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  • Flashback: Blogging as a medium to spread health care issues and advocacies

    While still undecided what article to post first for 2011 , I read my first ever post in this blog. I was nostalgic and a bit in awe. I never really thought I’d come this far with just writing and posting my health care ideas online. More so, raise some eyebrows and grab attention to my online discourses.

    physician blogging

    It was an unfamiliar  niche back then, with awfully fewer local  health care blog icons to emulate while I’m still familiarizing myself with blogging as a social media. I was dipping my toes on an uncharted system, a free for all, but  risky undertaking especially for physicians who are generally viewed as conservatives and slow (or even critical ) at adapting to any form of social media.

    Friendster, Myspace and Multiply are booming back then, but these forms of social media target the personal “online space” market.  Facebook and Twitter is still in its infancy and internet penetration in the Philippines (roughly 3-5%) is almost the same as our health care budget  today. The health care niche is a new frontier with some risky uncertainties. You don’t know what type of readers you get when you write health care ideas online. We also don’t have a specific measure to know who’s reading what you rant about online and if your “message”  reaches your specific target audience.

    Still, the potential remains. There’s not much holding someone full of ideas and a baggage of English grammar rehabilitation program.  There’s lot of free online space to practice. Just don’t press the “publish” button without  having the read your draft 5 times.

    My strategy then was to use personal experiences and then sharing them online as a “jump off” point to get my messages message across a broad spectrum of readers. Knowing that the personal online space market is popular back then (it is up to now I suppose), it’s the best way I can capture or grab the attention of potential readers. It is a very risky strategy in fact, since much of health care issues are” grey zones” and the health care community is strongly comfortable with health care conservatism. Social media back then was the realm of the online geeks.

    Again, I saw it as an opportunity  or rather, an alternative form of spreading some of my health concerns and advocacies. There’s no better alternative for me than the fast,  easy and lower cost of publishing  ideas, online. Blogging and the new social media also opened the gates for building communities of critical minds exchanging ideas and creating an even bigger community of health care online front liners.  Of course regulations regarding its use like HIPAA or a set of online health blogging ethics (HONE Code) has to be in place for this potential to be truly maximized. Nonetheless, blogging as an alternative social media has the potential to erase that obstacle in spreading health care issues and advocacies brought about by the costly  and slower traditional forms of media .

    The question now is “can we sustain this form of social media? Is it here to stay or is it on its way down? Leave your answers in the comment section below!

  • It’s about time Bonedoc!

    Since I started The Orthopedic Logbook about three and half year ago, I never thought such knee jerk “jump” at this social media will have any impact on  any readers at all.  Health blogging  is at its greatest boom back then and I know my blog would just be one of the thousands targeting the health niche. But grabbing a niche and be popular wasn’t my agenda then. It isn’t,  and will not be up to now.

    Bonedoc, author of this blog, The Orthopedic Logbook

    I’d started blogging about almost everything including health care in order harness my writing skills and share information.  There’s a lot I learned (and I’m still learning) in med school, the hospital and in the lives of every patient physician’s out there. Holding these information to myself will benefit no one. There’s no way but to share it too, to be part of a greater community knowledge and for a better health care. The  influx of information, including those in medicine,  came rapidly and tremendously because sharing of ideas exploded.  This blog contribution to health care, though how minuscule, will go a long way in shaping the minds of wired, health care citizens.

    I’m bringing health and health care information right in front of our wired health citizens out there, Filipinos and globally. Majority of Filipinos are not yet connected to the net, but the increasing trends points to a better scenario in the years to come. That’s inevitable too. Filipinos will surely, later if not sooner. The powers of these new social media in connecting people and providing information is an inescapable paradigm. Either we take advantage of it or we stagnate with health care information.

    So next year, after 167 posts and 108 comments,  The Orthopedic Logbook will

    1. Continue to deliver personalized health and health care ideas right in your desktop.
    2. It will also maximize the other emerging social media to help anchor these ideas to your needs. Facebook and Twitter have invaded the web and health care has yet to capitalize on these growing third media.
    3. Majority of Filipinos are interconnected via cellphone and sms, that should be another good area to explore.
    4. The author will also talk on various social media forums on health care and health care blogging.
    5. I will also try to “create” community for health care readers and health care writers…

    Thank you my dear patrons and readers. Expect a better and simpler Logbook in the years to come! Don’t hesitate to subscribe to this blog, comment on any of my posts or just contact me thru mail for any suggestions to wanted to convey. I promise you I’ll answer them in the soonest possible moment!  Thank you once again and Merry Christmas!

  • What should a dissatisfied patient do regarding their physician’s “bad” service

    Recently, I’ve been receiving   complaints from patients regarding some attending physician’s “quality” of service. Complaints like, “the doc saw me late already” or “my waiting time is far longer than my physician encounter time”  or “this was not explained to me” or  the difficulty of some patients (or relatives) to talk to their physicians. In most cases, the attending physician’s technical competence is unquestionable, but the patients or relatives sometimes felt they still didn’t receive adequate care or service from their physicians. What must they do?

    a patient unhappy with the physician services rendered to him (Photo credits from http://www.art-of-patient-care.com/doctor-patient.html)

    I always tell these “complainants’ that any doctor-patient relationship is contractual by nature. Meaning both parties has to agree and deliver their end of the deal to consummate the “contract”. The contract is of course the delivery of health services required by the patient’s current health needs.(Read my perspective of this here.) This may sound simplistic but for purposes of discussion, this “understanding” of a contract should suffice. If one party, does not agree or adhere to the contract, then the relationship could be terminated after due process.

    In non- emergent situation,  and if the service is available, patients have the choice on who will be their doctor or what type of service they could avail. That by choosing or agreeing to be under the service of a particular physician, the patient also has the responsibility of paying the services of that physician. That is the contract, no matter how business like it sounds.   In cases where one party felt that other party did not deliver the expected service , he or she may choose to end the contract after duly informing and after paying the services rendered by the physician. (By the way, the physician under certain circumstances and on valid grounds, may opt to terminate a patient-physician relationship too but let’s leave that discussion in my future posts.)  In my practice, I always offer this option to all my patients even prior to our patient-physician relationship.

    Problem comes in when patients just change physician services without adequately informing their previous and frequently, their succeeding physicians. Far worse is the situation  wherein patients  “leave” their previous physicians without paying their bills on the pretext of a “bad” service.  This is not good practice either and probably will only harm patient’s reputation also.  In the first place and except in emergency situations or some government health training facilities,  the choice of  any physician is really the patient’s responsibility. Health is the business not just of the physicians and institutions but of the patients as well. If you don’t know any of your physicians in the community, then you cannot blame someone else for receiving a bad service. Remember, that physician  gave his or her professional service and in the context of a contractual form of relationship, that has to be duly paid even if you’ll change physicians.

    Patient doctor relationship is based on trust (photo from http://harvardmedicine.hms.harvard.edu/doctoring/patient-doctor/index.php)

    So if you want to change your attending physicians for a valid reason, inform your physician of the transfer. Pay your end of the  contract, meaning the services rendered. Cultivate the habit on talking to your doctors. Pour in your concerns on them and seek necessary answers to lingering questions.   But don’t forget to inform the physician if there’s something good also about his or her service that you liked. I always believe no doctor would want any patient to feel bad about their brand of service. Just be honest. If those physicians do not change for whatever reason, that’s their catch. Remember that health community is far more sensitive than we thought on issues like this. These type of service screw ups always catches up someone else ears. If you don’t like them, then do not patronize them. That way, you won’t complain at the end of your contract. That simple.

    Or is it? What do you think?

    “The essential quality of the clinician is an interest
    in humanity, for the secret of the care of the patient is in caring
    for the patient.”    – Francis Peabody Class of 1907, Harvard Medicine

  • How will I (probably) celebrate christmas

    Physician on call Christmas eve

    The first question really was, “Do physicians really celebrate Christmas?”.  Hardly an easy question to answer because , even here in my community, physicians are a diverse mix of personalities, cultural upbringing and religious beliefs. But a fairly common experience among physicians will give you an idea where most doctors will base their answer(s) to this posit.

    Time.

    Indeed any physician’s career is synonymous with the word “busy” and time, even if mostly it is theirs to spend,  is rarely in their control. Me for example, has had most of my adult life Christmases (and new years), in the hospital or in the operating room. Firecrackers and alcohol made it a point that I am preoccupied with mangled limbs during these times when everyone else is busy merrymaking or hearing a mass or is with their family. In other words, majority of my Christmases is spent with patients. Not a good thing for my family perhaps but yes, there’s quite a few profession with such altruistic endeavors instead during our supposed “rest” or vacation. So my answer will be “yes, physicians do celebrate Christmas but mostly, of attending to our patients”.

    More time.

    If for some reason a doctor ‘frees” some time off his busy schedule and patients, chances are, he or she’d be attending other social functions related to his profession. I remember receiving Christmas party invitations last year scheduled for almost all days of that week ! December and the Christmas season   makes us a much sought after godfathers for every living angels in this part of the world.  In the Filipino culture and tradition, saying no to an invitation is taboo. Finding gifts for all of these events are a bit too overwhelming if you don’t have a staff to handle it for you. I don’t have a staff, so now you know why I looked harassed and disheveled during Christmas season. Even that single Christmas decoration, a single ‘parol” in our kitchen has gone caput this year.!

    But this year, there will be less of these social events and more time with my family. Not even gifts, just the basic spending time with a family that for so long ago, miss me during the previous Christmas season. And for all those scrupulous patients (including careless parents)  who despite strong warning from health officials, still blow those hellish firecrackers and get injure in the process, I will make sure you get your share of ‘lessons’ learned correctly. That’s not without saying I’m charging double  for intentional recklessness that rob me of my valuable family Christmas time!

  • Will admitting medical errors publicly improve patient care?

    For this well known Massachusetts’s General and Harvard Medical School hand surgeon,  YES.  Admitting publicly should ultimately improve patient care according to Dr. David C. Ring. Or his “public admission” will all be in vain.

    Dr. David Ring, a well known hand surgeon at Massachusetts General Hospital, went public with his surgical mistake.

    Dr. David C. Ring, a well known hand surgeon and his colleagues at Massachusetts General Hospital, described in detail (New England Journal of Medicine) how a series of personal and system-wide mistakes led Dr. Ring to operate incorrectly on the hand of a 65-year-old woman with a painful “trigger finger.” Dr. Ring performed a carpal tunnel release, instead of a trigger finger release, a surgical error that would qualify as a wrong site and consequentially wrong surgery performed on the ” right ” patient. Realizing he made a surgical error fifteen minutes after the procedure,  Dr. Ring apologized to the patient and her family then asked the consent of the patient to perform the correct procedure.  When the patient consented, Dr. Ring reassembled his OR team and did the procedure without complications.

    Dr. Ring and his medical staff went through the process of  immediately rectifying the error post operatively.  But nothing could “undo” this mistake, according to Dr. Ring himself. Though such case didn’t resulted to litigation and malpractice suit for the surgeon,  such error put significant stress on both the patient and the surgeon.  He just hope that with his public admittance of this error,  other surgeons would improve on their patient safety protocols.

    Hopkins
    In this videograb from the first episode of 'Hopkins 24/7,' physicians gather behind closed doors in a Morbidity and Mortality conference. This is the first time Hopkins has allowed cameras access to a session. This is taken from John Hopkins Gazette

    My first reaction reading this article was a unbelieving “really?”. In academic and training institutions for physicians, mortality and morbidity conferences are regularly conducted to improve  patient care services and furtherance of the medical knowledge. But typically, they are for and amongst physicians only.  Such hospital process analysis is guarded by the cloak of confidentiality, if only to protect the patient first and foremost. The fact is nowadays, going public with such ‘admission’ is a mortal sin, tantamount to inviting a deluge of malpractice suits for both the physician and the institution.

    Thats why I am truly amazed by the act of Dr. Ring and his institution.  The courage and integrity by which they face this situation is only paralleled  by their unwavering desire to be at the forefront providing and improving the best of care for their patients. Such is characteristic of institutions of higher learning.

    Now as to whether we are ready for such sentinel public admission, I personally don’t think so.  Even if  malpractice suits are still uncommon in our health care system, a turnaround in terms of our healthcare education, knowledge, attitude and skills should be effected first before we reach the social and psychological maturity of our caucasian counterparts.  But this one should be an ideal goal. It might be utopian, but yes, it is still worth emulating.

    So, Dr. Ring, all I can say is “bravo!”. You made us all orthopedic surgeons proud of our profession.