying to make the patient better with a prescription pad, they
will just keep bringing you new problems to chew on until you figure out what
they really need.
The truth is that at the root of many medical
misunderstandings is a listening problem. Sure we hear
lots of things, but in our rush to package complaints into a convenient
diagnosis we often miss the elephant in the room. An excellent example of a doctor practicing
good listening skills was described in Signout’s blog this week.
Some parents appeared a bit overly concerned
about their young child’s cold symptoms. The resident taking care of them
wisely recalled that the mom had mentioned that her aunt died of leukemia
as a child. The doctor made the
connection between that bit of history and their angst – and reassured the
parents that the child’s blood tests were normal, and did not suggest
leukemia (without them directly asking the question). The emotional relief that
ensued was the most therapeutic effect of the physician encounter that day.
The moral of the story is that listening really can be
a healing art. And it’s not just
reserved for psychologists and psychiatrists.
*another case of good listening here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 1st, 2007 by Dr. Val Jones in Medblogger Shout Outs
Tags: Finance, Health Insurance, Hospitals, Medicare, News, Relationships
5 Comments »
In a really engaging recent post, ER doc Edwin Leap (via GruntDoc) discusses why it seems that the general public is outraged at reports of the occasional specialist who makes $500,000 and yet do not flinch at the much larger salaries of football players, musicians, or media tycoons.
I posted a response to Dr. Leap’s blog post, explaining my take on why people are so angry. Let me know if you agree:
You are right that there is a lot of anger towards physicians – it is the collateral damage of the broken physician-patient relationship. When third parties (insurers) got between us, and reimbursement dwindled with drastic cuts in Medicare/Medicaid, physicians had to make up the difference in volume. When you see 30+ patients/day none of them feels as if they’ve had a valuable interaction with you. And the physician’s memory of each individual patient (and their psycho-social context) becomes dim.
When we lose the sacred, personal, physician patient relationship – we lose the best of what compassionate individualized medical care has to offer. This is why patients believe that a government sponsored system can give them the same level of care that they currently receive. I shudder at the idea of handing over medical decision making to a distant bureaucracy that only knows what’s right for a population, not for the individual. But if doctors continue to treat patients like a commodity, the patients are actually receiving nothing more than population-based care anyway. Quality care is personal, and the physician-patient relationship is a trusted bond that cannot be easily broken. We need to know our patients well so that we help them to make the best possible decisions for their personal situation. I believe that the IMP movement (see Gordon Moore’s work) – where PCPs use IT to drastically reduce overhead costs so they can afford to see fewer patients – is one of the best ways to improve healthcare quality.
As far as Emergency Medicine is concerned – we need to get the non-sick patients out of the ER and back to the PCPs. Easier said than done – but if the patients have a real relationship with their PCPs they’re less likely to substitute an ER doc inappropriately.
My 2 cents! 🙂
Patients are angry about physician salaries because they know instinctively that they are not getting the quality care that they are paying so much for… Moreover, the major cost causers (hospitals that cost shift unpaid bills to the uninsured and take large cuts for hospital administrator salaries, and for-profit insurance companies) don’t have a name and a face to the patient. So docs take a double dose of anger on the nose, further damaging the already strained relationship. We must go back to our roots – and support the personal doctor patient relationship that has been a pillar of American medicine. Revolution Health can be our meeting place… the new digital medical home, supporting the old physician-patient team decision-making approach!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
