Cast & Curious

Tag: business of medicine

  • Do you want your healthcare professionals or healthcare institutions to have a social media policy?

    Yesterday I started a survey  asking healthcare professionals (physicians, nurses and allied medical professionals) if their healthcare institutions have a social media usage policy. (If you’re a healthcare professional you can still vote and comment in that post. ) Now its time to ask our clients, the Filipino patients:

    Do you want your healthcare professionals (physicians, nurses allied medical personnel) and /or healthcare institutions (hospitals, clinics) to have a social media policy?

    Philippines, the social media capital of the world!

    This question is important and highly relevant. Why? Philippines is the social media capital of the world and there’s a surge of content sharing in these social networks. That is according to this report by the Global Web Index. Sharing health related patient information on these social networks threads dangerously on an already greyed (if there is/was) privacy and health information laws here in the Philippines. Without enforced laws or governing policies, a breach of patient’s privacy and confidential information have consequences that pose a threat to the mutual trust between patients and his/her physician or that of his/her healthcare institution.

    The other reason is about enhancing patient communication. Social media is  an alternative, revolutionary way in which healthcare professionals or institutions communicate or interact with their patients.  Social media (though research data is lacking on this) could be  a venue for positive reinforcement of actual clinical consults and follow ups. A recent survey also shows that social media is now gaining ground as source of health information in first world countries. The absence of policies regarding its use defaults the interaction to a “free for all” and often negatively affect the overall outcome of these patient-physician  or patient-healthcare institution interactions.

    So again, I’m asking you, Filipino patients, or anyone since obviously you are the ones will be ultimately affected by this policy.

    Do you want your healthcare professional or healthcare institution to have a social media policy use?

    Please vote below and comment (in the comments section) if you wanted to explain your answer. Should you want to maintain anonymous, just email me privately thru this contact page and I will assure you of your confidentiality)

    [poll id=”3″]

  • Do you have a social media policy in your healthcare institution?

    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?

    Philippines tops social media usage globally! (Infograph from Mashable by Global Web Index)

    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.

    Filipinos spend one fourth of a day on social media network.(Thanks to Dr. Iris Isip Tan for posting this infograph)

    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.

    Health related IT technologies usage in US (source)

    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.

    [poll id=”2″]

    Thank you for voting!

  • Do we need a law that protect healthcare providers if they disclose or confess medical errors?

    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?

     

  • Challenge and fun of developing a clinical pathway

    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.

    Cartoon of Cpath taken from Medscape. Uphill challenge.

    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.

    [pullquote]Multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or visit (homecare).-wikipedia[/pullquote]

    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.

    SLH Staff on workshop for CPath Development

    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!

  • When surgeon shopping ends up with just facility shopping…

    “Hello! And again!” I happily greeted this patient sitting on my clinic chair. He smiled back , albeit sheepishly and said  “Sorry doc!” . “Don’t mention it, it is your right by the way”.

    (Photo credits goes to http://blog.drfirst.com/eprescribing/florida-providers-beware-of-doctor-shoppers/)

    I saw this patient about 2 months prior to this consult in one of my other clinic in another institution. He consulted me for a certain orthopedic problem, examined him, ordered the needed diagnostic procedures and appraised him carefully of my treatment recommendations. This including financial considerations and proximity of institutions where we can do the necessary procedures. Then I lost him to follow up.

    Mr. X resurfaced 2 weeks after, in my other clinic,  in another institution thinking he was seeing another surgeon. He was surprised as I am that we met for the second time in another clinic and in another institution.  I don’t know if he was just plainly uninformed or he wasn’t very particular physician names, but I’m pretty sure my name was clearly printed on this clinic door. The guy was surgeon shopping and is surprised that so far, he window shopped the same surgeon in two different institution  – me and myself.

    That aside, I went on with my routine patient consult gave the same treatment recommendations as before. His surgical problems needed the same surgical treatment. Nothing changed. Went he stepped out of my clinic door, I had this inkling I won’t be seeing this patient again. Indeed, I lost him to follow up. Again!

    Until this very moment, when he showed up (again) in one of my other clinic in another institution different from his previous consults with me. I greeted him “Hello, …again!” …He went pale. So the rest of the story goes.

    Just how he ‘window shopped for the same surgeon, three times, without him knowing” is mind boggling. But he obviously wasn’t very particular with names. He was shopping for the “surgeon” who will give him the treatment he liked.  It’s unfortunate he ended up with the same specialist three times, in the process.

    In a small city where “specialists” is as scarce as physician, “surgeon-shopping” may just be actually “healthcare facility shopping’. So patients, pay particular attention to your physicians names…