Number of specialized doctors who are unemployed growing, study finds | Toronto Star

http://www.careerealism.com/
www.careerealism.com/

Number of specialized doctors who are unemployed growing, study finds | Toronto Star.

Patients wait over a year to see consultants, especially in rural areas. Patients and physicians are frustrated.  This article adds gasoline to the fire.

My Uncle, a rural physician, suggests a central registry of consultants listing their wait times and ability to see referrals.

Lack of operating room time keeps many surgeons unemployed.  Patients wait; surgeons work part-time; the system ‘saves’ money.

Intolerable.

 

Improve Your Trip to Emergency

Patient Filling in a Form

Every dreads a trip to emergency. Here’s how to improve your chance of a great ED visit.

1. Avoid busy times – Never go on Monday, the first day after a long weekend, and Sunday evenings, if possible.  ED visits surge from 11:00 am until late evening.  It takes another 3-6 hours for an ED to clear out.  Aim for early morning or after midnight. Even the worst ED provides great service some of the time; make sure you arrive at those times.

 2. Prepare your chief complaint – Do you tell your whole life story at a job interview?  Don’t tell it in the ED.  Summarize your concern in a few sentences.

 “My stomach started to hurt after supper. It became sharp and constant overnight, and now I have a fever.  It really hurts when I push right here.”

What would you ask if your child had a ‘tummy ache’?

Where does it hurt?

When did it start?

What does it feel like?

Did you get hurt? etc.

If it’s too long to memorize, it’s usually too detailed. If you were just discharged from hospital, say that first.  Hopefully, you got a discharge instruction sheet.

3. Prepare your past medical history – Practice listing your diagnoses.

“High blood pressure, high cholesterol, borderline diabetes and mild asthma.”

If you had major surgery in the last 6 months, say so.  “I had a kidney transplant in May.”

4. Know your medications and dosages – Memorize or write them down on a wallet card. “The little white pill,” does not help.

5. Memorize true allergies and reactions – Swollen lips with penicillin needs to be told.  Find out from your family physician which things you react to, if you don’t know.

6. Bring your Health Card (Canada) – Cards expire.  Update it, if you change address.  If your card is invalid, you will be billed by your physician(s) and separately by the hospital.

7. Bonus points – Old ECGs, notes from your doctor(s) or hospital, X-Ray reports, descriptions of rare medical conditions…anything special about you.

Things to do after you’ve been seen, but are still in the ED:

1. Call for help if you or your family/friend gets worse.  Many patients get worse.  Speak up!

2. Minimize questions.  Staff should have told you how long things will take.  If not, ask once.  Let staff work; wait until they said everything should be done (4 hours, etc).  Do not ask “Are my tests back?” “When is the doctor coming?” “Where is the coffee shop?” etc.

3. Stay in your care area.  Hovering at the doorway is dangerous, impolite and does not make things move more quickly.

4. Don’t take your anger or frustration out on staff.  If they are rude, by all means write a letter.  That will do more than getting upset at the moment, and it strengthens your feedback to leadership.

Things you can do after you’ve left the ED:

1. Call your Family Physician and deliver lab and X-Ray reports from your ED visit.

2. Let your family/friends know you were sick, so they can help and be there if you get worse.

How can you tell if you’re not an average patient?

A.  You are on chemotherapy, have had an organ transplant, have an extremely rare condition cared for by sub-specialists in another center, are on a study drug, have more than 5 medical conditions, etc.  Most complicated patients know they’re not average, and are professionals at navigating the healthcare system.

Patients improve the performance of even the best teams using the pointers above.   Share your favorite tips for a visit to the ED by clicking on Leave a Reply or # Replies below.

See How Patient Flow Improved: Mini-Trial of RN-MD Triage

Early Success!

IMAG0166

We tried a nurse-physician team with 3 stretchers in our old (empty) waiting room.  We did not change our old process; just added a parallel process out front.

An RN met all ambulatory arrivals at the front door for a quick look as before (pre-triage).  Ambulance patients came in through a separate process.  We ran the parallel RN-MD trial from 10:00 – 13:00.

Process

Patient arrives to see an RN screener/sorter/pre-triage.

Patient directed to an RN-MD team with 3 beds in the waiting room.

Patient sent to registration.

Patient sent home or to appropriate clinical area.

If RN-MD process overwhelmed, patient sent to traditional triage.

At any point, patient sent to acute room as indicated.

Results for 3 hour trial:

30 ambulatory patients seen (less than average volumes?)

Time to see MD = 0 minutes for 27 patients (< 3 minutes from RN screener).

3 patients direct to acute room by RN screener.

5 patients (17%) seen and discharged home by the MD-RN team

3 exam spots added (6% additional capacity) at ZERO cost.

0 left without being seen

0 patients required traditional triage

Reflection

We identified a number of things to improve for our relaunch next week.

Staff who had strongly opposed the trial turned optimistic.

As a team, we had become overly anxious to try new things after a major change ‘failed’ in 2012 (we tried something for 2 1/2 days that didn’t work as hoped).  We got a boost today.

We’ll share process detail and performance data as we gain more experience.

Have you tried something like this?  Share your thoughts by clicking on Leave a Reply or # replies below.