[smartdoctor] Re: entering dangerous territory.
- From: Jasna Ercegović <jercegovic66@xxxxxxxxx>
- To: smartdoctor@xxxxxxxxxxxxx
- Date: Thu, 23 Oct 2014 12:46:51 +0200
Zdravstvenoj administraciji ( čitaj-progamerima) ništa nije nemoguće, jer
sve što HAZO naredi-oni ( promptno) provedu u djelo!
2014-10-23 10:21 GMT+02:00 Daniela <daniela.hamulka@xxxxxxxxx>:
> ako tako odlučimo, imat ćemo bombe u ordinacijama svaki dan...to je stvar
> zdravstvene administracije da nam riješi, zamisli samo još dodatni posao
> -argumentacija sa svakim pacijentom preko 40. , pa izludili bi svi
> skupa...to bi trebali odraditi oni koji su za to i plaćenj...stratezi
> zdravstvenog sustava ..na svim razinama ...
>
> 2014-10-23 8:08 GMT+02:00 Jasna Ercegović <jercegovic66@xxxxxxxxx>:
>
>> 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...
>>>
>>>
>>>
>>> Ne sjećam se da sam ikad izašao iz opasnog teritorija. *Ridiculous **[image:
>>> cid:B68@goomoji.gmail]*
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>> 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*.
>>>
>>>
>>>
>>> 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
>>>
>>>
>>>
>>> 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>
>>> .
>>>
>>>
>>>
>>>
>>>
>>
>>
>
>
> --
> Daniela
>
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