April 29th, 2009 by AlanDappenMD in Primary Care Wednesdays, Uncategorized
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In early 2006, four years into running my current medical practice, doctokr Family Medicine, I got a call from my medical malpractice carrier. Just weeks before I’d received a notice that my malpractice rates could go up by more than 25%. The added news of a pending investigatory audit was chilling. In 25 years of practicing medicine I’d never been audited.
“Is there a complaint, or a law suit against me that I don’t know about?”
“No,” the auditor told me over the phone, “We’ve never seen a medical practice like yours and feel obligated to investigate your process from a medical-legal perspective.”
“Great,” I thought, with a weary sigh. “I’m already battling the insurance model, the status quo of the medical business model, and slow adoption by consumers who are addicted to their $20 co-pay. All I’m trying to do is to breathe life into primary care and get the consumer a much higher quality service for less money than currently subsidized through the insurance model. And now this.”
The time had arrived to add the concerns of the malpractice companies to the list of hurdles to clear if a new vision of a medical care model was ever to catch flight.
I frequently am asked the question “Aren’t you afraid of the malpractice risk?” when I explain my medical practice model, which is based on the doctor answering the phone 24/7, resulting in the patient’s medical problem being solved by the phone more 50% of the time. The simplest counter to this question is to analyze the risk patients incur when the doctor won’t answer the phone. What happens when the doctor is the LAST person to know what’s going on with patients? The answer is obvious. But malpractice companies could have concerns beyond patient safety. Buy-in from the malpractice companies would be critical to the future viability of all telemedicine.
I prepared a summary paper, which included 12 bullet points, explaining how a doctor- patient relationship based on trust , transparency, continuous communications and high quality information systems significantly reduce risk to the person you’re trying to help.
Bullet 1: The industry standard is that 70% of malpractice cases in primary care center on communication barriers. My medical team deploys continuous phone and email communications and 7 days a week- same day office visits when needed between doctor and patient thus significantly reducing these barriers.
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The remaining bullets could be summarized by the conclusions from the Institute of Medicine’s visionary book Crossing the Quality Chasm: A New Health System for the 21st Century using a table developed by The American Medical News when they reviewed the book. I carefully plotted our practice standards compared to the traditional business model as it stands today based on this table:
The auditor showed up, spent 4 hours reviewing our practice, electronic medical records, compliance to HIPPA, our intakes, on-line connectivity, procedures, and practice standards. While the auditor reviewed, I sat as unobtrusively as I could, feeling my brow grow damp with perspiration, as I carefully answered her questions. During the auditor’s time, I never moved to sway her to “my way.” I just let the data that I had accumulated from four years of practice do the talking.
Once the auditor left, I waited for two weeks for the results. By the time their letter arrived, I was scared to open it. The news arriving made me jubilant. The medical practice company announced a DECREASE in my premiums because we used telemedicine and EMR to treat patients so fast (often within 10 minutes of someone calling us we have their issue solved without the patient ever having to come in).
I will admit that I felt, and actually still do feel, vindicated by having my malpractice insurer understand fully the value that the type of telemedicine my practice offers to our patients: round-the-clock access to the doctor, speed of diagnosis, and convenience, which all led to healthier patients and lower risk.
Doctors answering the phone all day for their patients, it’s not just lower risk, it’s better health care at a better price. It’s a win-win-win strategy whose day is arriving.
Until next week, I remain yours in primary care,
Alan Dappen, MD
April 28th, 2009 by Dr. Val Jones in Announcements
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April 28th, 2009 by Dr. Val Jones in Expert Interviews, Health Policy
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Sam Solomon over at Canadian Medicine, did a great job of introducing our recent interview. Please check it out.
Educated in Nova Scotia before she moved to the United States to do degrees in biblical studies and medicine, Dr Val Jones is now one of the most popular physician bloggers. Her work has appeared in MedPage Today, Revolution Health, a now-defunct blog called Dr. Val and The Voice of Reason and, most recently, her own internet company Better Health.
Last year, Dr Jones was accredited as a member of the National Press Club in Washington, DC, and has focused much of her recent reporting on health policy reform efforts. She still practises medicine part-time as a rehab specialist at Walter Reed Army Medical Center. Dr Jones is also a talented cartoonist and her cartoons‘ take on medicine displays a sharp, wry sense of humour.
This week, Dr Val agreed to answer some questions for Canadian Medicine:
Canadian Medicine: Did you know as an undergrad at Dalhousie University, in Halifax, Nova Scotia, that you wanted to be a physician?
Click here for the rest of the post.
April 28th, 2009 by Dr. Val Jones in True Stories
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Doctor: Mr. Smith, your urine test is positive for cocaine.
Mr. Smith: [Blank Stare]
Doctor: Have you been snorting cocaine recently?
Mr. Smith: No.
Doctor: Then why is there cocaine in your urine?
Mr. Smith: Maybe your nurse put it in there.
Doctor: If my nurse had cocaine, I don’t think she’d put it in your urine.
***
Bonus tip for pain management specialists: cocaine’s half-life in the urine is 2-4 days. “Random” urine drug testing on Mondays offers a higher yield than other days of the business week because most patients abuse illicit drugs on weekends>>weekdays.
April 28th, 2009 by admin in Better Health Network, Health Tips
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A meeting this week called Experimental Biology had some really interesting new research presented on eggs. I have written about eggs in the past and tried to clear up some of the confusion around whether they are good or not. Check out my past blog called The Incredible Edible Egg for more background on nutritional plus’s and minus’s on eggs. I also wrote a fun post on eggs which included some food safety tips. I personally love eggs and my favorite way to eat them is a spinach and feta omelet! Mmmmmm……
Here are some of the findings presented at Experimental Biology 2009 this week:
Eggs for Breakfast Helps Manage Hunger and Calorie Consumption
A study led by Maria Luz Fernandez, Ph.D., professor in the department of nutritional sciences at the University of Connecticut, investigated the differences in post-meal hunger and daily caloric intake when eating a breakfast of either protein-rich eggs or carbohydrate-rich bagels. Although the two breakfast options contained an identical amount of calories, the researchers found that adult men who consumed eggs for breakfast:
- consumed fewer calories following the egg breakfast compared to the bagel breakfast
- consumed fewer total calories in the 24-hour period after the egg breakfast compared to the bagel breakfast
- reported feeling less hungry and more satisfied three hours after the egg breakfast compared to the bagel breakfast
Protein for Breakfast Helps Teens Control Appetite
Researchers from the University of Kansas Medical Center assessed the impact of a protein-rich breakfast on appetite and overall calorie consumption among teens who traditionally skip breakfast. While each test breakfast contained 500 total calories, the researchers examined variables including the protein form (solid food or beverage) and the amount of protein versus carbohydrate in the breakfast.
- Teens consumed fewer calories at lunch when they ate a protein-rich breakfast of solid foods compared with a protein-rich beverage breakfast
- Post-meal hunger was significantly reduced when the teens ate a protein-rich breakfast of solid foods
Cracking Open Heart Health Myths
Florida State University researchers examined the relationship between cardiovascular disease (CVD) risk factors such as body mass index, serum lipids and levels of high-sensitivity C-reactive protein (hs-CRP) (a marker for inflammation), and the degree to which these factors are influenced by dietary intake of fiber, fat and eggs. The study found:
- No relationship between egg consumption and serum lipid profiles, especially serum total cholesterol, as well as no relationship between egg consumption and hs-CRP
- A positive correlation (meaning the more the higher the risk) between dietary trans-fat intake and CVD risk factors, as well as a negative correlation (meaning lowered risk) between fiber and vitamin C intake and CVD risk factors
These studies support more than 30 years of research showing that healthy adults can consume eggs as part of a healthy diet. Eggs are all-natural and packed with a number of nutrients. One egg has 13 essential vitamins and minerals in varying amounts, high-quality protein and antioxidants, all for 70 calories. Eggs are also an excellent source of choline, an essential nutrient vital for fetal and infant brain development but also good for everyone.
For more information, check out the Egg Nutrition Center
