Wednesday, October 31, 2007
Tuesday, October 30, 2007
This booklet also includes a sample of a typical bill. Printed on the sample bill are notes explaining what different areas of the bill mean. We have also included some questions that patients often ask their doctors or hospitals about their bills, and answers to those questions. There is also a page that you can use to write notes or questions to ask your doctor or hospital about your bill."
❍ Clear: All financial communications should be easy to understand and written in clear
language. Patients should be able to quickly determine what they need to do with the
❍ Correct: The bills or statements should not include estimates of liabilities, incomplete
information, or errors.
❍ Concise: The bills should contain just the right amount of detail necessary to communicate
❍ Patient Friendly: The needs of patients and family members should be paramount when
designing administrative processes and communications."
Hospitals can be very "creative" in the way they bill their patients - especially when it's a third party which is paying the bills. Here are some useful guidelines to follow.
Second, in order to be successful in the future, providers must be willing to make radical changes. Consumerism in health care poses a truly different way of doing business. Incremental change—nibbling around the edges—will not be enough to get us where we need to go.
Third, we cannot go it alone. The only way to make the system truly work for the consumer is to collaborate creatively with other providers, commercial and government insurers, employers, regulators, and— first and foremost—consumers themselves.
1. Patient Healthcare Advocate – “Health Buddy”.
Phone and on-site credentialed clinical advocacy services to patients and their family
members sold as a voluntary benefit through employers and to individuals. This helps
put patients more confidently in charge of their care because of access to an
2. Global Research Network Use electronic medical records to identify potential subjects for clinical research. More rapid access to a broader and more diverse patient population by researchers should accelerate clinical trials, reduce costs, increase drug safety and medical practice innovation and population-wide surveillance.
3. Health Key Providers and other stewards of patient healthcare information use a secure “key” to identify an individual patient’s data. Making those “keyed” data available outside of firewalls gives patients web access to their records anywhere in the world when they need it.
This is a clever idea ! Now that insurance companies and banks are getting into the healthcare space, this is a logical extension of their offerings.
Check out the entire list !
Sunday, October 28, 2007
This is a great tool - check this out. You'll have a pretty good idea of what your doctor will be considering once you check out this site !
I already "talk" to more patients by email today than I do in real life !
Enhanced Medical Decisions, Inc. - Announcing DoubleCheckMD.com (Beta) -- A Powerful, First-Ever, Online Medical Search Technology That Empowers Users
The librarian can play an important role as an infomediary in dispensing information therapy prescribed by the doctor !
Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery -- Rosen and Kwoh 120 (4): 701 -- Pediatrics
Fortunately, most patients have much more realistic expectations during their second IVF
cycle , which means that managing them is much easier. The index of a good IVF clinic in my mind is how many patients come back for their second attempt !
I especially enjoy treating patients who have failed an IVF cycle at another clinic. Not only are these patients more medically challenging;, it's much more fun to treat them, because we provide so much more personalised attention and care, which means they are more
appreciative . After all, unless patients have experienced poor quality care at another IVF clinic, how can they judge how much better we really are ?
I see myself as being a Sounding Board, and I try to help my patients walk through their options. I do my best to not impose my answers or to tell them what to do , even though this can be hard . I often play the role of a Devil's Advocate, to make sure they have considered all the pros and cons before deciding. I will often give them a "cooling off" period, during which they have time to mull over their choices, so they can follow their heart.
I do have biases, and I share these with them, so they can factor these in when deciding. At the end of the day, they should have peace of mind they did their best !
This is such a great idea ! Retired doctors can be excellent patient advocates; and their skills are very poorly used at present. They have a lifetime of wisdom to share - why can't we tap this properly ?
Incidentally, retired doctors are a great resource when you want a second opinion; or when you want a referral to a specialist.
So it is safe for you to do so ? At what age should you start worrying about your eggs ? 30 ? 35 ? What about all the celebs having kids at the age of 40 ? And can't IVF fix all problems ?
Unfortunately, there is no alarm on your biological clock, and every woman has a limited number of eggs which will run out as she grows older. So how do you know how old your eggs are and how much time you have left ? How can you assess what doctors call your "ovarian reserve" ?
There are 2 simple numbers which will help you to do so - your FSH level; and your antral follicle count. These are two basic numbers every woman who is more than 25 needs to know, so she can make well-informed decisions as to how long she can safely postpone childbearing.
Let's review some basic biology. Women are born with all of the eggs (oocytes) that they will ever have. A female fetus will have the greatest number of eggs around 16-20 weeks of pregnancy (5 million); at birth this number decreases to about 1 million; and by puberty it's down to about 300,000. This constant and dynamic process of decline continues until menopause and is not interrupted by birth control pills, pregnancy, or ovulation. From this reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive life. Once a women runs out of eggs, she reaches her menopause. About 10 years prior to the menopause is a phase called the oopause, when the egg quality is good enough to produce hormones to generate a regular menstrual cycle ( and this sometimes lulls women into a false sense of security); but not enough to make a baby.
There is a continuous process occurring in the ovaries where eggs are constantly being prepared for the maturation process. It takes 3-6 months for eggs to develop and mature. As the eggs are developing, they transition from a primordial ( immature follicle) to a mature follicle, called an antral follicle. Antral follicles are visible by vaginal ultrasound. Antral follicles therefore represent the reserve of eggs in the ovaries ; and these are the follicles which can be stimulated by fertility stimulation medications (gonadotropins).
An antral follicle count ( AFC) is done during the 2nd-4th days of menstrual flow and is performed by doing a vaginal ultrasound scan. Studies show that the AFC is predictive of the expected ovarian response to gonadotropins. An AFC less than 6 total (between both ovaries), predicts a poor stimulation response. This means a low AFC can correlate with diminished ovarian reserve.
The other simple test for checking how young your ovaries are (the ovarian reserve) is by doing a blood test to measure the level of FSH ( follicle stimulating hormone) in the blood on Day 3 of your cycle . This is called the basal ( day 3) FSH level. Young women with lots of follicles produce a hormone called inhibin, which inhibits the production of FSH, which means they have low Day 3 FSH levels. A normal level is about 3-4 mIU/ml. A high level ( more than 8 mIU/ml) suggests poor ovarian reserve; and a very high level ( more than 20 mIU/ml) is diagnostic of ovarian failure.
These 2 basic tests should be a part of the annual checkup for all women. Unfortunately, most family physicians and gynecologists are clueless about the importance of this test. When a 28 year old asks them whether it's safe for her to postpone childbearing, most of them give her a reassuring pat on the head, and tell her not to worry !
While this advise may be fine for some women, it's a major disservice for others. I feel women need to take matters in their own hands, and ask their doctor to measure their FSH levels, so there is a sound scientific basis for their reassurance. If the FSH level is borderline high, which suggests poor ovarian reserve, further testing to check ovarian reserve is called for, including an ultrasound scan for antral follicle counts.
As Robert Ringer explains, remember that there is a price you pay for every decision you take in your life. There is a price you pay for pursuing a career; and there’s a price you pay for having a baby. No matter what you do in life, do it with your eyes wide open to the tradeoffs involved. And then deal with those tradeoffs with a mature confidence ... and don’t complain. If you find that you are not willing to live with the price of a decision you’ve made, cut your losses short and try to reverse the error as quickly as possible.
- Personal health records (PHR) are a portable resource that patients and their families can use for the long term.
- Patients will use PHR technology as a critical resource for health improvement, prevention, and long term medical care affordability.
- PHR will give patients emergency access to critical information and allow the record to be customized to clearly define their preferences for treatment. For example, pregnant mothers can clearly identify their delivery preference. A delivering OB/GYN still can counter the patient’s preference for the safety of the mother, but there would be no ambiguity about the mother’s wishes. Likewise, patients who want their organs donated in the case of mortal injury could make their preferences known.
The technology platform that appears to be emerging for medical banking is the integrated health card solutions. Several insurers have been experimenting with this technology. Of the early adopters Exante Bank of United Health Groups appears to have made significant progress in developing a product as well as a client base for a early for of this platform know as an integrate health care (IHC) technology."
This is actually a big opportunity for a clever and innovative health insurance company in India ! Insurance has now become privatised in India, which means it is no longer just a seller's market. Huge IT companies such as TCS and Infosys employ a large number of young employees who are in the reproductive age group. Many of them get so caught up in the rat race that they tend to put off child-bearing in order to pursue a lucrative career - which means that by the time they are settled and want to start a family, many of them find that their biological clock has ticked on, leaving them infertile. Now these are smart young driven employees, who are used to being successful and getting their own way. They have become senior in the company and can exercise quite a bit of clout ! If they need IVF treatment ( which they feel is partly a result of the overtime and long hours they had to pay in order to advance in the company), they want the company to pay them back by covering for their fertility treatment. Companies are going to start feeling the heat - and they are going to pressurise insurance companies to provide this coverage !
The good news is that many studies done in the US have proven that providing this additional coverage does not increase the cost of insurance cover by a significant amount , so that this is a very cost-effective option insurance companies should be happy to provide. Not only will this be a valuable differentiator for them and a great USP, they can also project themselves as being pro-family and employee-friendly. It's my prediction that infertility coverage is an option insurance companies in India will soon provide to corporates, if they don't want to lose their business. Health insurance is a "hot area" in India right now - and infertile couples will benefit from this.
Of course, if the carrot approach does not work, I think infertile couples need to use the stick option. Many of them are smart and successful executives and entrepreneurs, and they can get together to lobby and advocate for making infertility coverage compulsory for all insurance companies. This is exactly what Resolve did in the US many years ago, as a result of which infertility coverage is compulsory in 13 states in the USA.
Hopefully a group of infertile couples or an infertility support group in India will file a PIL ( public interest litigation) in the High Court, based on the grounds that it's unfair for insurance companies to discriminate against infertile couples by refusing to cover their medical treatment. Infertility is a disease caused by medical problems ( such as blocked tubes); and modern treatment is very successful and cost-effective in providing a solution !
The right to have a baby is something most of us take for granted, and we often lose sight of the fact that 1 in 10 married couples will not be able to have the child they want. Infertility is a very common problem, and if you stop to think about it, you will realise that you know at least one person who is infertile amongst your own group of friends or relatives. However, it remains one of those taboo topics which no one wants to talk about, even though it interferes with one of the most fundamental and highly valued human activities – building a family.
Millions of infertile couples in Indian cities today face many obstacles in their attempts to build a much-wanted family, and one of the most frustrating is the lack of insurance coverage for medical treatment. What this means is that while infertility specialists in India can provide even the most advanced reproductive techniques to solve extremely complex infertility problems, at a level of sophistication which is comparable with that in the West (and at a fraction of the price), most couples cannot avail of these techniques because these are not covered by their insurance policy. So near – and yet so far, would sum up the situation for most couples!
The financial burden that some of the treatments may place on couples can be large, and adding this on to the emotional and physical consequences of experiencing infertility can literally be the last straw which breaks the camel’s back. The strong desire to build a family gives many the strength to face these obstacles, but infertile couples also need additional support from their employers and insurance companies.
While most diseases and medical conditions are covered by insurance, the disease of infertility is often singled out for exclusion, and such discrimination is unfair! Thus, to add further insult to injury, infertile couples not only face the emotional pain associated with not being able to have a child, but also face obstacles put in front of them by their health insurance and employers for reimbursement of the medical expenses they incur on their treatment.
Unfortunately, insurance companies in India still do not provide health insurance coverage for infertility. This is a very archaic attitude, but because the insurance industry in India is still a monopoly, this situation is unlikely to change, until the field gets privatised, or Indian companies fall in line with their Western counterparts.
- Infertility is not an illness;
- Treatment of infertility is not medically necessary;
- Treatment of infertility is experimental.
- Infertility treatment is too costly for a country like India to offer
Medically necessary is usually defined by insurance policies as medically appropriate for treatment of an illness under professionally recognized standards of health care – and treatments such as IVF are now universally acknowledged to be standard medical treatments, which are no longer experimental.
While certain infertility treatments can be costly, most are quite inexpensive, and only about 5% of all infertile couples will need expensive treatments like IVF. Moreover, if expensive medical procedures like bypass surgery can be covered, then why should treatment for an abnormally functioning reproductive system be excluded?
Why this discrimination against infertile couples in India? Ironically, this is because of the high premium Indians have always placed on the family unit! The major role of the woman in Indian society was seen to be to have children to propagate the family name. Therefore, if a woman could not have children, she was singled out, ridiculed, ostracised and stigmatised.
In fact, given the value Indians have placed on having children, infertile couples should actually receive even more tender loving care from others – and be helped in their quest to complete their family!
However, because of centuries of misconceptions and myths regarding infertility (for example, "a barren woman has been cursed by God, and being punished for the sins of a prior life"), it will take a long time for social attitudes in India to change. Infertile couples are an easy and soft target for everyone –
- friends ("life is incomplete without a baby!");
- in-laws ("when will I become a grandmother?");
- relatives ("what do they want to earn money for – they do not have any children to leave it to!"),
- neighbours ("they may have a lot of money, but what’s the use, they don’t have any children");
- acquaintances (" no good news yet? Go see this doctor my sister-in-law’s cousin went to – he’s the best!") ;
- co-workers ("you don’t have any kids, so can you stay on a little longer to finish this job – I need to go back to take care of my children!");
- right to servants (" the reason she shouts so much is because she doesn’t have any children – serves her right!)
Many otherwise enlightened people take the attitude that infertility treatment is elective – and even compare it to cosmetic surgery. However, infertility is a serious medical condition – it is both a disease and a life crisis.
Others pontificate that these couples should just adopt a baby, rather than take treatment. While adoption is an excellent method of building a family for some couples, it is not acceptable to everyone– and forcing couples to do so when they don’t want to is very unfair.
A major problem is that infertile couples in India are too ashamed to stand up for their own rights – with the result that they often suffer in silence. However, infertility exacts a high toll! Not only do many marriages break up, many women are abused for being infertile as well. Also, infertile employees, because of the emotional stress they are under, are often not as productive in the workplace as they could have been if their problem was successfully resolved.
Fortunately, this discriminatory attitude is now being challenged by advocates for infertile couples – at least in the US. The pathbreaking Americans with Disabilities Act (ADA), provides protection against discrimination for Americans with a disability – a disability being defined as" a physical or mental impairment that substantially limits one or more major life activities."
The US Supreme Court has clearly ruled that reproduction is a major life activity. Since infertility is a physical impairment that substantially limits the ability to reproduce, this means that if an individual experiences discrimination because of his or her infertility, a claim can be made that this is illegal under the ADA. Thus, a police woman employed by the city of Chicago sued the city recently because it did not provide infertility insurance coverage. The Court ruled that infertility is a disability under the ADA, and today the city of Chicago covers the cost of infertility treatment incurred by all its employees.
Many employers in India are not still aware of the issues and concerns facing those with infertility. Employers need to be more understanding of the special needs of those of their employees who are infertile, and be willing to make workplace accommodations for those undergoing infertility treatments – for example, allowing the employee to change her work schedule or to take some time off. Employers, insurance companies, and legislators in India also need to take steps to recognize that reproduction is a major life activity – and that infertile couples need all the help we can give them.
Unfortunately, most infertile couples in India do not feel comfortable speaking publicly about this very private struggle, even though they represent all racial, religious, socio-economic and ethnic groups, as well as both sexes.
We all need to remember that infertile couples are our neighbors, co-workers, friends and relatives - and they just want to experience the joy of raising a family - an experience that so many of us take for granted!
McKinsey & Company - Synthesis - Accounting for the Cost of Health Care in the United States - January 2007
Gumption after gumption, piece by piece, they were able to develop a software system that could actually manage the insurers and all their crazy denial rules. Those late night Mountain Dew runs started to pay off as they began to AGGREGATE data from various insurers to increase their percentage of first time claims approval. Soon, an emergent rules engine was developing based on the power of their ANALYTIC engine. This then allowed them to automatically ADVISE practices of insurance rule variations before they were submitted for adjudication. They began to share this software engine with the other clinics they purchased and soon were selling their services to affiliate organizations. (These three elements - AGGREGATE, ANALYZE, and ADVISE - are three core ingredients to Health 2.0 companies)."
# Realize that Health 2.0 is all about Patient Empowered (not the misnomer 'Consumer Directed') Healthcare whereby patients have the information they need to be able to make rational healthcare decisions (transparency of information) based on value (outcomes over price). In the Health 2.0 paradigm, everyone in the healthcare process is focused on increasing value for the patient.
# Realize that Health 2.0 is absolutely reliant on interoperability of health information. Everything from the Personal Health Record (PHR), to the Clinic Health Record (CHR), to the Enterprise Health Record (EHR), to the National Health Record (NHR) must be based on standards, be seamlessly transitioned between environments per standardized security and privacy protocols, and be accessible anytime from anywhere.
# Undergirding this foundation of information, the Four Cornerstones (Connectivity, Price, Quality, and Incentives) of the Value Driven Healthcare movement begin to create a virtuous cycle of innovation and reform. Transparency serves as a key catalyst in this process by creating positive sum competition that can deliver better outcomes at a lower cost.
# As more information becomes available as a result of increased transparency, there will be a wave of innovation at all points along the full cycle of care to appropriately determine value.
# An increased amount of personal health and outcomes information will create an ongoing role for infomediaries and related services providers to add value at each stage of the full cycle of care. These value added Health Advisory Services (more later) will offered by hundreds of companies, in thousands of forms, to millions of people who are can benefit from the remixing of medically related information. It is easy to see how the new Web 2.0 framework, with its inherent social networking and collaboration tools, will make this "long tail" of medicine a "value"able venture.
We deliver these services at each critical step in the revenue and clinical cycle workflow through a combination of software, knowledge and work:
• Software. athenaNet, our proprietary internet-based practice management and EMR application, is a workflow management tool used in every work step that is required to properly handle billing, collections and medical record management-related functions. All users across our client-base simultaneously use the same version of our software application, which connects them to our continually updated database of payer rules and to our services team.
• Knowledge. athenaRules, our proprietary database of payer rules, enforces physician office workflow requirements, and is continually updated with payer-specific coding and documentation information. This knowledge continues to grow as a result of our years of experience managing back office service operations for hundreds of physician practices, including processing medical claims with tens of thousands of health benefit plans.
• Work. The athenahealth service operations, consisting of nearly 400 people in the United States, and more than 700 people at our off-shore service provider, interact with clients at all key steps of the revenue and clinical cycle workflow. These operations include setting up medical providers for billing, checking the eligibility of scheduled patients electronically, submitting electronic and paper-based claims to payers directly or through intermediaries, processing clinical orders, receiving and processing checks and remittance information from payers, documenting the result of payers’ responses and evaluating and resubmitting claims denials. "
Saturday, October 27, 2007
I like their philosophy of empowering patients with access to this information.
As they put it ---
" I am not technically trained, should I be using CureHunter at all? And can I understand it?
Don't underrate yourself. As a general rule we believe it is fundamentally good for patients to become knowledgeable about the diseases life may throw at them and the medicines they are advised to take. Often by reading extensively, participating in their patient associations, and talking to others with their condition, patients can support the efforts of their doctors to help them get well. You may, for example, become aware of signs and symptoms that help your physician refine your diagnosis. You may note particular side effects--sometimes very subtle--of medications you are taking that would cause your physician to change your prescription. And with serious study, you may even develop insights to new cures. Only you really know the patterns of your daily life, the stresses put on you by work or school or family or play; the daily
choices of food and medicines you consume. You are your own best instrument and always monitoring your good health as well as your illnesses and the aches, pains, and dysfunction they bring with them. The more aware you are of your own body and behaviors, the more likely it is you can bring good information to your physician and team up with him or her. The fact that you have ordered a CureHunter Patient Summary Report means that you are already a "patient activist" for your own best health. To use this report well, however, you must have a general understanding of the science and methods that produced the data contained here. That said, CureHunter is very different from most "consumer health information" resources you might find on the Internet or at your public library. Because CureHunter does not rewrite (or water down) the technical medical articles for "consumer consumption," in many cases the actual "key statements of outcome" shown in your Summary Report will be very difficult to understand because they are
directly extracted from the peer-reviewed scientific literature and are quoted without modification. This "control on original sources" is critical so that similar findings can be counted, and most importantly repeated patterns in many thousands of clinical observations can be analyzed for how those patterns shed light on both the causes and cures for human diseases. In the final analysis, even if you are technically trained in one area of science, this is pretty complicated work. And that is why we recommend you take printed versions of your CureHunter Patient Summary Report to your physician. Talk about the data
together and see what your doctor thinks. You may wish to discuss your report with your pharmacist, too. Or if you have friends or associates in the biological sciences or in your patient association, ask them for their opinions. Getting well is a team effort. No one, "knows it all" with over 200,000 new research articles published each year."
Friday, October 26, 2007
•General medical sites from WebMD to MayoClinic.com are expanding their video libraries. At the Mayo site, you can see how to do a biceps curl, inject insulin and check your blood pressure. At WebMD, a mix of expert interviews, patient stories and news pieces grows by the day.
•Sites devoted to specific disorders are adding video, too. The American Cancer Society (www.cancer.org) features videos on its campaign to increase access to cancer care. Autism Speaks (www.autismspeaks.com) offers a set of videos that show the early signs of autism. Videos on seizures and their treatment can be found at epilepsy.com.
•A revamped eMedTV site, coming soon, will be built around 1,200 short videos that explain procedures, disorders and medications. Many of the videos have been used in major hospitals to inform patients before they consent to treatment, says the site's developer, physician Art Schoenstadt.
•Video bloggers ('vloggers') are sharing their own health stories "
And you can see our library of healthcare videos at www.drmalpani.com/health-videos !
Thursday, October 25, 2007
Even though India is a leading IT power and exports medical skills and people to the West, it's a tragedy that there is such little good quality information for patient education written in Indian languages on the Web. Ironically, it's easier to find Hindi materials for patient education on a US website than on an Indian
This is an extremely valuable resource - we need to grow this !
So how do they convince the patient to sign the dotted line and give "informed consent" for the surgery ? Doctors are cleverly misusing ultrasound testing to do so. While there is no doubt that ultrasound scanning is extremely helpful during pregnancy to confirm the well-being of the baby, the commonest racket is to get the ultrasonographer to over-report minor variations as abnormalities, and then scare the patient that the baby's welfare is at stake.
The number of "abnormalities" which are reported are mind-boggling for their creativity ! I have seen patients being subjected to caesarean sections for a huge range of normal findings , including:
1. nuchal cord . This is a condition in which the umbilical cord is near the neck. This is perfectly normal and safe, but they scare the patient by saying that this cord can tighten during delivery and strangle the baby, which is why a caesarean is much safer !
2. reduced amniotic fluid. It's common for the amniotic fluid volume to decline as the pregnancy progresses. Here, the scans are repeated frequently, and the sonographer "documents" a declining trend in the amount of fluid. This is "creatively interpreted" as suggesting "fetal distress" which requires a caesarean section !
3. oblique lie. Often the baby's head does not settle down into the pelvis until quite late during pregnancy. If it does not do so by 36 weeks, patients are told that this suggests that head is "too big" or the "pelvis is too small" and that a caesarean section is needed to prevent birth trauma !
The beauty of these "reported abnormalities" is that they are "soft findings" which are dynamic and therefore cannot be conclusively documented. Since a baby is a "high-investment" product, no patient wants to take chances, and they are happy to do what their doctor suggests.
What's even worse is that if they get a second opinion from another obstetrician, the new doctor will also most probably agree with the first one, since it's much more profitable for a doctor to do surgery, than to allow for a normal vaginal birth !
Interestingly, ultrasound over-reporting seems to be widely prevalent in gynecology as well. Patients who are infertile are "documented" to have small subserous fibroids ( of no clinical importance) and then advised to undergo laparoscopic surgery ( which is projected as being "minor surgery") to remove these. The other common "finding" is a small ovarian cyst ( which is extremely common) for which they are advised to undergo laparoscopy to "rule out and treat" endometriosis.
Similarly, older women with heavy menstrual bleeding are diagnosed as having fibroids or endometrial hyperplasia ( a fancy term for a "thick endometrium " ) and told that they need a hysterectomy !
It's becoming increasingly difficult for patients to protect themselves from this sort of overtesting and overdiagnosing which lead to unnecessary overtreatment ! The best bet is to find an ethical doctor who will guide you properly !
* Demonstrate significant value with employers
* Improve employee health care decisions
* Add value to member services
* Attract the young and wired market
* Increase Web services success
* Build marketable benefit designs"
This is exactly why patient education libraries are so important. They are a very cost effective way of providing reliable information to patients; and can save the doctor and hospital valuable time and energy !
Healthwise Supports Consumer-Directed Health Plan Goals
* Help members make health-improving choices
* Help members make cost-effective choices
* Add differentiating value for employers
* Build satisfaction"
Wednesday, October 24, 2007
Specifically, Senator Moore's bill:
* dedicates needed resources for nursing scholarships, loan repayments, mentoring programs and faculty development to increase the number of nurses.
* requires all hospitals to file their staffing plans for each unit with the Department of Public Health, and to publicly post the plans.
* requires hospitals to use and publicly report on “nurse-sensitive” measures to track how patient care is affected by the nursing care hospitals provide."
few simple rules and tools to break out of the old patterns. The Ix Solution rules and tools can create the disruptive innovation needed to reinvent health care in a more positive and cost effective way.
#1 The Self-Care Rule. Help Boomers do as much for themselves as they can.
#2 The Guidelines Rule. Help Boomers ask for the health care that they need.
#3 The Veto Rule. Help Boomers say “No” to care they don't need.
3 Tools for Health Care Transformation
Self-Service Tools: 24-7 access to health information, symptom checkers, and decision aids in self-care guides and on Web sites.
Information Prescription Tools: Short information prescriptions “prescribed” to patients by their doctors or health plans at every “moment in care.”
Long-Term Engagement Tools: Ongoing, interactive programs that are personalized and targeted to meet each individual’s self-management needs over time."
A great way to convert problems into opportunities !
FIVE QUESTIONS FOR .... Maureen Regan and Julie Vargo / Two authors bring infertility out of the closet
Great idea. Of course, initially they will measure only what they can - and not the most important stuff ( clinical competence). But at least it's a start. Getting doctors ( and nurses !) to rate doctors would also be a useful metric which is worth tracking !
Monday, October 22, 2007
Interestingly, it's not possible for you to relax your body - after all, you can only contract your muscles - you cannot relax them ! So what's the secret ? Here's a simple tip. What you need to do is to actively contract the opposing muscles. So if you want to relax your biceps, you need to contract your triceps !
What this means is that during the embryo transfer, you need to actively push your buttocks down to the bed; and keep your knees wide apart. This will force the inner thigh muscles ( the adductors) to relax, allowing your vaginal muscles to relax, thus making the doctor's life ( and yours !) much easier.
Learning how to do pranayama ( a type of breathing which yoga teaches) and meditation also help !
Sunday, October 21, 2007
" We recently implemented a full-featured electronic health record
in our independent, 4-internist, community-based practice of general
internal medicine. We encountered various challenges, some
unexpected, in moving from paper to computer. This article describes
the effects that use of electronic health records has had on
our finances, work flow, and office environment. Its financial
impact is not clearly positive; work flows were substantially disrupted;
and the quality of the office environment initially deteriorated
greatly for staff, physicians, and patients. That said, none
of us would go back to paper health records, and all of us find
that the technology helps us to better meet patient expectations,
expedites many tedious work processes (such as prescription writing
and creation of chart notes), and creates new ways in which
we can improve the health of our patients. Five broad issues must
be addressed to promote successful implementation of electronic
health records in a small office: financing; interoperability, standardization,
and connectivity of clinical information systems; help
with redesign of work flow; technical support and training; and
help with change management. We hope that sharing our experience
can better prepare others who plan to implement electronic
health records and inform policymakers on the strategies needed
for success in the small practice environment.
Ann Intern Med. 2005;143:222–226. www.annals.org"
When is it allright for a doctor to lie ? Is it safe to allow the doctor to decide ? Even if it's much easier to just insist that the doctor tell the truth all the time, regardless of the circumstances, is such an "all-or-none" approach the right one for all patients at all time ? Isn't this taking a legalistic approach and oversimplifying a complex problem ? Shouldn't doctors be allowed to be flexible and can't they be trusted to use their own judgment when making these decisions ? Or has society become so distrustful of the medical profession that this would be considered anathema, and that we should insist that doctors should tell the truth every time, even if it harms their patient ?
I'd like to hear from you !
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Saturday, October 20, 2007
In fact, the distinguishing mark of a senior doctor is that he knows how to lie - and when to do so. This is not something which can be taught or written down, which is why it is a sixth sense which is acquired by experience. I am sure all senior doctors will agree that they have lied for their patients' good during their career - and anyone who does not agree with this is telling a much bigger lie.
Is it ethical to lie ? This is a hard call. It's much easier to just tell the truth all the time - but there are times when hiding the truth and lying is in the patient's best interests. Good doctors know this - and will use a lie as a valuable therapeutic tool, when they feel that the truth would harm their patients.
Am I suggesting that we return to the "good old days" when the "doctor knew best" and cancer was a word which was never discussed openly. Of course not ! I am a big believer in patient autonomy and the patient's right to know . However, in clinical practise, there are situations when the patient does not want to know the truth ; and times when the truth can actually be harmful. Some patients what their doctor to shield them from the truth, and good doctors can sense this . They know when to hide the truth; and from whom.
This is not an easy skill to acquire, and requires reflective contemplation and practise. It's a privilege which can easily be abused by a bad doctor, but a good doctor can use a lie ethically , if he does so in order to help his patients .
Unfortunately, you cannot change the "perceptions" of hospital administrators, but you can hope to change practices. Medicine is information science, and those in the medical profession who take it as business than a profession, play the following game, that's characteristic of any business transaction --
a) you should have an information advantage over your client (or patient), and
b) you should scare your client/patient/patient-party and then you let them decide what's best for them.
QED, system-wise, in areas and times when the practice is slow, the number and frequency of surgeries/cesarian sections/expensive intervention goes up. Hospital administrators too take advantage of this asymmetry of information and therefore create imposing structures in the names of hospitals, as if hospitals are factories where the "sick" are made better.
Your concept is aimed at tipping the scale at the other end, empowering the patient. If I were you, I'd not bother messing with the hospital administrators, they are not our audience. I'd focus on the patient (or people at risk) and then go for tailoring messages to the segment of population that matter. Information presentation is the crucial key here. In presenting the information, revert the two points we alluded to above:
c) the patient should now have an information advantage (one, he or she already has, his or her personal physical problem, that he or she knows better than the doctor to start with. The physician, on the other hand, is an expert with the technical knowledge as to what works). Educate the patient so well that she knows what's the problem and the physician then will be able to fine tune the diagnosis and the treatment process. That means creating evidence based literature and translating that in the language of a class Eight pass idiot. Can we the doctors, do it? With similes, stories, comparisons, parables, comics, graphic novels, games, etc?
d) Information, if properly tailored, should minimize irrational fear in the mind of the patient.
Some of the best doctors with whom I got trained, without exception, I found all these "best"/great doctors were extremely polite and teacherlike with their patients, even in their most busy schedules. It's purely my personal opinion and therefore it's of little worth, but I must share this with you -- I found that the technically most incompetent doctors also tend to be very rough and ruthless with their patients. Sorry for this long post, and I will sign off with these two aphorisms by Don Berwick
e) from the perspective of patients, the aphorism is -- "Nothing about me without me": in other words, patients should be clearly explained why some diagnostic procedures or treatments were offered
f) from the perspective of the doctors -- "Every patient is the only patient" -- self explanatory. "
Dr. Arin Basu MD MPH
Allan Smith's Research Group
1950 Addison Street
Berkeley, CA 94704