August 18th, 2010 by Shadowfax in Better Health Network, Health Policy, News, Opinion
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An alert reader alerted me to this related piece in Slate: “We Can’t Save You: How To Tell Emergency Room Patients That They’re Dying.” An excerpt:
The ER is not an easy place to come to these realizations or assess their consequences. A handful of physicians are trying to change that. Doctors like Tammie Quest, board-certified in both palliative and emergency medicine, hope to bring the deliberative goal-setting, symptom-controlling ethos of palliative care into the adrenaline-charged, “tube ’em and move ’em” ER. Palliative/emergency medicine collaboration remains rare, but it’s growing as both fields seek to create a more “patient-centered” approach to emergency care for the seriously ill or the dying, to improve symptom management, enhance family support, and ensure that the patient understands the likely outcomes once they get on that high-tech conveyor belt of 21st-century emergency medicine.
Emergency medicine and palliative care-certified? That’s an interesting mix. We have a great palliative care service where I work (in fact, it just won the national “Circle of Life” award.) It makes a lot of sense to have a palliative care nurse stationed in (or routinely rounding) the ER, though. I think I’m going to suggest this to our hospice folks.
*This blog post was originally published at Movin' Meat*
August 18th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News
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New primary care arrangements show how primary care is evolving — or splitting apart, depending upon one’s perspective.
Retainer fees let one practice handle more patients by phone or email. But, points out Richard Baron, FACP, affluent communities can take advantage of such arrangements, and not every community is. And Sam Fink, FACP, of southern California says tele-visits are no substitute for hands-on care. In another model, nurse-led facilities service the poor in north Philadelphia, and more states are expanding the power of the pen to cover shortages.
Another trend is the shared medical appointment. Led by physicians and conducted by “behaviorists,” the sessions cover a half-dozen or more patients at a time for both primary and specialty care.
Even pharmacists are getting in on primary care. Blue Shield of California is trying a pilot project of pharmacists, believing they have the clinical and patient communication skills to be as effective as doctors, but for less cost. But primary care doctors aren’t completely ceding their profession. There are also pilot projects in California to train more doctors and steer them into communities facing a shortage of primary care services. (USA Today, Fox News, ACP Internist, New York Times, Whittier Daily News)
*This blog post was originally published at ACP Internist*
August 13th, 2010 by DavedeBronkart in Better Health Network, Health Policy, Opinion, True Stories
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Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio.
This item has nothing to do with OpenNotes itself –- it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document.
Here’s the story.
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In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note “primary,” not specialists. I imagine they needed to keep the study design simple.
So here I am in the study, going through life. Five weeks ago I wrote my first realization: After the visit I’d forgotten something, so I logged in. Read more »
*This blog post was originally published at e-Patients.net*
August 11th, 2010 by Davis Liu, M.D. in Better Health Network, Health Tips
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As a practicing primary care doctor, I continue to work incredibly hard on making my bedside manner even better so that patients feel heard. The other reason is because as most doctors learned in medical school 90 percent of getting the right diagnosis comes from taking a good history from a patient.
Unfortunately with shorter doctor office visits and doctors interrupting patients within 23 seconds of starting, you need to know how to get your concerns across. While I don’t believe this is the responsibility of patients, the reality is not everyone has access to doctors with great bedside manner.
How to talk to your doctor is quite easy if you follow three simple steps. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
August 9th, 2010 by StevenWilkinsMPH in Better Health Network, Health Policy, Opinion, Research
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Anyone who’s ever been downsized or otherwise lost a job knows the feelings: Personal loss (social, financial and routine), self doubt, and in some cases fear of what the future will bring. Unemployment and its cousin, underemployment, are not subjects that a lot of people are comfortable brining up in polite conversation — even with their doctor.
Given today’s tough economic environment, chances are that 15 to 20 percent of the people sitting in most doctors’ waiting rooms are out of work. Do you know who they are? You should. Read more »
*This blog post was originally published at Mind The Gap*
