Check this out. What you will see is an interesting potential juxtaposition to the physician that we talked about yesterday. Remember? Dr. MacKenna was an “Integrative Psychiatrist” who incorporates tai chi, nutrition, sleep management, and other lifestyle factors into her approach to helping her patients optimize their level of mental health.
Today we see Dr. Tammie Chang, of all things a pediatric hematologist-oncologist, whose coaching practice focuses on helping female physicians develop “boundaries” in their practices, and in their lives, which can then serve as foundations for “loving their lives as female doctors.”
Bottom Line. Like I said in my last post, there are a lot of different spins that can be put on the development of coaching practices by physicians and for physicians. Which are long-term winners? Which are instant losers? What is the best way to market these services?
Check this out. We have done versions of this riff before. Doctors complaining that while NPs and PAs are exhorted to practice at the “top of their licenses,” MDs are increasingly relegated to grunt work. But this time around, the complainant is an anesthesiologist, who wonders why in Europe, anesthesiologists always have an assistant in the OR, while in the US it’s a solo act.
SO. Here’s the part that confuses me about this. Unless I am missing a point, the establishment of the role of the certified registered nurse anesthetist (CRNA), with multiples thereof working under the supervision of an anesthesiologist, is one of the best examples of the leveraging of physician time with which I am familiar. Check in at our local surgi-center for a procedure, and you get a quick interview with the MD. Into the OR you go, and the CRNA is the one who is hitting you with propofol. Makes sense. Well leveraged.
Bottom Line. In years to come, it will be fascinating to continue to watch the shifting of roles amongst physicians and other medical professionals. Hopefully, the focus will remain on efficiency and safety of patient care, and politics will be left by the wayside!
Check this out. What you will see is an important reminder of an obvious fact. Here, our friend The Country Doctor explains that it is not hard work, but inappropriate work, that causes physicians to burnout. Why, he asks, are all the non-physician players in healthcare encouraged to work “at the top of their licenses,” while doctors are left to do the grunt work at the bottom of theirs?
Bottom Line. As the doctor reasonably summarizes, “I find the priorities of modern primary care bewildering.” Thinking back to my Ph.D. program in Industrial Psychology, I am very prone to agree with him. If an “efficiency expert” were called in to look at primary care in the US in 2021, what would his reaction be? Dismay?
Here’s a better question. Why hasn’t an efficiency expert been called in???
As you will see in these survey results from FirstWord, that is the desired scenario for about half of the 100 doctors they polled. Throughout the six months of reporting on the results of my On Doctors’ MindsSM conversations, that about lines up with what I have been finding. As we predicted back in November of 2020, many doctors are looking forward hopefully for a return of the “old normal.” BUT. About half of all physicians we have talked to, and especially many specialists, have learned over the course of the pandemic to “do without” PSRs, readily getting the answers and information they need in their practices from other sources.
While you are looking at these results, check out the data concerning virtual details. Here, 57% of doctors reported that they find them to be equally or more “effective” than personal PSR visits. BUT. In my conversations with physicians, the majority of doctors are avoiding these virtual visits like the plague (Sorry!) due to difficulties in scheduling and the extra time required. Translated, perhaps the virtual details that are happening are “effective,” but most of my discussants, and I believe most physicians more generally, are not letting them happen.
Bottom Line. Throughout our study of the effects of the pandemic on office-based physicians, we have been telling our pharmaceutical clients that they had best be prepared to increase their physician micromarketing sophistication as the pandemic winds down. Doctors are differing widely in their preferred mode of communicating with pharmaceutical companies. One size definitely doesn’t fit all here, and we need to be ready to respond to these differing physician preferences.
Just because an HCP is able to avoid getting infected by one of the COVID patients she is treating doesn’t mean she is out of danger. Nope. She can still get sued!!!
Check this out. What you will see is a list of Federal “Good Samaritan” laws that are already in place, including one specifically signed by President Trump in March to limit HCP liability during the pandemic. You will also see a report that the nation’s 50 Governors are being “urged” to back legislation that will shield HCP’s from litigation.
BUT. What seems to be a plethora of laws sue-proofing HCP’s is actually the reverse. The number of different laws that have already been penned, and those yet to come, virtually guarantees that physicians will be sued by plaintiff’s attorneys having a “field day” in the pandemic’s aftermath.
Bottom Line. This is really going to get stupid. As president of my community’s homeowners association, I just received notification that it is likely that our HOA’s insurance policy will NOT cover our defense or any awards if we get sued because someone claims he got COVID from our community swimming pool. A SWIMMING POOL! The CDC has declared that chlorinated water is, as one might guess, an extremely unlikely place for the bug to hang out. And how anyone could prove that he got COVID from our pool remains a quandary for our Board. BUT. In a world where plaintiff’s attorneys can get big bucks from settling a case without ever seeing the inside of a courtroom, all things are possible.
SO. Pity the HCP’s involved in this mess for yet another reason. The knock on their door might well come from a “nice” guy in a suit bearing a subpoena.
Yesterday, we discussed the fact that one of the states a hospitalist reported going through as he deals with treating COVID patients is “transformation.” Over the course of the last two months, he has come to understand that the “scrubs” have let the “suits” take over and ruin medicine. He is now vowing to stand up and be counted in the fight for good healthcare and for better physician quality of life.
Here’s another one. A self-proclaimed one minute read that implores doctors to “wake up” and start living the lives that they want to be living, rather than continue to be abused into living someone else’s.
Bottom Line. “Wake up.” I am betting that as we come out of the pandemic, you are going to hear expressions of that theme a lot. Doctors and Nurses have doubtless been jerked around enough, with 15 hour shifts, lack of PPE, etc., that they are indeed likely to want to seek out a better lot in life. AND. Being used as political footballs and being yelled at by gun toting demonstrators demanding to be “liberated” so that they can crowd the ICU’s will likely fan the flame.
There’s only one question. Will medical professionals be able to get organized enough to get changes made? Banding together has never been their strong suit, which is how they find themselves in their current situation.
Check this out. What you will see is a hospitalist talking about the FACTS (Fearful, Angry, Courageous, Transformed, Stressed) that are the states that he experiences in response to the now frequently heard question, “How are you holding up?”
Since the other four states largely speak for themselves, I’d like to focus on his discussion of “Transformation.” Importantly, this blogging physician concurs with the graffiti on the left side of the pictured hospital door that “Storms don’t last forever.” BUT. What you see here is the protestation by this blogging physician that the impacts of this storm WILL last forever. Why? Because he has realized as the result of his pandemic experience that healthcare in America is badly broken and that he has been just doing his “job” and doing nothing to help to fix the system. In this piece, he has vowed to maintain a different stance in the future. He believes that he has been transformed by the COVID experience and is looking to transform healthcare as a result.
Bottom Line. In recent weeks, I’ve talked to several other physicians who are feeling the same way. They are NOT ready, willing or even able to go back to “business as usual” when the pandemic dies down. How many physicians feel this way? How many will act on this feeling?
Check this out. What you will see is a spin on the COVID-19 virus I hadn’t considered, but should have. Here you will see a retired nurse express her opinion that healthcare workers have a real ethical dilemma as to whether or not they should be treating COVID patients in the absence of appropriate protective equipment. What if they get infected themselves? What if they spread the virus to other patients?
Bottom Line. I never thought about healthcare workers having a choice, let alone a dilemma, about whether they should be going to work under these circumstances. This nurse says that if she were still working, she would be staying home.
Between practitioners getting sick and those choosing to stay home(?), this could get very dicey!
Check this out. What you will see is pretty much what you would expect during the Covid-19 pandemic. Dr. Hartsock, the physician pictured above, is a Hospitalist. And she is scared to go to the hospital every day. Scared for herself and scared for other healthcare workers. Scared because 10% of the infected patients in Italy, a country which we seem to be mimicking, are healthcare workers. AND. Scared because, for some reason, when people on the frontlines of fighting this pandemic get the COVID-19 virus, they get it BAD! And yes she is asking for donations of PPE (Remember when we didn’t know what that acronym stood for?). Like I said, pretty much what you would expect a physician in this position in March 2020 to be saying.
So why do I refer you to this post if its content is so predictable? Answer? Because it got me to thinking. You see, I have a “stock speech” about physician mental health that I have given several times at conferences, as a Webinar, etc. In it, I cover physician suicide, depression and burnout. Such manifestations of physician mental health issues are of great concern due their frequency and impact on the practitioner AND on patient care.
SO. Against this backdrop, I am pondering the longer-term impact of the COVID-19 pandemic and the practitioner fear it is understandably causing. Will rates of physician suicide, depression and burnout increase significantly? I am thinking PTSD here.
And will rates of “compassion fatigue” increase among the nurses who are working amazingly long hours, afraid of getting sick themselves and having to hold dying patients’ hands since no visitors are permitted? Again, I would think, a resounding yes.
Bottom Line. My prediction? Those of us who deal with health care providers, as professionals and as patients, are going to be dealing with the psychological sequalae of COVID-19 long after the virus itself has been beaten into submission!
Check this out. What you will see is a report that Vermont is joining a cadre of other states, and many foreign countries, in moving toward the recognition of “Dental Therapists” as hamburger helper for dentists. Translated, we will increasingly see these Therapists performing tasks that have taken up a lot of Dentists’ days.
That’s sort of not very important. What is important is that we have now come to recognize the litany of standard issues that arise when PA’s, NP’s and other care extenders seek to occupy territory previously only occupied by “doctors.”
Like. Pushback from the appropriate professional societies.
Like. Debate as to whether they can operate in solo practice or need “supervision” and, if the latter, what kind of supervision?
Like. What kinds of procedures are they allowed to perform?
Like. What good does it do to argue that they are going to be working in “underserved” areas when any law providing them with licensure lets them work anywhere they damned well please?
Bottom Line. And so it goes. The big question here is really the extent to which, a few decades from now, the majority of “healthcare” will be provided by care extenders? Obviously, for those of us in the healthcare marketing vertical, the answer to this question matters a lot. Restated, the question sounds a lot like “Who will our customers be in the future?”