I’m publishing this blog post a bit late. I can’t stand not writing about a blogger friend and defy her preference for “slipping away” silently.

Goodbye blogger friend. We will miss your blog posts, your writing and your knack for demystifying music to us, cold souls.

Goodbye fellow bone doc. Even if we rarely had a chance of actually doing bone surgeries together, we shared the same tenacity for fishing out the medical absurdities of our work.

I hope you did take the “wave and smile” I made during your induction to the fellows fold a warm welcome and congratulations.

Not a farewell, I hope.

By for now blogger, fellow bone doc.

Copyright secured by Digiprove © 2012 Remo Aguilar

Philippines ranks first in the global social media penetration according to a February 2011 market survey by Global Web Index. In this survey, it was also pointed out that asian countries do more ‘content sharing‘ than sharing messages as in other countries (UK, Canada). What is the implication of this survey results to Philippines’ healthcare system?

Possibly huge. Possibly positive. Sometimes, menacingly negative.

For Filipino patients, the surge of content sharing and social media usage puts a huge stress on prevailing (or lack of) Philippine laws that govern patient information confidentiality. The lackluster enforcement of such laws, if there is/was, is/are sporadic. One does not need to look further. The gruesome photos (trauma, surgical, etc) that somehow lands on your Facebook wall is a testament to this breach. It’s also not uncommon to read patient blogs, tweets and comments on Facebook that cast doubts on healthcare professionals or or institution’s credibility. Some even lead to sensational malpractice suits.

To healthcare professionals (physicians, nurses, allied medical professionals) the responsibility is even greater. In first world countries, there are stringent rules of engagement for healthcare professionals on how they relate to their patients and to healthcare institutions on social media. Such policy govern healthcare professionals employed in healthcare institutions and who’s social media usage directly or indirectly affects that of his or her employer. In the Philippines , while majority of healthcare professional and institutions  does not seem bothered  yet,  catastrophic consequences still hangs in the future . How many times have you encountered photos on Facebook that are in one way or another health patient or institution related? Too often?

For healthcare institutions, this surge is promisingly positive should they take advantage of social media usage. This study by the Global Web Index for example is a market survey for business entrepreneurs. This could be an area for healthcare institution to reach out, communicate to their clients and improve the institutions online visibility. This is what the Mayo Clinic, Mount Sinai hospital for example is doing crafting their own social media policy to enhance patient – institution communication.

But without a policy to govern such social media practices by their employees (internal) or their patients (external), the healthcare institution risks running into so many potential negative social media issues aside from economic ones (employees using social media at the workplace).

As an afterthought, let me share another info graphic about use of health related IT technologies in US (source). Take a look at the social media usage. To think, Philippines is ‘ahead” of US in terms of per population social media usage. I don’t know if Philippines has have similar figures in terms of health related social IT. This should be an interesting research for healthcare markets.

So to answer this post title-question, I’m making an informal, non scientific survey here. This is open to all medical and allied medical professionals. Please answer the poll and please comment below if you need to explain your answer.

Thank you for voting!

Copyright secured by Digiprove © 2011 Remo Aguilar

Central to correcting medical errors is accepting one first, if it did happen. Improvement in healthcare delivery will only happen if we learn from our mistakes and make concrete, active steps to rectify it. This is what we actually do during mortality and morbidity conference- analyze medical events and cases to help improve delivery of healthcare services.

The health care industry accepted the occurrence of medical errors decades ago. But disclosing medical errors publicly is unpopular even in countries where litigation is relatively not so common. Why? No one really knows. In our society however, publicly apologizing for one’s true medical mistakes is akin to killing your medical career. I guess it’s a bit easier to admit moral turpitude publicly than let’s say admitting you misdiagnosed a patient. The acceptance is just too low.

But what can we do? First, we should create an environment of open-mindedness among medical peers and enact laws that will protect disclosures of medical errors publicly. That way, we can freely examine medical errors to institute appropriate corrective actions based on acceptable and evidenced based medical practice.

This is what John Hopkins University Hospital is doing since 2001. Their  Disclosure Policy  protects and actually encourages employees to confess or report medical errors. This is partly the reason why JHUH  litigations have continually decreased ever since the policy has been implemented.  John Hopkins is the top ranked hospital in the US for 20 years already.

Medical errors simply don’t surface over time. For us, providing a “medical whistle blower” law might just be the first step in improving delivery of healthcare services. Don’t you think so?

 

Copyright secured by Digiprove © 2011 Remo Aguilar

When evidence based medicine (EBM) came to the halls of PGH  during my residency training, I was one of those few who “liked” its surge because of its “collaborative” approach and  ’standardizing” effect on treatment protocols for a specific disease.  So honing my skills on study appraisals was a consequential habit I gained even into my private practice.

But as a surgeon physician, I hated paper works. EBM entails lots of reading, studying and sifting through researches and thus, paper work. I’ve always hated the voluminous paper works that goes with caring for your patients. As I go through to my private practice, I began scrutinizing my clinical practice looking out for ways ( aside from and in addition to EBM) to standardized treatment and save on unnecessary stuff, like paper work, time and cost , without sacrificing quality of care.

Enter clinical pathways. I first heard clinical pathways development in one of our specialty meeting, when Philhealth (Philippine Health Insurance Corporation), Philippines  largest and government owned HMO, mandated Philippine Medical Association (PMA) and its components society to come up with clinical practice guidelines and clinical pathways for diseases specific to sub specialties. I only have faint ideas about clinical pathways back then but I surely know its one process you get from CPGs itself. They’re siblings I guess.

So when Philhealth came to our hospital for inspection, I only offered our CPaths when they asked for our clinical pathways. I was asking  the physician evaluator what clinical pathways and if we don’t have the data yet, how are we going to go about it, they too have a few ideas. It was a new thing here in the Philippines and even us, don’t know where to learne this stuff.

The good thing is, the Philippine Society for Quality in Healthcare (PSQUA) held a workshop on clinical pathways and I was one lucky sent to attend such training. I’ve certainly learned from that workshop, and it’s such gratifying to know we’re abreast with the current trends and are developing our own pathways fit for our local socio-cultural, economic healthcare situation.

Last week, I was able to give back a workshop on Clinical Pathways development to our very own hospital staff. Most of them are allied medical professionals who are our partners in the care of our patients. One doctor. Never the less, imparting learned skills is always an important thing in any collaborative effort, especially in caring for our patients. The great misnomer about clinical pathways is that it’s not all about doctors and collaborating with other specialties. In fact, it was more of collaborating with the different health care professionals ( nurses, pharmacist, dietitian, etc ) that help us care for our patients. That’s is what developing a clinical pathway is all about.

Well, it’s not important that I like statistics, and I enjoy teaching. Imparting knowledge is one hell of a gratifying activity I would pick at, anytime!

Copyright secured by Digiprove © 2011 Remo Aguilar

In one community where I practice, no hospitals offered diagnostic procedures like CT Scans or MRI (Magnetic Resonance Imaging). Thus the current practice is to immediately transfer the patient to a nearby hospital with such capabilities. This, in spite of the fact that medical professionals here can actually perform the needed medical procedure after the CT was done. This practice went on for so long as I can remember and physicians bothered less and less about honing their skills managing ill patients diagnosed with the help of  a CT Scan.

Until one day, one hospital invested in a cat scan. Many physicians suddenly find themselves in a dilemma. That despite, the availability of a ct scan now, many physicians lacked or simply forgot to learn or re-learn how to manage patients that was diagnosed with the help of a CT scan.

The quandary is not about what you don’t know, but about how confident are you in managing those that you now knew because there’s a CT. Should they still refer the patient to another city for treatment despite the fact that the diagnostic technology is available here already? Would you see this as an opportunity for re-learning or would you simply refer the patient and free yourself the hassle of it?

This is just an example of technologies that threaten conventional practice. Many physicians view it as a threat, simply because they lose patients in the process but somehow, there’s this lukewarm acceptance for re-learning of skills. For some, this an opportune moment for seizing the timing for creating value added services (like ICUs and neurosurgery) in the hospital. For patients, this is totally a welcome development and improvement. Lower costs and convenience for both the diagnostic procedure and the value added service cannot be simply ignored. New technology, if indeed necessary, is here to stay.

So are you going to just ignore it and go on with your old practice or re-learn skills to adequately manage the influx of patients as a result of new technologies? Put your comment below.

Copyright secured by Digiprove © 2011 Remo Aguilar