Comments on: Small Changes, Big Dividends

By: dr r

dr r — Mon, 19 Jan 2009 16:55:18 +0000

not belittling your doc, but removing excuses for other docs.

-R

By: dr r

dr r — Mon, 19 Jan 2009 16:53:49 +0000

At the VA, the 100% electronic records system forces you to learn to multitask typing your H and P while simutaneously engaging to patient in a a manner that they find fulfilling.

So, the simple act of talking into a dictaphone is no big whoop (although I used to always write up my H and P outside of the room in other clinics, strictly due to time constraints (hate to say it, but with the county clinic workload (Ben Taub in houston), inturuptions during script writing, H and P’s etc added up in a way most clinics don’t)

By: Beach Bum

Beach Bum — Mon, 19 Jan 2009 14:30:54 +0000

As a pianist, I hear you about the hand injury thing. I’m currently working through an injury to my left thumb (MCP joint), and while it’s not a huge injury, I’m still paranoid and panicked about it. Hope you’re better soon.

By: enrico

enrico — Mon, 19 Jan 2009 14:19:33 +0000

What a great discussion so far,thanks to all you for commenting! I did want to mention something that I thought of but neglected to mention in the article. I realize it’s far easier to take this more measured approach as a subspecialist (this doc does only hands/upper extremeties w/in the confines of already being specialized as an orthopod) with a far more consistent patient population than, say, a hectic family practice doc seeing just about everything that could possibly come in the door. While this fact is totally not lost in my mind, I think the general principles still apply. Perhaps a similar letter can be mailed after-the-fact for first-time patients, for example.

There are lots of ways to make small changes to both empower patients, increase physician satisfaction in their practices and improve the overall healthcare climate in this country. We just need to be creative and sensible as much as we are willing to throw money around.

By: purplesque

purplesque — Mon, 19 Jan 2009 13:34:47 +0000

Great post, E! I think your orthopod is wonderful, and there are lessons in there for all of us. In psych, things are quite often not as transparent, but I always call family members/other doctors in front of the patient. Most of them seem to appreciate that.

*Goes to buy good paper stock*

By: dr b

dr b — Mon, 19 Jan 2009 04:22:26 +0000

This illustrates some good advice I received early in residency: ” A good physician makes 5 minutes feel like 20 to the patient”

This is not trivial (especially in today’s high volume environment), but also not impossible

Listen
Eye contact
Repeat things the patient has said back
Sit down if possible (a subtle way to ’slow down’ time for the patient)
Modification of treatment plan, however trivial it may seem to YOU, based on patient feedback/compliants if medically reasonable
Force some patient ownership of their own treatment (it gives you leeway later if things don’t work if they feel they “chose” the treatment, although in the end 99% choose what you strongly recommend anyway, and if it’s not important enough to warrant a strong recommendation, then hold on to the “dammit i’m the doctor” chips for later!)
Get rid of the GOD complex

In retrospect, I think this all is in the SPIRIT of the ‘manners’ article referenced earlier. Unfortunately, as is common in many corners of the medical establishment, the comments from the ‘blogosphere’ following the article dismissed or ridiculed the article partially based on the authors board certification (psychiatry). But the suggestion to at the least evaluate your practice techniques in light of the new “patient-centric’ paradigm that is gaining ground is a good suggestion for ALL, regardless of how applicable the details may be to any individual specialist.

My 0.02 cents (well, more like a dime, that was damn long!)

By: rlbates

rlbates — Sun, 18 Jan 2009 23:11:38 +0000

I’m glad you found a hand surgeon you are comfortable with, Enrico. So happy for you (well not the injury). Take care.

By: Karina

Karina — Sun, 18 Jan 2009 22:13:46 +0000

Thank you so much for posting this. It is inspiring and a wonderful lesson.

I still like to write physical social letters up to this day and on occasions I’ve been asked why I bother when there is email. I smile back but lightly saddened that the behavior may be akin to something peculiar and unusual anymore. But THIS warms my day. Thanks!

By: Christine

Christine — Sun, 18 Jan 2009 21:25:40 +0000

Stumbled across your blog and had to comment on this – I couldn’t agree with you more. I’m not in the medical field, let me state that first. I saw a neurologist a few years ago for recurrent headaches. He was Canadian, but had moved to the US for whatever reason (I’m in Ohio). The exam was completely different from the rush-rush 5 minute deal I’m used to, and after he made his diagnosis, he dictated not only his office note, but the consult letter he was sending to my PCP. We then chatted about the state of healthcare. Amazing. If only he were a PCP……………

By: Strong One

Strong One — Sun, 18 Jan 2009 21:20:04 +0000

Trivial.. Hell no. I wish this was the normal practice of all physicians!
I worked for/with an ortho (ironic) and he did the very thing you’re discussing (aside from the letter – which was way kewl).
It encapsulates what we as patients and providers wish for.
Glad you were cared for in such a profound manner. Best of luck with that tear. I know TFCC tears are a B@TCH.

By: Victoria Powell

Victoria Powell — Sun, 18 Jan 2009 20:07:44 +0000

I am so glad you took the time to post this. As a Work Comp nurse I have had the pleasure of meeting other physicians who practice this way and it makes a huge difference in the patient’s mind. My personal PCP always dictates in the room with me and on several occasions we have commented/discussed things during that time to clear up any misunderstandings. Patient’s oftentimes think that something secretive must be in their records since they are often difficult to obtain. Wonderful post. Looking forward to more.