I Have To Believe In My One Percent – Dr. Eric Schultz

It’s a rainy Saturday night, and I’m huddled in a doorway, pleasantly buzzed after a few drinks with a beautiful Russian girl I will never see again. The sky is wet iron, tinged with bronze from the reflected light of San Francisco. Rain patters the concrete and nips at the hem of my jeans. The moment is broken when a distinguished man hurries towards me and says:

“Listen, you’ve gotta help me. My name is Roland Chase. I’m from Burbank. I was driving up the coast when I was carjacked. They took my wallet, man.”

His salt-and-pepper beard is shaved very close. Clean leather shoes, but a cheap watch. He’s awfully dry for someone who was carjacked in the rain. Noticing details is part of my training.

“My wife and kids are in the car waiting for me. I called the CHP and they won’t help me. It’s only $12.87 for a can of gas….”

Not 20 bucks; $12.87. Scams work better with specifics. To him I must look like another kid on the town with more cash than sense. I wish I had gray hair to match my years of cynicism.

Clouds pout overhead. An 80 percent chance of downpour, 99 percent chance of scam.

I’m an ER doctor. I trained in the worst neighborhoods of L.A. and Philadelphia. The paramedics would bring me the freshly dead, all gray and blue and colors that people shouldn’t be. I’d pump on their chests to try to bring them back. I’d juice them with adrenaline, shock them with electricity, even cut open their chests to squeeze their hearts back to life.

Dead stays dead. When you don’t take care of your diabetes or your high blood pressure, you’re asking for reprisals. Crack cocaine and Mad Dog are not good bedfellows. With every death, I got weaker, smaller.

But I never lose kids, I used to say. No child dies in my ER. I had to draw a line somewhere.

Baby Jessica was only 11 days old when her parents rushed her in. She was small even for a newborn. I’ve eaten bigger burritos. Her skin was cold, her arms limp at her sides. We put a tube down her tiny throat and pumped in oxygen. We gave her saline and sugar and antibiotics.

She was 12 days old when she died. Her parents stared at me without speaking. The pediatrician, a prim tiny woman who could have been anyone’s favorite aunt, tried to console me. I didn’t stand a chance, she said. One percent at best.

“Sir, can you just help me out with a little something….” Chase pleads with me, pulling at the sleeves of his coat like a junkie. I feel his need burning.

By my final year of training I was burned out. I had lost too many times. I hated medicine. I hated pumping on dead people and I hated trying to take care of idiots who didn’t care for themselves.

It was Christmas Eve when the paramedics rolled Rosalita in while she flailed in the throes of a seizure. She had just had a baby six weeks earlier, and her tear-stained sister told me she had tried to kill herself. If I didn’t figure out what she had taken, her brain would fry in her skull.

Only one small detail of the EKG tracing stood out. It suggested tricyclic antidepressant overdose. I picked up a syringe of sodium bicarbonate: baking soda in water. It was a long shot. Less than one percent.

Rosalita awoke three days later. I watched her take the first steps of her new life. “My legs hurt,” she whined. “Can I have a pain pill?” I would have liked gratitude, but I don’t need it. Every year on Christmas Eve I toast to one less orphan in the world.

Yesterday a gallon of blood drained onto my shoes while I struggled to keep a man alive after he flew off his motorcycle. I still try to convince alcoholics to go to AA, smokers to quit, diabetics to take their insulin. I still scream “Don’t you die on me!” and yet they do. Even children.

I hand $20 to Mr. Ronald Chase, or whatever his name was. He rushes off, his heels clapping wet pavement. Ninety-nine percent chance he’s off to buy a forty or crack or black tar heroin or whatever.

But maybe, just maybe, he’ll fill his gas can and rescue his family from a dark street on a rainy night.

I have to believe in my one percent.

Source: One Percent | California Magazine

Why your next ER visit could cost you more if you have BCBS

A trip to the emergency room could soon become more expensive for some Texans. Starting June 4, the state’s largest health insurance provider, Blue Cross Blue Shield, is changing how it processes ER claims.

The company says the change is for BCBS’s fully insured group and retail HMO members. If you go to an out-of-network ER for something they determine wasn’t serious or for a life-threatening condition, the company says you may be responsible for the total cost.

According to BCBS, the review process for claims after June 4 will be the following:

  • Request medical records and an itemized bill for the claim.
  • BCBS will review each medical record and eliminate inappropriate charges. The member’s symptoms and concerns will be reviewed.
  • Pend – not deny – claims during the review
  • Review each claim using a multi-step process.

A BCBS spokesman said in Texas some members were using ER for things like head lice, thinking it’s more convenient.

According to a national study by RAND Corporation, about 13.7 to 27.1 percent of all emergency department visits could be taken care of at urgent care centers or clinics. They say that could lead to savings of approximately $4.4 billion annually.

The Texas Association of Health Plans released a separate report, analyzing costs at different types of facilities.

According to TAHP, if you have bronchitis, you could spend about $3,000 to receive treatment at an emergency room. But if you saw your doctor, the cost is reduced to $136. At an urgent care, they estimate you’d spend about $167.

But emergency medicine physicians worry the change will deter people from going to an emergency room when they really need it.

“As patient advocates, it’s our duty to speak out and stand up for the patients, especially the ones that are weak and vulnerable,” said Dr. Nicholas Steinour. “When you’re sick, when you’re injured, when you’re concerned, the last thing we want you to do is think about is the insurance company going to help me on this?”

As an example, Steinour talked to us about having a sore throat. If you go to an emergency room with a sore throat, and they determine it’s a respiratory infection, you’ll have to pay for your visit. But he said a sore throat can be a sign of more serious infections.

“Just as likely or potentially likely you could have a peritonsillar abscess or epiglottis that without a trained medical expert looking in your throat, doing the appropriate testing we’re not going to be able to safely exclude,” he said. Steinour explained those conditions, if left untreated, could block your airway.

“When the ambulance sirens are on there’s a reason for that,” he said. “There are many conditions where seconds, minutes, certainly hours, make a huge difference as far as outcomes go. The last thing we want you doing is stalling, calling an insurance company to ask is this OK. That to me is completely inappropriate and really irresponsible.”

Anand Raghunathan is a stroke survivor. He talked to KXAN about why seconds matter in emergency situations.

He said back in 2001, he was in his mid-20’s. He was healthy. But he suffered a stroke. “My right side basically collapsed,” he said.

Raghunathan said his friends took him to an emergency room almost right away, and he doesn’t know what would’ve happened if he waited any longer to go seek medical attention. “Word finding, memory issues… That could’ve been a lot worse had I not gone.”

In six other states, Anthem has already rolled out its “avoidable emergency room policy.”

But there are some exceptions. That includes if a patient is sent by ambulance, when a patient is under the age of 15, lives more than 15 miles from urgent care or is seen on weekend nights or holidays.

Have a comment? Leave it in the post below:

Source: Why your next ER visit could cost you more if you have BCBS – BIGCOUNTRYHOMEPAGE

Drug epidemic ensnares 25-year-old pill for nerve pain

WASHINGTON — The story line sounds familiar: a popular pain drug becomes a new way to get high as prescribing by doctors soars.But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments. The drug, called gabapentin, is one of the most prescribed medications in the U.S., ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients.Those same forces are changing the drugs that Americans abuse, according to experts.“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the over-the-counter diarrhea drug Imodium.The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb.“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016.Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including possibly reclassifying it nationwide. Like others, Peckham says gabapentin is not dangerous on its own, but can be when combined with opioids and other drugs that suppress breathing.Still, there is little consensus about the next steps, or even the scope of the problem.Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors with nerve pain, says he has never seen patients deliberately misuse gabapentin.And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Center for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.But there are questions about how much is being prescribed for proven uses — and to what extent patients are benefiting. A recent review of research by the Cochrane Group confirmed gabapentin’s benefits for several forms of nerve pain, but found little evidence of its effectiveness for more common muscle and joint pain.Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA

Source: Drug epidemic ensnares 25-year-old pill for nerve pain

When a Physician Gets Yelled At – Jordan Grumet MD

It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children, and grandchildren. It was a good relationship — until Harvey got sick, that is.

Originally, there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle-aged man. A few CT scans later, and he was in the oncologist’s office discussing chemotherapy. A regimen was decided on, and therapy began the next day.

Therapy was hard. Nausea. Retching. More weight loss. Far from feeling better or cured, Harvey could feel the clothes slipping from his emaciated body. It was as if life itself was drip dripping away as the chemo bulldozed into his broken veins. And this pissed Harvey off.

He lashed his family. He cursed his friends. He spun into a whirlwind of the most resistant depression. A depression, his therapist would later tell me, whose only salve was anger. While the anger allowed him to carry on, often he left those around him scorched.

His doctors were no exception. We often spent half of each visit withstanding abuse before getting down to the business of the appointment. He blamed us for the cancer. He blamed us for the lousy response. He blamed us for the side effects of his abysmal treatment.

So when I walked into the hospital room to tell him the scans showed his latest chemotherapy had failed to stem the red tide of death, I have to admit that I had already somewhat detached. How could I not? Although he was fairly lathered by the results, it was the mentioning of hospice that finally led to my expulsion. His wife ran after me with tears in her eyes. I’m quite certain that she paid dearly for her kind act of decorum.

Harvey died shortly thereafter.

I am prone to remember the pleasantries Harvey, and I enjoyed before his health deteriorated. I am neither disturbed nor saddened by the anger. I cannot even say that I would not have been the same way if I had been lying in his hospital bed.

What surprises me, in retrospect, is how little he affected me and how his anger didn’t penetrate the hardened shell.

Over my career, I have been yelled at, cursed, blamed, hugged and even loved by my patients. And like the poor life force oozing out of Harvey’s beleaguered body, it drip drips down my back.

And into a forgotten puddle on the ground.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion.

Source: When a physician gets yelled at

ER doctors: Anthem policy to deny coverage for some visits is dangerous

A group of emergency room doctors is pushing back on a program from Anthem Blue Cross and Blue Shield that could deny reimbursement for those using the hospital emergency room for treatment the insurer doesn’t deem an emergency.

Emergency room physicians say the policy ultimately could lead to higher health-care costs or even lost lives.

But the Indianapolis-based insurance company said treatment in a hospital emergency room is considerably more expensive and time-consuming than if a patient had gone to an urgent care or walk-in clinic.

In an attempt to contain healthcare costs, it began testing a program — that began rolling out in Georgia, Missouri and Kentucky in 2015 and was extended Jan. 1 to include Indiana, Ohio and New Hampshire — that could deny reimbursement for emergency room visits the insurer deems unnecessary.

The program applies to those with an Anthem plan provided from an Indiana employer or a policy that was purchased on the individual market. Anthem would not reveal how many customers it has, but the company indicated it is the largest health plan in the state.

“Anthem’s avoidable ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies as the costs of treating non-emergency ailments in the ER has an impact on the cost of healthcare for consumers, employers and the health care system as a whole,” Anthem spokesman Tony Felts said via email.

But the change has caused a backlash of criticism and stories of people who went to the emergency room because they thought they were suffering from a serious issues, but ended up with significant medical bills because their conditions were deemed to be non-emergency matters.

The American College of Emergency Physicians has fought back against the policy by issuing press releases and videos highlighting the dangers in the program. Beacon Health System declined to comment on the issue, but Saint Joseph Health System indicated it has taken action to build awareness about the change with signage and handouts throughout its physician network locations.

“Unfortunately, patients impacted by policies like these are sometimes unclear about what the policy means as far as the way they receive or seek medical care,” Saint Joseph spokeswoman Jessica Schramski said in a statement. “These policies often encourage patients, without any medical training, to make decisions about what constitutes an emergency. …”

We urge patients to always seek medical care immediately if they feel they are experiencing an emergency.”

Dr. Gina Huhnke, immediate past president of the Indiana chapter of the College of Emergency Physicians, said it seems as if Anthem is using Indiana and the other states as a testing ground for a practice that will likely keep expanding or be adopted by additional insurance companies.

Non-emergency use of emergency rooms isn’t nearly as widespread as Anthem suggests, with only about 5.5 percent of the ER visits labeled as non-urgent based on figures from the Centers for Disease Control, she said. Conversely, 94.5 percent of ER visits are therefore real emergencies, she added.

“The problem with the policy is that it puts people in the position of trying to make a diagnosis before deciding where to go,” said Huhnke, who is an emergency room physician in Evansville, Ind. Chest and abdominal pain are common reasons for a person to visit the emergency room, she explained.

And if someone with a significant problem goes to a walk-in clinic or ignores the problem altogether, the situation could get a lot worse, resulting in even higher medical expenses for the insurance company, she explained.

“My biggest concern is a patient who won’t seek care when they need it because they are worried about the bill,” she said. “A person with no medical knowledge cannot be expected to make an accurate diagnosis before deciding where they should go.”

And it’s unfair for Anthem for saddle patients with the bill if they made the wrong diagnosis or didn’t have the ability to get to a walk-in clinic, she said.

The emergency physicians said health plans must provide fair payment for emergency services or patients will suffer. It said the public should contact legislators and others to fight back.

But Anthem already has and will continue to make changes to the program to ensure it is effective and fair, Felts said, adding that it has “expanded the list of always-pay exceptions.”

“If a consumer chooses to receive care for non-emergency ailments at the ER when a more appropriate setting is available, an Anthem medical director will review the claim information and medical records using the prudent layperson standard. In the event a member’s claim is denied, they have the right to appeal,” he explained.

Source: ER doctors: Anthem policy to deny coverage for some visits is dangerous | Public Safety | southbendtribune.com

5 things doctors should always subconsciously communicate to patients | Suneel Dhand

Communication is the cornerstone of good healthcare. Despite all the external challenges we face with the system in which we work, those few minutes we spend with patients and their families are precious—and are what we will be remembered for. We therefore owe it to our patients to be at our very best and to make them the absolute center of our world for that time. Few things could be more important for a physician than being able to communicate well.

Communication is, after all, a science—and it’s an area that I am personally very passionate about. I have been honored to give many presentations on this subject, and even one-on-one coaching to my fellow physicians. It simply is not taught enough in medical schools. To be honest though, I do not believe there is any teaching in the world that could ever turn a poor communicator into a great one (just being brutally honest). However, there is a huge amount that any physician—or for that matter any professional—can do to greatly enhance their communication techniques.

The way anybody communicates and the way the recipient interprets everything is a complex interplay of many different factors; what we say, how we say it, and our non-verbal behavior including disposition and mannerisms (most research suggests that the vast bulk of our communication is in fact non-verbal). Here are 5 things that every physician has to always subconsciously communicate to their patient:

1.I am competent

It goes without saying that a physician must come across as being totally knowledgeable and confident in their field. They know their trade down a tee and project that in a calm and down-to-earth manner to their patient: “I am the best and you can trust what I am saying”.

2.I am not in a hurry

Working as a physician is one of the most hectic, unpredictable and high-pressured jobs. The reality is that any doctor is always going to be hurried and have a million and one things to do. However, doctors should strive to never allow their non-verbal behavior to project this to their patients.

 3.I am not motivated by money

I was at a party recently and was talking to another guest who had suffered an orthopedic problem. He went to see a specialist in upstate New York, and came out of the appointment convinced that the orthopedic surgeon was trying to be as interventional as possible “to make money”. I’ve actually heard patients make comments like this before, worried that a doctor is trying to “make money off them” by doing more tests. I cannot speak about whether these allegations were true or not (and I believe it’s the minority of doctors anyway who may be like this), but clearly the patient came out of the appointment thinking that. We can get into a debate about healthcare systems (and I’m certainly no fan of heavily centralized socialized medicine)—but at the other end of the spectrum, it’s terrible if any physician is purely motivated financially or for any reason projects this to their patients. The absolute last thing a doctor should be communicating is that they are driven primarily by money.

4.I am more interested in listening than talking

The average physician lets their patient speak for about 20 seconds before interrupting. Sure, all doctors certainly need to stay focused and remain time conscious—but give your patients a chance to speak! Just as in your personal life, sometimes you’ve got to just slow down, stop and listen—ceasing doing all the talking. Remember the famous wise phrase: “If speaking is silver, then listening is gold”. Also, no doctor should ever leave without giving the patient and their family a chance to ask questions.

5.I truly care about you

This relates to some of the above points as well, but the number one thing a physician should be communicating is their total care, dedication, and service to their patient. Nothing but the patient’s welfare is in our hearts. We want them to get better and be healthy as soon as possible and our communication displays empathy and compassion. Hippocrates, the father of medicine, put it very well over two-and-a-half millennia ago: “Cure sometimes, treat often, comfort always”.

Source: 5 things doctors should always subconsciously communicate to patients | Suneel Dhand

10 rules for frontline physician sanity | Suneel Dhand

These are tumultuous times for practicing physicians. The healthcare landscape is changing at breathtaking pace and less and less of our time is spent doing what we were actually trained to do: taking care of patients. I absolutely love the patient care part of my job, do everything possible to always remember why I went to medical school in the first place, and maintain focus on the aspects of my work which bring me the most personal satisfaction.
Here are my 10 rules for frontline physician sanity:

1.Clearly separate clinical from bureaucratic work
As more of our day is being spent on tick box and administrative duties, try to have a clear separation between the direct clinical work, when you are on show to the world and practicing your true art, and when you are performing those mind-numbing bureaucratic tasks. Also don’t be afraid to tell any administrator (politely and diplomatically of course) to either email you with any issues, but not to call or page you while you are seeing patients.

2.Try to spend as much time as possible with patients
Have an acute awareness of the time you are spending at your screen during the day. For most physicians, every extra minute will greatly increase the chances of burnout and professional misery. Try to view the computer as the tool it’s supposed to be (and in an ideal world should be), not as the main focus of your whole job as a doctor. Check out my article here about how I do this, so I can actually spend more of my day doing what I love.

3.Work out the computer shortcuts
Following on from the above point, every computer system will have its own unique quirks and shortcuts, that can significantly speed up your workflow. Spend time familiarizing yourself with these and document the minimum amount necessary for good clinical care and other necessary bureaucratic requirements.

4.Take regular breaks
Doctors are humans after all. The long hours are grueling and due to the unpredictable nature of medicine, doctors are nearly always running behind. Before you know it, your lunch break should have been 3 hours ago. Be strict with yourself about taking regular breaks, even if they are very short and involve you just closing your eyes and deep breathing (mindfulness exercise). Clear your mind at every opportunity. Also remember to eat regular healthy snacks during your day.

5.Make friends with those you work with
Any job is a whole lot better if you get to know, and ideally befriend, those around you. And that doesn’t just mean your immediate colleagues. Also the nursing, kitchen and even house staff. People you encounter every day. Have you been working with someone for an awful long time, and have no clue whether they have children, holiday abroad, or own a dog? Get chatting to them.

6.Empower yourself to improve the system
Change happens one small step at a time. There are undoubtedly countless ways that the system you work in, can be made better. Have you noticed a glitch in a process, a problem with patient care, or a glaring safety gap? Then give feedback! Whether or not anything immediately changes, your job is a lot more meaningful if you invest yourself in your workplace.

7.Take everyday frustrations in your stride
There isn’t a healthcare system in the world which is perfect. All western countries are struggling with the need to control escalating costs and manage chronic disease—all against the backdrop of expensive new treatments and aging populations. You cannot avoid daily frustrations. While they may occasionally get you down, if they are repeating themselves each and every day, is there a better way you can handle them? Another technique is to always come back and make everything about your patient: the zone where it’s all about you helping someone (probably why you first went to medical school).

8.Try to be as on schedule as possible
The reality of medicine is that you can spend 24 hours a day caring for patients, and there will still be more to do. For doctors’ own well-being, it’s important to try to be as organized and strict with time as possible. That doesn’t mean you should cut people off or be in a visible state of hurry. It just means you desire a good work-life balance and will structure your day around trying to finish at a reasonable time.

9.Have some great hobbies and lead a healthy lifestyle outside
Away from the workplace, and even away from family, have something that truly relaxes you and gets you away from it all. If could be hiking, golfing or boating. It could even be something else you’ve always wanted to do like swing dancing or martial arts (even better if it involves learning something new). It also goes without saying that for peak mental health, you should always strive for great physical health. So eat healthy foods and get plenty of exercise! Moreover as a doctor, what could be better than being a role-model for your patients in this regard?

10.Always have a long-term plan
It’s no secret there’s an epidemic of physician burnout and job dissatisfaction out there—that’s directly linked to the monumental loss of control and autonomy in our profession. I’ve found my own way to maintain my great love of medical practice and seeing patients, while also having other creative endeavors going on. If you’re completely happy in clinical practice, then great! If you aren’t though…hopefully your intention isn’t to leave completely, but whatever your long-term goal is: always be taking small steps to it every day.

Source: 10 rules for frontline physician sanity | Suneel Dhand

The real painting that speaks a thousand words, inspires me, and reminds me why I went into medicine | Suneel Dhand

A few weeks ago, I wrote a brief piece about a chart that speaks a thousand words. It’s basically quite an obnoxious graphic that shows the proliferation of administrators in healthcare, compared to physicians, over the last few decades. I’d encourage anyone who wants to understand where US healthcare has gone wrong, to simply look at this chart (click here to see it).

At the opposite end of the pleasant visual spectrum, I’d like to discuss a painting that totally inspires me every time I look at it. It’s a very famous painting that many of you may have already seen before. You can view it above. And before reading on, really look at it for a moment.

The painting was commissioned by Sir Henry Tate (founder of the Tate Gallery) in London in 1890. Sir Tate gave Luke Fildes, a well-known artist at the time, license to paint a picture of his own choosing. Fildes decided that he would paint a picture from a moment in his life that had greatly affected him. In 1877, Filde’s first son had tragically died in infancy. The doctor who took care of his son was a dedicated and compassionate physician, who held attentive vigil over his ailing child. The character and disposition of the doctor left a deep impression on Fildes, at a time when he was beside himself with anxiety and emotion. This impression remained with him for the rest of his life. The simple devotion of the doctor is depicted so touchingly in the scene.

From the moment it went on display, the painting became a public sensation. This was Victorian England, there was no television or mass media, and large swathes of the population couldn’t even read. It was so popular that it toured Britain, garnering attention wherever it went. There was one report of somebody being so overwhelmed by the painting, that they died on the spot. It was then reprinted in America, where it also sold over a million copies.

The painting has since become an icon for one simple reason: It symbolizes the good, caring, humble doctor—in complete service to an ailing and vulnerable patient. To me, it also means something else in these tumultuous times in healthcare. It serves to remind me of the human connection that lies at the core of all good healthcare. In our current system, it’s sadly the patient who so often gets lost in everything. We are overwhelmed by bureaucracy and administration. The typical physician now spends the vast majority of their day performing mind-numbing bureaucratic tasks—typing and clicking away on a computer. Perhaps the painting today would even be called “The Provider”—if corporate medicine and the world of regulators had anything to do with it—and would undoubtedly show the provider staring at a computer screen with concern, instead of the actual patient.

A while back, I wrote an article about an “old-school physician” I encountered, who made me reflect on how medicine has changed (you can read the article here). That’s the type of physician I had in mind when I first applied to do medicine. I was also privileged enough to be taught in medical school by physicians like that.

The Doctor represents the ideal that we should not only all be aspiring to, but also the ideal that will bring us the most career satisfaction. At a time when there’s an epidemic of physician burnout and job dissatisfaction—this 19th century painting should give us all pause for thought. Within that vision is symbolized an eternal truth. One that our patients are crying out for every single day. A good, caring doctor who connects with them and gives them gentle and honest attention.

Source: The real painting that speaks a thousand words, inspires me, and reminds me why I went into medicine | Suneel Dhand

Common Everyday Communication Complaints – Suneel Dhand MD

As physicians go about their extremely hectic days, see patient after patient, and balance it all with an ever-increasing administrative workload, it’s so easy to forget how each and every patient is a unique person with their own story to tell. It may seem like the next case of congestive heart failure or COPD is something we’ve seen a million times before—but who knows where the patient is in their understanding of the illness or their inner emotional state when we get round to seeing them. That’s why those precious few minutes we get to spend with our patients is the most important part of the day. That person may have been waiting hours to see us, so it’s crucial all doctors are able to get into the “zone” and give them the attention they deserve.

If we look at the total number of healthcare complaints that are given across America (or even the world), I’d hazard a guess that being on the receiving end of poor communication ranks well ahead of medical errors, adverse side-effects, or even cost objections. As somebody who, like most physicians, has heard hundreds if not thousands of these types of complaints, and is now in a position where I am teaching and writing about frontline communication skills—the issues that usually lead to negative feedback are typically quite basic, and don’t take too much time to prevent. Here are 5 of them:

1. “My physician was just too rushed”

This is probably the most common gripe. Yes, doctors are all very rushed, and healthcare is a frantic environment by its very nature. However, no doctor should ever give away their hurriedness with their body-language, tone of voice or mannerisms. Appearing calm and like you have all the time in the world (even when you don’t) is the noble goal to aspire to. It is often said that the greatest gift you can give to anyone, is the purity of your attention. For nobody is that more true than for a doctor who is faced with a patient.

2. “My doctors didn’t speak to each other”

This phenomenon, which I have previously named Too Many Cooks in the Kitchen Syndrome”, is endemic across America. How confusing it must be to get two doctors coming in to see a patient within minutes of each other, frequently giving them and their family completely contradicting messages. It could be a diagnosis or discharge date mix-up, but it’s enough to make the patient feel like there’s no true captain of the ship. The last thing anybody wants to feel when they are sick. It’s understandable that these types of experiences are going to bother, and probably irritate, our patients.

3. “My doctor acted dismissive”

There’s no such thing as a bad question or thought. Even if it’s that patient who is “Dr Google” and has brought with them reams of printed information, that’s just something we have to professionally deal with. After all, it’s their body in the end—and I’d take that extreme over a patient who doesn’t care or wants to be spoon-fed. Patients have a right to ask questions and it’s the physician’s job to act professionally, being the calm and understanding voice of authority.

4. “My doctor didn’t explain things coherently”

In the healthcare bubble, it’s all too easy to assume that our patients are completely health literate and understand all of the technical jargon. Knowing the appropriate wording to use according to education level, is something that can usually be figured out quite quickly within minutes of talking to any given patient. I’ve been surprised by so many seasoned physicians, when hearing them talk to patients both over the phone and in the hospital—using highly complex medical terminology that even I may need to look up myself!

5. “The doctor didn’t seem to care”

This is just about the worst thing that any patient can ever perceive after an interaction with a doctor. Fortunately, I’ve hardly met any doctors who truly don’t care. The issue is not so much questioning the reality of a physician’s dedication, but how they come across when they are communicating with patients. The first thing that any doctor must do to ensure that nothing like this ever happens, is simply to make sure that they listen more than they speak. That’s always the very first step in portraying empathy and compassion in any discussion.

The above complaints could actually occur with any professional who is dealing with the general public. But they are more important to avoid for anybody who works in healthcare, because we work in an emotionally charged environment—with matters of health, life and death on the line. Remember, good communication lies at the core of all good medical care. That doctor-patient moment that we get is where the “magic” of medicine occurs. It’s a time that is all about the physician, their skills, and using them to serve a patient. It’s a point of the day that no regulator, administrator, or computer can ever interfere with—if doctors choose for it to be that way. And the best way to do that is simply by making it all about communication and connection with the suffering human being who is wanting to put their trust in a dedicated physician.

 

Source: Common everyday communication complaints | Suneel Dhand

Physician communication skills: Meet Dr Steele and Dr Cooper | Suneel Dhand

There are two doctors working at the local hospital. They are both around the same age, been in practice for several years, and in the same specialty.Dr Cooper grew up in Ohio and went to medical school in California, before moving to New York after his residency training. Dr Steele grew up in Michigan, where he also went to medical school, before completing his residency in Florida, and then ending up in the same hospital in New York.Dr Steele isn’t as smart on paper as Dr Cooper. He got average USMLE scores and didn’t get into his first choice residency program. He just scraped by on his boards, but is now well established after a few years in practice. He enjoys most of his work, is loved by his patients and the staff he works with. He’s a great team player, connects well with all his patients and their families, and gets glowing reviews from them. He is jovial and cordial in his interactions and knows how to talk to people.Dr Cooper, on the other hand, went to one of the best medical schools in the United States and pretty much aced every single exam. He then completed his residency at a top medical center, before moving to the same hospital as Dr Steele. Dr Cooper unfortunately is not as good at communicating with patients. He is sound technically and has stellar medical knowledge, but is just not as polished when he talks to patients. He’s not terrible, certainly well-meaning, but just doesn’t interact well with patients and their families! They complain that he seems a bit rushed at times and doesn’t explain things in layman terms. The nursing staff think he’s occasionally a little abrupt with them, and is not very approachable. There have been a couple of instances where they think he’s got a bit mad with them over the phone, and they generally don’t like working with him. When his immediate clinical supervisor, the physician head of his group, speaks with Dr Cooper at the end of the year and diplomatically gives him some feedback, Dr Cooper is surprised to hear these things, and has no idea what he’s doing wrong.Anybody who works in healthcare is familiar with the above scenario. Doctors who are like night and day, within the same group. So what’s going on with Dr Cooper? He seems pleasant enough when you talk with him and is certainly a highly intelligent individual. What he is lacking unfortunately is one of the most important skills a physician can have. It’s a skill that’s woefully under-taught to all students, but is a bigger problem when it’s not taught enough to a healthcare professional. Let’s remove the jerk factor for a moment—because sadly in all fields of life, there are always a few people who simply don’t care and have little desire to communicate better. These are few and far between, and the vast majority of everyone in healthcare is always receptive and looking for ways to improve. Here are 3 things that were never taught to Dr Cooper:1.Listening skills If speaking is silver, then listening is gold. Being a good and sincere listener is the cornerstone of great communication. We are all very good at talking, but it’s the listeners who are actually the best communicators. Studies have shown that the average physician interrupts their patient about 20 seconds into talking. Of course, physicians have to remain focused due to time constraints, but 20 seconds isn’t nearly long enough if somebody has something important they are trying to tell us!2.Interpersonal skills with patients and colleagues. How we come across when we talk with people is something most of us are unaware of, or have never had any professional feedback on. Very subtle verbal and non-verbal behaviors will determine on a psychological level, whether people are likely to warm to you, especially in a professional situation. There are a myriad of factors including tone of voice, how you acknowledge what the other person is saying, and even how you smile. Most physicians can easily learn techniques to improve some of these. Ditto for how you talk with professional colleagues!3.Empathy and emotional intelligenceEmpathy is a trait that is also intrinsically linked to many of the above points, especially listening. Emotional intelligence is simply the ability to recognize your own, and other peoples’ emotions, and accordingly guide your own behavior. Healthcare being the unique field it is, improving this part of your character will greatly enable you to show more compassion—which is a crucial aspect of being a great clinician.These are just 3 things Dr Cooper can learn to improve his communication repertoire. Let’s be realistic: there’s probably no amount of teaching or coaching in the world that can turn a really bad communicator into a great one. Or ever make somebody who is at heart insincere, into a sincere one. However, there is always a lot that can absolutely take anybody up a few notches on the communication spectrum

—where they are at least not bad communicators. Speaking as someone who regularly teaches communication skills, I am convinced that everybody is capable of this. I was recently at an event where after I spoke, somebody told me how important they thought it was that people (in this case college students) learn these “soft skills”. I had actually completely forgotten that in the education world—communication is indeed referred to as a “soft” skill. I think that term actually does it a great injustice

—because while the word soft is meant to imply easy and harmonious interactions

—having the ability to communicate well is probably the single most important skill any professional needs to have for career success. Not least a Doctor.

Source: Physician communication skills: Meet Dr Steele and Dr Cooper | Suneel Dhand

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