Wednesday, January 27, 2010

Removing Barriers

Thank you to New York Senator Montgomery of Kings County for introducing legislation that will allow nurse practitioners to sign death certificates (S.2969). The bill passed the NY State Senate with strong bi-partisan support, 58-3. It must next pass the Assembly and then on to the Governor's desk for approval to become law.

Here is some additional information on the bill and its rationale.

iPad and Health

I am a techno geek. I love my iPhone and BlackBerry. I have a laptop, a netbook and a couple of desktop computers. I am currently piloting a Kindle DX, which is pretty cool.

Today, Apple introduced the iPad, their hotly anticipated tablet computer. It is a beautiful device, about the same size as the Kindle DX, though basically a blown up iTouch. While I can't wait to get my hands on one (it's not available for another 60 days or so), I wonder what apps will be developed to enhance the flow of information in health care. There are already a number of EHRs that run on mobile platforms and since this basically uses the iPhone operating system, it would appear that this is tailor made for health applications - both on the patient side and on the clinician side.

This device may aid in the modernization of health records. The flow and integration of data can and should be so much better. I believe this is a game changer and we will see a further explosion of health related apps and uses.

And it can be yours starting at $499. Very cool.

Wednesday, January 20, 2010

Show me the Love

I came across this wonderful post on Dr. Edwin Leap's blog, "Attention Doctors: People may not like you." It is relevant for all clinicians and talks about the interactions between patients and providers, patient expectations, and the handling of these expectations.

The important thing to remember is that we are providing a service to our patients. Patients come to us for our advice, opinion and to make them feel better. Some may not agree with our plan and will seek further opinion - and sometimes they certainly should. Patient's should be empowered to be actively involved in the decision making process. But oftentimes silos are created, further fragmenting care and communication. That's why I believe firmly that comprehensive care is best delivered in teams - where team members share the same focus and are aware of each other's strengths and weaknesses. There are so many patient variables to consider: culture, socio-economic status, gender, past medical history, genetics, etc. The list can go on and on. Surely, some providers are more apt to care for certain conditions given the complexity of the individual than others (and I'm not necessarily referring to traditional specialists per se). In addition, there are the many treatment modalities to consider. Is that treatment modality proven? Does the evidence support it? Will this treatment work for this specific patient?

I'm not sure what that model of health care truly looks like or if it even exists today. I don't think we need to get too complicated and assemble "true" teams complete with uniforms, logos, statistics, coaches, general managers, free agency, arbitration, and a trading deadline. Or should we? One of the main problems is that the health care "system" isn't coordinated by anyone or anything. Could this be the opportunity for the "medical home" concept to flourish?

The bottom-line is that we are judged by our actions and interactions with patients. We must constantly remind ourselves of this. Most of them will be favorable (hopefully) and some won't. Clinicians need to perform a delicate balance of providing evidence-based and compassionate care, being an effective communicator, yielding high-quality results while doing all of this cost efficiently. The question becomes, How can patients objectively evaluate this information? Does anyone have any suggestions???

Wednesday, January 13, 2010

Health "Advice"

An article appears in Health Magazine advising its readers "when its OK to skip the Doc." But of course in doing so, nurse practitioners get slapped. You see, the article refers to convenient care clinics - a continually hot topic - and how their nurse practitioner staffed model makes it OK for them to treat minor boo-boos but aren't capable of treating more serious maladies.

Now in all fairness, most clinics aren't currently designed to treat conditions beyond episodic-type care and health screenings though there are reports that say this trend may be slowly changing to include other conditions. I just don't understand why the inference is always that the NPs staffing them are limited to treating just those conditions as well. I know plenty of instances where NPs referred patients to other providers based on subtle signs picked up during a convenient care visit which might've otherwise gone unnoticed. Further, patients in these settings were easily able to access a clinician and ask for advice and direction. I'd much rather have that be the case than a patient ignore their signs and symptoms due to lack of access.

NPs can be found in all settings: from hospitals to private practice to school-based clinics and beyond. The "advice" in these types of health publications minimize the role we play and cause confusion to the public.

I'm sure that clinicians in retail eye care, urgent care centers and the infamous doc-in-a-box delivery models faced the same type of issues. We realize today that the status quo is no longer acceptable and we must have delivery models adapt to where patients the patients are.

The most ironic thing about this article is a link to a related article entitled, "Danger at Your Doctor's Office" and uses an unfortunate missed diagnosis by a physician resulting in an advanced terminal cancer in one of their patients.

The reality is clinicians make mistakes. Critical lab results get missed and reports get misfiled. This is the case across all disciplines. Hopefully, this will be less common with a move towards more streamlined electronic records. However, publications should be giving its readers evidence-based information to promote empowerment and advocacy to patients such as getting a copy of your lab tests and progress notes for your own file. And keeping detailed records of signs and symptoms, etc. This is the type of advice that patients should be given.