Tag Archives: Patient Care

Physician Leadership and Clinical Practice

A recent opinion piece in the Annals of Internal Medicine really resonated with me. It is entitled Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care and made many of the same points I cite for my own ongoing clinical practice, and which I often point out to maturing or aspiring physician leaders.

The authors lay out 4 reasons for physician leaders to remain clinically active:

  1. Access to information about how the organization really works. I can tell you from personal experience that this is absolutely true. When I was a hospital chief medical officer, I used to joke (but truly meant) that I learned more about how the hospital really worked by being on call on a Sunday than by going to hours of meetings during the week.
  2. Credibility. This also rang true for me personally. I have had physicians’ attitudes toward me turn on a dime when they learned that I was still seeing patients and had not become a full-time “suit.” Despite the fact that effective organizational leadership requires a distinct skill set from clinical expertise, it is exceedingly difficult to be a physician leader without having genuine clinical bona fides.
  3. Personal fulfillment. Amen to that too. I refer to this as having an opportunity to “connect to purpose” by getting back to the reason why we became physicians in the first place – to forge intimate bonds with others, and to make a positive difference in their lives.
  4. Job security. OK, so they didn’t call it that, but they did say that physician leaders should maintain their clinical skills so that they can go back to being clinicians when their leadership roles expire. This reason fell a little flat for me. Most leaders I have seen do not go back to full-time (or predominantly) clinical practice, and it seemed like a hedge against failing rather than a positive game plan.

Here’s a big reason for physician leaders to continue to practice that the authors didn’t discuss. For me, physician leadership is an extension of clinical practice. Clinicians have the sacred and honorable ability (and responsibility) to make a positive difference for each patient that they see. I have always embraced the idea that physician leadership is about extending that ability and responsibility from one patient at a time to many patients at a time. I think that maintaining the one-on-one connection that can only be had through clinical practice is an important reminder of that higher calling.

What do you think?

Test Responsibly

I got a heads up the other day that our organization had been dissed by a CNN reporter who was frustrated by her inability to get tested for Zika. You can read her original piece and the follow-up here. Short version is that she was upset that it was difficult for her to get tested after returning from a vacation to Costa Rica where she encountered “a good amount of mosquitoes” and later developed a mild febrile illness.

I won’t defend that she was made to feel like she was getting the run around, and it seems like – at the very least – we could have done a better job of communicating with her. But what she seems to dismiss, even though it goes to the core of her encounters with all of the medical providers she contacted, is whether she should have been tested at all. Continue reading Test Responsibly

Yelp!

I have written previously about some “aha moments” that I have had as a clinician, when something that I knew was coming seemed to arrive with a thud in my own practice. I had another one of those moments a couple of weeks ago.

I was finishing up with a new patient, and had explained to him and his wife my assessment and recommendations, and had answered a bunch of questions they had.  I was frankly feeling pretty good about how the encounter had gone and as he was walking out of the exam room he said (more or less): “thanks doc; I’m glad I came to see you, and I am going to give you a really nice review on Yelp.” He was not kidding.

I didn’t know quite what to say immediately, but I ended up thanking him (somewhat awkwardly, I suspect) and then recovered enough to tell him that while I would – of course – appreciate a nice review on Yelp, I wanted him to know that he might be getting a patient satisfaction survey in the mail, and I would really appreciate it if he filled it out and sent it back in. Encounter over. New world order in place.

Continue reading Yelp!

Patient Advocates? Really?

I was disturbed by a recent article in the New York Times about the Texas Medical Board. The piece described the decision by the Board to sharply curtail the use of telemedicine in the state. Specifically, the Board mandated that telemedicine services could only be provided in the context of a pre-existing patient/physician relationship, and that such a relationship must be established face-to-face, and not via electronic means. According to the Times, the restrictions were strongly supported by the Texas Medical Association.

Sigh.

This seems to me to be a wrongheaded, backward looking and overall pretty lame attempt to stem the inexorable tide of patients and physicians connecting in new ways. I really wish I could believe the Board member who said he voted for the new restriction because he was “terribly, terribly worried about the absence of responsibility and accountability” in electronic encounters. It sounded to me, instead, that he was “terribly, terribly worried” about a new business model for medical care that provides greater convenience and lower cost to patients than traditional office visits.

Continue reading Patient Advocates? Really?

System Readiness

I took advantage of the holiday slow-down in routine meetings to visit our Health System’s new serious transmittable disease unit – the “Ebola Unit” – at Glen Cove Hospital. Wow!

I had the good fortune to have Darlene Parmentier, the nurse manager of the unit, tour me around and explain how patients will be cared for. Darlene is an experienced clinician and had a ready answer for every one of my questions. In fact, she had answers for lots of questions I never thought to ask! Despite the fact that the physical space had been transformed from an unoccupied “regular” hospital inpatient unit into a highly specialized containment and care facility in just days, I was amazed at the thoughtfulness of the design. Here are just a few of the salient features:

  • A dedicated pathway (including a dedicated elevator) from an external ambulance bay directly into the patient care area
  • Ample living space for care givers who may choose to stay on the unit between shifts, complete with thoughtful touches like a ping pong table and an X-box
  • Designated training areas, recognizing that continuous simulation and drilling are integral to the effectiveness of the unit
  • Well marked “zones” that correspond with the risk of contact or exposure to infectious agents, and dictate the different the levels of personal protective equipment that must be worn
  • The pervasive evidence of planning, not just for the range of clinical challenges that may arise, but also for the needs of patients’ families, the impact on caregivers and the reaction of the community and news media

Overall, I came away incredibly impressed. Once again, our Health System has stepped up to do the right thing for our patients and our staff, and I am confident that any patient who needs treatment there will get great care.

Let’s hope it never happens. Continue reading System Readiness

A Global Force for Good

A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy – a global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America the world over,” but I liked it. I thought it captured a deep truth about the Navy, which is that it is undoubtedly a “global force” and that the force exists for a good purpose, but I guess most people thought that it made the Navy sound too much like a bunch of social workers.

I was reminded of the phrase, and of an experience I had while serving in the Navy Medical Corps, when I read a recent article in the Annals of Internal Medicine.  A Navy physician retold the story of a mission he was on to a remote village in Honduras. He and his team were flown into small villages, where they would “see dozens of patients each day and dispense an assortment of symptomatic medications” and where “the most practical health benefit that we provided villagers consisted of hundreds of tooth extractions.” He further noted that “although advertised as humanitarian missions, these exercises provided US military personnel with experience working with military and civil authorities from host nations.”

Continue reading A Global Force for Good

Residency Ratings

I have been a big proponent of seeking the feedback of our patients regarding their experiences with our care, and of pushing our organization to be more transparent about the results. I believe that sharing performance motivates everyone to raise his game, and that we should embrace valid ratings on specific measures. On the other hand, I have always thought that global “rankings” divorced from specific performance measures make little sense.

As Malcolm Gladwell pointed out in the New Yorker a few years ago rankings of complex, multidimensional things like cars or colleges are inevitably flawed, because they don’t account for the fact that different people will value various attributes in different ways. There is no “best car” since I may value handling and acceleration, and you may value styling and safety. Likewise, there is no “best college” because one student may value class size or athletic facilities while another values research opportunities and proximity to a large city.

Continue reading Residency Ratings

Sometimes “Sorry” is all it Takes

In my administrative role, I have the great pleasure of signing thank you letters to patients and family members who have acknowledged the great care they have received by one of our physicians or other caregivers. It is a nice way to tell the patient “we got your note” and to simultaneously recognize the provider by copying her or him. The best part is that I get to read the patients’ letters, which are filled with gratitude, and remind me of the great privilege we have to make a positive difference in the lives of our patients.

Sadly, I also have to deal with the occasional patient complaint. Although these are clearly a lot less fun to address, they also point out the impact that we have on the lives of the patients and families that we serve.

Continue reading Sometimes “Sorry” is all it Takes

Price Transparency

About a year ago, I shared details of my own out of pocket medical expenses and concluded that we have to have to be more transparent with our patients (and potential patients) about the costs they will face for our services. The urgency of price transparency as a business imperative and a professional responsibility has only increased since then.

Consider that we are now a year in to the implementation of the Affordable Care Act. Everything that I have read suggests that consumers were intensely price sensitive when it came to choosing which plans they elected. Well, duh! The benefits are defined by “metal” levels (e.g., Bronze, Silver, etc.), and there is almost no way for people to compare the quality of competing narrow networks or individual providers, so price differences drove decision-making. Likewise, the healthy people who bought insurance because they were compelled to by the individual mandate generally chose high deductible plans to minimize their monthly payments. This, in turn, makes them much more price sensitive at the point of care. That means that patients may resist recommended treatment. It also means that physician offices will face more challenges in collecting fees from patients who have not yet met their deductible for the year. At the very least, patients will be more interested in learning what costs they will be exposed to.

Continue reading Price Transparency

Improving Ambulatory Care

I recently attended the IHI conference entitled “Improving Patient Care in the Office Practice and the Community” in Washington, D.C. It attracted about 1000 people from around the country to share their stories about how to make care better, and I want to share two of them with you. Continue reading Improving Ambulatory Care