Cast & Curious

Tag: Learning & Development

Learning and development (L&D) is a function within an organization that is responsible for empowering employees’ growth and developing their knowledge, skills, and capabilities to drive better provisions of healthcare.

  • Improving Quality of Care with Quality Time in the Clinics

    Two weeks ago, a patient walked into a clinic and asked if he can be accommodated for a consultation. It was for a non emergent complaint but the patient lives in a far flung community that a “reschedule” would be costly for him.  There was already a line up of patients scheduled for consults and follow up that afternoon. Some of these patients are also scheduled for a procedure after the clinic hours. Based on this doctor’s regular outpatient clinic load, his staff estimated they might be extending clinic hours that afternoon.

    Since the physician have scheduled procedures that afternoon and was already seeing patients beyond estimated “quality time”, what do you think should doctor do without jeopardizing the quality of care rendered in his outpatient clinic? Will he see this patient and shorten up the time intended for the other patients or just extend his clinic hours thereby extending also the waiting time for patients who are decked for procedures?

    Share your thoughts as we again “crowdsource” feedback of physicians and patients on “Improving Quality of Care with Quality time at the Clinics”  in our tweetchat and HOA tomorrow 10 AM Manila Time (UTC + 8) April 27, 2014 here at #HealthXPh

    [su_box title=”QUESTIONS”]

    • T1 What factors determine optimal patient consultation time?
    • T2 How can patient waiting times at clinic be reduced?
    • T3 How can time at the clinic waiting room be better spent? CT: As a patient, what do you think should this doctor do? As a physician, what will you if you are in his position?Why? [/su_box]

    Suggested Readings:

    Time and the Patient–Physician Relationship
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496869/

    Healthcare Clinics in the Philippines
    http://www.philippinesplus.com/2012/12/04/healthcare-clinics-in-the-philippines/

  • State of internet and social media usage among physicians

    State of Internet usage among physicians globally

    The emerging social media is undeniably capturing the attention of physicians. If we are to believe the recent Manhattan Research survey, some 81-89% of physicians in US, Europe and Asia access the internet to  gather medical and pharmaceutical information. A S and R survey recent survey on Sermo TM, an online community of physicians, approximately 77.5% of physicians use social media professionally, especially to communicate with colleagues. In Asia, physicians from South Korea is second only to US physicians in terms of internet usage professionally beating their European counterparts by as much as 7%!

    What about physicians in the Philippines? Are they taking advantage of social media as a tool for their professional practice?

    In my succeeding posts under the category “social media”, I will be attempting to report on the current usage of social media among physicians in the Philippines. But before that, let me post this JESS3 / The State of The Internet video from Jesse Thomas on Vimeo, which sums up beautifully the current global internet and social media use .

    JESS3™ / The State of The Internet from JESS3 on Vimeo.

    Overwhelming? Indeed it is. But what’s more interesting is the social media usage of physicians in the Philippines. Since some physicians maintain “profiles” on many online social networking sites, it would be interesting to know if they use social media in their practice. If you are a physician or a para medical personnel, do you use social media in your practice? Leave a comment here and we’ll know in my succeeding posts!

  • Reviving the physician’s administrative function

    Right. I almost forgot. The medical staff do have “dual” functions.

    The medical staff has a dual and overlapping management system- the administrative which involves the activities of a medico-administrative character, and professional, which concerns of the clinical aspects of its functions.

    The physician is typically absorbed with the clinical aspects of his profession and rarely bother with administrative functions unless he or she is managing a large group practice or a hospital. Private, solo practice large reduces the physician’s administrative function to bare minimum.

    This may not be necessarily true in a practice that involves a tertiary institution.

    This realization struck me as I was tasked an administrative position of setting up clinical services for a tertiary level health care facility. While defining clinical functions is not a “breeze”, setting up additional administrative functions for the involved physician is like “walking into a storm”. Again, this is seemingly related to physician’s preference to clinical functions rather than the administrative part. In reality, most physicians shy away from ANY administrative functions at all.  I now understood why physician administrators grow (or lose) gray hairs by the hundreds each day.

    physician as administrator
    physician as an administrator, what gives?

    The reason?  My personal observation is this: As a physician, we were trained mainly on the clinical aspects of our profession. The few that got some training on the administrative skills probably got stuck in such functions. This compartmentalization of functions seem to enhance productivity on either of such functions but not on both. We were trained to specialize. Even solo, private practice seem to support this observation. The other reason is that physicians are generally slow to adapt to any change. Our comfort zone is just to comfortable to let go suddenly.  Thus, physicians tiptoes and are slow to adapt to administrative changes intended to improved  health care delivery.

    This is where I am looking for ways to get viral and enthusiastic response from the medical staff. This dual function of hospital based physicians are intertwined and complementary. Defining such functions is necessary for providing top notch health care service and the smooth operations of the health care institution. I’m not just saying this because I’m now part of a hospital administration. As I’ve said before,  have I recognized administrative functions before in a solo practice, my practice would have been smoother and productive.

    In your practice, do you really care about administrative functions at all?

  • Balancing Act: Community and tertiary care orthopedic practice

    Barely five years into a private medical-surgical practice, some people got interested how I’m “doing” with my “kind” of orthopedic practice.  Orthopedic practice refers to an orthopedic surgeon’s working environment, the plethora of patients or cases he handles, the time, effort and money he or she invests on it as well the returns (monetary or otherwise) he gets from this professional career. This is rather a simplistic definition, one that is based on a business model, but roughly what approximates a “medical-surgical practice” in the real Philippine health care settings. This definition is further muddled by “subtypes” of an orthopedic practice as well as the mix and match attitude by most orthopedic surgeons practicing in this country.

    Before I’d shed light on my kind of orthopedics, let me describe what I think is the two extremes in orthopedic practice- the community type, generalist orthopedic practice  and the super specialist tertiary level academic orthopedics.

    A community type of orthopedic practice usually caters to patients with general orthopedics (osteomyelitis) and extremity trauma (fractures) problems and usually the first line of orthopedic care in the provinces. These patients are commonly admitted to a non specialist, primary to secondary level, health care institutions found within the surgeon’s community or area of practice. Academic orthopedics on the other hand,  is basically a tertiary, level I trauma care practice that deals with, specialized or complicated orthopedic problems (e.g. arthroplasty or spine cases) that requires super specialist institutions with supporting facilities (ICUs) . Such specialist type of orthopedic practice is usually coupled with training residents in the orthopedic specialty. Some hospitals add admitting and/or administrative privileges to the surgeon.

    The contrast between these two types of orthopedic practice is probably  apparent in the  amount of time and effort an orthopedic surgeon “invest” on each cases .  A super specialist academic orthopedics is generally thought to be more time, effort and learning  intensive, compared to a community type of orthopedics.  It is also perceived that specialist care are more lucrative, pay and prestige wise.  Of course there will be exceptions to this observation, as the delineation between “learning” in the country side versus the urban centers is gradually grayed by the advent of fast information and the internet. But for our purposes here, let me just simplify definitions to differentiate between the two.

    Why am I differentiating between these two types of practices?  Theoretically speaking, somewhere between these two practices is the middle ground which is for me, the logically desirable type of practice –time, effort and income wise.  Thus, a balanced orthopedic practice (in my opinion) is one that  involves continuous learning and at the same time, offers a “relaxed” environment that caters more to delivering quality orthopedic care in a community setting.

    Many surgeons believe such “balanced orthopedic practice” is not easy “find” , difficult to live with, or is unsustainable. The inherent affinity of the orthopedic practice to orthopedic implants and gadgetry as well as to a tertiary level health care institutions is believed to be the primary reason for such negative perception . While many many orthopedic surgeons still conglomerate on urbanized cities and tertiary level care institutions because of  this logistics necessity, a trend towards community type of orthopedic practice is picking up pace because of improved information technology and delivery of much needed orthopedic implants.

    One former mentor asked me if I’m happy with this dual type of orthopedic practice. I answered ” yes” although I qualified it immediately by saying “.. with some necessary lifestyle and living adjustments” . Personally, I find it natural that this two sub types of practice  complement each other. A community practice without continuous learning is boring. Likewise, teaching orthopedics without actually doing what you teach is too good to be true. Somewhere between these two “extreme” sphere of practices lies a compromise that I felt, will produce the balancing act.

    “But what about lifestyle modifications as you said?” I for one, chose this balancing act, because it fits my lifestyle. Compared to an urban, high volume, city practice, I certainly preferred the relatively relaxed working environment of a community practice. On the other hand, I cannot let go of the many opportunities for learning that these big academic institutions could give. Besides, I love teaching. Teaching could have  been my career if not for the ‘healer” awakening I got in college. Like one mentor said ,  “there’s no better way of learning than to help others learn“.

    Well, a community type of practice will rarely make you rich, but I’m pretty sure you’d be able to put food (or a house and a car perhaps along with some other perks) in your family’s table. A simple living will surely come handy in surviving this dual type of orthopedic practice. But it does pay well in the amount and quality of time you spent with your love ones! I guess it all boils down to what fits your lifestyle and your priorities. Mine just happened to be where I wanted to be years before I became a doctor.

    So which one do you prefer then, the community type of practice? the academe?or both?

  • SurgExperience 3.10 Online Surgical Grand Rounds

    SurgExperience, the online surgical grand rounds,  is up already in Scan Man’s Notes. Surgexperience 310 enumerates a plethora of blog post that will definitely raise you brows on issues- from politics of health care to semantics of weird care!