Physician Productivity

Maybe it’s my German ancestry that makes me enjoy reading productivity blogs. My favorite is Asian Efficiency but there are others that cross my blogging path. Today I came across this article: Why Your Brain Can’t Handle an All-Day Schedule.

ScheduleThis is not the first time that I’ve read about loss of productivity in environments where people sit in front of a computer all day. But it lead me to thinking about physicians who practice in present day medical office environments where the pressure of productivity is all-encompassing. Even though my schedule is not nearly as demanding as many doctors, on those days where I see more than 18 patients I realize that it is not only my intellectual capacity that plummets, but more importantly, my empathy quotient takes a nose dive. Somewhere around 4 pm, or #17, I am pushing away the weight of all the unfinished tasks, unfilled prescriptions and forms sitting on my desk as I try to listen to a patient problem. Couple this with the continual interruptions while trying to finish notes and it becomes obvious why physicians lack creativity if they remain in the typical constraints of a normal medical office.

Over the last several years primary care physicians have been pushed to see more patients, adopt new skills, like EHR, with steep learning curves while keeping up productivity-an oxymoron if one ever existed. This while we accept less pay, keep up with continuing educational needs and remain supportive to spouses, children and often elderly parents. If you add up the hours involved in just doing the above there is little space for exercise, reading, mediation or any other “leisure” activities that give life deeper meaning.

It is little wonder the creative element is lost on doctors.

Let’s hope new models of reimbursement, EHR’s that truly help us take care of our patients, Medical Social Media, improving patient advocacy and better models of care give physicians back some time–and with it, the creative art of medicine.

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Doctors 2.0 – First Blog Post

It’s a few days early but why not get a leap on my conference blogging? My daughter and I arrived in Paris in preparation for the Doctors 2.0 conference:

“THE” INTERNATIONAL EVENT OF 2013 IN HEALTHCARE SOCIAL MEDIA & WEB 2.0


After not sleeping on the flight over (I never sleep on airplanes) we arrived at our very pleasant apartment in the Marais, set up through “A La Carte Paris“. Kelly walked in the door, checked out the very high tech amenities as well as the bathroom hidden in the bank of cabinets on the wall: 

Oh MY — there it is!





















She then announced “We’re staying in an Inspector Gadget’s apartment!”






We spent the afternoon on a walk through Montmartre given by Chris through City Free Tours. After a beer in the Place de Tertre we made our way home and decided to eat in and then crash. 

Not too much Social Media in Medicine was accomplished today, but everyone deserves a day or two off. I’ll be tweeting from the meeting and looking forward to learning more on that topic starting Wednesday night when I’ll have the pleasure of dining with some of the best on #hcsm, @HealthHashtags, @clearmd, and #doctor20 IRL.*

In the meantime, Bon Appetit.



*In Real Life. 

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Can Social Media reduce Physician Burnout?

In late fall of 2011 I was tired of medicine. While seeing patients was still enjoyable, I felt under-appreciated in my employment and frustrated by the endless BS that I dealt with–new laws undermining the trust my patients place in me, increasing requirements from insurance companies for ordering tests or medications, more forms to sign, less time with patients, a cumbersome EHR to learn, more non-CME education requirements from the system I belonged to…the list grew endless. Most of it boiled down to less control over my professional life and less time to spend with the people I enjoyed-family, friends and patients.

The following February I began writing

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a blog on my professional frustrations as well as the occasional reward. Shortly after that I discovered Twitter–first as a “lurker” listening in the background, then as an active participant. I met so many interesting people–physicians, e-patients, Social Media gurus, pharmacists, nurses, other healthcare providers, patient family members, the list is endless. Through Twitter my office knew early on about the multi-state fungal meningitis caused by tainted steroid vials, the Newtown shootings (unfortunately) and the Open Notes study. If Mayo and Cleveland Clinics were using Social Media to reach and teach their patients, it was likely that Social Media was not just a passing fad. Meanwhile my fascination with the phenomenon grew

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I began a master’s level course on Social Media that is mind-blowing (and free) developed by +Bertalan Meskó, an MD-Phd from Hungary who is a Medical Futurist.

I read “The Creative Destruction of Medicine” by +Eric Topol who recently spoke  on the Colbert Report about the future of medicine. I submitted blogs and was  published by Dr. Kevin Pho, “social media’s leading physician voice”.

In October of 2012 I attended Mayo Clinic’s Social Media in Medicine Summit and met a few hundred people interested in how Social Media is changing medicine.

Patients now get a business card with the access site to a patient portal, my twitter handle and my blog site. They can contact me 24/7, understanding that I’ll answer with the same availability as my email.
In the process I found new ways to engage myself and my patients–using QR codes, putting up a white board in the exam rooms, recommending apps.

RelayHealth

Last year’s experience served to recharge my professional gusto. Patients are more interesting, I deal with the non-stop frustrations with more aplomb and less emotional exhaustion. I look forward to seeing my new friends on the #hcsm tweetchat on Sunday night. Suddenly the future of medicine looks a lot less lonely and a lot more interesting.

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The Three “P”s of Mayo–Patient-centered, Physician-led and Collaborative Partnership

Last week I attended the Mayo Clinic’s Annual Social Media Summit in Rochester. What most impressed me had nothing to do with the conference. On Tuesday afternoon before the Summit began I toured Mayo Clinic. It was supposed to be for an hour but lasted more than two because our group, consisting of one doctor and nineteen PR professionals, was so interested in the information being fed to us. I don’t know why the publicity folks were so intrigued, but for me Mayo’s philosophy of “patient-centered, physician-led” care hearkened back to a time when the patient-physician relationship was inviolate. It was stimulating to realize that my instincts of how medicine is best-practiced are right on target.

My myopic opinion regarding the fragmentation of healthcare sees the destruction of the patient-physician relationship by multiple entities, who are primarily interested in a piece of the economic pie, as central to our healthcare mess. At Mayo, no project moves forward unless there is a physician who champions it and it is the physician’s responsibility to ensure that every project is dedicated to improving some aspect of patient care. Physicians are salaried so they spend the time necessary to care for patients and are not incentivized to increase the numbers of patients seen or do procedures to enhance the bottom line. 

Every person I met who worked for Mayo reiterated the importance of putting patient care and comfort first. It was incredibly refreshing. The Mayo logo emphasizes a patient-first policy as well. I’d seen the logo multiple times but somehow never thought about what the three shields represent. Our tour guide explained: Patient care, research and education. The educational aspect was obvious as we walked multiple floors of patient care areas. I noticed no TVs in patient waiting rooms but many had computer screens where patients could learn about their conditions. It is a refreshing and calming atmosphere without the cacophony of media noise. There is art everywhere. Waiting rooms are spacious and well-lit. Meditation rooms and educational spaces abound. 

Children’s waiting area


Mayo has always represented excellent healthcare in my mind. Patient reports that come to me after a visit there are extraordinary due to the extent of the integrative care the patient experiences from multiple medical disciplines coming together. I expected to be impressed. I did not realize I would also be reassured. Putting patients first is what I’ll continue to strive to do, despite insurance interference, governmental policies or EHR dysfunction.


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Reducing Fragmentation and Patient Care NOW not Next Year

I do not recommend doing this, but today I attempted to listen to two Webinars at the same time. One was also tweeting the discussion and the other had very detailed slides which made it easier to follow but as studies show, we are not really capable of that kind of multi-tasking. The topic of the first suggested it would discuss Primary Care and its future. However, what the expert proposed was a “How to” plan for bringing more customers into a healthcare system. This was boiled down to a recommendation that these system open small clinics, run by NPs, in competition with drug store and grocery store clinics of similar ilk in order to funnel patients into the listeners’ systems. The other Webinar was a discussion by three mobile health leaders (mHealth) on the future use of their products in the global mobile health arena (wow, that rhymed).
It’s is a good idea to know what is going on in the minds of healthcare system development teams and as I listened to the expert’s remarks I could not help but ponder on what, in my humble opinion, would build the kind of “team loyalty” that hospitals and other healthcare systems are dreaming of. What is it that patients want? I agree that they need healthcare access in their busy lives at more convenient times of the day than traditional physician offices offer. What my patients tell me (and what people tell me at cocktail parties) is that they would prefer access to their very own providers, those individuals who know them best. No insult intended to NPs because they are essential to the healthcare team, but they are physician extenders, not physician substitutes. What about developing systems that give patients greater access to their own providers? This would really engender loyalty to a healthcare system, especially one in which physicians are employees, more and more the norm these days. I believe mHealth can do that. What if you could access your physician after hours via Skype? Or text your doctor just for a quick conversation about whether you should seek immediate care or be seen the next day? Gee, what if the physician had access to their schedule and could book them on the spot?!? What I’m advocating here is a “concierge” type practice without the concierge price. Of course there would have to be some sort of reimbursement procedure to give already overworked primary care doctors the incentive to take care of patients in this way but wouldn’t that be a cheaper investment than opening the equivalent of “Little Clinics” everywhere?
Along with the cost, the second complaint I routinely hear from patients about their medical care is its fragmentation. From a patient and a primary care perspective, no one on the health care team is talking to each other. In fact, frequently the word “team” is a misnomer. Using tools like Doximity physicians can employ a HIPPA compliant platform to discuss cases and improve care. Of course the phone always works, but with the ability to ask questions and respond in a timely but convenient fashion, doctors and other providers like NPs, PTs, etc. can reduce the fragmentation patients feel from their healthcare team.
Of course I realize that ACOs (Accountable Care Organizations) are supposed to be developing this kind of care. But does the bureaucracy that surrounds these systems bother anyone else but me? Do we really have to wait for the lumbering movement of government sponsored programs in order to improve communication, fragmentation and access to care when the technology is already here today? 
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The Lurking Physician

In addition to reading a number of medical bloggers, I “lurk” on twitter chats and try to watch twitter updates from the 88 people I am currently following. The majority of the people I follow are doctors who are interested in how social media can help patients, plus a few “learning” entities like Brainscape just to improve my language studying skills (which I highly recommend). I am just a neophyte to Social Media but am excited by its potential for my patients.

Brainscape

Suddenly the ability to followup with patients directly without a medical assistant playing messenger in between seems more attainable. Communications would be cleaner and both physicians and patients would be better served. Right now I do this on a small scale by using email but this is fraught with difficulty. Patients send me their information and sometimes they cannot open my email response because it is encrypted (per HIPPA requirements). Other times their emails are caught by my spam filter and I never see them! As I’ve written about in previous posts, there are recommendations by august bodies like the AMA on how to use email professionally but frankly, they are both out-of-date and a little out-of-touch with their recommendations. However, having said that, HIPPA fines are substantive so no one wants to be caught in the wrong while communicating with patients.

In the meantime, patients are becoming more web and social media savvy. It is exciting to have a patient come in who has been on the Mayo clinic website and is asking about what preventive steps they should be taking instead of me initiating the discussion. It makes me feel like a partner in their care instead of a mother giving advice. I am a mother and I enjoy that role. Nurturing is part of healthcare but when I feel more like the disciplinarian then an advisor, neither I nor the patient are likely to benefit.

The “early adopter” physicians and e-patients on Twitter, Facebook, Google+ and LinkedIn, among others, are working hard to improve the lines of communication so that patient care is better. It’s an exciting time to be involved and I am looking forward to learning more and sharing a lot.

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I’ve got some bad news and some good news

That’s the old joke, right? “I’ve got good news and bad news-the bad news is that you have Alzheimer’s. That good news is that you’re going to meet lots of new people.” Unfortunately telling people bad news is no joke and I mused on the experience today as I read an oncologist letter to me regarding one of my patients with a terminal cancer. How do you do that day in and day out? This morning I had to tell a patient, a former smoker, that his chest xray was abnormal and he needs further tests. I’ve known this patient for years and am worried about him. Maybe it will turn out OK…maybe not.

The fact that it bothers me is a good thing. It reassures me that patients’ concerns remain foremost in my practice of medicine. I notice when it’s time for a vacation or at least a few days break from my office, that one of the first things I lose is empathy. When a patient comes in with a problem that seems simple and unnecessary for a doctor’s visit, if my first reaction is “this guy’s wasting my time” I have to stop and think “why do I feel that way?” Usually it has nothing to do with the patient and everything to do with me–worried about my daughter who is working in a third world country, worried about my mom’s forgetfulness and is it something more insidious, etc.

It is curious to see how individuals react to a life-threatening illness. Most of them have such dignity. Often it is the family members whose behaviors become difficult, which in turn makes the emotional turmoil to a patient worse. I remember memorizing Kubler-Ross’s Stages of Grief in medical school. I have been amazed at how much that optional course has enabled me to help patients and their families by better understanding what they are going through. Although things are improving immensely, with programs like Baptist East’s Cancer Resource Center and Friend4Life as well as specific coordinated care centers for certain cancers, the system is still difficult to navigate.  

Often, once a patient begins the work of honing down the diagnosis and determining the treatment of their life-threatening illness, the primary-care physician loses contact with him/her. If my patient is constantly in other doctor’s offices, undergoing uncomfortable procedures and treatment, it is hard for me to add the burden of another doctor’s visit. This is where I see social media as an exciting place for improving care and remaining in contact with my patients. It would be easy to check-in with patients privately on a business Facebook page (which I don’t have yet) or send  private tweets on how they are doing (once all the HIPAA compliant rules are in place). Even now they can send me a secure email private message. These channels would help me to identify when I might need to step in, give advice or just more support. The future is here and I’d like to embrace it. Family physicians have been giving patients bad news for a couple of hundred years. But only in the recent past have we stopped walking their journey with them. I don’t think that’s good medicine, for the patient or for me.

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