PGY 39, Day 31
Predictably busy and not much time to think or play. Happy July!
Beyond capacity ... Problem Solving ... Mission Integrity
Why health care institutions don't address chaos?
Paterns of utilization need to be acknowledged, and surge capacity needs to be built around the needs of the patients served. Why not? It makes sense and $$$ to serve well.
No time to expand now. Will share some of my thoughts and "TOOLS" later this week.
Dr. Mike
Sunday, July 31, 2011
Thursday, July 28, 2011
Mission: Healing, July 28, 2011
PGY 39, Day #28
Missed yesterday. Too busy to write. Pushing capacity. Interns are in the thick of it and totally overwhelmed. Time to train up is not put into the staffing formula.
More later.
Dr. Mike
Missed yesterday. Too busy to write. Pushing capacity. Interns are in the thick of it and totally overwhelmed. Time to train up is not put into the staffing formula.
More later.
Dr. Mike
Tuesday, July 26, 2011
Mission: Healing July 26, 2011
PGY 39, Day #26
Early Morning Meeting today. Let's see what the day brings. Hopefully, our leadership will not be following congress for tips on leadership skills.
Dr. Mike
Early Morning Meeting today. Let's see what the day brings. Hopefully, our leadership will not be following congress for tips on leadership skills.
Dr. Mike
Monday, July 25, 2011
Mission: Healing July 25, 2011
PGY 39, Day # 25
Long day after a short night. Had to take care of some family heal care problems yesterday. Got in late and had a long, productive day in the ICU. Exhausted. More tomorrow.
Dr. Mike
Long day after a short night. Had to take care of some family heal care problems yesterday. Got in late and had a long, productive day in the ICU. Exhausted. More tomorrow.
Dr. Mike
Thursday, July 21, 2011
Mission: Healing July 21, 2011 StepWisely(R) #1 Dr-Pt Relationship
PGY 39, Day 21
Patients First: Patient Safety First - the essence of the Doctor-Patient Relationship
How you can help your doctor to help you despite the Business of Medicine!
Business of Medicine = $$$
Profession of Medicine = Patient Care
The Business of Medicine is NOT The Profession of Medicine
How to Bridge the gap?
The other day I saw a blog ... something about how you can protect yourself when you need hospital care. For some reason that is beyond me, some folks think they can direct themselves, without PROFESSIOINAL MEDICAL guidance ... without a Doctor to find the best hospitals and health care. Of course, some of these folks are selling something.
Well, you can take care of yourself and protect yourself and your family to a certain extent by being smart, but the best thing you can do and the first thing that you should do is to find a doctor you can trust and establish a relationship with that doctor. Yes, the Doctor-Patient Relationship is #1 and still the key Optimal Patient Care. The next question is how do you find a good Doctor with whom you are comfortable and in whom you have confidence? That may be a bit more of a challenge for many reasons.
Regrettably, over the last 70 years (in the US) many factors have contributed to the decline of the Doctor-Patient Relationship, and I have seen things get much worse over the course of my career. The bottom line is this: over the last several decades and especially the last 25 years, the Business of Medicine has put multiple third parties between the Doctor and the Patient and some of these third parties have $$$ as their primary objective. Well, it would be OK, to have money as a primary objective, if pateint care is perfect, but some of these thirds parties will cut corners on patient care and patient safety to make more money(eg, Health Care Providers), or keep their money(eg, Health Insurance Companies). This is where the Doctor-Patient Relationship comes in. It is the responsibility and the sworn duty of physicians to take care of The Patient First and above all else to promote patient safety. This is an obligation that comes with the Hippocratic Oath ... the Oath that most, if not all Physicians take upon graduation from medical school, and this is a serious matter.
This oath creates the foundation of the Doctor-Patient Relationship, and it is essential to providing optimal patient care. Patient Care is never perfect, because the Science of Medicine is not perfect, but the physician's obligation remains and is based upon the best available science. Next, I will ... when I get to some high speed internet access, put the oath in here. In the meantime, think about what I have said and know that it boils down to Do the best thing possible for your patients at all times, do the right thing, and do no harm.
Do you have a relationship with a Trusted Doctor? If not, why not? If not, you need to find one. I will give you some tips here in the future, but for now, when you do see a doctor, make sure he/she graduated from medical school and make sure he/she took the Hippocratic Oath. Ask him/her what it means and how it is important to your relationship.
Ciao for now.
Dr. Mike
Patients First: Patient Safety First - the essence of the Doctor-Patient Relationship
How you can help your doctor to help you despite the Business of Medicine!
Business of Medicine = $$$
Profession of Medicine = Patient Care
The Business of Medicine is NOT The Profession of Medicine
How to Bridge the gap?
The other day I saw a blog ... something about how you can protect yourself when you need hospital care. For some reason that is beyond me, some folks think they can direct themselves, without PROFESSIOINAL MEDICAL guidance ... without a Doctor to find the best hospitals and health care. Of course, some of these folks are selling something.
Well, you can take care of yourself and protect yourself and your family to a certain extent by being smart, but the best thing you can do and the first thing that you should do is to find a doctor you can trust and establish a relationship with that doctor. Yes, the Doctor-Patient Relationship is #1 and still the key Optimal Patient Care. The next question is how do you find a good Doctor with whom you are comfortable and in whom you have confidence? That may be a bit more of a challenge for many reasons.
Regrettably, over the last 70 years (in the US) many factors have contributed to the decline of the Doctor-Patient Relationship, and I have seen things get much worse over the course of my career. The bottom line is this: over the last several decades and especially the last 25 years, the Business of Medicine has put multiple third parties between the Doctor and the Patient and some of these third parties have $$$ as their primary objective. Well, it would be OK, to have money as a primary objective, if pateint care is perfect, but some of these thirds parties will cut corners on patient care and patient safety to make more money(eg, Health Care Providers), or keep their money(eg, Health Insurance Companies). This is where the Doctor-Patient Relationship comes in. It is the responsibility and the sworn duty of physicians to take care of The Patient First and above all else to promote patient safety. This is an obligation that comes with the Hippocratic Oath ... the Oath that most, if not all Physicians take upon graduation from medical school, and this is a serious matter.
This oath creates the foundation of the Doctor-Patient Relationship, and it is essential to providing optimal patient care. Patient Care is never perfect, because the Science of Medicine is not perfect, but the physician's obligation remains and is based upon the best available science. Next, I will ... when I get to some high speed internet access, put the oath in here. In the meantime, think about what I have said and know that it boils down to Do the best thing possible for your patients at all times, do the right thing, and do no harm.
Do you have a relationship with a Trusted Doctor? If not, why not? If not, you need to find one. I will give you some tips here in the future, but for now, when you do see a doctor, make sure he/she graduated from medical school and make sure he/she took the Hippocratic Oath. Ask him/her what it means and how it is important to your relationship.
Ciao for now.
Dr. Mike
Friday, July 15, 2011
Mission: Healing, July 15, 2011
PGY 39, Day 15
I must confess to being a coffee snob. That means I love coffee, and I have become more and more picky about what coffee I will drink, and where & when I will drink it. When I am working in the OR, I will get up extra early, so I can take the time to make and drink my coffee. For me, it has become an important ritual ... and (with regard to this particular ritual) the ultimate is having the time to roast beans in the evening, grind them in the morning, sniff them and the fresh grind and fresh brew in the morning. Then comes the drink ... nothing like that morning cup, brewed with crystal clear spring water ... sipping it to the tune of birdsong and the sight of morning sun as it cuts through the darkness to dawn on us and show us what this day has to offer. That's the way I like to start the day and it does happen sometimes.
Generally, I don't have the perfect ritual, but the morning coffee ritual is always part of my time for recovery and healing ... time for contemplation and consideration of the stuff of the days before and time for planning this day and the days to come.
So, as this bright and sunny day emerges in the midst of my coffee ritual, as usual, I think about the past, present and future.
Yesterday I spent several hours doing administrative work for WVU. This included Quality and Performance Improvement activity, and some email correspondence with the Dean about a few contentious "issues". Of course, these are confidential matters, so you will not get any details here. But, the point is that several hours of my time were spent doing work for WVU.
Buona Fortuna ... e una bella giornata!
Dr. Mike
I must confess to being a coffee snob. That means I love coffee, and I have become more and more picky about what coffee I will drink, and where & when I will drink it. When I am working in the OR, I will get up extra early, so I can take the time to make and drink my coffee. For me, it has become an important ritual ... and (with regard to this particular ritual) the ultimate is having the time to roast beans in the evening, grind them in the morning, sniff them and the fresh grind and fresh brew in the morning. Then comes the drink ... nothing like that morning cup, brewed with crystal clear spring water ... sipping it to the tune of birdsong and the sight of morning sun as it cuts through the darkness to dawn on us and show us what this day has to offer. That's the way I like to start the day and it does happen sometimes.
Generally, I don't have the perfect ritual, but the morning coffee ritual is always part of my time for recovery and healing ... time for contemplation and consideration of the stuff of the days before and time for planning this day and the days to come.
So, as this bright and sunny day emerges in the midst of my coffee ritual, as usual, I think about the past, present and future.
Yesterday I spent several hours doing administrative work for WVU. This included Quality and Performance Improvement activity, and some email correspondence with the Dean about a few contentious "issues". Of course, these are confidential matters, so you will not get any details here. But, the point is that several hours of my time were spent doing work for WVU.
Buona Fortuna ... e una bella giornata!
Dr. Mike
Sunday, July 10, 2011
Mission Healing: July 10, 2011
PGY 39, Day #10
I tried to post this on the ACPE website discussion that I had told you about earlier. Today, this one, somehow got lost in cyberspace, and I can't paste into the ACPE discussion, and I am not going to type it in again. The discussion is the hottest spot on the website with over 60 posts and more than 400 views. Keep in mind, these are all Doctors who are (presumably) busy.
This is what I wanted to post ... it is going on my blog instead and I will invite them to view it here.
"Hello, Dr. G:
Thank you for your good words. I am just glad to see this discussion in print, and that it is being sponsored by ACPE. ACPE is showing true leadership by enabling such a conversation. But, I don't really see it as a debate, and I don't see anyone holding back ... even though I am sure that some are afraid to speak for one reason or another.
From the postings so far, I see quite a bit of agreement, but I have also noticed that there are many viewers and only a few "posters". I wonder who is watching and I wonder what they have to say? Hope they speak up.
Nevertheless, although my personal preference is to see PLs and PEs on the front lines with me on a regular basis for many reasons, I don't think anyone said that "practicing full time in patient care" is required to have a "more important or more relevant" opinion. More important than any words or opinions expressed on these electronic pages are the facts that define our success as physicians in meeting our obligations to the patients. In other words, we all know how to talk the talk, but how well do we walk the walk?
To keep us all walking ... perhaps a bit more in synchrony toward meeting our patient obligations, we all need sensors on the front lines. I like real people as sensors ... real doctors and real patients. Short of being the patients. or providers, on the front line, the next best thing is for all PEs and PLs to get out there on the front lines on a regular basis. And, while you are at it, drag the non physician Execs and Leaders out there with you as well. Feel the heat of the battle. Is it so scary, or time consuming to to get out there every once in a while ... to see, feel, smell, hear and touch what is actually going on out there? Is it so hard, that PEs and PLs can't go there? If that is the case, maybe those folks belong in another business.
It is time for us to face the facts that the Business of Medicine has become an out of control monster composed of and driven by an outrageous number of third parties most of which are political, self serving or both. This BUSINESS OF MEDICINE MONSTER, drives us ... more and more away from our sworn obligations to the patients. This monster rides on our backs ... the backs of doctors and patients ... the backs of the DOCTOR-PATIENT RELATIONSHIP. This monster has control, it holds the whip and the leash ... and it is not about to relinquish that control. That is why I see the need for a new paradigm.
But, that will take time and effort ... probably 3-6 months to start and 3-5 years to build an alternative program with long term viability. In the meantime, I will continue to push to get the PEs and PLs out onto the front lines and I will continue to look for and work with & for PEs and PLs who are clearly aligned to helping me to continue to carry out all aspects of my Healing Mission on the front lines and all the other lines for as long as I have something to offer.
My hope is that ACPE will continue to enable this discussion and will help us take the next steps toward developing a new paradigm that will help us all to stay on target with our Healing Mission. With any luck, some of our current PEs and PLs will participate in the process and help us to make it right.
Dr. Mike"
I tried to post this on the ACPE website discussion that I had told you about earlier. Today, this one, somehow got lost in cyberspace, and I can't paste into the ACPE discussion, and I am not going to type it in again. The discussion is the hottest spot on the website with over 60 posts and more than 400 views. Keep in mind, these are all Doctors who are (presumably) busy.
This is what I wanted to post ... it is going on my blog instead and I will invite them to view it here.
"Hello, Dr. G:
Thank you for your good words. I am just glad to see this discussion in print, and that it is being sponsored by ACPE. ACPE is showing true leadership by enabling such a conversation. But, I don't really see it as a debate, and I don't see anyone holding back ... even though I am sure that some are afraid to speak for one reason or another.
From the postings so far, I see quite a bit of agreement, but I have also noticed that there are many viewers and only a few "posters". I wonder who is watching and I wonder what they have to say? Hope they speak up.
Nevertheless, although my personal preference is to see PLs and PEs on the front lines with me on a regular basis for many reasons, I don't think anyone said that "practicing full time in patient care" is required to have a "more important or more relevant" opinion. More important than any words or opinions expressed on these electronic pages are the facts that define our success as physicians in meeting our obligations to the patients. In other words, we all know how to talk the talk, but how well do we walk the walk?
To keep us all walking ... perhaps a bit more in synchrony toward meeting our patient obligations, we all need sensors on the front lines. I like real people as sensors ... real doctors and real patients. Short of being the patients. or providers, on the front line, the next best thing is for all PEs and PLs to get out there on the front lines on a regular basis. And, while you are at it, drag the non physician Execs and Leaders out there with you as well. Feel the heat of the battle. Is it so scary, or time consuming to to get out there every once in a while ... to see, feel, smell, hear and touch what is actually going on out there? Is it so hard, that PEs and PLs can't go there? If that is the case, maybe those folks belong in another business.
It is time for us to face the facts that the Business of Medicine has become an out of control monster composed of and driven by an outrageous number of third parties most of which are political, self serving or both. This BUSINESS OF MEDICINE MONSTER, drives us ... more and more away from our sworn obligations to the patients. This monster rides on our backs ... the backs of doctors and patients ... the backs of the DOCTOR-PATIENT RELATIONSHIP. This monster has control, it holds the whip and the leash ... and it is not about to relinquish that control. That is why I see the need for a new paradigm.
But, that will take time and effort ... probably 3-6 months to start and 3-5 years to build an alternative program with long term viability. In the meantime, I will continue to push to get the PEs and PLs out onto the front lines and I will continue to look for and work with & for PEs and PLs who are clearly aligned to helping me to continue to carry out all aspects of my Healing Mission on the front lines and all the other lines for as long as I have something to offer.
My hope is that ACPE will continue to enable this discussion and will help us take the next steps toward developing a new paradigm that will help us all to stay on target with our Healing Mission. With any luck, some of our current PEs and PLs will participate in the process and help us to make it right.
Dr. Mike"
Saturday, July 9, 2011
On the Lighter Side ...
Today, (actually it was Friday) I am OFF! That means, I am goofing off and doing some things that have needed to be done for a long time, like oil change and do it yourself auto maintenance & cleaning. So, after the oil change (6000 miles overdue), I go to the local branch of "megachain" auto supply, to get some fabric/carpet cleaning stuff(there are about 30 to choose from. It takes me a while to figure that out, but pick one that should work and is the least toxic. I actually know what the chemicals are.) & fog light bulbs (they have been out for about 6000 miles, which is not too long in my life. I drive quite a bit.). While at the store,I have the guy run the diagnostics on my "check engine" idiot light, which has also been on and off for about 20,000 miles.(Should I get a tune up?).
Anyway, the funny part of the story is this: I buy the fog light bulbs and carpet cleaning stuff, but and before walking out the door, I made the mistake of asking, "Is this a tough job?" He jumps on the question and instantly (acting as if he knows what he is talking about) proceeds to make it sound like a big production. I don't know if he thought I was too old to get down on the ground and back up again, or what, but he said, "ya gotta put da car up on da lift and ya gotta get on your back and all that." So, I'm thinking to myself, "Hmmm, sounds like a PIA. Maybe I should leave this to the dealer. I can't bring the bulbs to the dealer. O .. boy ..." But, "o boy", I buy the bulbs anyway.
"Perfect conditions!" Warm and dry in the driveway when I get to the house. Carpets and seats clean. Still warm and dry. "To hell with it," I pull out my camping matt, lay it on the pavement and pull out the old bulb and fixture in less than 30 seconds. "OH" ... bulb out in another 30 seconds "OH" ... new bulb in another 30 seconds ... back in place ... another 30 seconds. Same thing on the passenger side ... and they work.
Engine Diagnostics said one of the vacuum regulators also needed to be replaced, so I bought that part. "It is easy. Right on top of the engine." When I checked under the hood, it instantly became clear that it is easier said than done to replace that part. I will give it a shot, when I have a whole day.
Moral of the story ... don't listen to the guy at the counter of "megachain" auto supply, when you need advice about how to replace auto parts.
Dr. Mike
Anyway, the funny part of the story is this: I buy the fog light bulbs and carpet cleaning stuff, but and before walking out the door, I made the mistake of asking, "Is this a tough job?" He jumps on the question and instantly (acting as if he knows what he is talking about) proceeds to make it sound like a big production. I don't know if he thought I was too old to get down on the ground and back up again, or what, but he said, "ya gotta put da car up on da lift and ya gotta get on your back and all that." So, I'm thinking to myself, "Hmmm, sounds like a PIA. Maybe I should leave this to the dealer. I can't bring the bulbs to the dealer. O .. boy ..." But, "o boy", I buy the bulbs anyway.
"Perfect conditions!" Warm and dry in the driveway when I get to the house. Carpets and seats clean. Still warm and dry. "To hell with it," I pull out my camping matt, lay it on the pavement and pull out the old bulb and fixture in less than 30 seconds. "OH" ... bulb out in another 30 seconds "OH" ... new bulb in another 30 seconds ... back in place ... another 30 seconds. Same thing on the passenger side ... and they work.
Engine Diagnostics said one of the vacuum regulators also needed to be replaced, so I bought that part. "It is easy. Right on top of the engine." When I checked under the hood, it instantly became clear that it is easier said than done to replace that part. I will give it a shot, when I have a whole day.
Moral of the story ... don't listen to the guy at the counter of "megachain" auto supply, when you need advice about how to replace auto parts.
Dr. Mike
Friday, July 8, 2011
Mission: Healing, July 8, 2011, ACPE Post
This is my latest post on the American College of Physician Executives discussion regarding, Why Physician Leaders are not Leading Health Care Reform. I am advocating the start of a new paradigm. Specifically, I think it is a good time to start a Non Profit Doctor-Patient Health Care Cooperative. I think I made a couple Executive Physicians angry. What do you think?
This is what I said early this morning ...
"Doctors:
This is a great discussion from my perspective. Why? Because front line docs are talking with Physician Leaders & some are paying attention. Sorry, Dr. Cardinal, but, with all due respect, physician leaders and especially physician executives need to work the front lines. Why? It keeps them honest and aligned with the healing mission.
I have never been there, but I have heard and read that respected Generals work the front lines with their troops and their boots on the ground. They may not man the machine guns, rifles, tanks and other weapons, but they are in there with the troops & they understand the war.
I have not had the honor of working for Geisinger, but I have worked front lines, administrative lines, academic lines, public health lines and research lines in many environments, and in institutions ranging from my own private rural medical practice in Maine, to academic Critical Care Anesthesiology Divisions at SUNY in Syracuse, Tulane in New Orleans & WVUH Morgantown. Maybe Geisinger is different, but I have never seen any PEs or PLs in the Intensive Care Units or Operating Rooms. Closest I have been to a PE was the hug I got from Paul Whelton AFTER evacuation from Tulane, where I had the honor of serving during Katrina and the days that followed ... he was the only one around and i admire him for that. All the others have been ... well, I just don't know where they have been. I only know where they have not been and I do know how it has been on those front lines. I do know that few have been listening.
So, nevertheless, I have begun this PGY 39 still committed to the Healing mission & the oath that I took upon graduation ... on the front lines (and all the other lines) ... still optimistic ... because joy comes from the DOCTOR-PATIENT RELATIONSHIP ... & this is a labor of love. I am still optimistic about the Healing Mission, but not about the "business of medicine". Medicine will survive ... the business of medicine will not.
ACPE is the only professional organization I have ever joined that has been supportive & worth the money. ACPE has enabled my continued growth as a physican-healer-administrator-teacher-researcher. I am wondering if it is an organization that can support us in in the creation of a new paradigm that is destined to survive. I am wondering if it is going to be a part of the solution, or not. We will see. So far, so good ... this dialog is a good start.
Dr. Mike"
This is what I said early this morning ...
"Doctors:
This is a great discussion from my perspective. Why? Because front line docs are talking with Physician Leaders & some are paying attention. Sorry, Dr. Cardinal, but, with all due respect, physician leaders and especially physician executives need to work the front lines. Why? It keeps them honest and aligned with the healing mission.
I have never been there, but I have heard and read that respected Generals work the front lines with their troops and their boots on the ground. They may not man the machine guns, rifles, tanks and other weapons, but they are in there with the troops & they understand the war.
I have not had the honor of working for Geisinger, but I have worked front lines, administrative lines, academic lines, public health lines and research lines in many environments, and in institutions ranging from my own private rural medical practice in Maine, to academic Critical Care Anesthesiology Divisions at SUNY in Syracuse, Tulane in New Orleans & WVUH Morgantown. Maybe Geisinger is different, but I have never seen any PEs or PLs in the Intensive Care Units or Operating Rooms. Closest I have been to a PE was the hug I got from Paul Whelton AFTER evacuation from Tulane, where I had the honor of serving during Katrina and the days that followed ... he was the only one around and i admire him for that. All the others have been ... well, I just don't know where they have been. I only know where they have not been and I do know how it has been on those front lines. I do know that few have been listening.
So, nevertheless, I have begun this PGY 39 still committed to the Healing mission & the oath that I took upon graduation ... on the front lines (and all the other lines) ... still optimistic ... because joy comes from the DOCTOR-PATIENT RELATIONSHIP ... & this is a labor of love. I am still optimistic about the Healing Mission, but not about the "business of medicine". Medicine will survive ... the business of medicine will not.
ACPE is the only professional organization I have ever joined that has been supportive & worth the money. ACPE has enabled my continued growth as a physican-healer-administrator-teacher-researcher. I am wondering if it is an organization that can support us in in the creation of a new paradigm that is destined to survive. I am wondering if it is going to be a part of the solution, or not. We will see. So far, so good ... this dialog is a good start.
Dr. Mike"
Mission: Healing, July 8, 2011
PGY 39, Day #8. Worked into the morning of the 5th in the ICU. Everything went quite well and now I am in the recovery phase; this time after an 8 day week. During recovery time, I generally catch up on sleep, reflect on the clinical work, tie up the loose ends and take care of my administrative and personal stuff that has to be put aside during the intense focus on leading the SICU team ... to care for the patients.
We had some remarkable and dramatic patient care problems this past week. And, I might add, that the outcomes were remarkably good! That is something to celebrate. When I get back to the unit at the end of the month, I will make a point of telling folks how well they did. We will review the cases in SICU M&M for teaching purposes.
SICU is so intense, that I can't do much of anything other than work with the team to make sure the patient get optimal care. I have designed some tools to help keep inexperienced providers on target with the Healing Mission ... Patients and Patient Safety first. There is so much noise and so many distractions that it is particularly difficult to keep newbies on focus. It can be done ... it is always a tough job ... orchestrating optimal comprehensive care of critically ill patients ... but, it is a beautiful thing when it is done right. Doing the right thing for the patients and families ... despite the obstacles and the complexities ... that is the Healing Mission.
Dr. Mike
We had some remarkable and dramatic patient care problems this past week. And, I might add, that the outcomes were remarkably good! That is something to celebrate. When I get back to the unit at the end of the month, I will make a point of telling folks how well they did. We will review the cases in SICU M&M for teaching purposes.
SICU is so intense, that I can't do much of anything other than work with the team to make sure the patient get optimal care. I have designed some tools to help keep inexperienced providers on target with the Healing Mission ... Patients and Patient Safety first. There is so much noise and so many distractions that it is particularly difficult to keep newbies on focus. It can be done ... it is always a tough job ... orchestrating optimal comprehensive care of critically ill patients ... but, it is a beautiful thing when it is done right. Doing the right thing for the patients and families ... despite the obstacles and the complexities ... that is the Healing Mission.
Dr. Mike
Monday, July 4, 2011
Mission: Healing, July 4, 2011
Happy 4th of July! PGY 39, Day 4
Yesterday brought worries to the surface of the interns. Let's see what today brings. So far, there are no panic calls. Yesterday, there was contained panic.
Dr. Mike
Yesterday brought worries to the surface of the interns. Let's see what today brings. So far, there are no panic calls. Yesterday, there was contained panic.
Dr. Mike
Sunday, July 3, 2011
Mission: Healing, July 3, 2011
Another short night and days blending together. The calendar says it is another day and that tomorrow is a holiday, but this is a block of time: an 8 day week for the patients ... time, virtually 100% of which is dedicated to the patients. We will see what today brings.
I will go in soon ... sooner if they call me for a problem.
Dr. Mike
I will go in soon ... sooner if they call me for a problem.
Dr. Mike
Saturday, July 2, 2011
Mission: Healing, July 2, 2011, PGY 39, Day 2 Continued
Here it is! My post to American College of Physician Executives discussion from today. We will see what I get for responses.
Dr. Mike
This is PGY 39, Day 2 for me. That means Post Graduate Year 39 (after medical school) for those who are unfamiliar with the term. PGY 39 ... WOW! I remember the day I graduated and the day I took the oath. Things have changed, but I still take that oath seriously.
Running the SICU service with two PGY 1s (AKA interns) and some back up from PGY 2s and 3s. We get the job done despite the distractions. How? Focus on the Mission. What is the Mission? Healing; AKA Patient Care. That is the only way I can keep inexperienced house staff and nurses on target to provide comprehensive quality care.
Do we talk about money? Yes. Do we talk about Quality and Performance? Yes. Do we talk about the needs of the providers? Yes. But, all of the conversations not central to providing optimal patient care are secondary to our talk about specific patients, their needs and the needs of their families and loved ones. We engage everyone in the process of care ... patients, families, docs and support staff ... all the folks who help us care for those patients. They all help us to stay on target with the mission, goals, objectives and the process of providing optimal care for OUR patient. It works ... it is hard work, but it works and it is the right thing to do and it is rewarding. Not for the money, but for the pleasure that comes from doing the right things for these folks who need us. It is about love ... there is not enough money to endure the stupidities that have grown into great obstacles and barriers between Doctor and Patient.
Yes, it all gets harder as the complexities of care grow ... not because patient care is harder, but because increasing numbers of various (removed from the front line) third parties impose more and more tasks and distractions that detract from our efforts to accomplish the mission.
How many of you work the front lines? How many of you feel "production pressure"? How many of you work for a "Physician Leader" who is pushing you to cut corners on Patient Care and Patient Safety for short term $$$ gains and profits? How many of our "Physician Leaders" work the front lines? My bet is that there are very few of us out there. And, how many of us who work the front lines have a significant voice in driving the health care machine that we work in? I suspect very few have a say.
What does that have to do with anything? Get out there and try it ... try breaking away from those closed door executive meetings and get yourselves embedded in the front lines. You might learn something about the needs of the patients and front line providers.
Think about it, and think about this: This is the time for a new paradigm ... or return to the old paradigm. Return to the fundamental practice that is the DOCTOR - PATIENT relationship. Simplify ... get the third parties out. That would save 30 - 60% of each and every health care dollar. If you don't take care of patients, you have no business making decisions about how patient care is provided! Get out! And, those of us on the front lines will have to carry some necessary administrative burdens. Such is life as it should be, in a DOCTOR-PATIENT driven health care system.
I sat at one of my obligatory hospital meetings the other morning. During the usual boredom, I counted the number of people there who rarely, or never take care of patients. They have created a bumbling and very expensive bureaucracy to justify their own existence. What for? To deal with the complexities created by other third parties that never take care of patients. This is the BUSINESS OF MEDICINE and not the PROFESSION OF MEDICINE.
The business of medicine is not equal to, nor does it have the capacity to provide optimal patient care. In other words, the BUSINESS OF MEDICINE does not equal GOOD PATIENT CARE. There are too many gaps and obstacles in the production lines (product line/factory mentality) designed to make money ... forcing doctors to become line workers who work on their patients for the sake of the company. The Healing Mission ... the Human Factors ... are lost in the confusion that ensues when we chase the money.
That approach can never work, because it is designed to make money and not designed to provide individualized care to patients and families. The HEALING MISSION can only be accomplished through the bond between DOCTOR and PATIENT in the context of their FAMILY. Why did we let this happen? We followed the money!
Let's try something different. I believe the time is right for a new paradigm. LET'S START a NATIONAL NON PROFIT DOCTOR - PATIENT COOPERATIVE. Build greed out of it. Cap salaries and eliminate profits. Put all money back into care, and "profits" back into the hands of the members.
My sense is that about 5 - 10 % of the patients we serve are interested in being active participants in their health care. That is a large number of people. And, according to my calculations, that could, over time, create a large enough population base to enable development of a NATIONAL, or INTERNATIONAL NON PROFIT DOCTOR-PATIENT INSURANCE COOPERATIVE that could fund itself for routine care and buy, or create catastrophic back up coverage to be used anywhere.
Idealistic? Yes. Possible? Yes. Anyone interested? Let me know. I need a few good, experienced, dedicated and courageous docs (and patients) who are ready to work with me and to take a step into the unknown for the sake of the patients we all serve ... and for the sake of the profession ... to honor the oath that most of us took upon graduation from medical school. You have little to lose and, perhaps, we all have a little something to gain.
Dr. Mike
MFM@IHS ip
Dr. Mike
This is PGY 39, Day 2 for me. That means Post Graduate Year 39 (after medical school) for those who are unfamiliar with the term. PGY 39 ... WOW! I remember the day I graduated and the day I took the oath. Things have changed, but I still take that oath seriously.
Running the SICU service with two PGY 1s (AKA interns) and some back up from PGY 2s and 3s. We get the job done despite the distractions. How? Focus on the Mission. What is the Mission? Healing; AKA Patient Care. That is the only way I can keep inexperienced house staff and nurses on target to provide comprehensive quality care.
Do we talk about money? Yes. Do we talk about Quality and Performance? Yes. Do we talk about the needs of the providers? Yes. But, all of the conversations not central to providing optimal patient care are secondary to our talk about specific patients, their needs and the needs of their families and loved ones. We engage everyone in the process of care ... patients, families, docs and support staff ... all the folks who help us care for those patients. They all help us to stay on target with the mission, goals, objectives and the process of providing optimal care for OUR patient. It works ... it is hard work, but it works and it is the right thing to do and it is rewarding. Not for the money, but for the pleasure that comes from doing the right things for these folks who need us. It is about love ... there is not enough money to endure the stupidities that have grown into great obstacles and barriers between Doctor and Patient.
Yes, it all gets harder as the complexities of care grow ... not because patient care is harder, but because increasing numbers of various (removed from the front line) third parties impose more and more tasks and distractions that detract from our efforts to accomplish the mission.
How many of you work the front lines? How many of you feel "production pressure"? How many of you work for a "Physician Leader" who is pushing you to cut corners on Patient Care and Patient Safety for short term $$$ gains and profits? How many of our "Physician Leaders" work the front lines? My bet is that there are very few of us out there. And, how many of us who work the front lines have a significant voice in driving the health care machine that we work in? I suspect very few have a say.
What does that have to do with anything? Get out there and try it ... try breaking away from those closed door executive meetings and get yourselves embedded in the front lines. You might learn something about the needs of the patients and front line providers.
Think about it, and think about this: This is the time for a new paradigm ... or return to the old paradigm. Return to the fundamental practice that is the DOCTOR - PATIENT relationship. Simplify ... get the third parties out. That would save 30 - 60% of each and every health care dollar. If you don't take care of patients, you have no business making decisions about how patient care is provided! Get out! And, those of us on the front lines will have to carry some necessary administrative burdens. Such is life as it should be, in a DOCTOR-PATIENT driven health care system.
I sat at one of my obligatory hospital meetings the other morning. During the usual boredom, I counted the number of people there who rarely, or never take care of patients. They have created a bumbling and very expensive bureaucracy to justify their own existence. What for? To deal with the complexities created by other third parties that never take care of patients. This is the BUSINESS OF MEDICINE and not the PROFESSION OF MEDICINE.
The business of medicine is not equal to, nor does it have the capacity to provide optimal patient care. In other words, the BUSINESS OF MEDICINE does not equal GOOD PATIENT CARE. There are too many gaps and obstacles in the production lines (product line/factory mentality) designed to make money ... forcing doctors to become line workers who work on their patients for the sake of the company. The Healing Mission ... the Human Factors ... are lost in the confusion that ensues when we chase the money.
That approach can never work, because it is designed to make money and not designed to provide individualized care to patients and families. The HEALING MISSION can only be accomplished through the bond between DOCTOR and PATIENT in the context of their FAMILY. Why did we let this happen? We followed the money!
Let's try something different. I believe the time is right for a new paradigm. LET'S START a NATIONAL NON PROFIT DOCTOR - PATIENT COOPERATIVE. Build greed out of it. Cap salaries and eliminate profits. Put all money back into care, and "profits" back into the hands of the members.
My sense is that about 5 - 10 % of the patients we serve are interested in being active participants in their health care. That is a large number of people. And, according to my calculations, that could, over time, create a large enough population base to enable development of a NATIONAL, or INTERNATIONAL NON PROFIT DOCTOR-PATIENT INSURANCE COOPERATIVE that could fund itself for routine care and buy, or create catastrophic back up coverage to be used anywhere.
Idealistic? Yes. Possible? Yes. Anyone interested? Let me know. I need a few good, experienced, dedicated and courageous docs (and patients) who are ready to work with me and to take a step into the unknown for the sake of the patients we all serve ... and for the sake of the profession ... to honor the oath that most of us took upon graduation from medical school. You have little to lose and, perhaps, we all have a little something to gain.
Dr. Mike
MFM@IHS ip
Mission: Healing, July 2, 2011
Day 2 of PGY 39 will continue, as it has been a night without much sleep ... a continuation of yesterday without distinction. Sickness does not know the clock, or the calendar, so one day blends into the next. We live in the moment ... each moment dictated by the needs of the patients we serve.
Quiet and calm West Virginia morning ... mourning dove, birdsong, cool, sweet air, sunshine and calm for the moment. All reports calm in the house this morning as well. We shall see.
Dr. Mike
Quiet and calm West Virginia morning ... mourning dove, birdsong, cool, sweet air, sunshine and calm for the moment. All reports calm in the house this morning as well. We shall see.
Dr. Mike
Friday, July 1, 2011
Mission: Healing, July 1, 2011
July 1, 2011 ... another first of July ... 39th year starts today. Could that be right? Yes that is right. This is the start of my 39th year in medicine. I'll think back on that ... reflect on it a bit with the new folks, before we start rounds today. They will be in a frenzy of fear and excitement.
Dr. Mike
Dr. Mike
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