Category: System

Clinic walls used to sag with special shelves and trays full of forms. Cupboard doors refused to close as forms refused to stay inside. Extra forms always slipped out onto counters and floors, when you tried to yank one out from the bottom of a pile.

A secretary’s job description included being able to answer: “Where’s the form for the new clinic?”

Last time we looked at forms, I aimed at bureaucrats and the heavy loads they tied on doctors’ backs. It was accurate but not entirely fair. Many physicians (most?) love forms and hide an insufferable desire to bureaucratize.

Thousands of Forms

Computers now store all our old paper forms, plus hundreds and hundreds of new ones—over 1,100 in some cases.

One form is for ordering a CT scan at Southlake Hospital. Another for CTs at Markham.

Anything required outside the clinic needs its own form. Hand-written notes will not do.

Inside hospitals, Pre-Printed Orders multiply forms near infinity.

Forms set the standard of practice for all tests, most treatment protocols, and many referrals.

Doctors started designing their own clinical forms for personal use years ago. It started with simple stamps and templates designed to speed the chore of charting negatives—just paste the same idealized note over and over, while adding positives if necessary.

Today, chart-taking excellence means inserting a scoring tool for every clinical question for which a scoring tool exists. The only thing worse than not using a clinical form is not knowing one exists for the clinical problem at hand.

Does your patient feel depressed? There’s a scoring tool for that.

Anxious? One for that too.

Confused? Forgetful? Out of shape? Look in the forms’ list.

Even if you cannot find a form to fit perfectly, you can tweak the patient history a bit. Everyone will think you much smarter for having used a form.

Redundant Forms?

A dozen different versions of a similar form begs for streamlining.

Pray no one takes notice. An enthusiastic manager might convene a committee to help simplify your forms and propel him up the civil service at the same time. Continue reading “Faith in Forms Changes Medicine”

His abdomen gaped from sternum to pubis. Fat pushed up against the bed rails.

The crater in his gut held a wedding cake’s worth of gauze: a sponge soaking up yellow fluid. Tubes, lines, drains, and leads – with monitors attached to half of them – buried our patient. Aside from gnarled toes and mottled ankles, only a few square inches of skin showed.

“There’s nothing surgery can’t make worse,” someone said, sotto voce. Most of us missed the point.

As a surgical resident, I remember the rush of adrenalin, the anticipation of opening an abdomen. Our goal was always the same: get in before the staff surgeon finished scrubbing.

But staff never rushed into a new case. They would ask questions, walk down for coffee, then ask almost the same questions again. They hunted for any possible reason to not operate. It drove me nuts.

Proof of Exudate

Surgeons fix things on the sickest patients (often at 3 a.m.), which no medicine can cure. They operate when certain nothing else will do. Ideally, surgery is not just the right treatment; it is the only treatment.

I watched my Chief Resident operate on my first case as a resident.

“Wahoo!” he yelled.

A trickle of pus had oozed out behind his knife. The pus proved he chose wisely. The pre-operative uncertainty – Does this patient really need an operation? – was gone. He whooped with relief.

Flu Vaccine Fiasco

Surgeons avoid surgery until certain there is nothing better. They do not cut because they can but because they must. Nothing else will do.

Bureaucrats do the opposite. They build bureaucracy because they can, not because they must. It is what they do.

Apparently, the Ministry of Health (MOH) sends out flu vaccine directly to pharmacies across Ontario. Individual pharmacists have vaccine shortly after the MOH release.

Every year, doctors complain, “Why do all the pharmacies have flu vaccine and we have none?” Continue reading “Flu Vaccine Fiasco”

Women earn less than men.

The latest OMA study adds to studies that suggest the same thing. But the OMA data might also offer clues for how to fix the gender pay gap.

Can we find a solution before it festers and consumes the profession?

Gender Pay Gap

Some use this graph as forensic accounting. This mindset focusses on ways  to assign blame and mete out punishment. It adds another gloomy finding to fuel burnout and depression.

Ample scope exists for debate about causes. This post is not about that. Instead, is there a way to focus on solutions that unify the profession? Does the data suggest a way to improve the gender pay gap?

Successful Women

If we look at the tails of the curves, it looks like both women and men make it to the top, or very close to it.

This points to two lines of investigation.

First, the graph suggests the absence of a structural barrier. The tails do not seem to end 16% apart.

Of course, maybe those women who land on the tail of the curve have to work 16% harder to get there. Maybe they have found a way to work 16% more hours to earn the same as men who work less? This should not be too hard to find out.

But more important, this tail points to a fascinating area of study.

Some women generate enormous income, over three times higher than average for all doctors.

What makes these uber-successful women so productive? Could these high-earning women teach the rest of us? Continue reading “Gender Pay Gap: A Way to Fix It?”