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Tag Archives: Random Thoughts

ERP Makes the News

ERP, who guest posts on this very blog, got interviewed for an article about how to get treated “better” and “faster” in the emergency department published on AOL today. Congrats! The comment section to the article has some er, um … interesting reactions … and misperceptions about patients using emergency departments. All in all, the article isn’t bad and gives some decent suggestions like bringing a list of medications and recent tests with you and also bringing along an advocate. But the reporter calls us emergency “room” docs. Grrrr.

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I Always Feel Like …

… somebody’s WAtching meeeeee. From one of my favorite magazines comes the story that we are being watched – a lot more than we know. Wired Magazine reports that Federal law enforcement obtained telephone GPS data about Sprint customers more than 8 million times in a year. About 220,000 times per day. More than 9000 times per hour. About 3 times per second for every second of the whole year. These numbers don’t even include the data for the remainder of the cellular telephone market. Must be a lot of criminals in this country. I liked one of the comments to the article, though: “Any society that would give up a little liberty to gain a little security will deserve neither and lose both.” – Benjamin Franklin

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Patient SatisFICTION?

The director of our group was called to the administrative offices to explain why our Press Ganey scores had dropped eight percentage points. A slightly larger than normal proportion of patients rated us as “good” rather than “excellent” for the past couple of months. Now the hospital wants answers. It wouldn’t be so bad if the hoops we had to jump through were rationally related to the care that we are providing. They aren’t. The things that are useful measures such as “quality of care” and “medical decisionmaking” are intangibles that can’t be measured and plugged into a spreadsheet. Try it. Describe what “quality care” is and then figure a way to quantify it. Is quality care adhering to published guidelines? What if there aren’t any guidelines for your patient’s situation? Does quality care amount to less complications than the other practitioners in your specialty?If so, then a large percentage of physicians will cherry-pick healthy patients who are less likely to suffer complications. What happens to doctors who care for the severely ill patients? Maybe quality of care is equivalent to low cost. If we use that definition, then we’re going to be creating an incentive for doctors not to order “unnecessary tests” and not to find diseases. The old saying goes “if you don’t go fishing, you won’t catch any fish.” It is nearly impossible to come up with a quantifiable definition of “quality care.” So what happens? In some specialties, we allow our worth as physicians to be measured based on data that can be quantified: Our ability to make patients happy. When speaking specifically about emergency medicine, the measurements don’t start there, though. First, the system throws patients into situations that tend to make people mad or frustrated — in need of medical care and forced to wait, sometimes for an excessively long time, with a bunch of other people who are also in need of medical care — THEN we start measuring physician worth. Sometimes patient happiness isn’t related in any way to the physician’s care, but the staff gets blamed anyway. There are the creature comfort complaints like “the room was too cold” or “the food was horrible.” Patients may get blankets, but sometimes decreased satisfaction scores still carry over to the provider side of the survey. Then there’s the “I saw my doctor the next day and he said that you should have given me antibiotics for my cold.” Great. The follow up doc is both a backstabber and an idiot. Doesn’t matter that the patient would have gotten better even if the doctor prescribed soap suds enemas because nothing is going to make a viral infection go away except time. Nevertheless, the physician providing medically appropriate care gets lower marks because of another doctor’s inappropriate medical treatment. There are other examples, but you get the picture. The best similarity I can come up with is using a ruler to measure how cold it is outside. The instrument you’re using has little bearing on what you’re trying to measure. Then I did some studying and found out additional information about patient satisfaction surveys in general. To get an adequate sample size, for 1000 patients, you need about 280 respondents to have a 5% margin of error and you need 400 respondents to have a 1% margin of error. That’s between a 28% response rate and a 40% response rate for statistically valid data. Larger sample sizes need less response rates, but these numbers are just to give a general idea. Know what the response rate for a well-known patient satisfaction survey company is? Between ...

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Have At It

As I was fixing the wiring in my basement, a thought popped into my head about another way to decrease costs of medical care in this country. Get rid of prescription requirements for most medications and procedures. How many people would go to the doctor for a sore throat if they could buy a strep test over the counter? If the strep test is positive, they go to the pharmacy and purchase some penicillin over the counter. If you twisted your ankle and could walk into a radiography center and get an x-ray of your ankle for $100, would you bypass the emergency department? If you could buy your blood pressure medication over the counter, would you keep going to your doctor for those $150 checkups? Would you even purchase routine insurance? Or would you stick with just “major medical” coverage? I know that issues would have to be worked out with an open access system – such as preventing narcotic abuse and preventing antibiotic resistance due to people taking Zithromax for the flu or Levaquin for their coughs. Maybe we’d have to limit the number of CT scans or angiograms that someone may receive to keep down the radiation doses. You can purchase an HIV test or a pregnancy test over the counter. Why can’t you purchase a strep test or mono test over the counter? It’s not uncommon for medications once available only by prescription to go “over the counter.” Look at all the acid blockers and at Prilosec as one example. Why shouldn’t most prescription medications be available to everyone over the counter? If it isn’t a controlled substance, people should have access to it. What harm is avoided by having a medical provider as a “middleman”? In almost any other situation, if I choose to take care of a problem myself, I can do it. If I want to cut my own hair, I get a pair of scissors, look in the mirror, and start hacking. I don’t need a stylist’s prescription to purchase scissors. If I want to sue someone, I can go to court, fill out the papers, pay the filing fee, and play the lotto. I don’t need a lawyer’s OK in order to gain entrance to the court house. If I need to fix an electric outlet, I can go read about it online, buy the stuff at Home Depot, then hope I don’t get the red and the blue wires mixed up. I don’t need an electrician’s permission to purchase conduit. When I get in over my head doing any of these things, I either take my chances or I call someone who knows more about the problem than I do. Why should medicine be any different? Think about it. If everyone had open access to medications, medical testing, and radiographic studies, there would no longer be an issue of what is and is not “necessary.” If a patient wants a test, then the patient purchases the test. If a patient wants medication, then the patient purchases the medicine. Be a lot fewer “designer” prescriptions being filled if patients had to pay full price for them. With patients obtaining their own tests, there would be less medical malpractice for failure to order testing. The patient wouldn’t need a doctor’s order to get the test. Worried about breast cancer? Go have a mammogram done. Worried about lung cancer? Go get an x-ray … or a CT scan for that matter. If patients get in over their heads, then they can seek the advice of someone who knows more about the problem than ...

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Kitty Tamiflu

Why are we now testing 13 year old cats for swine flu? So what if the cat has the swine flu, seasonal flu, or just a head cold? Are we going to get out the kitty face masks? Cat paw sanitizer? Cat litter sterilizer? No more sharing milk bowls? Then they get a positive test and the news agencies are all over it like it’s some big story. WHOtv 13 News. KCRG TV9. Pioneer Press. I’m sure some epidemiologist will come up with a reason for testing every conceivable genus and species for this disease. Woohooo! Now the swine flu can infect pigs, birds, humans, cats, and a couple of mangy ferrets. Catnip is now a vector for the disease. Combine all of these animals together and you can come up with some thing that looks like one of those freaky “Where the Wild Things Are” characters. Maybe I’m uninformed of the significance of this breakthrough discovery and someone can enlighten me. Until then, my response to cats being afflicted with H1N1 is “So what?” Oh wait … I forgot. Quick. Everybody fly to Boston and put in an application for a job at Ropes & Gray. Then just mix in some of the Tamiflu you’ll get as a fringe benefit with your cat’s Meow Mix at the first sign of a sniffle. Everything will be juuuuust fine. Picture credit LOLcats

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Bad Ink

Reading through my news feeds, clicked on a link to the Chicago Tribune, and then pictures of Obama Halloween masks caught my eye. Took a look at those. Strange enough. When I clicked back to the Chicago Tribune home page I saw a picture of a criminal mug shot showing a dude with a tattoo across his forehead, so I clicked that link out of curiosity. I can’t look at some of these pictures without laughing out loud. If one of these guys came up to me and demanded my wallet at gunpoint, I’d prolly be dead because I’d just bust out laughing. Especially the Joker on the bottom and Gold Monotooth Dude with a Bennie inked on his neck. What a rip.

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