February 10th, 2011 by RyanDuBosar in Health Tips, Research
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Physicians said in a survey that noncompliance with advice or treatment recommendations was their foremost complaint about their patients. Most said it affected their ability to provide optimal care and more 37 percent said it did so “a lot.”
Three-quarters of patients said they were highly satisfied with their doctors. But they still had complaints ranging from long wait times to ineffective treatments.
Those are just some of the findings from two surveys, the first a poll of 660 primary care physicians conducted by the Consumer Reports National Research Center in September 2010 and the second a poll of 49,000 Consumer Reports subscribers in 2009. The magazine reported its results online.
In the doctors’ poll, physicians named these top challenges:
— 76 percent of doctors said when it came to getting better medical care, forming a long-term relationship with a primary care physician would help “very much.”
— 61 percent said being respectful and courteous toward doctors would help “very much,” while 70 percent said respect and appreciation from patients had gotten “a little” or “much” worse since they had started practicing medicine. This was a two-way street, since patients reported the same feelings.
— 42 percent physicians said health plan rules and regulations interfered “a lot” with the care they provided.
Also noted in the poll, 37 percent of physicians thought they were “very” effective when it comes to minimizing pain and discomfort for their patients, though 97 percent thought they were “somewhat” effective. But, 79 percent of patients said their doctor helped to minimize their pain or discomfort, according to the Consumer Reports blog. The gap might be explained by doctors thinking of their overall effectiveness with all of their patients, including those with chronic pain conditions that are difficult to diagnose and treat, and who are as a group less satisfied with their physicians. Read more »
*This blog post was originally published at ACP Internist*
February 8th, 2011 by RyanDuBosar in Better Health Network, Research
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Physicians see nearly one in five patients as “difficult,” report researchers. Not surprisingly, these patients don’t fare as well as others after visiting their doctor.
Researchers took into account both patient and clinician factors associated with being considered “difficult,” as well as assessing the impact on patient health outcomes. They reported results in the Journal of General Internal Medicine.
Researchers assessed 750 adults prior to their visit to a primary care walk-in clinic for symptoms, expectations, and general health; for how they functioned physically, socially and emotionally; and whether they had mental disorders. Immediately after their visit, participants were asked about their satisfaction with the encounter, any unmet expectations, and their levels of trust in their doctor. Two weeks later, researchers checked symptoms again.
Also, clinicians were asked to rate how difficult the encounter was after each visit. Nearly 18 percent were “difficult.” They had more symptoms, worse functional status, used the clinic more frequently and were more likely to have an underlying psychiatric disorder than non-difficult patients. These patients were less satisfied, trusted their physicians less, and had a greater number of unmet expectations. Two weeks later, they were also more likely to experience worsening of their symptoms.
But the label works both ways, as physicians with a more open communication style and those with more experience reported fewer difficult encounters, researchers said.
On a lighter note, TV’s comedy “Seinfeld” dedicated an entire plotline from one of its many episodes to Elaine, her doctor, and the label of being a difficult patient. It’s worth watching here.
*This blog post was originally published at ACP Internist*
February 7th, 2011 by EvanFalchukJD in Opinion, True Stories
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Some people may tell you that healthcare IT will solve many of the quality and cost problems in healthcare. I don’t believe them.
I know a 70-year old man named Carlos (not his real name) who was hospitalized following a bout of hydrocephalus. Hydrocephalus is a build-up of fluid in the skull, which affects the brain. Among other things, people with hydrocephalus can be confused, irritable, and nauseous. Carlos had all of these symptoms.
Carlos’ problem was fixable by inserting a special kind of drain in his head called a “shunt.” This kind of shunt is, essentially, a series of catheters that runs from the brain into the abdomen, and which drain the excess fluid. You can’t see it from the outside, so it’s meant to stay inside of you for a very long time.
For a week after Carlos’ shunt was installed, his symptoms completely disappeared. But they soon started to re-emerge. Worried, his family took him to the hospital. Doctors found that his hydrocephalus was back — the shunt wasn’t draining properly. They admitted him to the hospital, and the next day they put in a new shunt. The surgery went well.
But again, about a day later, he started to have the same kinds of symptoms. The doctors sent him for a CT scan, which showed, to their surprise, no problems with the shunt. Unsure of what to do, they decided to wait and see if the symptoms resolved. It was possible, they thought, that the symptoms were from the quick drainage of fluid through the shunt. Read more »
*This blog post was originally published at See First Blog*
January 26th, 2011 by Elaine Schattner, M.D. in Health Tips, Opinion
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A few years ago I started writing a book on what it was like to be a cancer patient and an oncologist. This morning I came upon this section on second opinions:
Is It OK To Get A Second Opinion?
Definitely. And there’s no need to be secretive about it, or to worry about hurting the doctor’s feelings. Second opinions are routine in fields like oncology, and are often covered by insurance. Be up-front: Any decent oncologist can understand a cancer patient’s need to find a doctor who’s right for them, with whom they’re comfortable making important decisions. And in difficult cases, some specialists appreciate the chance to discuss the situation with another expert. So a second opinion can be beneficial to patients and physicians alike.
When things can get out of hand, though, is when patients start “doctor shopping.” For example, I’ve cared for some patients with leukemia who’ve been to see over 10 oncologists. If you’re acutely sick, this sort of approach to illness can be counterproductive — it can delay needed therapy. From the physician’s perspective, it’s alienating: Who wants to invest her time, intellectual effort, and feelings for a patient who’s unlikely to follow up? Besides, oncology is the sort of field where each consulting doctor may have a distinct opinion. (If you see 10 oncologists, you may get 10 opinions.) Beyond a certain point, it may not help to get more input, but instead will cloud the issue. Read more »
*This blog post was originally published at Medical Lessons*
January 24th, 2011 by Davis Liu, M.D. in Better Health Network, Opinion
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A recent post on the Health Affairs blog proclaimed “The End of Internal Medicine As We Know It.” What the post is really asking about is the future of primary care in the world of healthcare reform and the creation of accountable care organizations (ACOs). While doctors should be naturally concerned about change, I don’t completely agree with this article.
ACOs are organizations that are integrated and accountable for the health and well-being of a patient and also have joint responsibilities on how to thoughtfully use a patient’s or employer’s health insurance premium, something that is sorely lacking in the current health care structure. These were recently created and defined in the healthcare reform bill.
Yet the author seems to suggest that this is a step backwards:
Modern industry abandoned command-and-control style vertical integration decades ago in favor of flatter, more nimble institutions.
Not true. Successful organizations are ones that are tightly integrated, like Apple, FedEx, Wal-Mart, and Disney.
The author talks briefly about how Europe in general does better than the U.S. in terms of outcomes and costs and has a decentralized system. All true. However, contrasting Europe and America isn’t relevant. After all, who isn’t still using the metric system? Therefore solutions found outside the U.S. probably aren’t applicable due to a variety of reasons. Americans like to do things our way.
What I do agree on is that doctors need to be part of the solution and ensure that the disasters of decades ago — like labeling primary care doctors (internists and family physicians) as “gatekeepers” rather than what we really do — never happen. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
