Cast & Curious

Tag: Leadership & Management

Leadership in health care involves influencing and motivating medical personnel to contribute to the success and effectiveness of medicine, patient care, and health care practices.

  • Do you charge professional fees for additional procedures done to address complications or morbidity?

    This question was thrown on me recently by a newbie colleague who was agonizing on whether or not to charge patients for an additional procedure he did to address a complication. I instantly went blank thinking what to say.

    when surgery goes wrong…will you charge mr. bean?

    In the field of medicine or at least here in the Philippines, there’s really no hard and fast rules on charging professional fees for services rendered to patients. This service for fee setup of our healthcare system is somewhat messy and often embarrassing to patients and doctors alike. The price haggling is totally unnerving. Sadly, this is what plague the professional practice of most physicians here in the Philippines.

    Such charging “grey” is even more embarrassing in cases where patients entailed additional services outside of their routine or planned operative procedure. While explaining and appraising procedure risks and complications to patients is a requisite of any informed consent, most patients still think that additional procedures,  should be an additional work for the physician and the healthcare providers alone. Patients or their financiers are not obliged to pay the healthcare providers for the services rendered for these additional procedures. Wherever, that notion came from, the stress on the attending physician(aside from that of managing the complication) is enormous, working on a very limited logistics to address complications. Besides, Docs have mouths to feed too.

    This situation is akin to the “heroic” services rendered by physicians to dying patients. Just because the patient dies (despite the doctors valiant efforts to revive the patient), the fees for the physician’s services (resuscitation)  does not “die” with the patient too. Services rendered have to be paid even if the service given did not achieve its original goal (that of reviving the patient). Can this situation be applied to procedures done to address morbidities?

    What do you think??

  • 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.

  • The (high) cost of hospitalization in the Philippines

    I’m not talking about top quality health care that is available to those who can afford. I’m not even compounding the issue with other factors such as health insurance system and access to medical care. Not even the extensive use of public health facilities by the poorest 30% of the Filipino population.

    I’m talking about this patient’s words

    Doc, di nalang ako magpapaadmit sa ospital kahit kelangan. Di ko po kaya ang gastusin” (Doc, I don’t want to be admitted in the hospital  even if its needed. I can’t afford the expense)-Indang

    Her words not only rang the current “cost” of being a “poor” sick here in the Philippines but of frustration and disgust for having been a victim of a doubly whammy – that of being a poor and getting sick here in the Philippines.

    The findings of a study to assess the three year implementation of Health Sector Reform Agenda
    narrates a littany of negative factors that promotes this double whammy among the poorest of this country. One i could highlight is this:

    The average hospital bill is three times the average monthly income. Costs are so prohibitive so that a 10 percent increase in the price of private hospital services will reduce utilization by as much as 30 percent.

    Not only sounded true but also alarming. Compared to the Mayo Clinic which is among the highest-quality, lowest-cost health-care systems in America, ours pales on its reach and delivery. Philippine General hospital tries to deliver such high quality low cost health care system also but even such healthcare system hurdles not a few logistics problems.

    Here’s one good thing the guys at Mayo clinic are doing:

    …Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible. No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs. “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing,”

    I’d like to think this should be another thrust among health care reforms (among a plethora of other issues) be implemented. Maybe we should look at our health cost utilization and unnecessary diagnostic costs. Put patient first and then work on to minimize health financial expenses. Maybe its not who pays or how are we paid as physicians and how we can maximize health expenses. Lowering cost of expense is second only to quality life of patients.

    What do you think?
    (Photo taken from the Daily Herald, here)

  • Desirable traits of a good (or excellent) surgeon

    What makes a good surgeon?This is a common question that comes into the mind of patients whenever they choose their surgeons or physicians to entrust their life. There are probably a hundred of these “desirable” traits but they generally fall into “categories” of surgeon attitudes and are definitely interrelated. Medical school (and residency training) attempted to make us all adept at new skills and the science behind the art of medicine, yet there are some who excel in the hearts of their patients and colleagues. Here is why .

    • According to Dr. Thomas Russell, Executive Director of the American College of Surgeons“surgeons have to be technically adept…”, able to change when needed “…and have new ways of doing things” . This means that surgeons should have wide array of technical skills and be able to adapt or tailor his expertise to the patients he’s handling or his community of practice. This is remarkably important among us Filipino surgeons, that though we lag behind in technological advances in medicine (notice the disparity between what is taught in med school and what you have in the real life practice), we should be able to innovate from what we have with our solid foundation of scientific knowledge.
    • Compassionate and love for humanity. Filipinos are known for their superior compassion and love for their patients. Our patients expects us to be compassionate every time we deal with them. Being a Filipino, its a terrible offense not to.
    • Surgeons should be approachable and not difficult to deal with. Patients and colleagues hate any surgeon who treats them like they are inferior species of human beings. It will also save you from litigations and malpractice suits.
    • I would love a surgeon who is truthful and is open minded to any questions. He should be ready to answer any question from his patients and explain to them in a manner they can understand and relate. In this age of technological advances, not one patient wanted to be treated without having to know why and how his treated and what is his chances of recovering from the surgery.

    I can enumerate some more but this I think are the most important ones. A peculiar trait that Filipino patients wanted from their doctor or surgeons is their ability of a doctor or physician to “waive” partially or in whole the surgeons fee for rendering his professional service. While this trait is anchored probably on patient’s frugality, it can make or break your practice.