Great Cause

Starved for Attention
www.starvedforattention.org
Doctors Without Borders/Médecins Sans Frontières (MSF) and VII present Starved for Attention, a multimedia campaign exposing the neglected crisis of childhood malnutrition.

http://www.starvedforattention.org/take-action.php

Healthcare Tip

Here's a quick tip for understanding healthcare:

You as a patient are both a human being to us, and also a number to us. I say this so that people understand that there are two ways healthcare professionals look at people. For example, most hospitals and clinics use some sort of metrics to determine their performance in comparison with themselves or neighboring facilities. In doing this we take the human element out and review that we are off target by XX patients. The main purpose of this is to ensure that we provide the best possible care to people though, thus returning to the human element.

Here's a true example: We monitor HEDIS metrics for all of our patients. One metric revolves around which drugs to prescribe for elderly patients, as some drugs are more harmful or less tolerable to elderly patients. We had a lady walk into the clinic just fine, but by the time she made it to the exam room, it was apparent that something was wrong. She stopped breathing, and by the swift actions of the MA and RNs on my team, we saved her life. What does this have to do with HEDIS metrics and drugs? Well, this lady was overdosed by her daughter accidentally because she was coming into the clinic for an MRI, and the daughter wanted to be sure that she was comfortable and pain free. In doing this, the daughter gave her an extra pain killer. Obviously this could have ended very differently, but again, swift action saved the patient's life. This type of situation is what calls out why we monitor the drugs that people take to eliminate or greatly reduce these types of incidents. In this case, the patient was both saved, and should never have needed to be.

So, the next time you get a call to remind you that you need a screening, blood work, or an imaging study, please take heed. You may feel like just a number that day, but it is for the purpose of making sure you as a person get the best possible care.

Drug Treatment in the Elderly (Disease Management in the Elderly)
Drugs and the Elderly: Perspectives in Geriatric Clinical Pharmacology

Healthcare Jobs

I get a lot of questions on what different staff do and who they are. I've tried to provide a brief overview below.

An MA is a medical assistant with about 6 months of schooling. These staff typically room and discharge patients, take vitals, and do general office work for their provider. An LPN (licensed practical nurse) is in between an RN and an MA in skill level and can do some nursing functions with care plans from RNs or from protocols. They get about a year of schooling and can also do anything an MA can. An RN is a registered nurse who can operate under the verbal orders of a provider, operate outside of protocols as necessary within their scope, and use more critical thinking skills. The minimum education is about 2 years.

I use the term provider to describe physicians and allied health (nurse practitioners (NPs) or physician assistants (PAs)). Physicians are skilled at a high level and can have their own practices under their own license. Allied health staff are also highly skilled, and can do almost anything a physician can with limits and differences. There are two main differences between a PA and an NP: 1. An NP has to have been a registered nurse at some point. Some people go straight from nursing school to get a bachelor's an then on to an NP, but at some point in there the nurse had to become registered. 2. An NP can practice on their own, while a PA must practice under the license of a physician.

I hope that gives you a good overview. This is not to be all inclusive, but generally helpful information.

Healthcare Reform

Healthcare reform will reward providers that manage and coordinate services more cost effectively while improving quality of care. I think this is an interesting point. As we deal with the healthcare reform changes, consumers should become more aware of the interactions with providers and the healthcare system. Costs should be tied to need, in that, we should be able to charge people for the cost of a procedure if they insist on it regardless of medical effectiveness. The more people have to pay for the over-use of care that they demand, the less they will demand it. Patients and the medical community should be shifting our focus to maintenance of care and preventive medicine, not necessarily the latest and greatest surgeries and miracle pills.

There are five chronic diseases / conditions that account for the majority of healthcare costs. I see nothing in reform that addresses controlling these five issues. Diabetes, Coronary Artery Disease, Depression, Congestive Heart Failure, and Asthma constitute the majority of all healthcare spending in the US (Halvorson, 2007). We have made an important step in recognizing the need for change, however, the change we landed on does not get us to long term stability. We must change the way we pay for care, and we must focus on preventing disease and maintaining care. I recommend reading George's book, its a good overview of the whole situation, and it provides some great data. I don't agree with everything in the book, but it gives you great information to start from.

Realistic Expectations

I had a patient come into my office in the clinic today demanding to be seen for an emergent issue. I thought that this member was having chest pain or shortness of breath and we may need to get an ambulance. She was yelling for someone to come help her, so naturally I thought it was a serious issue. She was constipated. She had been for two days. She called in and left a message for our RN advice line three hours before and felt it was unreasonable to have waited so long, so she came in. Unfortunately, my staff were dealing with patients in need of medical advice for lacerations, radiating chest pain, and sever abdominal cramping (to name a few) and were unable to call this patient back.

A realistic expectation when obtaining healthcare is crucial to ensure that you get what you need, and you are also not over-reacting to different medical conditions. When you have a major medical issue, you want your healthcare team to be able to respond. We cannot do that if you call for two day old constipation or a stubbed toe, so please be reasonable in utilizing our medical resources.

Please note that I am not trying to give medical advice here and that there are many co-morbidities that may make constipation a more serious issue. Those should be discussed with your doctor. My point is that most people know if they have a co-morbidity that would make constipation more serious than a person who has not had enough fiber.

Best Hospitals 2010-11: the Honor Roll

Best Hospitals 2010-11: the Honor Roll

Ranking care delivery - HCAHPS

People are often perplexed at hospitals and care delivery systems. They are not sure where to go, or who provides the best care. To meet this need, Medicare and the Department of Health and Human Services created the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey in 2002 (Centers for Medicare & Medicaid Services, 2010). The intent of the survey is to "produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers" (Centers for Medicare & Medicaid Services, 2010). In other words, this is a complex customer satisfaction survey to rank care delivery systems. The information has been made public to help inspire systems to perform better and provide better patient care (Centers for Medicare & Medicaid Services, 2010).

If you want to know more about the healthcare delivery systems in your area, simply go to http://www.hospitalcompare.hhs.gov/ and search for hospitals in your area. I recommend the graphs view as it is easy to see how clinics and hospitals rank against the national average and neighboring facilities.

Reference:
Centers for Medicare & Medicaid Services, (2010). HCAHPS Online. Baltimore, MD. Retrieved from http://www.hcahpsonline.org 7/15/2010.