Wednesday, September 17, 2014

Is he the Steve Jobs for Health Care or a super-rich hypomanic snake oil salesman?

Forbes reports on disruptive influence in health care. Or perhaps he should be called an accelerator.

On a typically perfect summer day in Los Angeles, Patrick Soon-Shiong, the richest doctor in the history of the world, is bunkered inside his clandestine headquarters (nestled behind a security gate so unobtrusive that Uber cars consistently miss it), ready to show around a kindred spirit. T. Denny Sanford, who made a $2.8 billion fortune selling high-interest-rate MasterCards to people with bad credit scores, is now in philanthropy mode, giving away most of his fortune to children’s charities and hospitals. And he’s come to see what’s been touted as the future of medicine.

Soon-Shiong, 62, has a lot to show. First, he walks him through a mock-up of a futuristic hospital room: 
He shows off a darkened room covered in computer screens: a control center from which a handful of doctors can monitor hundreds of patients, even when those patients are at home. And finally he calls up several computer programs that make sure doctors know, up to the latest scientific-journal article, the best treatment available. It’s a sweeping assemblage of data-driven toys–fueled by $1.3 billion worth of furtive acquisitions, almost entirely using Soon-Shiong’s own money.

He will be worth watching............

Wednesday, August 27, 2014

There's no place for disruptive behavior in healthcare

Why disruptive docs may not be so bad after all

Hospitals need to balance patient satisfaction with outcomes, total experience

Sometimes disruptive behavior can be a good thing.  Not all disruption is due to  technological changes, such as electronic health records.  And some technical disruptions often spur other developments and growth in other industries, perhaps even creating a whole new niche.

Has the healthcare industry gone too far in cracking down on disruptive behavior? Is it okay for doctors to be rude, dismissive and act like jerks if they have superior surgical skills?
Hospitals have long struggled with how to handle disruptive behavior among doctors, sometimes turning a blind eye, other times disciplining or firing them. Getting rid of disruptive docs has become a popular approach as the industry rewards organizations for high patient satisfaction scores.
The biggest problem with disruptive workplace behavior is the negative impact it can have on the patient, FierceHealthcare reported earlier this year. In many instances, the bad behavior distracts the healthcare team, which can lead to medical mistakes.

But aarticle by Becker's Hospital Review calls into question the "zero tolerance" movement and why disruptive docs may not be so bad after all. While some surgeons may be cold and abrasive, they may also be better doctors than their kinder, gentler counterparts, according to the article. Yet the doctors with the better bedside manners are rewarded because they have higher patient satisfaction scores even though they have poor patient outcomes compared to their meaner counterparts.

"In trying to shape our trainees to be all things to everyone ... we run the risk of creating a workforce caught somewhere in the middle, not doing anything well," Shen says.
So how does the industry balance the need for happy patients and skilled clinicians? One way is to recognize that satisfaction--how positive a patient feels about an encounter--is just one part of the patient experience, writes Jason A. Wolf, president of The Beryl Institute, in a blog post for Hospital Impact.

There are divergent opinions as to what effect disruptive behavior can have..

The Joint Commission clearly states,  "disruptive behavior is a sentinel event"

The preceeding quotes are attributable to FIERCEHEALTH

Another point of view, from The Health Care Blog

lawyerdoctor says:
Kudos to Dr. Gunderman for his thoughtful, and analytical evaluation of our current “quality morass.”
We used to have people who were responsible for providing “quality health care.” They were called DOCTORS. If someone didn’t do the right thing, they may or may not have received a butt-chewing. The most powerful incentive for the hospital to provide quality care to the patient was likely the surgeon, whom everyone respected and likely feared a little bit.
One of the most powerful experiences of my medical education was being fortunate enough to spend some time under the tutelage of a small-town general surgeon. He was the most scholarly, genteel, polite, and skilled physician (or person) I think I have ever met. He was so revered and respected in the community that one day he almost made the Director of Nursing break into tears from one simple courteous statement. It was during an operation wherein the staff had forgotten to supply an important surgical tool, and we stood there in sterile scrub, hands folded across chests, for what was about 10 mins (but seemed an hour).
The surgeon said kindly: “Nurse X, you understand that WAITING – is the thing that I do LEAST well.”
I thought the entire nursing staff was going to faint. The item was produced forthwith.

Thursday, June 19, 2014

Disruptive Men in Health Care

One of my favorite blogs, Disruptive Women in Healthcare, at which I frequently lurk quietly stalking those ladies who are assertive, bright, imaginative, charming ( I have to throw that in) and articulate.

Here is the new blog, DISRUPTIVE MEN IN HEALTH CARE. Perhaps I should name it "Disruptive Persons in HealthCare. In the last several years we have a new culture of 'anger management' in which surgeons, and doctors are not allowed to yell, be polite at all costs, and tolerate dangerous or risky behavior. This will be a forum for polite expressions of our displeasure with the system.

Ezekiel Manuel: One of the advisory panel which developed the
Affordable Care Act.

Male and female physicians are accused of being disruptive when their authority is questioned or an order ignored. I am a bit old fashioned, however a brief admonition is within the scope of human relationships. As a physicians' role is minimized and their duty to protect and treat patients is obstructed by well meaning but uninformed para-medical personell, many physicians approach the breaking point of patience.

In a Medscape article  this topic "Are Doctors Arrogant"?  by Leslie Kane, Editor, is addressed with, Good Doctors Have Some Bad Moments . 

Some doctors have admitted that at times it's hard to maintain their patience, and frustration triggers a snappish response. Throw into the mix the fact that doctors may have less time to see each patient and answer questions, and you have the ingredients for a negative interaction. 

Therapeutic Talk in Primary Care, and Professor Emeritus in the Department of Family Medicine at UMDNJ-Robert Wood Johnson Medical School. "Someone who has done the hard work and has gone into medicine because they care about people, and are interested in helping peoples' lives and making the world a better place, is not going to be arrogant."
So how did the arrogant doctor epithet arise?
In the past, doctors were considered authorities who told compliant patients what to do and treated them with a paternalistic attitude. Some doctors may retain those behaviors today.
Arrogance or Self-confidence?
"Arrogance is totally different from self-confidence," says Dr. Stuart. "When you're confident, that's your assessment of your own competence. You have the experience and the wisdom, you know what you can do, and your confidence says that. It's your relationship to yourself and your own expertise,
Arrogance is a different ballgame. "This has to do with your judging that other people are inferior," she says. "It has more to do with not seeing other people as being up to your standards."
Could the confidence that comes with being accomplished and successful make someone arrogant? Typically no, says Dr. Stuart. The trait of arrogance develops or resides within a person at a much earlier stage, arising from one of two paths: "I am indeed better." Someone who has always lived a privileged life, feels entitled to all of the finer things, or has always been looked up to may take it as a given that he or she is better than others. "People who had a sheltered, protected existence with no perception of what the real world is like for other people may consider themselves an elite group, entitled to feel superior," says Dr. Stuart."I made it, so why can't you?" By contrast, a person who was deprived as a child and worked very hard to pull himself up by the bootstraps may then look down on others who don't have the same perseverance or initiative to take charge of their life and create similar success.
"Professionalism is not about putting on a happy face or being someone you are not; it is about providing quality care for the patient," says Dr. Adler. "Patients are more informed and have access to more information than ever before. Much of that information is incorrect and sometimes harmful. That means that part of the professional duty is to teach as well as treat. Still, remaining pleasant and calm is easier for some doctors than for others. There's no uniform physician personality; many doctors have a natural "people person" inclination, while others are more stoic.
I will be inviting and encouraging guests to add their own positive remarks, and/or negative observations regarding health care, policy makers, and the insertion of ' personality '  into daily medical business.

Comment if you are willing to express your opinions, without regard to political correctness, however profanity is not welcome.