care Archives - shawn whatley md

Medicare vs. Patient Care

Conference participants wore ‘I Love Medicare’ pins in Calgary.

Nietzsche might ask

Do you love medicare because patients benefit, or do you love medicare because you benefit?

Do you love ‘free care’ more than patient care?

People can care more about the idea of universal health care than they do about the care patients receive.

They deny data showing

long waits

poor patient outcomes

lack of access

lack of coordination

high cost

inefficiency

lack of control

provider frustration

Their solutions focus on

more control

more funding

more rationing

more cuts to salaries > 100k

more patient education to divert access

They would rather fight for a failed system than fight for improved patient care.

dog-ma-tism

n. An arrogant, stubborn assertion of opinion or belief

dog-ma-tism n.

1. positiveness in assertion of opinion especially when unwarranted or arrogant

2. a viewpoint or system of ideas based on insufficiently examined premises

Medicare dogmatism will guarantee mediocrity at best.

We need a system that:

puts patients’ needs first

makes patient experience central to funding

gives patients great access

offers patient choice

guarantees quality care (Quality should be a given)

demonstrates business excellence

attracts the best leaders

rewards great outcomes; not mediocrity

aligns incentives for every provider

rewards grass-roots provider innovation

gives control to health-care experts

This can happen in a publicly funded system, but it will never happen if people resist change.

We need to stop thinking that health-care is so special, complicated and unchangeable.

Do we love medicare more than patient care? Can we have an adult conversation about change? What do you think?

Improve Your Trip to Emergency

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.

Emegency Departments That Lag

Time to treatment equals quality for much of emergency medicine. It’s also the easiest way to decide whether an ED is any good. Missed diagnoses, errors of judgment, and clinical mistakes can be hard to spot by comparison.

Emergency Departments That Lag

1. Long Line up at triage –

The most at-risk patients stand in the line-up for triage. Every day, patients walk in with a deadly process inside of them. Until they have been seen, they are unsafe. A line up to be seen is indefensible.

2. Long triage process –

Triage should be sorting; not a primary nursing assessment. Patients need a diagnosis and treatment. In most cases, this means getting patients and physicians together as fast as possible. A long triage process does not add value for patients.

3. Long Line up at registration and long registration process –

Registration – getting a chart made – does not add value for patients; it only delays care. It must be short!

4. Packed waiting room –

There is no reason for patients to EVER wait in the waiting room. Please argue in the comment section below if you disagree.

5. Patients must repeat their story over and over and over.

Providers should quickly check what others have recorded, verify the facts and ask additional questions. Starting over with every provider drives patients nuts.

6. No discharge excellence

Patients should leave the ED with copies of lab and radiology reports, written discharge instructions (if necessary), and clear instructions for follow-up and return visits to the ED.

7. Dismissive attitude

Patients should be welcomed to the ED for ANY complaint. No complaint is trivial for a patient. We – healthcare providers, media, government, all of society – seem to think healthcare would be just fine if it weren’t for all the patients. Besides being unwelcoming non-verbally, there’s a big difference between “Why are you hear today?” and “How can I help you?”

Rules in case you get sick:

Don’t go to your family doc unless you’ve tried something yourself first.

Don’t go to your specialist unless you go to your family doc first.

Don’t go to the ED unless you’ve gone anywhere else first.

Don’t go to the ED unless you are nearly dying.

If you are dying, you shouldn’t go to the ED because we can’t do anything for you…

Excuses

But all our beds are full of admitted patients!

Definitely the most popular excuse, admitted patients definitely make it almost impossible to provide emergency care some of the time. But, even with admitted patients blocking beds, patients should still be brought into the ED and seen on exam tables. If they can wait on chairs in the waiting room, they can wait on chairs inside after they’ve been assessed.

Thankfully, Ontario has started to hold hospitals accountable for getting admitted patients out of the ED, and up to the wards.

Who owns morale?

Management owns operations; staff owns morale. Sure, you can crush morale in even the most engaged staff, but blaming management for staff attitudes will mire an ED in under-performance. Staff control their own morale, and it must be part of performance management.

How does your ED stack up? As a patient, have you researched your local EDs to see which ones to avoid?