Marc Siegel wrote a column on January 18th in USA Today that discussed why doctors are unsure of  “Obamacare”. We at Disruptive Women believe it is important for all sides to be presented, so in contrast to the information in our post yesterday on the Jonathan Gruber event we hosted this week, take a look at this column.

By Jane Sarasohn-Kahn. To doctors working in eight countries around the globe, the biggest benefit of health IT is better access to quality data for clinical access, followed by reducing medical errors, improving coordination of care across care settings, and improving cross-organizational workflow.

However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in Australia, Canada, England, France, Germany, Singapore, Spain and the US.

As the subtitle of the report recognizes, there is an age chasm at the age of 50: physicians under 50 years of age more likely believe in the benefits of health IT; fewer older doctors do, on a global basis. Accenture points out that younger doctors are comfortable using computers during patient interactions in the exam room, compared with older physicians who prefer face-to-face conversations without what they may perceive as a disruptive interruption of looking at a keyboard or computer screen. (more…)

The following is a guest post by Ms. Nasreen Sulaiman a Senior Instructor at Aga Khan University School of Nursing. She  has worked with palliative patients.

By Nasreen Sulaiman. Palliative care is an urgent humanitarian need for people worldwide with cancer and other chronic fatal diseases as it provide comfort and ease suffering. Nearly 80 % of the cancer patients in Pakistan present late in stages 3 & 4 with terminal disease.  In Pakistan, the concept of palliative care is in its infancy stage and need to be strengthened. In Karachi, one of the mega cities of Pakistan, only two hospices each of 20-25beds provides palliative care services where the health care professionals’ main focus is on providing the physical aspects of care. Pain management, a crucial aspect in the palliative care still remains partially addresses due to lack of narcotic supplies and other medications.  Furthermore, I strongly feel that other than providing pain and symptom relief measures, the social, emotional, and spiritual needs of the patient should also be given prime importance in order to provide holistic care to the patients. Nurses need to learn to utilize various non-pharmacologic measures such as therapeutic communication techniques, use of humor, guided imagery, therapeutic touch, relaxation exercises, religious songs and other diversional activities in order to ease the suffering, emotional distress and provide optimal comfort and support to the patients including their caregivers. Moreover, in palliative care settings, caregivers hold a great importance as they are the ones who are providing the total care and most of the time with the patients. Caregiver role strain is an essential area to be looked at. Caregiver support is another area to be looked upon. We need to establish caregiver self-help groups or other avenues to support the caregivers as they go through lot of emotional pain and need immense help and affection which may assist them to perform their roles effectively with the patient suffering from the disease.

By Casey Quinlan. It’s not easy hearing your name and [insert dread diagnosis here]. I know this only too well after having to find the funny in my own journey through cancer. Cancer is, however, most often a diagnosis that you fight to a defined end. What’s it like to find the funny in a chronic condition like multiple sclerosis?

I have a number of friends who are battling MS, one of whom, Amy Gurowitz, shared a link on Facebook the other day to Jim Sweeney’s online empire of improv humor and chronic disease. Jim’s MS journey started with vision problems in 1985, he was officially diagnosed in 1990, and has been dealing with the disease – finding the funny most of the time – ever since.

Jim’s body of work includes decades of live improv, his one-man show “My MS & Me,” which you can hear on the BBC Radio 1 site. His MS has progressed to the point that he’s now in a wheelchair, and his public presence is mostly limited to Twitter, where his profile describes him as a housebound hedonist (hey, it made ME laugh) and YouTube.

How much courage does it take to laugh out loud, in public, at an incurable disease? Jim certainly has courage at the level required.

Other examples of funny-or-die in managing chronic disease include Mark S. King’s fabulously funny My Fabulous Disease blog (Mark is HIV-positive). The aforementioned Amy Gurowitz laughs out loud about her MS in a number of places, including MS Soft Serve and MS-LOL (life of learning OR laugh out loud, you pick).

On the provider side, there are a number of docs who are breaking up the waiting rooms and wards.

Dr. Patricia Raymond is a gastroenterologist whose mission in life is to take the “ick” out of colonoscopies. She bills herself as The Fabulous Butt Meddler. Since she looks like Bette Midler, the joke works on every level.

Dr. Zubin Damania, a/k/a ZDoggMD (“Slightly Funnier Than Placebo”), is a hospital medicine specialist in Palo Alto as well as a veritable buffet of medical humor, some G-rated and some most definitely NSFW. His videos alone guarantee hours of laughter. (more…)

The following is a guest post by Dr. Jessie Gruman. This blog post was originally published at Prepared Patient Forum: What It Takes Blog

“My doctor can titrate my chemotherapy to the milligram but can’t tell me when I am going to die,” a friend who was struggling with his treatment for cancer complained to me a couple years ago.

Had he lived, he might have been reassured by the announcement last week of a new scale that allows clinicians to estimate the time remaining to people with advanced cancer.  He was spending his final days “living by the numbers” of his white blood cell count, the amount and size of his tumors and suspicious lesions, the dosage of various drugs and radiation treatments. And he was peeved about what he saw as a critical gap in those numbers.  He believed (hoped?) that because his cancer was quantifiable and the treatment was quantifiable, that the time remaining should be similarly quantifiable.  He needed that information to plan how to use the time that remained.

Many of us would make a different choice about knowing how long we will live when we are similarly ill.  But most of us are attracted to the certainty we attach to the numbers that precisely represent aspects of our diseases. (more…)

By Jane Sarasohn-Kahn. Nuns and priests were CEOs at 770 of 796 Catholic hospitals in the U.S. in 1968. This year, there are only 8 of them leading 636 hospitals. Sister Mary Jean Ryan, who retired as CEO of SSM Healthcare, says, “We’re a dying breed.”

Why has this happened, and why should we care — whether or not we’re Catholic?

The New York Times covered this story on August 22, 2011, titled, Nuns, a ‘Dying Breed,’ Fade from Leadership Roles at Catholic Hospitals. NY Times editors smartly placed this story in the “U.S.” section and not under the “Religion” corner of the paper.

At the crux of this historical transition at religious hospitals is whether the values that drove the heart and soul of these institutions — caring for the needy, the safety net population, and the larger community — will translate when MBAs and MHAs take over leadership of these organizations. The Times wrote, “Although their influence is often described as intangible, the nuns kept their hospitals focused on serving the needy and brought a spiritual reassurance that healing would prevail over profit, authorities on Catholic health care say.”

This is not a marginal issue in American health care: in 2009, 1 in 6 hospital admissions was in a Catholic hospital.

Health Populi’s Hot Points: With the U.S. economy in decline or stasis in most of the nation, and health benefits for covered workers lucky enough to be covered by a health plan, moving more financial burden onto employees, more health citizens in the U.S. have been moving into safety-net, under-insured, or un-insured status. As such, more people seek care in emergency rooms and outpatient care in the community, and more have a difficult time paying for health care (my blog posts have featured this issue over the past 4 years; search on the topics of safety net, Medicaid, self-rationing, and medical home in Health Populi‘s search box). (more…)

WATCH exclusive video interviews with 15 of this year’s Top 25 Women in Healthcare!
They discuss some of the key factors that have contributed to their career success and share their advice for other women considering a career in healthcare administration.

By Jane Sarasohn-Kahn. Patients who perceive their visit to the doctor was patient-centered, with more communication, receive fewer diagnostic tests and referrals, and yield lower expenses for diagnostic testing. A new study finds that patient-centered care leads to lower spending on health care over one year of care due to fewer specialty care referrals. A contributing factor to lower costs is increased patient participation during the visit, which reduces patients’ anxiety and perceived need for further investigations and referrals. In the milieu of more effective patient-physician communication, physician gets more knowledge about the patient. This brings greater trust between patient and doctor, as described in Patient-Centered Care is Associated with Decreased Health Care Utilization, published in the Journal of the American Board of Family Medicine published in July 2011, and penned by Dr. Klea Bertaks and Dr. Rahman Azari.

This is not a new concept: ten years ago, the IOM’s seminal report, Crossing the Quality Chasm: A New Health System for the 21st Century, called for “patient-centeredness.”

What is patient-centered care? Bertakis and Azari call out four communication behaviors:

1. Eliciting understanding and validating the patients’ perspective
2. Understanding the patient within his or her psychosocial context
3. Reaching a shared understanding with the patient of the problem and its treatment
4. Creating a partnership in which “activated” patients share in decision making, power and responsibility.

These four precepts were codified in a 2007 publication from the National Cancer Institute, Patient-centered communication in cancer care: promoting healing and reducing suffering.

Health Populi’s Hot Points: Adopting a patient-centered approach isn’t solely about reducing health care costs: it’s about patient empowerment, effective communication between doctor and patient, and participatory medicine. The secret in this sauce is in the communication between the partners: greater sharing of information from each side of the conversation, building greater trust, and leading to a decreased use of unnecessary diagnostic testing, hospital care, and specialty referrals. While long-term outcomes haven’t yet been quantified in the patient-centric approach, this study adds to the growing evidence base that participatory medicine is a win for the patient, a win for the physician, and a win for the larger health system and health economics.

Originally posted on Health Populi on July 19th.

By Val Jones. I’ve often heard physicians say that “the history is 90% of the diagnosis.” In other words, they can usually determine the underlying cause of a patient’s problem just by listening to their account of how it evolved. The physical exam is merely to confirm the diagnosis, and is often cursory, limited, or ignored.

I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.

The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone.  I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms.

And then something interesting happened – based on the short description of an imaginary patient’s complaint, I began to go down an inappropriate (and expensive) diagnostic pathway. Since I couldn’t see the patient, and some of the symptoms could have been life-threatening, I suggested some pretty aggressive measures. I would not have ordered any of these tests had I been able to see the patient in-person, because I would have been able to see what was actually wrong quite quickly.

I realized that when two doctors plan for the care of a patient they’ve never met, all manner of inappropriate and expensive testing and treatment can occur. So I wondered to myself: what will happen to our healthcare system if we continue to divorce ourselves from patient contact? When diagnostic algorithms become even more rigid, and patients are pressed into diagnostic code categories with pre-determined courses of action prescribed for them long in advance? It’s going to become easier and easier for people to be locked in to an incorrect diagnosis, and subjected to a battery of expensive, and unnecessary tests and procedures… when all that was needed was a pair of human eyes and a thoughtful exam at the very beginning.

I’m pleased to report that I passed my specialty board exam, and I’m now certified in Physical Medicine and Rehabilitation. However, as I consider my clinical future – I know that to be a good diagnostician, I must spend time with my patients in-person… and I’m looking forward to it.

Anna Gawlinski

The following is a guest post by: Anna Gawlinski, RN, DNSc, FAAN, Director, Research and Evidence-Based Practice and Adjunct Professor at Ronald Reagan UCLA Medical Center and UCLA School of Nursing and Elizabeth Henneman, PhD, RN, Assistant Professor at The School of Nursing at the University of Massachusetts-Amherst.

It’s easy to criticize the current state of our health care system. All over the place, even outside of Washington DC, people are talking left and right (politically, that is) when they should be talking right and wrong (care, that is). But, one important talking point that’s almost always left out of the equation is our role, the role of the nurse. Or more specifically, the critical care nurse whose job it is to save you or your family members’ lives if hospitalized in the intensive care unit (ICU).

With its latest effort to reduce medical errors through the National Patient Safety Initiative, the government is putting dollars behind this effort. Hospital ICUs not only house a hospital’s sickest patients, but they also account for up to 30 percent of a hospital’s costs. As many as 1 in 5 patients die in the ICU and this is partially attributed to the severity of medical conditions and the high rate of health care-associated infections (HAIs). However, we all know that medical errors also play a huge role.

Medical errors occur in the ICU. In the past, many have been of the mindset that they are inevitable. However, our study recently published in the American Journal of Critical Care illustrates that nurses can play a significant role in reducing medical errors. (more…)

Addressing the inevitability of nurses caring for older adults with mental health and substance abuse issues, the American Academy of Nursing’s Geropsychiatric Nursing Collaborative (GPNC) released a new short video: “Discover Mental Health: The Forgotten Piece in Elder Care.”

The video conveys that while not every student will become a geropsychiatric nurse, almost all nurses at some point in their careers will care for older adults with mental health issues. Therefore, nurses will need the requisite knowledge, skills and compassion to improve the quality of life for this most challenging, rewarding and neglected population.

View the video. Note that this video can be used as a standalone resource or segments can easily be excerpted for specific uses. It is available for free download on the Portal of Geriatric Online Education: POGOe, Product #20893   (You must have an account to access the video for download, but registration is free.)

Please share with your colleagues. GPNC would love to hear who is using it in what venues and any responses about its utility and value. Send comments to Pamela Dudzik at pdudzik@aannet.org.

The following is a guest post by Sandra Phillips Sperry and Caryl Mahoney. Sandra Phillips Sperry, MPA, APC, RN, CMC, FACHE is the Principal & EVP of Management Transitions a health care transition management firm and Founder & CEO of Connect2Care America, LLC an internet based health care advocacy service established in 2010. She is a senior healthcare executive with over 20 years of diverse experiences in hospital operations, financial management, clinical integration, business development, and hospital facilities planning and design. Caryl Mahoney has extensive executive experience in Human Resources, Organizational Development, Strategic Planning, Employee Relations, Coaching and Communications.Caryl’s experience includes healthcare management as a senior executive, consultant to Fortune 100 corporation and the intelligence community of the federal government.

By Sandra Phillips Sperry and Caryl Mahoney. An unavoidable fact of business life is that the workplace is fraught with the potential for conflict. High performing organizations and effective teams must attend to not just the work that gets done, but how it gets done.  Unfortunately, intimidating and bullying behaviors have always been an unwelcome part of the healthcare workplace.  Unresolved, these toxic behaviors can lead to debilitating consequences such as lowered morale and productivity and loss of quality staff.  These toxic behaviors effect performance and are evidenced among peers, patients towards staff, staff towards patients, and throughout the matrix of the organization.  Toxic behavior or personalities can be defined as exhibiting counterproductive work behaviors that demoralize and incapacitate individuals, teams, and organizations.  These behaviors reflect a disconnect between stated organizational values and performance.  The behaviors are often tolerated because an individual is viewed as talented, in a position of power, a significant contributor to the bottom line, a “driver” of other’s performance or simply affected by situational stress.  There is significant evidence that toxic behaviors are no longer just an irritant to can be put up with but are serious disruptions that contribute to decreased productivity, safety and increased cost.  The nature and form of bullying is often unclear in the workplace.  Overt bullying behavior is more easily recognized in a schoolyard, but can be masked or more subtle in the workplace.  Dealing with bullying in the workplace is a compelling reason for the broadening of organizational goals and culture.  Developing individual and group awareness can result in positive organizational outcomes and wise personal and professional relationships.

The Institute for Safe Medical Practices (ISMP, 2010) survey findings found that 49% of health care professionals felt that intimidating behaviors had altered their ability to manage medication orders.  The Joint Commission for the Accreditation of Hospitals (JCAH) found that 70% of sentinel events were directly correlated with poor communications that are the result of negative, toxic behavior and bullying in the environment.  Findings were of such significance that standards for the management of bullying and toxic behavior were established (JCAH, 2009).  Another example is the work of Kusy and Holloway (2009) who found that 64% of individuals surveyed from a range of industries responded that they were currently working within a toxic situation or with a toxic individual.   Unprecedented interest in workplace bullying in the U.S. and globally has arisen out of the recognition that bullying, intimidation and other toxic behaviors have severe consequences and are on the rise first in our families, then in the education system, and finally in the workplace. (more…)

The following is a guest post by Elizabeth Madigan, PhD, RN, FAAN who is a professor of nursing at the Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, Ohio. She has been an RN for more than 30 years and has spent the last 14 years as a researcher focused on quality and safety in health care, primarily home health care.

By Elizabeth Madigan. There really is no low hanging fruit in safe health care. The “hurray for checklists in health care” mantra that has been recently promoted in the popular media, misses a couple key points—it’s not the checklist that improves the outcomes—it’s the change in the organizational culture and where that cultural change happens. Anyone who has worked in quality improvement or performance improvement long enough knows the familiar story of a blip of improvement in patient outcomes following one simple intervention that is not maintained and often falls to worse when QI and PI attention moves to another problem. Persistent changes come about through changes in organizational beliefs and operations. The Institute for Healthcare Improvement has identified the importance of the engagement of key leadership in bringing about organizational change, but it also requires the frontline workers, regardless of the health care setting, who do the heavy lifting in making changes in day-to-day work practices. The implication of the popular media is that if the health care industry would adapt the same successful and (oh by the way) very simple approaches (the checklists) from aviation or nuclear power, we would see big and persistent improvements in patient safety. Here’s the rub: on the other end of that checklist is a person, not an airplane or a nuclear plant. And people, particularly people seeking health care, are complicated in ways that airplanes and nuclear plants are not and deserve a provider who recognizes their unique perspectives, needs, backgrounds and current status. The other part of the story from both the aviation and nuclear power industries is that the successes associated with the checklists resulted from changes in the organization as well. For example, in the aviation industry, co-pilots were encouraged to and actually empowered to question the pilots about safety issues. Can using checklists help improve health care quality and safety? Should checklists be integrated in some parts of health care? Absolutely on both counts. Are checklists low hanging fruit that the health care industry has chosen to ignore because health care providers are (pick one) greedy, not caring, resistant to change or not smart enough to recognize? Not a chance. All of health care is under increased scrutiny for quality and safety outcomes; implying that the industry and all the research to date has missed the simple “silver bullet” solutions is not helping and is actually counter-productive to addressing the complex issues here.

By Jane Sarasohn-Kahn. In February 2011, 1 in 10 jobs in the U.S. is in health care employment; nearly 14 million people in the U.S. work in health care employment, with health care representing 10.7% of all jobs in America. The growth rate of health care jobs rose 1.2 percentage points since the recession kicked in late 2007. Since the start of the recession, health employment grew 6.3%; the number of non-health jobs fell by 6.8%. The chart starkly illustrates this story (click the chart to enlarge for easier reading).

Altarum Institute has crunched the health job numbers from the Bureau of Labor Statistics (BLS) and published their analysis in Health Sector Economic Indicators, published February 9, 2011. Altarum’s top-line: health care employment has reached an “all-time high” in the U.S.

Outpatient care settings accounted for the fastest-growth in jobs with a 12-month rate of increase of 5.3%. The hospital segment grew the slowest, at a mere 0.7% — basically flat-lining (though still representing, by far, the largest segment in terms of jobs). Home health jobs grew by 4.3%.

Health Populi’s Hot Points:  It is impossible to separate the U.S. health microeconomy from the nation’s macroeconomy. With only 39,000 new jobs added to the U.S. economy in January 2011, we economists look for bright signs wherever we can find them. One-third of this increase in total new employment was in health care.

The number of jobs in the health sector will continue to grow. This will continue to be the case for the next decade, at least. Among many drivers for health job growth, two are at the top of the list in 2011: health information technology and the aging of the population. There will be intense demand for workers skilled in health information technology, based on the adoption of electronic health records by providers (both doctors and hospitals), along with growing digitization of all health information generated by digital imaging, point-of-care diagnostics, smart infusion pumps, and other medical devices. Dr. Blackford Middleton of Partners HealthCare projects a need for an additional 40,000 to 160,000 workers in health IT in the coming years.

As for aging, the chart shows already-growing demand for more home care workers. Boomers won’t age quietly into that good night, wishing to avoid institutional care in nursing homes. So home care work will be re-defined back in the person’s home — requiring even more digitally savvy workers to re-imagine and re-design what home care is. This will mean more jobs for new kinds of design and ideation, applying the disciplines of anthropology and sociology, and of course, more IT developers who can marry, say, miniature accelerometers to milk bottles and sensors to scales.

How we define health care jobs today will morph into a new definition for jobs in health tomorrow.

Originally posted on Health Populi on February 10th.

By Jane Sarasohn-Kahn. While 8 in 10 U.S. adults want a physician to have primary responsibility for the diagnosis and management of their health care, many people are not sure who’s a medical doctor. Surprisingly numbers of health consumers don’t think that orthopaedic surgeons, family practitioners, dermatologists, psychiatrists, and ophthalmologists are MDs.

The American Medical Association‘s survey, Truth in Advertising, published in January 2011, follows up the AMA’s 2008 survey which had similar results.  Data based on consumers answering the question, “Is this person a medical doctor,” are organized in the chart.

90% of people say that a physician’s additional years of medical education and training are ‘vital’ to optimal patient care. At the same time, only 51% of people say it’s easy to identify who is a licensed medical doctor and who is not by reading what services they offer, their title and other licensing credentials in ads and marketing materials.

In a related story, my colleague and friend Michael Millenson wrote in Kaiser Health News today about “Fixing the Failure at Physician Compare.” Physician Compare is the Centers for Medicare and Medicaid Service’s (CMS’s) portal meant to assist the health citizens (whether enrolled in Medicare or not) in finding doctors in their local communities. Millenson writes,

“In reality, the site is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable. Put bluntly, the agency, whose leader famously called himself a ‘patient-centered … extremist’ in a 2009 Health Affairs article, has produced a consumer tool that practically shouts, ‘We couldn’t care less whether any consumer ever uses this.’”

The AMA survey was conducted in November 2010 among 850 adults.

Health Populi’s Hot Points: The AMA poll and Millenson’s analysis point to the desperate need for greater health literacy, transparency and useful, usable tools for health citizens for becoming more engaged and empowered in their health and health care choices. Most health citizens don’t aspire to be couch potatoes when it comes to tapping into health information: in fact a majority of U.S. adults who have a primary care doctor would like more comprehensive information about their doctors online, learned in a survey conducted in November 2010.

AHRQ is soliciting comments for the Agency’s project, Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT.  This project will focus on consumer health information search and storage, and health monitoring. Health Populi readers involved in consumer-facing health IT innovation and design should tap into this site and get involved. As the Physician Compare early experiences point out, AHRQ — which is a ‘sister’ organization to CMS under the umbrella of the Department of Health and Human Services — can benefit from your input.

Originally posted by Jane Sarasohn-Kahn on January 27th on Health Populi.