We’re Moving!!!

Photo: lendaproducts.com

Photo: lendaproducts.com

 

I am happy to announce that the PookieMD blog has moved to http://physicianpracticeseminars.com. The new blog has some cool features that I couldn’t do on this platform. 

 Ya’ll come visit and we will continue the fun!  See you soon!

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Book Club: The E Myth Physician

I love to read, especially anything related to business and medicine.  I have finally realized, after 15 years in practice, that is not enough to just be a doctor.  Whether we like it or not, we are all small business owners, and some of us are even entrepreneurs.  Today I will review The E Myth Physician, by Michael Gerber. Gerber is a small business guru, and has written extensively on how to start a business, and common mistakes entrepreneurs make.   His best book, in my opinion, is The E Myth Revisted.  I bought the E Myth Physician hoping for great things, but was disappointed.  The book simplifies when it should be more detailed, and lacks a clear understanding of what exactly physicians do. 

However, I thought the chapter, “On the subject of work” was worthy of discussion.  Gerber casts physicians in to three roles: that of the technician, and that of the manager, and that of the entrepreneur.  Physicians tend to focus on the technician role–that of seeing patients, curing diseases and saving lives.  There is also the role of the manager–scheduling the patients, filing, posting charges etc.  The physician may or may not be involved in the manager role, but none the less, if he isn’t he should at least know what the manager does!  However, according to Gerber, most physicians neglect the last, and most important role, that of entrepreneur.  You may have no interest in being an entrepreneur, but like it or not you are.  If you are an owner or a partner in a medical practice, you are an entrepreneur.  Ignoring this will not make it go away.

Gerber advises us to do “strategic work”  i.e. work on the business, not just in it.  He notes that entrepreneurs will do strategic work in order to help their practice/business thrive.   He advises us to ask and then visualize answers to the following questions:

  • Why am I a doctor?
  • What will my practice look like when it is done?
  • What must my practice look, act and feel like in order to compete successfully?
  • What are the Key Indicators of my practice?

The point of “strategic work” is to have us lift our heads up beyond the minutiae of everyday practice, and make sure our medical practice is in line with our vision of why we are doctors.   Asking these questions will help us design the future of our practice, and plan for that future.  One of my favorite sayings is, “Hope is not a strategy.”  We all need a clear vision of what we want our practice business to look like, why we are doing it, and how we will realize that vision.  To that end we are all entrepreneurs.

Hip Hip HIPAA–Myth Busting 101

Photo: starpulse.commythbusters003_m

As far as I am concerned HIPAA has added another layer of useless paperwork on to the backs of physicians, and I particularly resent the cost it has added to primary care.  Therefore, I was excited to see an article on HIPAA myths.  Below is my summary of HIPAA myth bustin’:

Myth 1: You can’t have a sign in sheet.  Yes, you can.  You must limit the amount of patient information on the list.  E.g. don’t have the chief complaint.

Myth 2: You may not say a patient’s name out loud in front of other people.  Again, say the name, but use the minimal amount of information, rather than, “Mrs. Dysmenorrhea, Dr. Strangelove is ready for your pap test.”

Myth 3: Patients may sue you for non-compliance.  No, but HHS (Health and Human Services) recently fined a home care companyfor a major security breach.  Moral: be especially careful with laptops, pdas etc.

Myth 4: Patients are entitled to a free copy of their medical records.  They are certainly entitled to the records, but not for free.  The cost to the patient may include the cost of labor to copy the records, as well as the cost of supplies and postage.

Myth 5: You may not use a fax to send protected patient information.  Not true, grass hopper!  Faxes must be sent to known locations, from secure machines, with the number pre-programmed to reduce dialing errors.  The cover sheet must contain a request to destroy the  information should it go to an incorrect destination.

So, be safe out there.  And yes, we can finally say our patients’ names again.

The Hospitalist Shift From Hell, and How to Fix It

I came home from my last 12 hour hospitalist shift exhausted.  My eyes were bleary eyed from staring at the EMR , and I was in the state of beatendownness where you have been totally crushed by admissions, cross cover, your coworkers, staff and patients.  Owning a coffee shop was looking better and better, and hey, I love coffee.  However, looking back at the shift from hell is helpful.

Here is a list of what went wrong,and how I will fix it:

  1. I didn’t have a check list in front of me.  I was rushed and frazzled, and didn’t go through my usual mental check list.
  2. I didn’t take a break.  I should have handed the shock box, I mean pager, to one of my co-workers and walked outside for a moment of peace.
  3. I ate too much crap.  Yes, crap. In my frustration I just put my face in to the fridge in the physician lounge and went for it.  Sigh.  I should have brought something from home.
  4. I doubted myself.  I spent a lot of time justifying my thinking to myself.  (I had just finished reading How Doctors Think, and was trying to double check my thinking.)  Doubt slowed me down to the point where I began to question everything.  Solution: hmm, brain transplant?
  5. I wasn’t wearing my scrubs.  I was trying to look more doctor like, so I had on a nice sweater, pressed pants, and the white coat.  (You men wouldn’t understand…)  Next time, forget fashion, I’m wearing scrubs.
  6. I let my colleagues get to me.  We were all crabby from the heavy workload.  Next time I will take a deep breath and remember we are all getting crushed, and put on the lens of perspective.
  7. I was quick to anger.  I got mad when a patient didn’t have a call button close to him, and I found it on top of the sharps box.  He had just had a total knee replacement, for pity’s sake!  I asked the nurse if the staff had a check list they followed when they cleaned the room, so this wouldn’t happen.  She indicated that “they’re pretty good at putting the call light where it should go.  I don’t think they need a check list…”  Ha I say!  How many times am I trying to find the blankety-blank call light for the patient?!  Time for another big breath!  (BTW, check out If Disney Ran Your Hospital.  Good ol’  Walt would see it my way!)
  8. I was exhausted from the get go.  My own mom was in the hospital recently and I spent a lot of time with her, which was good but tiring.  It was eye opening to be on the other side of the bed.  I tried to do too much, and should have gotten help from friends and family, AND NOT FELT GUILTY FOR ASKING!  (Yes, this is a woman thing,doctor thing,  mother thing, brought up Catholic thing.  I’m working on it.)
  9. I wasn’t wearing the no complaining bracelet.  I have a bracelet that I wear to remind me not to complain.  If I do complain, I move it to the other wrist as a reminder to stop carping.  I will wear it today.
  10. I worried too much.  I was worried about patients, my daughter, my dog being in a cold dog house, the dinner in the oven that would be waiting for me when I got home at 9:00 p.m.  And yes, I forgot to set the oven.   By focusing on worry, it was harder to place the focus where it belonged: on the patients.  The daughter and dog were fine, my husband turned on the oven, and the patients were okay.  Today I will leave my home worries at the door of the hospital when I go in.  They will be there waiting for me when I walk out late tonight.

By the way, the ED docs I worked with were great!  They knew we were getting crushed, and were kind and gracious in the face of the united hospitalist of grump coalition they faced.  Today will be better, I’m sure!

And lastly, I’m only human.

Disclaimer: I have no association with the authors mentioned above, and recieve no financial gain in mentioning their books.

Low Tech Health Care Reform: Stop Smoking!

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Photo: sonofthesouth.net

I have a very simple way to save the government billions of dollars in health care costs, and make Americans healthier, almost immediately:

Outlaw tobacco.

Likely to happen? Not a chance.  The tobacco lobby is way too powerful, and the tobacco states will rally loudly and strongly against it, not to mention big pharma that will see a decrease in revenues as the use of patches, gums and pills goes down.

Okay, next option: tax the poo out of cigarettes.  Currently the average tax by state on a package of cigarettes is $1.19.  The state with the lowest?  Not surprising, South Carolina, where the tax is just $0.07.  The tobacco states  average is $0.33 per pack, while other states average is $1.30.  Pathetic, but it shows that there is a lot of room to increase the taxes, especially in the tobacco states.  There should be a HUGE federal tax on cigarettes.  Likely to happen?  See above r.e. tobacco lobby.

Next option: teach ’em young.  The feds need to mandate a  ‘smoking is bad’ curriculum YEARLY kindergarten through 12th grade.

Last option: We docs keep plugging at our patients.  I’m not so optimistic on this accord, but I’ll keep trying.  Here was my must recent attempt to convince a patient to stop smoking.  I report a conversation I had with a 70ish year old gentleman, on his way to the OR to have his foot whacked off secondary to peripheral vascular disease.

Me:  (earnestly) Mr. Marlboro, what can I do to help you stop smoking? Would it be helpful to have the nicotine patch while you are in the hospital?

Mr. Marlboro: (just as earnestly)  No, I don’t need the patch.

Me: You know, while you are in the hospital, it’s a great time to quit, because you can’t smoke here.  Besides, cigarettes are so expensive.

Mr. Marlboro: Well, I don’t care about the expense.  I’d just spend the money on something else.  Besides, I’ve smoked all my life, and it’s never hurt me.

At this moment, the transport team arrives to take him to the operating room.

Me: (defeated) Oh.

Good luck out there.  Sounds like I need to brush up on my motivational stop smoking speech, as I’m not envisioning President Obama or Mr. Daschle following my suggestions.

Health Care Reform With Out High Tech: Changing a Culture of Fatness to a Culture of Fitness

flickr.com

photo: flickr.com

 

President Obama has a stimulus package all ready to roll out.  Reportedly, it will include money ear marked to expand COBRA.  If this is true, there will be precious little left to fund the ‘everybody has to have an EMR’ mandate.

Good, I say.  Let’s work on some low tech solutions that will reap true benefits.  Yes, I admit that the low tech, grunt it out in the trenches approach is not nearly as sexy as an EMR with bells and whistles, but this time, I think low tech will trump high tech.  Here goes the PookieMD save the world through hard work approach:

First, focus on America’s growing middle.  Here are five low tech ways to cut the fat and increase activity.  (Literally and figuratively!)  I will work from the global to the micro.

  1. Mandate the physical education be held every day from kindergarten through 12th grade.  Our plump kids are the diabetics  and cardiac stentees of tomorrow.   Making time for health now will pay off immensely later as we make physical movement a daily part of children’s day.  (By the way, cup stacking is not a sport!  Getting the heart rate up counts!  For a great look on what happens when schools institute a required daily physical education class read Spark, by John Ratey, MD.  Hint: test scores go up, learning improves and discipline problems go down.  Pretty good for having a bunch of kids run around a track!)
  2. Offer tax benefits to companies that have in house exercise programs.  Tax benefits would be proportional to percentage of employees participating.  We need to change the culture of fatness into a culture of fitness.
  3. Get your office workers in shape.  With all due respect, many times the office help are bigger than the patients.  One practice I know had a very successful biggest loser competition.  Why don’t YOU sponsor it, and include yourself? Consider a small prize (gift basket with soaps/lotions?) for the biggest loser.  Of course, absentee rates and sick days will go down as you and your staff get more fit.
  4. Make fitness a part of your office culture.  Have info on health clubs, classes, rec centers available.  Consider a group visit for obese patients, focusing on exercise. Do group walks, enter a 3 k, host a weight watcher type group, do SOMETHING.  Getting your office in the news would be a nice side benefit.
  5. Encourage patients to “chunk”.  (No we don’t want chunky patients!)  The surgeon general recommends 30 minutes of exercise daily.  Encourage the couch  potatoes to start by walking 15 minutes two times a day, or 10 minutes 3 times per day.  There is no law that says it should be all at once, although it’s a good goal.  For the  obese, a gym can be intimidating, so start simple: encourage walking, then jogging, and then maybe a trip to the gym.  It doesn’t get much easier than a walk around the block or up the stairs.  (You do take the stairs at the hospital don’t you?)  Additionally, the television is filled with exercise shows–for those who still can’t tear themselves away from the small screen.

These ideas aren’t new, definitely aren’t sexy, and won’t get your sponsorship from a drug company.  However, they will work and we, as physicians, hold the keys.  We need to start with legislation, and move on to what we as ‘health coaches’ can do.    We can have huge impact on the huge, and not so huge.  Please, please, let me know what WE can do together to move our country to health, starting TODAY in our medical officese and clinics.

Technology will not save health care, personal responsibility will.

 

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During  President Obama’s speech he stated

“We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost.”

I completely, totally disagree.  President Obama, health care doesn’t need high technology, health care needs personal responsibility.  America’s health care costs are excessive for several reasons, and most have nothing to do with technology.  America spends 15% of it’s gross domestic product on health care, or from a different perspective,  $5711 per capita.  Our closest big spender?  The wealthy country of Luxembourg,which spends $4611 per capita.  Japan spends $2249, and Italy, where they eat all that pasta, spends $2314 per capita.  Why are we spending so dang much?

Here are the reasons, and they have nothing to do with technology:

  1. We Americans are pigs.  30% of our population is obese.  Note I said obese, not over weight.  We eat in our cars, chow on super sized fat filled “fast food”, and consider opening the refrigerator a sport.
  2. Television watching has morphed into an art form.  The average American watches FOUR hours of T.V. daily! Who has time to watch that much?!  In addition the wii is now considered a way to exercise.  C’mon, gimme a break!  The only way a wii can help you get exercise is when you walk the cardboard box it came in out to the garbage.  (Yes, I have played!)
  3. The Marlboro Man still rides.  Nearly 20% of Americans still smoke.  (Sadly, including our president.)  Those most likely to smoke were those below the poverty level, with the least amount of education, (and the least access to health care).

Sloth is causing Americans to be unhealthy.  High technology will make us more efficient in the way we diagnose and treat illnesses, but it will not prevent them.  Obesity, tobacco and inactivity are the root cause to heart disease, diabetes mellitus, many cancers, and  COPD.  The fanciest technology in the world will not change this.  What will?  America will spend less when we have sweeping cultural changes such that Americans get off the couch, toss away the remote, and spend their money on healthy foods, rather than cigarettes and french fries.

President Obama, I’m glad you’re here, but please, focus on the root of the problem.  Pruning the tree will not change the roots!

Next post: HOW we can create a healthier America with out expensive high technology.