Cast & Curious

Tag: Physician

  • A doctor in the family

    I too believe that having a physician member of the  in the family offers some distinct advantages. The best example of course is the relatively access to healthcare professionals. Medical information, drug prescriptions, when needed are easily obtainable. With a physician relative, navigating through the maze of complex healthcare system seem a bit more bearable for the average patient.

    Such advantages though isn’t without compounding problems.  Complex family dynamics often interfere (sometimes negatively) with physician’s ability to be objective medically. Thus, it has been a norm among physicians to hand over treatment of sick family members to their colleagues. In this situation, that physician family member is often relegated to a healthcare facilitator. [pullquote] A healthcare facilitator, by virtue of his knowledge about the ins and outs of the prevailing healthcare system efficiently facilitate the carrying out of different medical procedures for his or her sick family member.[/pullquote]He or she also acts as the official medical information person for the family and translates these medical information into something understandable by the family members. In the bureaucratic parlance, a “fixer”. Not the best of titles for someone with lots of suffixes in their name, but yes that’s what we do, when a member of our family gets sick.

    A physician may chooses to manage his or her sick family member, despite this potential bias.  It will never be easy though and may sometimes take a toll on the personal life of that physician.

    I squirm at the sight of my mom being stung by needles. If she winces in pain, I wince in pain too. I feel terrible whenever she complains swallowing several pills even if it is exactly what she needed. When she asks me “are you going to cut me again?”, my heart melts. In these moments, I hate to be the doctor in the family. Nobody likes to inflict pain on your patients in the promise of them getting well. Try telling that to my mom.

    Is it easier then for physicians to manage a sick member of the family? Again, the simple answer is NO, IT ISN’T.

    I don’t find talking about medical illness to our family less painful either. Simplifying a medical information is a bit challenging too. Despite aiming for a shared decision making, you ultimately end up  making the decision yourself, being the “more medically informed” in the family. Ergo, a bigger responsibility. Sadly, you cannot make a “no decision”.

    There is an inescapable reality that families with doctor are exempted from the problems besetting an average Filipino family. The costly health care system, the complex Filipino family dynamics and other multitude of problems, does not discriminate whether you have a doctor in the family or not.  The power of the stethoscope doesn’t discriminate patients, family or not.

    The hardest part I think is taking responsibilities should medical knowledge fail to address a medical condition of a family member. I have yet to meet a physician who boasts that he or she “healed” a family member from sickness, but I can practically name a few who took on their lives for “failing” to even ease out the pain his or her relative feel from sickbed.

    Would you call it then an advantage, having a physician in the family?  I, a physician and a son, ultimately don’t think so.

    (Let me hear what you think)

     

  • Blogging up there, somewhere.

    I’m publishing this blog post a bit late. I can’t stand not writing about a blogger friend and defy her preference for “slipping away” silently.

    Goodbye blogger friend. We will miss your blog posts, your writing and your knack for demystifying music to us, cold souls.

    Goodbye fellow bone doc. Even if we rarely had a chance of actually doing bone surgeries together, we shared the same tenacity for fishing out the medical absurdities of our work.

    I hope you did take the “wave and smile” I made during your induction to the fellows fold a warm welcome and congratulations.

    Not a farewell, I hope.

    By for now blogger, fellow bone doc.

  • 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!