Communication, patient-provider (photo taken from http://www.aafp.org/fpm/1999/0500/p23.html )
I was doing my usual morning rounds last tuesday when a watcher of one of my patients approached me before I saw their patient in his bed. This watcher mentioned that someone went inside their patient’s room and asked questions that raised the curiosity of the family. The watcher spoke a different dialect and though I understood most of what she’s trying to convey, she fumbled with words and was obviously concerned at the “questioning” incident. I asked about the details of the incident, but none of them can give me a clear idea what was the “questioning” all about.. All I can deduce from the watchers was that someone asked them and “implied” a question of competency and thus are worried about their decisions in seeking my care.
Unfortunately, none of the watchers asked (they are probably too shy or too gentle) the name nor remembered the identity of the person. They describe the interviewer as wearing a white dress and was asking other questions like “Why go to this hospital?” or “Who told you or referred you to this institution?”.
I asked the family then if this did affect their perception of my competency. I heard a resounding “Hindi po” or “No, it didn’t”.
I suddenly remembered who the interviewer could be. None of these watchers realized that the interviewer was actually doing a sanctioned survey. I have yet to encounter this response variance (meaning, the watcher doubted competency as a result of being interviewed) in any surveys I’ve been involved. This however pointed out one thing- a communication gap between the interviewer and the interviewee. The interviewer broke protocols by not introducing herself (blinding?) which rose suspicion and doubts on the part of the interviewee. Imagine what a simple mistake like this evoking a different response!
I felt relieved discovering this fact but was bothered by the communication gap. I spent more time explaining the survey and placate these watchers apprehensions. This time spent explaining will go a long way protecting a provider’s image from a simple neglect of introducing oneself before any patient or watcher’s interaction.
So doubts? Nah. But I’m sure that staff will have something to learn from communications 101!
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!
injured kid..they evoke so much pain from injury largely not of their making
Of all orthopedic trauma cases I’ve worked on, my heart bleeds the most for pediatric patients. I don’t know but their helplessness and innocence always evoke this feeling of worry. Many pediatric trauma cases are often a result one adult, guardian or parents, gone remiss in guiding or understanding a child growing up. While many adults blame kids for crossing streets alone or unguided (thus running their vehicles over them), they too agree its the kids guardians or parents that really had an oversight. An irony?
Maybe. But the pediatric trauma patient is almost always a victim. Why? Imagine suffering an injury as a result of a road mishap only adults understands, or being blamed for violating traffic rules even licensed drivers rarely follow? And they wretch in pain for something they rarely know?
This is exactly why treating pediatric trauma patients entails stretching a surgeon’s patience more than you can offer any adult patient. Why adults busy themselves finger pointing on so many things, the child wretch in pain for an injury he or she rarely knew of. That is something pitiful than any other thing. Don’t you agree?
The short answer is yes, they should. Consider this:
The Philippines, a developing country, is the social networking capital of the world. It tops the list of nations who uses Facebook. Or before Facebook, Philippines also topped the list of nations using Friendster.
Social network penetration is incredibly high in the Philippines, reaching 95%. Facebook is the country’s most popular website, more so than Google, and has a penetration rate of 93.9%. The Philippines is also the eighth most popular country for Twitter use on a global scale, with a penetration rate of 16.1%. The popularity of photo sharing has increased by 46% in the country in one year, largely due to Facebook. Social networking is so popular among Filipinos, the country has been nicknamed “The Social Networking Capital of the World.” –The Ten Nations Where Facebook Rules the Internet | 24/7 Wall Street
Infographic from this site ( http://internacionalmagazine.com/2011/03/comscore-has-crowned-philippines-as-the-world%E2%80%99s-heaviest-users-of-facebook/1490/
Also, most of the other nations in the list are developing countries in Latin America and South East Asia. These social media platforms are good mediums for health education and should augment health drives using traditional media.
Medical information through the internet is readily available and fast. Most of informed patients nowadays get their medical information through the internet. Also, most of this informed patients (or their relatives, guardians etc.) also maintain a social media presence in facebook, twitter or in a blog. The multiplier effect of posting it on your facebook profile is just way beyond that can be achieve by traditonal means, like books.
Interactivity is fast, patient questions can be addressed rapidly and doubts can be clarified and , it is a good jumping off for a “real” clinic consult. The potential for improving physician-patient relationship and interactions using social media is enormous. Not taking on this opportunity simply deprive the already shortchanged health education in developing nations.
Is this enough reason for you to act now and have your social media presence be felt?
We love to write, no question about that. Like Doc Stef, most of us would love to write the Anais Nin way:
To write. To sit down with pen and paper, to think, and rethink, and put your thoughts in order…with nary a thought for whether your current piece is going to be “popular” or not –The Anais Nin Way, Last Minute Madness
If there’s one thing that brought us all in front of our computers and online, that is the urge to write. They have papyrus before, parchment papers and lately the mighty pen. Type writers became synonymous with writers in the 60’s and towards 80’s. We, we were borne in the age of the internet. Writers get stuck with writing, but
Blogging might have evolved into a microblogging platform like tweets and status updates. None has so far came near the huge space (and the Nobel Prize?) that blogging has to offer, inkeeping a (online) journal, as Doc Mel says.
Doc Ian has turned his blog into a “life’s time stamp and online picture frame”
..capturing and displaying snapshots of daily events and once in a lifetime triumphs. It’s a record of what has happened, events that may ultimately be forgotten if they were not written about..-Why I Blog?, So Far So Good
Something about anything, everything and sometimes, nothing (Like Doc Ligaya‘s first post).
I blog to voice out, rant, shout out and say to the unknown audience what I think about the things I write about and the world we live in.– I Blog Because I Am :Scrubbed Out
Often that something is about ourselves, our thoughts (I write because I think ), egos (right Doc Anakat?), frustrations (get off me!) or floating thoughts. We may not care if somebody reads or listens:
Because at times, we wanted our blogs to be our mirror- a reflection that wouldn’t punch us in our face when we call it “stupid”. No not the one we get on Facebook that invades our “wall”, our privacy. Sorry Doc Cherry, you can’t delete your blog.
Oh, yes we blog to the advancement of the human specie- environment, political, scientific or religious. We blog whats close to our heart, like Doc JA‘s pro life advocacies,
We felt we have a voice wanting to be read by the millions on the internet. Even if there’s virtually zero readers on your RSS feed, we still feel good because we thought we said something to advance a cause, or halt an avalanche of deviants. A Nobel prize? At least that, we can do in our blogs.
Why not on FaceBook? On Twitter?
..call me old-fashioned. Blogging is like being in a coffee shop with a friend. Communication is unhurried, you can both stay up all night, and go home to your respective places without one needing to know what the other person wears (or does not wear, perhaps) when sleeping…-Why Blog When It Is As Obsolete as MIRC: The Last Song Syndrome
Personal, but not too private. The blog is such a thing. You can build it to your taste, show it to everyone (if they wish to) but they should never, ever write on your “wall”.
I just realized then that my blog survived the ‘delete’ button because unlike everyone else, no one can create my posts, much less, immortalize my thoughts in here. In this page, I am the boss of me.- You Call It Narcissism If you Like : Merry Cherry, MD
I would agree. We love to write for a a myriad of reasons or none. We were born in the age of blogging. Our writing evolve in it. Revolutionary in the early days. Then we stuck with it even if it fades away. Why? We want it to be personal, without someone else tinkering with our privates, or our “wall”. No body wants someone else to write in his wall, like in this video.
Would you? I would prefer you’d write your comments below, and not on my wall!
(This is Blog Rounds: Voice of the Filipino Doctor Season 2 ,First edition. Whew, It was both fun and challenging! Thanks to you all who joined! And those that didn’t, join us in our next rounds!)
I just realized then that my blog survived the ‘delete’ button because unlike everyone else, no one can create my posts, much less, immortalize my thoughts in here. In this page, I am the boss of me.-