Check this out. What you will see is a complicated interplay of public perceptions of physicians and the doctors’ own self perceptions. Said what?
Here’s the deal. Prior to the pandemic, Americans were increasingly likely to trust medical advice found on Google and in the social media, and decreasingly likely to trust physicians. Scroll forward. COVID has brought a return of the perception that “the Doctor knows best.” Only problem is, now that they have been placed back on their pedestals, doctors are more than well aware of their limitations in preventing mortality and morbidity caused by the coronavirus. AND. They still have to deal with the administrative claptrap that was burning them out prior to the pandemic. AND. They are wrestling with new factors like telemedicine which were thrust upon them by the pandemic.
Bottom Line. It’s not an easy time to be a physician. Was it ever?
Who would have thunk it??? Check this out. What you will see is a family physician who has made a business out of helping physicians free themselves up from the heartbreak of charting “backlog.” Doctor after doctor with whom I have spoken, especially in recent years, has reported having problems in this area. One physician comes to mind who had been up at 4:30 AM the Friday of our conversation, busily pounding away at patient charting. He reported that he would be similarly occupied that night, and well into Saturday morning.
Bottom Line. The major point of this “Charting Coach” is that backlogs are better avoided than dealt with ex post facto. For example, charting after each patient visit is much more efficient, and more psychologically healthy, than doing all of the charts at the end of the clinical day.
Words to live by in our own careers! “I can always do it later” is typically not a good thing to be saying to yourself!!!
Check this out. What you will see is a fascinating little piece by our old friend “The Country Doctor,” pictured here. In it, he explains the three functions that a PCP serves. Sick Care, Chronic Disease Management and Disease Prevention and Screening are all inherently parts of being a Family Physician.” Goes without saying. BUT. The real point of this piece is that the emphasis that is placed on each of these areas of practice requires some careful thought and is really situation specific.
For example. “Sick Care” is what immediately comes to mind when most people think about primary care. The rapid proliferation of Doc-In-A-Box facilities and telemedicine, both of which are focused on immediate care for the sick, are supportive of this perception. Sick Care is sort of all they do.
On the other hand, at Hilton Head Island’s Volunteers In Medicine, where I am proud to be on the Board of Directors, we emphasize the other two functions. Given that the majority of our 10,000 patients are underserved minorities, we feel that we can do the most good by helping them to manage conditions like hypertension and diabetes, and by making sure that they get screening procedures like mammography done according to guidelines. Sure, we treat the sniffles too, but that is a secondary function.
In most private Primary Care practices, as the good doctor points out, there is a real issue of the availability of time to perform all of these functions, so prioritization becomes extremely important. For example, Disease Prevention, if left to its own devices, can be very time consuming. Because of its “routine” nature, this post suggests that an MD degree is not required to perform this function. Support personnel and media like emails and letters can meet this need very adequately.
Bottom Line. SO. Again, the optimal emphasis of primary care really comes down to “setting.” As usual, reading Dr. Duvefelt’s piece got me to thinking. What is the primary value of being a member of a “concierge” practice, such as the one of which I am fortunate to be a member? Is it more the ability to get a same day appointment if you are sick, or to have a doctor with time available to service you in all of these three areas? I am thinking the latter.
The title of this post is correct. We should in no way confuse the three functions of primary care. Rather, we should consider each of them and decide, for a particular practice setting, which should be emphasized.
In our previous post, we talked about the importance of eliminating “implicit bias” in healthcare through more culturally sensitive training for healthcare practitioners. Today’s post is just a quick addition to the thought. Check this out. A simple idea here. That is, in eliminating implicit bias, based on race, sex, etc., it is essential to have in place role models that are diverse. When we say the word “Doctor,” we want the listener to be as likely to picture a person of color or a woman as they are to flash on a nice, white “Marcus Welby, MD.”
Bottom Line. As was noted in the previous post, there is still a paucity of racial minorities in the physician ranks. Therefore, is essential to get these practitioners out and visible to the community, as role models, as an important part of our efforts to eliminate implicit bias.
Check this out. What you will see is a really important piece on implicit racial bias within healthcare. Why did I underline “within” twice? Simple. Because it is the most important point made here. That is, while it is generally assumed that any racial biases shown in healthcare are the results of general biases coming from society at large, it turns out that the medical community has its own, special, forms of disparity. They are found in the lack of persons of color in the healthcare media, the extremely small representation of minorities in academic medicine, and so forth. In fact, the point is made that disparities in healthcare delivery actually spill over, making racial inequality there even worse.
Set forth here are practical steps that can be taken to correct this egregious situation. Steps like having broad based “bias training” for healthcare students. Having translators and translations readily available. And appointing a “chief equity officer” to pull this initiative all together within an institution.
Bottom Line. A few days ago, I wrote about the excellent program being mounted by Johnson and Johnson, i.e., their $100 Million, 5-year commitment to “Race to Health Equity.” Today’s piece puts a new spin on this mission. It’s not just about getting more healthcare to the disadvantaged. It’s also about making sure that the practitioners are not dispensing bias with their medicines.
Check this out. Download these survey results from Skipta and think about them. Huge survey sample here, with important results available for free. Why wouldn’t you give this a spin?
What you will see are important findings. Very interesting when I compare them with the results of the 10 personal conversations I am having with physicians each month in my On Doctors’ MindsSM project. (NOTE: I am doing this project pro bono. No charge to clients. Want a copy of the monthly findings, including curated video tapes of my conversations with the doctors? Send “I want in” to firstname.lastname@example.org. She will sign you up).
The biggest deal that Skipta sees HCP’s focusing on in wrestling with the future is adapting to the “new normal.” Responding to the changes which the pandemic keeps throwing at them. Yup. In my conversations with doctors every month, I am hearing them talk about the “dynamic” situation. Changes coming at them fast and furious, and in fundamental areas that they never thought would change. Who would think that patient visits would just suddenly disappear in March and April of 2020? Or just as quickly return in early Summer?
And relatedly, finances. Skipta found that to be a hot topic. I am finding the same thing. Practices applying for PPP, furloughing staff, taking 15% cuts in annual revenue, learning to operate with leaner staff and finding it to be very doable and therefore permanent. Again, who would have thought that the finances of medical practice would fundamentally change overnight?
The third big area that Skipta and I have both found to be important as doctors look to the future is patient “engagement.” How to keep patients tapped into the diagnostic and treatment processes when you are interacting with them on Zoom. I talked to two Rheumatologists on Friday that reported exactly the same thing. A lot of the substance of their specialty hinges (Sorry, pun intended) on being able to lay hands on a patient’s joints. No can do on Zoom. Patients also report that they are missing the social aspect of going to the doctor when they are relegated to Telemedicine.
Bottom Line. Use huge surveys or informal conversations as your basis for predicting the future, and you will find the same thing. HCP’s underlying values remain the same, but lots of logistics are changing to constitute the new normal.
The safest way to predict the future? Survey research to learn the numbers and in-depth conversations to learn the backstory.
Check this out. What you will see is medical politicking at its worst. A surgeon bizarrely charged with collecting cash from a patient at the point of care rather than going through normal billing procedures. Based on this infraction, the doctor’s reappointment to his institution’s faculty was placed in jeopardy. Not liking the handwriting he was seeing on the wall, he hired Barney Cohen, Healthcare Attorney. Long story short, Barney was able to get the matter dismissed. Turns out that the hospital had no policy against doctors collecting cash. AND. The fact that one of the physicians sitting on the board that was reviewing the matter was his “competitor” was seen as hopelessly tainting the process.
Bottom Line. So, what is the point here? Easy one! We need to disabuse ourselves of the notion that “medical malpractice” is the only cause of physician legal woes. Hospital politics can be just as onerous!
Check this out. What you will see is the “startling announcement” that physician sleep deprivation significantly increases the risk of serious medical errors. Equally neck snapping is the report that sleep deprivation, and resulting errors, are higher for those physicians in training than they are for those doctors already in practice. The article concludes by suggesting that someone should tell those responsible for medical training about this, so that they can make appropriate scheduling adjustments.
Bottom Line. Am I nuts, or have we all known about “overworked Residents” for decades???
The combination of newbie status and sleep deprivation has always struck me as a bizarre and potentially lethal admixture. Yet, the “right of passage” of ridiculously long work weeks remains a key element in the physician training process.
Check this out. What you will see is a story outlining a new campaign, being mounted by Pfizer and BMS, aimed at getting patients experiencing symptoms that might be AFib, DVT or PE to go their doctors. NOW! Both companies are painfully aware of the data showing that patients are staying away from their physicians in droves as a result of the pandemic. They are also painfully aware that this absenting is causing them big bucks. So, they are sending patients to this URL to get them motivated to show up at their practitioners’ offices.
Bottom Line. Read the story. Check out the URL. As always, I’m thinking a couple of things. First, I’m thinking that the two companies are pursuing a worthy goal. There is little doubt that patients are dying because of pandemic-based avoidance of physicians’ offices.
But second, I am scratching my head pondering:
1. How likely patients are to ever get to this URL, and
2. How likely its content is going to be to motivate them to make an appointment with their doctors?
I’m unfortunately going with “not very” as my answer to both of these questions. Which leaves me to ponder. How can this worthy goal be better accomplished?
Check this out. What you will see is a brief but important report on a residency program designed to train dentists to intervene in a limited array of primary care medical issues. Why not? As they give dental exams to patients, issues like oral cancer, eating disorders, substance and child abuse, etc. can be readily detected IF the practitioners are trained in what to look for and what questions to ask the patient.
Bottom Line. It will be interesting to see the extent to which dentists opt to enroll in an “oral physician” residency program. Given the way insurance billing works, this is not a great way for dentists to learn to make extra money. BUT. What a great way to learn to more holistically serve the patient, especially the underserved patient who is lucky to get to see one practitioner, any practitioner, during the course of a year.
For example, at the Hilton Head Island Volunteers in Medicine Clinic, where I serve on the Board of Directors, there is a tight connection between our physician volunteers and our dental program. For our 10,000 patients, all of whom are uninsured or underinsured and underserved, having the medical clinic and the dental program under one roof lets us do a far more efficient job of working to eliminate health care disparity.
The special training provided by the residency program described in this article would obviously go a long way toward enhancing this efficiency.