Doctors Are Always Targets
The NY Times Op-Ed article entitled, “Doctor, Shut Up and Listen” was another potshot at physicians. Even the title told you what was coming. Before I even read it, I surmised that this piece was about doctors rushing patients and missing things. And I was right. Do you know how I knew? Because the system is broken and the hospitals and administrators are forcing too many patients onto the doctors’ schedules and asking them to do ridiculous metrics that mean nothing. So, this article, where doctors don’t communicate well, is supposed to be enlightening?
Here are some highlights from this turkey shoot:
- Asked why she hadn’t mentioned this information before, she said she’d “never been asked.” Until then, her providers would sooner order tests than take the time to talk with her about the problem.
- A review of reports by the Joint Commission, a nonprofit that provides accreditation to health care organizations, found that communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals
- Over the next two years, patient satisfaction with doctors, as measured by a standard questionnaire, moved the hospital’s predicted score up in national rankings by a remarkable 40 percentile points.
- I realize that many colleagues may see methods like ours as too intrusive on their clinical practice and may say that they don’t have the time. But we need to move away from the perception that social skills and better communication are a kind of optional extra for doctors. A good bedside manner is simply good medicine
The article mentions the Joint Commission, satisfaction surveys, a physician-training program and so many administralian words that it is quite obvious who wrote this piece of crap. You guessed it, an administrator! Nirmal Joshi is the chief medical officer for Pinnacle Health System.
Do I think doctors should be better communicators? Hell, yeah! But we need time. We need less patients. End of story. Administrators cannot bend reality just because they want to. They can create all the new programs they want. They can hire as many LELTs as they want. It doesn’t matter. The truth is that there are too many administrators and not enough doctors. The wrong people are in charge of the healthcare system.
Interesting article. The last two sentences say it all and, with a slight change could also apply to education.
“The truth is that there are too many administrators and not enough doctors. The wrong people are in charge of the healthcare system.”
Change that to — “…. there are too many administrators and not enough teachers. The wrong people are in charge of the Education system.”
Gotta shout out the bird-brain answer for unfixing what isn’t broken. We have rolled in the electronic scribblers to write down what the doctor didn’t actually say – now we will have “Medical Communication Specialists” – they actually exist, look ’em up! to tell patients what the doctor doesn’t mean…and pass the buck, since their paycheck comes from McIndustry Hospitalco.
“Dr. Bix is giving Grandma the chemotherapy to cure her cancer.” (The family is ecstatic, although the treatment is palliative. Let Dr. Bix deal with that problem.)
“Dr. Bix can’t cure Grandma’s cancer, but is going to give her some chemotherapy just because.” (OOOOH, that greedy Dr. Bix!).
“Dr. Bix knows of a chemotherapy for Grandma’s cancer, but he’s not going to give it to her.” (Cruel Dr. Bix! No matter that Grandma’s 96, demented and blind.)
These are some of the ‘splanations that industry will come up with, guaranteed. When faced with a job, split it up into the smallest particles, and give the duties to the least-paid (and least-qualified) person. And hire a couple dozen checkbox-checkers to check up on the mess.
Here, hadda cough this hairball up for you…
“The need for health promotion and education was recognized in the United States in the 1970s in response to growing disillusionment with the limits of medicine, pressures to contain high medical care costs, and a social and political climate emphasizing self-help and individual control over health. Health promotion and education were given official recognition with the Canadian Lalonde Report and the United States Surgeon General’s Healthy People report. Both reports addressed the notion that individuals play an important part in modifying behaviors to sustain or improve their health.
Patient education, a specific type of health education, is practiced by use of a process of diagnosis and intervention. Patient education is an expanding and evolving field and is now recognized as an essential component of health care.”
Firstaways, good Canadian trees were killed and pulped to print this report. That is an ecological travesty. Next, the more people practicing diagnosis and intervention on diseases, that helps, yah?
“At the conclusion of an episode of care, a resident and his or her attending physician debrief with the following questions, which address all cells in the matrix:
1) Was care for this patient as good as it could be?
2) Describe patient interactive feedback and involvement in matrix completion of care.
2) What improvements in the competencies in information delivery systems by the resident and faculty and changes in the system of care would result in improved care for the next patient?”
Paid for by the University Center for Clinical Improvement and the Institute of Healthcare Improvement.
Nurse – just put a pillow over my face for a little while, willya?
Well, the corporatization and mechanization of medicine is only going to make communication issues much worse. Small practices where docs have traditionally spent plenty of time with patients can no longer afford to do that, and larger practices/hospital groups are only focusing on reimbursement and coding.
As the ACOs put docs in the uncomfortable position of “saving money” by not doing “unnecessary”
procedures and tests, doctors will continue to lose face and trust from the patients.
It’s going to be a long hard road for new doctors coming out, I’m glad I’m near the end of my career.
Old truths are reinvented as amazing “new” insights. A good bedside manner is simply good medicine? Everyone from Hippocrates to Osler knew that. The industrialization of medicine is going to have some very rough growing pains. Ultimately, the poor will have to get whatever care they can get from the maw of the government/big business system; unfortunately, many lower middle class people are being sold on the idea that Medicaid is going to provide them with good health care at someone else’s expense. Middle class and wealthy people are already learning that in medical care, like everything else, you get what you pay for.