Category: Healthcare Management

“Secret Shoppers” In Medicine

Don’t spend a lot of time on this URL. The above title pretty much gives you the message of what I would like you to think about today. Did you know that there are faux patients? People who are perfectly well sent into hospitals to check on the quality of care being delivered by the staff?

I always thought secret shoppers just went from one supermarket to the next, checking on the price of a can of corn.  But having one lying in a hospital bed watching whether or not a nurse washes her hands frankly never occurred to me.  

Okay. You should actually go ahead and spend a few minutes at that URL. You will find that there are agencies like Etch Strategies, that hire trained sociologists to be these secret shoppers and then to craft the story of what is going on at the institution to report out to its senior management. 

Bottom Line. Here it comes again. Wait for it. This is where I generally say “I am of two minds” on this one. And I am saying that again.  

While on the one hand it sounds like these secret shoppers are performing a very important role in safeguarding patient safety, I must admit that if I were an HCP being “spied on,” I would be more than a little miffed.

Interesting trade off!

Diagnosis By Social Media

Check this out. If memory serves me, we have seen a version of this before. I even blogged about it. Last time, it was an on-line place to share your symptoms. Symptoms that no clinician had been able to diagnose. Maybe, just maybe, somebody out there in digital land has had the same symptoms, had actually gotten a diagnosis and could help you toward a cure.

This time there is a TV show that provides the opportunity for symptom sharing and diagnostic contributions. Netflix. Is the opportunity to watch patients suffering from graphic maladies the next reality TV? Have we run out of towns to focus on for “Real Wives Of….?”

Bottom Line. The interesting thing to me here is that there is a real M.D. involved. She seems bright, earnest and convinced that this kind of out of the box, “out of the hospital,” approach can yield beneficial results. Maybe. Out the other end of this, I would like to see the results. How many patients were actually helped by this approach? Absent such evaluation, I am afraid we are just dealing with prurient interest. The opportunity to watch sad cases and tell ourselves how lucky we are that we are not them.

Legitimate medical Hail Mary pass or just more reality TV? We’ll see!

The Folly of Self-Referral

Check this out. What you will see is an interesting little riff by The Country Doctor on the topic of self-referral. In it, he points out that many people, including yours truly, tend to favor a system that allows patients to make their own appointments with specialists without going through a primary care physician for a referral. My penchant for avoiding being “gate kept” has always been a major reason why I avoid anything that looks like an HMO like the plague. BUT. He goes on to make a reasonable point, questioning whether patients have the ability to figure out which specialty they should be consulting, let alone which subspecialist might be best for a particular problem. Where do you go for chronic pain in the stomach? Surgeon? Gastroenterologist? Psychiatrist?

I think he has a point. While still not being too keen on the idea of having to be clutching a referral slip when I enter a specialist’s office, I greatly value the ability of my concierge Internist to direct me to the right place. She not only sorts out for my wife and I the appropriate specialty to consult, but also which specific doctor in that specialty would be best suited for our presenting medical issue. Example. Our physician diagnosed my wife several years ago as having thyroid cancer. Living on Hilton Head Island, SC, with a “medical community” ranging from our little island to Savannah to the South and Charleston to the North (including Medical University of South Carolina, with its thousands of doctors), who should she go see? Based on her experience and expertise, our doctor sent us to Dr. Denise Caneiro-Pla at MUSC. She just happens to be flat out the best Endocrine Surgeon (I never even knew there was such a thing!) south of the Mason-Dixon Line. Probably in the U.S. The outcome? Excellent medical care and a cure, thanks to Denise.

Bottom Line. I think that this issue needs some reconsideration and repositioning. While I still object to being subjected to patent cost saving moves by HMO’s requiring of a referral for a specialty consultation, especially for “out of network” care, I have very much come to value my Internist’s guidance on the matter. It would indeed be “folly” for me to sidestep this expertise.

A Little Hypocrisy???

Check this out. What you will find is an article informing us that Rite Aid is upping the age requirement to purchase tobacco products to 21.  Walgreens “coincidentally” did the same thing on the same day.  

So where is the hypocrisy here? A couple of places. First, this move seems to suggest that it is safe and okay for people 21 and older to buy cigarettes. How can an organization that is increasingly trying to become a bigger player in “health care” offer up carcinogens for sale? Conversely, to their credit, CVS phased out tobacco products in 2014!!!

To sweeten the dose of hypocrisy, Rite Aid claims that it is doing everything it can to reduce the risk of smoking. Things like placing tobacco products in less conspicuous places in their stores, training pharmacists to counsel patients on smoking cessation, etc. Aw, c’mon!!!

Bottom Line. Let’s not kid ourselves. Or allow ourselves to be kidded. For chains like Rite Aid and Walgreens, tobacco is big business. But inquiring minds want to know. Should important links in the health care chain be selling products known to produce deleterious effects on their customers’ health?

Res ipsa loquitur!

The Importance Of Removing Sutures

Here is a fascinating little article. Commentary from one surgeon as to why it is so important for the doctor who placed the sutures to be the one to remove them. Why? Two main reasons. First, it permits the physician to learn the cosmetic results of his work. AND, it allows patients to seek additional information that they may have missed in the fracas of the postoperative setting, or to pose questions that have occurred to them about the healing process.

Why do I find this article so interesting? Two reasons. First, there is a general trend among surgeons in many specialties to have suture removal done by a Nurse or Physician Assistant. While increasing the efficiency of the use of the physician’s time, this trend eliminates the important feedback and communications experiences described above.   

The second is based on a recent personal experience. TMI, but during a routine body scan by my Dermatologist in December, Dr. Hall expertly detected a sneaky little growth under my left sideburn. A biopsy revealed that it was melanoma. Off I went to have that puppy removed by Dr. Joel Cook, the leading Mohs surgeon in South Carolina. As expected, Dr. Cook did a marvelous job during my day-long visit to his beautiful clinic. As he closed the wound, Dr. Cook told me to go home to Hilton Head Island and have Dr. Hall remove the sutures in a week. Part of me was relieved that I would not need to make the four hour round trip back to Charleston to have Joel remove the sutures. BUT.  Part of me wanted to have Dr. Cook take another look at his handy work, and to have the opportunity to ask him about the healing process.  

Imagine my surprise when I went back to Dr. Hall’s office as instructed, and in walked one of her associates, a woman I had never met, to remove the sutures. I had no idea what her credentials were to do suture removal, but she did a fine job. BUT. Dr. Cook didn’t get to see how his handiwork turned out, and I certainly had no opportunity to ask questions or get advice about after care.

Bottom Line. Why do I think any of this is important? Simple. As the practice of medicine becomes increasingly fragmented in the name of efficiency, physician and patient alike wind up being denied the ability to “close the loop.”  

I think that is a shame!!!

What Family Practice Should Look Like

Check this out. Usually when I do a riff on Pamela Wible, M.D., it focuses on her work in understanding and preventing physician burnout and suicide. This article is the flip side of Pamela. The side that, following her own near suicide, focused on developing an ideal family practice setting. Based on ideas contributed by her patients. No outside funding was necessary. $280 per month rent, $1,200 per year malpractice insurance and NO staff! Read the description of the practice carefully. Picture, with me, the smile on Dr. Wible’s face as she bicycles to and from the office. She works part time, but on a schedule that doesn’t require patients to miss work.

Bottom Line. Yup, the see-a-patient-every-ten-minutes model of Family Practice almost killed this caring doc. What you are looking at here is the “after” picture. After she decided to take control of her practice. And her life.

Heart-warming stuff! Can other physicians be helped to see the light? Dr. Wible is trying to help them do just that, by providing a template for creating a practice like hers.  

Should we help her to help?

When Is A Surgeon Too Old To Operate???

The FAA requires that airline pilots retire at age 65. Should there be a similar rule for surgeons?  Check this out. What you will learn is that there is no simple answer to this question.  

Data on the topic are equivocal. Some studies show better outcomes for patients operated on by older surgeons, some show worse.  

What do we know? We know that cognition and other abilities decrease with age, but that variability on these dimensions actually increaseswith age. Thus, some older (?) doctors are still good to operate, others not so much.  

We know that performing some simple procedures might be fine for older surgeons, while longer/more complex surgeries might tax their stamina to a breaking point.

We know that some hospitals are setting up special programs to evaluate the competency of older surgeons. And that such programs are being met with significant resistance on the part of, you guessed it, older surgeons!

Bottom Line. SO. This NYT article clearly indicates that the answer to the question of when a surgeon is too old to operate is complicated and multifactorial. My hope and bet is that the surgeon himself is the best judge of his own ability, and that no doctor is going to knowingly put a scalpel to a case that he believes is beyond that ability.  

AND. My fear is that, like in so many areas in medicine in 2019, well- intentioned concern about older physicians will cause some august body to establish testing requirementsfor older surgeons that might not have appropriate levels of validity.  

I sincerely hope not!

Imagine…

 

Check this out. What you will find is the story of a physician mother who temporarily loses her young son in a busy department store. The story of her panic. The story of her confusion. The story of the relief that she felt a few minutes later when her husband successfully retrieved the boy. Why, you might well be wondering at this point, did Vanderveer send me into this sea of household appliances to join the boy and his parents?  

Three reasons. First, the blogger had a great insight that I think is very worth sharing. The notion that a little real-life experience like this can help one to imagine the angst that migrant parents feel when their children are snatched away at the U.S. border and spirited off to God knows where. And, to imagine the panic that overtakes those children as they are trundled off to God knows where and for nobody knows how long. The point? If you are having a hard time getting in touch with something someone is going through that seems abstract, just stop for a moment and imagine how even a miniature version of such an experience might make you feel. A valuable learning moment.    

Second, the blogger points out that by definition, physicians are responsible for caring for everyone. All lives matter. Equally. But Atul Gawande, noted surgeon and healthcare researcher, points out that as a society, we are increasingly engaged in separating out “us” versus “them.” Separating lives that matter from those that don’t. Like is happening at the border. His observation that this is a slippery slope that doesn’t bode well for healthcare, or for society at large, is sage.

And last but not least, the blogger ponders in another, related post how the impact of this childhood trauma will affect the children involved. What kind of view will they have of society when they grow up? And what might they do as a result?

Bottom Line. A lot of worthwhile pondering can come out of a physician mother’s momentary loss of contact with her son. Maybe it is time we all approached even life’s seemingly minor experiences with some more deep dives into thought!

The Changing Role Of The Pharmacist

The physician pictured above, Dr. Vamsi Arbindi, blogs under the title “The Medical Intellectual.” Laying claim to that territory is one thing, defending it is another. But in this post, I think he does a very good job of doing just that.

Check it out. What you will see is a clear and lucid report of how the role, and the training, of pharmacists has changed in recent years. Example. Formerly a five-year bachelor’s program, pharmacy is now a graduate degree. I didn’t know that!

Pharmacists are now giving the vaccines that physicians used to administer, are licensed to prescribe various medications in some states, are looking to be able to bill independently as “providers,” and are making other moves that have them, like PA’s and NP’s, nibbling away at the role of the physician. 

BUT. Vamsi goes on to make a really good point. Unlike other health care professionals, pharmacists are often employed by corporations that have policies that substantially impact a group that has neither the professional culture nor the legal protection in place to push back.  

So, what does all of this mean in the real world? It means that if the “corporation” has a program in place to clean up its act pertaining to opioid abuse, it can tell pharmacists to “deny” prescriptions that they consider to be suspect. Etc.  

Bottom Line. And what does this mean for those of us in the healthcare marketing vertical? Simple. It means that both as professionals and as patients, we need to keep an eye on the changing roles of the pharmacist and the impact of pharmacy corporations on these changes.  

AND. Maybe even reach out to help to make sure that these changes are in everyone’s best interest!

Insurance Companies That Can Kill

Check this out. What you will see is the story of a lawsuit against AETNA for denying coverage for a potentially lifesaving therapy for the woman pictured above. The outcomes? She died. AND. The insurance company was ordered to pay her family $25 Million.

We have talked many times before about the deleterious impact that insurance company “prior-auths,” denials, and other interventions can have on patients’ health. But here we get some new insight. Like the medical directors admission that they had spent more time preparing for the litigation than they had making the denial decision.  

Bottom Line. Read the story yourself. I am guessing that you will get as angry as I did! But think about the context in which this story is written. And answer the question in the headline. Will the “mega-merger” of AETNA and CVS make this kind of travesty even more likely?

My guess? Yup!