[smartdoctor] Re: entering dangerous territory.
- From: Jasna Ercegović <jercegovic66@xxxxxxxxx>
- To: smartdoctor@xxxxxxxxxxxxx
- Date: Thu, 23 Oct 2014 08:08:50 +0200
Ida, ja bih podvukla ili potcrtala i ovu rečenicu iz gornjeg članka:
"*Ultimately,
though, it’s up to physicians to choose*". I rekla bih da su i kod nas
liječnici izabrali ( osim 12%)- our current system still rewards speed and
procedures much more richly than patient interaction
Jer jedino kad bi SVI u PZZ odlučili raditi najviše 40-ak pacijenata /dan (
uključujući u to i administraciju) , uvelo naručivanja i posljedično liste
čekanja, sigurno bi to odjeknulo u medijima i možda bi se tek onda uvažili
naši svakodnevni vapaji-ovako.....
2014-10-22 19:58 GMT+02:00 BARI <bari.sita@xxxxxxxxxxx>:
> *From:* smartdoctor-bounce@xxxxxxxxxxxxx [mailto:
> smartdoctor-bounce@xxxxxxxxxxxxx] *On Behalf Of *dr Zlatko Sušanj
> *Sent:* Wednesday, October 22, 2014 6:23 PM
> *To:* smartdoctor@xxxxxxxxxxxxx
> *Subject:* [smartdoctor] Re: [smartdoctor] Koliko pacijenata može doktor
> sa SIGURNŠĆU vidjeti/pregledati dnevno?....nakon trideset pacijenata
> ulazite na opasan teritorij...
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> Ne sjećam se da sam ikad izašao iz opasnog teritorija. *Ridiculous **[image:
> cid:B68@goomoji.gmail]*
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> Your Middle Name Is Danger,Ida
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> 2014-10-22 11:18 GMT+02:00 BARI <bari.sita@xxxxxxxxxxx>:
>
> ….good medicine simply can’t be practiced in five to seven minutes.
>
> I would argue that if any practice has a significant amount of patients
> over the age of fifty, then seeing more than about *twenty-five to thirty
> patients a day* is irresponsible. …..once you go above that number in one
> day *you’re entering dangerous territory*.
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> Koliko pacijenata može doktor sa SIGURNOŠĆU vidjeti/pregledati dnevno?Ida
> How many patients can a doctor safely see a day?
>
> Luis Collar, MD <http://www.kevinmd.com/blog/post-author/luis-collar> |
> Physician <http://www.kevinmd.com/blog/category/physician> | December 31,
> 2013
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> Today’s question is a simple one. How many patients can a physician see in
> one day and still be thorough? Don’t get me wrong; I’m all for efficiency.
> But we need to recognize when efforts at efficiency become “medical
> sloppiness” or, frankly, malpractice.
>
> With health care policy and insurance reimbursement what they are today,
> it’s not uncommon to encounter physicians seeing forty, fifty, and even
> sixty or more patients a day in the outpatient setting. The truth is,
> though, no matter how experienced the doctor, no matter how technologically
> streamlined the practice, one physician can’t maintain medical accuracy at
> that frenetic a pace. Many physicians like to think they can because they
> manage to see every patient on their schedule and do their thing. But, in
> most instances, good medicine simply can’t be practiced in five to seven
> minutes.
>
> Sure, there are cases where that is all that’s required. A young, healthy
> patient, a simple physical, or a stable patient that just needs a
> medication refill can usually be handled that quickly. But I often see
> physicians trying to care for medically complex, older patients on multiple
> medications in the same fashion. The rationalization is usually that, with
> enough experience, one can take care of these patients just as quickly. But
> the issue, then, becomes precisely what constitutes “handling” a patient.
>
> A patient with a complex medical history always requires more time. Trying
> to argue otherwise is simply intellectually dishonest. You can’t take a
> history, no matter how focused, reconcile all current medications looking
> for undesired interactions or required modifications, review labs, monitor
> patient progress, look for better therapeutic approaches, address new
> issues, encourage communication, conduct a thorough physical exam, and
> spend time on health counseling / preventive care in five to seven minutes.
> It just can’t be done that quickly with these patients.
>
> I’ve worked in offices where this level of “efficiency” is touted as the
> future, the result of effectively leveraging new technology. But the truth
> is, as much as it pains me to say it, it’s just bad medicine. And the
> argument that a particular practice doesn’t have that many complicated
> patients is, in most cases, yet another fallacy.
>
> Complicated patients are not to be confused with medically interesting
> patients. Many of the most common chronic illnesses that find their way
> into physicians’ offices are, in fact, not interesting or exciting for
> seasoned medical professionals. After all, diabetes isn’t exactly
> extraskeletal myxoid chondrosarcoma or any of the “sexy” hemorrhagic
> fevers, but that doesn’t mean it isn’t an exquisitely complex illness
> requiring a thorough clinical approach.
>
> So the average primary care physician may not have many “medically
> interesting” patients, but they probably do have many complex patients. I
> would argue that if any practice has a significant amount of patients over
> the age of fifty, then seeing more than about twenty-five to thirty
> patients a day is irresponsible. Seeing three to four patients an hour
> yields a number somewhere in that range. And while some patients can be
> “handled” more quickly than others, once you go above that number in one
> day you’re entering dangerous territory.
>
> If you look at the available data and the current incidence of obesity,
> heart disease, hypertension, diabetes, and depression to name a few, then
> any practice serving patients over the age of fifty must, by definition,
> have a good number of complex patients. Although common, none of these
> illnesses are “simple.” Quick refills, not listening, not asking probing
> questions, shoddy physical exams, not looking for all possible signs and
> symptoms of disease progression, poor or no counseling, and not actively
> staying ahead of a disease are all poor practice. More importantly, those
> practices lead to poorer patient outcomes and increased health care costs
> in the long run. That is particularly true with this patient population.
>
> The challenge, of course, is that our current system still rewards speed
> and procedures much more richly than patient interaction and thorough
> analysis. Although not a new concept, as reimbursement continues to
> decrease necessarily (Medicare’s pockets aren’t as deep as they used to be)
> and more patients gain access to the system, addressing the question of
> “medical speed” will become increasingly important.
>
> Admittedly, the thoughts presented here are only based on anectdotal
> evidence collected over several years of working with numerous physicians,
> in multiple settings, and at several different hospitals. However, I do
> believe there is a trend here. The more “evolved” our health care system
> becomes, the more pressure is placed on physicians to leverage technology
> and see more patients, the more bad professional habits are being developed.
> Technology
> can help increase efficiency, but it can’t yet replace ample time with an
> interested, compassionate, well-trained physician. *Not every patient
> requires thirty or forty minutes, but if we’re going to be honest, forty or
> more patients a day is simply ridiculous.*
>
> I would challenge all physicians to honestly evaluate how long they spend
> with complicated patients. More importantly, I’d be interested in knowing
> how they define a complex patient. And I would question any definition that
> doesn’t include even the most common chronic illnesses. No matter how
> “boring” these may be, their intrinsic complexity and impact on public
> health certainly justify more than a few minutes of diagnostic effort, even
> with routine follow-up visits.
>
> I would also encourage all patients to expect more from their doctors than
> a couple of questions and some quick advice in five to seven minutes. If
> you’re there for a simple cold, then maybe that approach is appropriate.
> But if you have a chronic illness and are concerned by some new symptoms or
> recent changes in your overall health, you should expect much more from an
> office visit.
>
> And finally, I would encourage all policy makers to recognize the valuable
> role physicians play in our society. We need policies that encourage them
> to do their jobs properly instead of punishing them for it. Ultimately,
> though, it’s up to physicians to choose. I hope they are true to their
> training and show humility in the face of complex, albeit common, diseases.
> *It’s
> a shame to simply toss all that “medical school stuff” out the window
> simply because the system is currently what it is.*
>
> *Luis Collar is a physician who blogs at *Sapphire Equinox
> <http://sapphireequinox.com/blog/>*. He is the author of *A Quiet Death
> <http://www.amazon.com/gp/product/0615900070/ref=as_li_qf_sp_asin_il_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0615900070&linkCode=as2&tag=kevcom-20>
> .
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