May Medical Article Highlights
May 29th, 2014
As health-care professionals, we know the importance of continuing education.
In addition to keeping up with my Ophthalmology journals I’m also interested in improving patient care, streamlining efficiency and the latest medical breakthroughs.
I come across so many informative and interesting posts on social media and in my RSS reader. I share them on my own Twitter and Facebook pages and have also collected some of the best posts and given you short summaries of the articles in a monthly highlights post.
In 2004, there was a shift in how a Wisconsin hospital conducted its daily operations, after they realized that patients weren’t central to their values. After this change the leaders in this hospital had to transform their thinking, and they created a new model that saw patients as the captain of the ship, doctors were experts, and nurses were care managers. This paradigm shift drastically improved patient satisfaction, and led to “safer medication prescribing, shorter stays in the hospital, greater satisfaction among health care providers, and improved patient flow between departments.”
Vancouver hospitals are slowly making the shift to this paradigm. However, this shift has been slow because it was initially based on “militaristic, hierarchal models.” It may also take a bit for all medical professionals to get use to the idea that they are a service industry, and they are there to serve patients.
I think if every hospital acted like the one in Wisconsin, the world would be a better place! I am very concerned with patient satisfaction, and do my best to ensure that patients are comfortable, informed and satisfied. I understand and embrace that I am here to serve patients, and need to put them in the driver seat when it comes to their health.
“Regulation works best when a practice of unquestioned value has become the norm.” Dr. Lucian Leape
A Rhode Island hospital had at least three occasions in 2007, where a surgeon operated on the wrong side of patients’ heads. It is often assumed that these incidents nearly never happen. Unfortunately, researcher Johns Hopkins has estimated that these “incidents” occur more than 4,000 times in the U.S every year. A startling realization, that can make patients feel even more uneasy before going under the knife.
The solution proposed to this unfortunate surgical error, is the use of checklists. It seems so simple, and if it can really prevent this awful surgical mistake from occurring, then why not try to implement it?
Harvard professor Atul Gawande published a book on this proposed solution, and from that the New England Journal of Medicine used the solutions in the book to conduct a study. They found that the use of the checklist was in fact, able to decrease the death rate from surgery by almost half. We all make mistakes; even if we’ve performed an operation 1000 times it is still possible for anyone to overlook a step. The use of the checklist, if followed consistently and properly, seems to be a promising solution.
As a surgeon myself, it is essential to make sure you follow all the necessary steps, and remember that you have the life of a human being at your hands. I think the idea of checklists is great, and could be a sure way to decrease errors from continuing to occur. We can’t let our pride stop us from using this simple method of preventing mistakes.
“If the medical market functioned like the car industry… providers would have adopted electronic records long ago.” David Blumenthal
Although our world is rapidly becoming more technical, and more and more industries are transitioning to a more digital way of doing things, the medical world has somewhat lagged behind. Many of us are aware that the use of digital information, vastly improves worker productivity. In terms of medical care, not only would it improve productivity, but it would ensure that the patient is getting the best possible care that they can.
The reason for this lag comes from the provider’s perspective. There are many costs, and difficulties in setting up these systems. The start-up costs are large, and there is more work involved initially, as staff have to be retrained.
Dr. David Blumenthal is not only a doctor and former Harvard Medical School professor, but he was the national coordinator for health information technology. He goes into detail on why this process has been slow, and how and when this may change. He sees that the big hold out in the health care future stems from a common problem in society. He explains, “We have lots of information, and we don’t always know what to do with it. Your doctor, your nurse, is not prepared to process the information they already have…and adding more in will just make it even more anxiety-provoking and overwhelming.”
I know that when my office implemented electronic medical records it was a huge learning curve. At first it decreased the amount of patents we were able to serve until we were fully immersed in the system. It is the way of the future and will lead to improved patient care and safety.
For doctors, the debilitating effects of working work night shifts can feel unbearable. In fact, research has shown that when the body’s clock is out of sync for long periods of time, it can cause serious and even fatal heart problems. Not only that, it’s becoming clearer, that disruption of our body’s clock can also cause numerous diseases including, diabetes, cancer, and strokes.
A study conducted at Manchester University found an enzyme in mice that keeps the body operating on a 24- hour rhythm. When this enzyme is suppressed, it can effectively reset itself, giving the body an easier way to adapt to the change. Researchers have found a drug that can inhibit the same enzyme, and could possibly help the body adapt to changes, allowing people to have a smoother recover from jet lag or night shifts.
The importance of sleep is crucial, and when you disrupt it by working the night shift, you can negatively impact your body. This drug sounds promising, and although it may not be available to anyone for the next five years, it will certainly positively for those in the medical field.
It wasn’t until recently that doctors discovered that their quality of care could be measured. We now have hundreds of quality measures, and physicians have to accept that this is here to stay. So, what is it that makes a good doctor?
Interestingly enough, Dr. Ashish Jha, author of this article, took to twitter, and conducted her own survey. She asked followers what they felt was the top ten important qualities in a doctor. Surprisingly “Having empathy” was the top answer, and number five down the list was “competency”. It appears that patients already assume that doctors are competent, and what they want is more of the “soft skills”.
According to Dr. Jah, to measure doctor quality, we can use patient experience surveys to focus on the “soft skills.” However we need to use our current metrics to assess good systems.
Since the Affordable Care Act in the U.S, it was recorded that eight million people signed up for health insurance. With this massive increase in patients, doctors can’t keep up, and there has been a push to allow nurses to take on more responsibility, thus freeing up doctors, and allowing the practice to run more smoothly.
Dentists were faced with a similar situation in the past, and research shows that they relied on their hygienists to take on patients. In fact, States that allowed hygienists to take on more responsibility saw less wait times. This example has pushed forward a strong contention for allowing nurses to take on more responsibility, freeing up doctors, and allowing less wait times.
Nurse lobbying groups are arguing that nurse practitioners are just as capable as doctors; however, doctor lobbying groups are arguing that they are more competent than nurses. Despite what each group is saying, it won’t be possible for doctors to keep up with the surge of patients, and they may have to let go, and give nurses more responsibility.
Being in the medical field I can relate to the overwhelming demands put on doctors to see large amounts of patients. It can be difficult and overwhelming, and is tough on patients as they have longer wait times. Relying on a healthcare team consisting of physician assistants, technicians and nurses can free up doctors, and allow a practice to run more efficiently.
According to the WHO we need 15% more doctors, indicating a major shortage of doctors. It has been estimated that by the year 2025, we will be short 130,600 doctors. To remedy this worrisome problem, it has been proposed that we consider ways to manufacture doctors faster and cheaper. On average it takes doctors 14 years to complete all their schooling.
Our current medical system can be biased, as it takes a large amount of financial resources to be able to become doctors. The lack of funds shouldn’t be a determining factor in who can become a doctor.
The solution proposed is to take away a few years off the process by approximately shortening each stage by 30%. It has been argued that the four years of premedical training shouldn’t be required, especially to those who can’t afford it. They also argue that fourth year is too simple, and in reality it should only be a three-year program.
I don’t know the exact solution but I think that there is a way to shorten the time needed to become a fully qualified doctor. It would be a step in the right direction if we reconsidered the way we conduct medical education.
“Making too much of online doctor ratings may lead physicians to do things that conflict with their professional judgment.” Dr. Richard Gunderman
Although the introduction of physician-rating sites has been a benefit to patients, and some doctors, it is often unreliable, and can be dangerous to make too much of them. The author of this article, Dr. Richard Gunderman, regularly receives emails concerning his online reputation. Often these emails are from online vendors.
Many uninformed patients will use doctors’ ratings to assist them in finding a family doctor. There is a very low participation on these sites, which allows for any disgruntled patient to pollute a physician’s rating with their experience. As these ratings become more influential, there will be a greater temptation for doctors to manipulate scores artificially.
I’m aware that the doctor ratings that represent a tiny fraction of all the patients I see but at a first glance it can be alarming. More education is needed to educate the public that doctor ratings can be misleading in both directions.
During the debate about Obamacare, I was encouraged to see Dr. Martin stand up with a strong voice for the Canadian Health care system. Although our system is not perfect, she made point to address the strong points in our system, as well as providing a great rebuttal to some of the tough questions she was faced with.
Dr. Martin clearly compared and contrasted the differences between both American and Canadian Health Care Plans, and made a point to address that Canada does not discriminate over whom shall receive health care based on what one can pay. She also made clear that the faults in our system are not to blame on one single person, but rather on the nature of the system.
I am very thankful to live in Canada and to have access to affordable health care and to be able to serve patients of all income levels. Although our system is not perfect, and could use some improvements, we are further ahead than other countries.
I was intrigued when I came across this article, as I too wonder what the best way is in regards to choosing residents. It wasn’t too surprising to hear that “grades” was a common method to tell if an applicant would become a successful resident or not.
A survey was conducted by the Journal of Surgical Education, and it discovered that the United States Medical Licensing Exam (USMLE) step 1, was the most common screening tool. Many doctors are aware that a good score on this exam gives you a one up over other residents. However, is this a good way to screen for good residents?
As many know, Google is a successful company, and you may be surprised to know, they don’t care much about grades at all! Senior vice president of people operations, Laszlo Bock feels that, “One of the things we’ve seen from all our data crunching is that G.P.A.’s are worthless as a criteria for hiring, and test scores are worthless — no correlation at all except for brand-new college grads, where there’s a slight correlation.”
I am encouraged to see that various companies are realizing that grades are not a good reflection on whether or not someone will be successful. Although it is important to show that you are well educated, grades are not good predictors or screening tools. I wonder if in the future we will see a shift away from using USMLE scores as a screening tool, and instead focusing on other characteristics when choosing residents.
“Cardiologists have been remarkably slow to abandon the old hypothesis—as many as 85 percent of angioplasties are elective and not emergencies.” David S. Jones
As new research on health is emerging, it is astonishing to find that doctors are disregarding the new evidence, and putting up an emotional reluctance to change old habits. A new study published in the Journal of the American Medical Association brings up the point that doctors are turning a blind eye to new evidence that could potentially change people lives.
On study asked cardiologist why they continued to recommend elective bypass and angioplasty despite new research showing there were other more effective options. The answers from cardiologists on this issue were surprising. Almost all their reasoning was purely emotion, not medical.
I can relate to the difficulty and resistant faced when trying to adopt new habits. However, when physicians have a duty to keep up with the latest research and adopt new standards. It is important as a doctor to understand that we need to be open and flexible to change.
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