15-Minutes or less Visits Take Toll on Doctor-Patient Relationship

 Patients – and physicians – say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. 

It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes. 

And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.

“Doctors have one eye on the patient and one eye on the clock,” said David J. Rothman, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons.

By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.

>READ FULL ARTICLE about the struggle for control from medscape.com

The Pitfalls of Friend Doctor's Advice

Everyone Wants Free Advice

There are some situations for which medical school simply doesn't prepare you. Consider Thanksgiving dinner, when Aunt Myrtle buttonholes you about a recurring rash that's been bothering her. Or the sideline consult that one of the parents at your kid's football game wants to have, right after her son lands awkwardly trying to catch a pass.

When you're a physician, informal requests for information are simply part of the conversational landscape. Sometimes those requests are a quick and easy way to help someone out with a bit of information, a simple clarification, or a reassuring affirmation. Other times they can escalate and become annoyances: A simple question can result in a follow-up phone call and more requests. And, in a worst-case scenario, they can present ethical landmines that may tempt physicians to cross professional boundaries.

How do you address or deflect such requests? Unfortunately, there are no easy answers. It depends a lot on you, your boundaries, and the situation.

READ FULL ARTICLE to find out more from medscape.com

Wisely Choosing the Right Care

Hello and welcome. I am Dr. George Lundberg, at large for Medscape.

In about 1989, then-Secretary of Health and Human Services of the US government Dr. Louis Sullivan stated that between 30% and 40% of American medical care was unnecessary, wasted, or inappropriate. In 2013, Massachusetts health dignitaries stated that 30% of medical care in Massachusetts is unnecessary or inappropriate.

If they are correct, why have we in the American medical profession not fixed that in more than 20 years? Could it be that generation after generation of people who populate the system simply like it the way it is -- veritable pigs addicted to the money trough?

READ MORE from medscape.com

Medscape Reference

Medscape's clinical reference is the most authoritative and accessible point-of-care medical reference for physicians and healthcare professionals, available online and via all major mobile devices. All content is free.

The clinical information represents the expertise and practical knowledge of top physicians and pharmacists from leading academic medical centers in the United States and worldwide.

The topics provided are comprehensive and span more than 30 medical specialties.

READ MORE from medscape.com

Diseases and Conditions

More than 6000 evidence-based and physician-reviewed disease and condition articles are organized to rapidly and comprehensively answer clinical questions and to provide in-depth information in support of diagnosis, treatment, and other clinical decision-making. Topics are richly illustrated with more than 40,000 clinical photos, videos, diagrams, and radiographic images.

Procedures

More than 1000 clinical procedure articles provide clear, step-by-step instructions and include instructional videos and images to allow clinicians to master the newest techniques or to improve their skills in procedures they have performed previously.

Anatomy

More than 100 anatomy articles feature clinical images and diagrams of the human body's major systems and organs. The articles assist in the understanding of the anatomy involved in treating specific conditions and performing procedures. They can also facilitate physician-patient discussions.

Drug Monographs

More than 7100 monographs are provided for prescription and over-the-counter drugs, as well as for corresponding brand-name drugs, herbals, and supplements. Drug images are also included.

Drug Interaction Checker

Our Drug Interaction Checker provides rapid access to tens of thousands of interactions between brand and generic drugs, over-the-counter drugs, and supplements. Check mild interactions to serious contraindications for up to 30 drugs, herbals, and supplements at a time.

Formulary Information

Access health plan drug formulary information when looking up a particular drug, and save time and effort for you and your patient. Choose from our complete list of over 1800 insurance plans across all 50 US states. Customize your Medscape account with the health plans you accept, so that the information you need is saved and ready every time you look up a drug on our site or in the Medscape app. Easily compare tier status for drugs in the same class when considering an alternative drug for your patient.

Medical Calculators

Medscape Reference features 129 medical calculators covering formulas, scales, and classifications. Plus, more than 600 drug monographs in our drug reference include integrated dosing calculators.

Image Collections

Hundreds of image-rich slideshow presentations visually engage and challenge readers while expanding their knowledge of both common and uncommon diseases, case presentations, and current controversies in medicine.

Electronic Patient–Physician Communications Face Barriers

Telephone calls and emails by patients can be very efficient, but these electronic communications may never be widely used unless physicians are reimbursed for them and are given extra time to do the work, according to a new study published in the August issue of Health Affairs.

Despite the potential advantages associated with e-communications, a 2008 study has found that less than 7% of physicians regularly communicate with their patients electronically.

READ FULL ARTICLE from medscape.com

When to Argue With the Doctor - AllHealthcare.com

Most of our daily problems, including common annoyances such as arguments with coworkers, are dismissed as not life or death. However, when nurses, healthcare professionals, and doctors are involved, it can be a matter of life or death. Egos need to be left outside the hospital by the professionals entrusted with the health and safety of the patients they care for, which sometimes means you must argue with doctors.The problem is that a hospital isn’t really conducive to arguing. And doctors aren’t like lawyers, who argue for a living. They’re used to having everyone accept their opinion as gospel, and can take it as a personal affront when anyone disagrees with them. Unfortunately, doctors are people and people make mistakes, and with nurse practitioners and RNs taking on more and more duties, nurses and doctors butting heads is becoming increasingly common.

via When to Argue With the Doctor - AllHealthcare.com.

Doctor Visit Preparation and Communication

The Empowered Patient Coalition Choosing a Doctor Fact Sheet

Prepare for Doctor’s Visits from the Partnership for Healthcare Excellence

Be Prepared for Doctor’s Visits from AHRQ

Tips for Talking to your Doctor from AHRQ

Communicating with your Doctor from the Ohio State University Medical Center

Questions to Ask the Doctor for Cancer Patients

How to Communicate Your Loved One's Symptoms from the National Family Caregiver Alliance

via Doctor Visits.

Need a terrific doctor?

(Health.com ) -- When it comes to finding a doctor, chances are you spend a lot more time worrying about your man, your kids, or your parents than yourself. After all, you're strong enough to soldier through the occasional cold, right?

If this sounds like you, you're not alone: In a recent survey, nearly a third of Americans who don't have a primary care physician (PCP) said they didn't think they needed one.

The truth is, we all do. Not only do people with a regular doc receive better overall care, but it's easier for them to get an appointment on short notice -- helpful for reassurance on day-to-day health queries, and especially crucial if you should ever find yourself in a serious health crisis.

"Finding a doctor before you get sick is especially important now that more insurance plans are requiring that PCPs serve as gatekeepers for our medical needs," says Trisha Torrey, author of "You Bet Your Life: The Ten Mistakes Every Patient Makes".

Your mission: To locate an M.D. with great experience; an organized, friendly office staff; and, most of all, the ability to collaborate well with you (it is, after all, your body and health).

via Need a terrific doctor? - CNN.com.

Lists of Things Physicians and Patients Should Question

Nine United States specialty societies representing 374,000 physicians developed lists of "Five Things Physicians and Patients Should Question" in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.

These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

What tests and procedures should patients and physicians talk about? Read the lists:

• American Academy of Allergy, Asthma & Immunology
• American Academy of Family Physicians
• American College of Cardiology
• American College of Physicians
• American College of Radiology
• American Gastroenterological Association
• American Society of Clinical Oncology
• American Society of Nephrology
• American Society of Nuclear Cardiology

Via Medical Lists

The Surprising Secret Behind Doctor Referrals

Advocates say patients now need to be more vigilant about how they're getting shipped around. Besides querying the doctor who's giving the name, they can use websites (like certificationmatters.org and castleconnolly.com) that verify and rate specialists. For those who want more details, the federal government will soon launch a major new resource: comprehensive physician "report cards." Based on the mother lode of records -- millions of Medicare files -- the reports will offer details on things like doctors' complication rates and their patients' hospital readmission rates. "It's an almost universal view into the behavior of doctors around the country," says David Lansky, CEO of Pacific Business Group on Health, a nonprofit coalition of employers concerned about quality and affordability in health care.

The Referral Road Map

With health care spending in the U.S. dipping after a 15-year rise, doctors and medical facilities are competing fiercely for patients.�

Take a look at what's at stake when your physician hands you a referral slip.

Still, that's months away, and most experts say referral marketing will only become more entrenched as health care cuts continue. Back at AdvisorsMD in Alabama, McKenzie says the company's expecting a strong 2012, with plans to launch new software that reps and doctors will be able to use to build more relationships. Like many in this field, she says, the firm is careful about which doctors it works with; she adds that the firm's efforts improve patient service by keeping doctors on their toes. After all, the best referral in the world won't keep the patients coming back if the doctor runs late, has bad bedside manners and overcharges. "We're not going to represent any Joe Blow who botches up patients," she says.

via The Surprising Secret Behind Doctor Referrals - SmartMoney.com.

Poll: Doctors Fall Short in Helping Many Seniors

April 24, 2012 — Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new survey from the John A. Hartford Foundation.

Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year.

Falls cause over 2 million injuries in people age 65 and older annually, but more than two-thirds of the time doctors and nurses didn’t ask older patients whether they’d taken a tumble or provide advice about how to avoid tripping on carpets or slipping on the stairs, the Hartford poll found.

Similarly, depression can cause people to become socially isolated, suicidal, or stop taking care of themselves, but 62 percent of seniors said doctors and nurses hadn’t inquired about whether they were sad, depressed or anxious.

The results, which cover a period of 12 months, speak to doctors’ and nurses’ lack of training in geriatric medicine.  Providers need to recognize that “care of an 80 year old differs from that of a 50 year old,” said Dr. Rosanne Leipzig, professor of geriatrics at the Mount Sinai School of Medicine in New York. But too often, this doesn’t happen.

Seven interventions examined in the Hartford study are part of Medicare’s annual wellness visit, which became a no-cost benefit available to all seniors in the government health program in January 2011.  Yet 54 percent of older people surveyed by the foundation had never heard of the Medicare wellness visit while another 14 percent weren’t sure if they had.

Via Poll: Doctors Fall Short in Helping Many Seniors

Doctor directory is first step to new “Physician Compare” website

 HEALTHY LIVING

Doctor directory is first step to new “Physician Compare” website

Jan 5, 2011 4:07 PM

The federal government recently took the first step toward a website that, if all goes well, will eventually help consumers shop for doctors based on patient reviews and the quality of the care they provide.

The program is part of the new health-reform law, which among many other things, required Medicare to launch the website, called Physician Compare, by January 1. For now, it’s mainly an up-dated nationwide list of health-care providers who accept Medicare patients.

Still, it's helpful. The directory is searchable by zip code or city and state, as well as by medical specialty.  Results show the doctor’s name, address, gender, phone number, and languages spoken. Those closest to you are listed first. And it includes not just M.D.s, but also chiropractors, clinical psychologists, dietitians, nurse practitioners, occupational therapists, optometrists, osteopaths, physical therapists, physician assistants, and podiatrists—932,000 providers in all.

You don’t have to be a Medicare patient to use the tool, since doctors and other health-care providers who see Medicare beneficiaries also see people under age 65.Doctors who are already reporting quality information to Medicare—under a program called the Physician Quality Reporting System—have a mention of that participation in their profiles. That's a plus since it indicates they are committed to divulging such information. Later this year, Medicare will also list doctors who participate in a voluntary effort to encourage doctors to prescribe medicines electronically.Addition information will be added over time including, by 2015, the first actual measures of quality of care. Data for those measures will come from patient surveys, payment records, and electronic health records.Via http://news.consumerreports.org/health/2011/01/physician-compare-website-doctor-directory-is-first-step-to-new-physician-compare-website-.html

The Patient Will Rate You Now

These days, I’d never consider trying a new restaurant or hotel without reading the on-line ratings on TripAdvisor or Yelp. I seldom even bother with professional restaurant or travel critics.

Until recently, there was little patient-generated information about doctors, practices or hospitals to help inform patient decisions. But that is rapidly changing, and the results may be every bit as transformative as they have been in traditionally consumer-centric industries like hospitality. Medicine has never thought much of the wisdom of crowds, but the times, as the song goes, they are a-changin’.

Even if one embraces the value of listening to the patient, several questions arise. Should we care about the patient’s voice because of its inherent value, or because it can tell us something important about other dimensions of quality? How best should patient judgments be collected and disseminated – through formal surveys or that electronic scrum known as the Internet? And what are some of the unanticipated or negative consequences of measuring patient satisfaction and experience? All of these questions are being debated actively, and some newly published data adds to the mix.

Via The Patient Will Rate You Now

Rating the Raters: Physician Compare

By NAOMI FREUNDLICH

Let’s say you’ve enrolled in a new health insurance plan and need to find an internist who participates. How do you decide which doctor to choose? My (long deceased) grandmother made her choices by using the following criteria: She looked for a male doctor with a Jewish-sounding last name who graduated from an American medical school—preferably one located in New York City. Nowadays her narrow (and culturally biased) criteria would have excluded some of the most esteemed practitioners around.

If you are like most people, you don’t depend on your grandmother’s advice to find a physician, but rather ask friends, colleagues or other doctors for recommendations. But taking one person’s experience with an internist or surgeon as a signal that he or she is “really good” is still far from the optimal way to choose a practitioner.

Over the years, several commercial websites like HealthGrades and Angie’s List have cropped up that provide such consumer-friendly information as the distance a doctor’s office is from the patient, and whether foreign languages are spoken there. They usually include ratings that reflect consumers’ personal experiences with the practitioner. For people who want to dig deeper, most state medical boards collect data that can be searched to find out where your doctor went to medical school, where he did his residency and what board certifications she has. In some states you can also search to see if the doctor in question has received disciplinary action or been sued for malpractice.

Via Rating the Raters: Physician Compare

Physician Empathy Linked to Better Patient Outcomes

September 13, 2012 — High levels of empathy in primary care physicians correlate with better clinical outcomes for their patients with diabetes, according to a new study of more than 20,000 patients in Italy.The retrospective correlational study of 20,961 patients with diabetes and 242 generalist physicians who treated them in Parma, Italy, found that patients whose physicians scored highest on a validated empathy test had the lowest rates of acute metabolic complications requiring hospitalization. The research was published in the September issue of Academic Medicine.The current study builds on a smaller study from 2011, conducted by several of the same researchers, that found that US physicians level of empathy correlated with the ability of their patients with diabetes to manage their disease, as measured by the patients hemoglobin A1c and low-density lipoprotein cholesterol test results. The 2011 study included 29 family physicians and 891 diabetic patients.These studies are "the first 2 [trials] that were aware of that have actually related empathy to tangible patient outcomes," explained Daniel Z. Louis, MS, managing director of the Center for Research in Medical Education at Jefferson Medical College in Philadelphia, Pennsylvania. Louis worked on both of the studies."Theres real evidence that these patients with diabetes mellitus had fewer complications" when their physicians were more empathic, Louis told Medscape Medical News. "Thats incredible."

via Physician Empathy Linked to Better Patient Outcomes.

Medical conspiracy beliefs change health behavior

NEW YORK (Reuters Health) - About half of American adults believe in at least one medical conspiracy theory, according to new survey results.

For example, three times as many people believe U.S. regulators prevent people from getting natural cures as believe that a U.S. spy agency infected a large number of African Americans with the human immunodeficiency virus (HIV).

J. Eric Oliver, the study's lead author from University of Chicago, said people may believe in conspiracy theories because they're easier to understand than complex medical information.

"Science in general - medicine in particular - is complicated and cognitively challenging because you have to carry around a lot of uncertainty," Oliver said.

"To talk about epidemiology and probability theories is difficult to understand as opposed to 'if you put this substance in your body, it's going to be bad,'" he said.

Like the theories about conspiracies to infect African Americans with HIV and to prevent citizens from accessing alternative medicines, the other theories on the list had mistrust of government and large organizations as themes.

They include the theory that the government knows cell phones cause cancer but does nothing about it, that genetically modified organisms are being used to shrink the world's population, that routine vaccinations cause autism and that water fluoridation is a way for companies to dump dangerous chemicals into the environment.

Some 49% of the survey participants agreed with at least one of the conspiracies.

In fact, in addition to the 37% of respondents who fully agreed that U.S. regulators are suppressing access to natural cures, less than a third were willing to say they actively disagreed with the theory.

With regard to the theory that childhood vaccines cause psychological disorders like autism and the government knows it, 69% had heard the idea, 20% agreed with it and 44% disagreed.

The survey results suggest people who believe in medical conspiracy theories may approach their own health differently, the researchers said.

For example, while 13% of people who did not believe in any conspiracies took herbal supplements, 35% of those who believed in three or more theories took supplements.

Overall, the researchers say people who believed in conspiracies were more likely to use alternative medicine and to avoid traditional medicine.

Oliver said the findings may have implications for doctors.

Instead of viewing patients who believe in conspiracy theories as crazy, he said doctors should realize those patients may be less likely to follow a prescription regimen.

via FULL ARTICLE: You're not alone: Medical conspiracies believed by many.

About Choosing Care Wisely | An Initiative of the ABIM Foundation

Choosing Wisely®

aims to promote conversations between physicians and patients by helping patients choose care that is:

Supported by evidence

Not duplicative of other tests or procedures already received

Free from harm

Truly necessary

In response to this challenge, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed. The resulting lists of “Five Things Physicians and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

This concept was originally conceived and piloted by the National Physicians Alliance, which, through an ABIM Foundation Putting the Charter into Practice grant, created a set of three lists of specific steps physicians in internal medicine, family medicine and pediatrics could take in their practices to promote the more effective use of health care resources. These lists were first published in Archives of Internal Medicine.

Recognizing that patients need better information about what care they truly need to have these conversations with their physicians, Consumer Reports is developing patient-friendly materials and is working with consumer groups to disseminate them widely.

via About Choosing Care Wisely | An Initiative of the ABIM Foundation.