April 10th, 2010 by RamonaBatesMD in Better Health Network, News, Opinion, True Stories
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Physicians aren’t exempt from the struggles with personal health insurance coverage, affordability, denied coverage, etc.
When I finished my medical training and opened my practice 20 years ago, I had to buy individual coverage. All options included a rider that excluded coverage on my uterus and ovaries due to fibroid surgery during my training, so when I had my TAH & BSO a few years later, the entire cost came out of my pocket. Fortunately I knew how to ask for cost reductions, but still.
My husband and I are both small business individuals. I have always carried our health insurance under my name (office). Over the years we have gone to a health savings account with a high deductible to keep the cost reasonable. Fortunately, we have been mostly healthy. Last month we received a letter from Assurant Health. Read more »
*This blog post was originally published at Suture for a Living*
June 30th, 2008 by Dr. Val Jones in Opinion
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As newly minted physicians begin their residency training and clinical care responsibilities on July 1, hospitalized patients might expect a bumpy transition. At least, that’s been the urban legend – “don’t get sick in July!” But is that really true? Are patients at higher risk for medical errors at teaching hospitals in July?
Some say, “no” and some say “yes.” I’m in the “yes” category, and some research suggests that medication error rates do in fact increase in the month of July. In the “no” category we have Jerome Groopman, renowned Harvard physician and author of “How Doctors Think.” He simply says, “Today, most hospitals closely watch over interns.”
This is what I wrote in a previous blog post:
There are many ways that an intern can make mistakes, without ordering a single test or procedure, and under the full scrutiny of red tape regulations and documentation practices.
When an intern fails to recognize a life threatening condition and chooses to do nothing, or to let the patient wait for an extended period of time before alerting his or her team to the issue, serious harm can befall that patient. And that harm is not caused by inexperienced procedural technique, or ordering the wrong medicine – it’s caused by doing nothing. This “doing nothing” is the most insidious of intern errors – and it is not remedied by any form of hospital quality improvement initiatives. It is the risk that a hospital takes by having inexperienced physicians in the position of first responders. Interns gather large amounts of information about patients and then create a summary report for their supervisors. The supervisors (more senior residents) don’t have time to fact check every single case, and must rely on the intern’s priority hierarchy for delivering care.
But many hours pass between the time an intern examines a patient and when a supervising physician checks back in with that patient. And within that period of time, many conditions can deteriorate substantially, resulting in the loss of precious intervention time.
Dr. Groopman describes an experience from his own life in which a surgical intern (in July) correctly diagnosed his son with an intussusception
(twisted bowel) but then incorrectly determined that the baby could wait to go to the O.R. Of course, untreated intussusceptions are nearly always fatal, and each minute that passes without intervention can increase the risk of death.
And so, in my opinion, it is in fact more dangerous to be admitted to a teaching hospital in July, but not necessarily for the reasons that people assume (procedures performed by inexperienced physicians or drug errors – though those mistakes can be made as well). Rather, it is because interns don’t have the clinical experience to know how to prioritize their to-do lists or when to notify a superior about a patient’s health issue. Timing is critically important in quality care delivery – and that variable is not controlled by our current intern oversight system.
Now that I’ve completely terrified you – I will offer you a word of advice: designate a patient advocate for your loved one (or yourself) if you have to be in the hospital as an inpatient (especially in July). If you can, find someone who is knowledgeable about medicine – and who knows how to navigate the hospital system. A nurse, social worker, or physician are great choices. That person will help you ensure that concerns are prioritized appropriately when your intern doesn’t yet fully appreciate the dangers behind certain signs symptoms. If you have no advocate, then befriend staff members who are particularly caring and experienced. Be very nice to them – but don’t be afraid to insist on being examined by the intern’s supervisor if you really are concerned. Unfair as it may seem, sometimes the most vocal patients get the best care.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 30th, 2007 by Dr. Val Jones in Health Policy, Opinion
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Labor Day was founded in the late 1800’s as a way to thank
American workers (as Peter J. McGuire, a cofounder of the American Federation
of Labor put it): “who from rude nature have delved and carved all the grandeur
we behold.” There is some debate
about who originated the concept of the holiday, but one truth remains:
“All other
holidays are in a more or less degree connected with conflicts and battles of
man’s prowess over man, of strife and discord for greed and power, of glories
achieved by one nation over another. Labor Day…is devoted to no man, living
or dead, to no sect, race, or nation… It
constitutes a yearly national tribute to the contributions workers have made to
the strength, prosperity, and well-being of our country.”
Resident physicians are on my mind with Labor Day
approaching. I know that they are toiling away in hospitals across the nation,
and many of them do not get to take Labor Day off for vacation. Physicians work for 3-7 years after
graduating from medical school, and are paid (on average) about the equivalent
of a home health aide or a medical secretary but work about twice the hours
during residency. In fact, if you calculate
out the salary by the hours they work, resident physicians are paid about $9
-$10/hour which is roughly $1.50 more than minimum wage.
Not surprisingly, resident physicians have joined unions to
lobby for more reasonable wages and caps on the number of hours they must work
per week. The national cap is now at 80
hours per week – about 20 hours more than a truck driver is allowed to work
(for “safety reasons”). Research from Harvard
suggests that errors made by overworked residents increase by 700% when they
have worked more than 24 hours in a row.
Residents from the University of New Mexico, for example, received wages in the lowest 1% for resident physicians in their region, and
were denied a salary increase until they recently joined forces with CIR (the Committee of Interns and Residents) to
negotiate more reasonable salaries and working conditions. The New
Mexico contract adds one more CIR chapter to the more
than 70 hospitals — each with multiple residency programs — that are part of
CIR.
Founded in 1957 to improve patient care and resident working
conditions, CIR has remained true to those two goals throughout the decades. In
1975, CIR won an end to every other night on-call in New
York City, and created the first-ever Patient Care Fund in Los Angeles, where
residents could purchase equipment or create innovative programs to help
patients. Campaigns to prevent needle stick accidents by moving to safer needles,
or needle-less equipment, have also improved working conditions for residents.
CIR has been on the forefront of safe and humane work hours
for residents, helping to win the 80 hour regulations in New York State
in 1989, which became the foundation for the 2003 national guidelines. But
evidence shows that this is still too many hours, and so the advocacy around
hours continues unabated.
So please have safe travels on your Labor Day weekend – we
wouldn’t want you to wind up at a hospital where the residents work more than
24 hours in a row for ~$9/hour. Resident
physicians are one group of laborers who don’t have much to celebrate yet this
Labor Day. But with CIR’s help, next
year might be a little brighter.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 14th, 2007 by Dr. Val Jones in News
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A recent analysis (via KevinMD) of average IQs of individuals in certain professions revealed that doctors have a mean IQ of almost 10 points higher than lawyers. Go ahead and snicker, docs – we may be smarter, but are we more successful?
Social and economic success does not have a 1:1 correlation with IQ. The study authors list several other determinants of success:
Ambition, perseverance, responsibility, personal attractiveness, physical or artistic skills, access to social support and to favorable social and economic networks and resources.
So basically, you can be quite a dim wit – but with perseverance, artistic skills and personal attractiveness, the world is your oyster. Or better yet, you can have no redeeming qualities whatsoever, but be born into a favorable social and economic network and do just fine.
However, in medicine you’re not really going to get by on charm alone. The grueling nature of the educational process (and the vast amount of information that one must master) requires substantial cognitive reserves. So I’m not surprised that doctors do well on IQ tests. However, the sign of a great doctor is not his/her IQ, but a complex interplay of character, compassion, and emotional intelligence. That being said – if I’m wheeled into an ER after being run over by a truck, I’d be pretty glad to know that the man or woman taking care of me is smart. And you can be pretty sure that he/she will be.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 14th, 2007 by Dr. Val Jones in True Stories
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This story is from my intern year diary. It’s a quick snapshot of a patient who had overdosed on heroine, coded, and was resuscitated. I think about him sometimes… especially when I read about the rampant drug abuse problem in the US.
—————
I poked my head into the 4-bed communal room on the sixth
floor. The nurse had called to say that
one of the patients was agitated and required restraints. I was asked to assess the situation.
It was immediately clear to me which of the four patients required
my attention. In the far, right corner
was a pale young man, stark naked and thrashing about in his bed. He was babbling something about Ireland and how
he needed to get home. I had gathered
from a quick review of his chart that he had overdosed on heroine, was
resuscitated after coding in the E.R. and transferred to the floor for
observation as he detoxed from the overdose.
I approached the flailing body tentatively. “Hello.
I’m Dr. Jones. You appear to
be quite distressed. What seems to be
the matter?” I said as I pulled a sheet up from the bottom of his bed and
placed it over his genitals.
The young man, barely in his twenties, lay very still as I
spoke to him. He stared at my face with
bulging eyes, speechless for a full 10 seconds.
“Are you alright?” I asked.
“Where am I?” asked the man in a quiet voice.
“Where do you think you are?” I asked, using the opportunity
to assess his mental status.
“I’m somewhere in Ireland,” he said, head turned
towards the window with a view of the Chrysler building.
Seeing that his reasoning was not intact, I replied kindly,
“Well, actually you’re in a hospital in New
York City. You
took an overdose of heroine and your heart stopped…”
“Wow, that sucks,” said the man, sincerely surprised by the
news.
“We were able to resuscitate you in the emergency room,” I
added.
“Cool,” he said, as if the event had transpired in another
person’s life.
“So right now you still have a lot of drugs in your system
which is why you feel confused,” I said, “I think it will take several days
until you return to your normal state of health.”
“Sounds good,” nodded the man.
“Do you know where you are right now?” I asked, suspecting
that his short-term memory had been completely lost.
“I’m in Amsterdam,”
he said, undisturbed by his delirium.
I sighed as I realized that nothing I said to him would
register for longer than a second or two.
“Such a young person, what a waste,” I thought.
The man started to thrash about in his bed again.
“What are you doing?” I asked.
“The back stroke,” he said, surprised that I didn’t know.
I glanced at the man in the bed nearby. He was watching our interaction with some
amusement. He had been reading the New
York Times with a book light. He was a
private patient on a heparin drip for a deep venous thrombosis behind his right
knee. I nodded at him and shook my
head.
Weeks later I heard that the young man’s thoughts were no clearer than they were that night, and that he was transferred to a nursing home for long term care. The brain damage that he suffered from his drug use (and lack of oxygen during his cardiac arrest) had caused permanent, irreparable damage. Another tragic victim of a brain on drugs.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
