Monday, December 15, 2014

EMR: Physician Rants

OK, I've heard some physician rants about Electronic Medical Records.  Change isn't always fun.  Here are some rants, just in case you or your physician are all giggles about the EMR, so you know there are other opinions.

"The Electronic Medical Record (EMR) is as "medical" as Medical Marijuana.  But, it helps to maximize "medical" billing.  It costs too much.  It leads to markedly diminished time for patient care.  It is shameful that it was mandated by poorly informed non-physicians.  It is shameful that physicians went along with it.  The idea seemed good, but the EMR doesn't deliver the goods to help patients or hospitals or physicians to improve quality and decrease cost. The new quality isn't quality- it's whatever is measurable.  We sold out our profession and our patients on this misguided transformation.  The Electronic Medical Record is an Electronic Billing Record."

Benefits:  Billing.  Medication lists.  Prescriptions. Legibility.

Harm: Loss of time.  Patient quality.  Patient satisfaction. Physician quality.  Physician autonomy.  Patient-Physician relationship.  Cost of health care.

What do you think?

Tuesday, December 2, 2014

What is Family Medicine?

Medical students have to sort out specialties to be able to select one for their career. Here's the definition of Family Medicine for those who wish to understand how their career dreams compare to a career in this specialty.

"Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity." (1984) (2010 COD).....from the AAFP

During their Family Medicine clinical experience, they may wish to refer to this definition each day to notice what manifestations of the specialty they've experienced or observed.  They may ask themselves:  
"Was that continuity of care I just experienced?  As I see the same patient and members of their family am I developing a comprehensive picture of their health needs?  Working with the patient, are we developing a comprehensive plan for their health screenings and disease care?"

Further information from the American Academy of Family Physicians is the Scope and Philosophical Statement of Family Medicine:  "Family medicine is the natural evolution of historical medical practice. The first physicians were generalists. For thousands of years, generalists provided all of the medical care available. They diagnosed and treated illnesses, performed surgery, and delivered babies. As medical knowledge expanded and technology advanced, many physicians chose to limit their practices to specific, defined areas of medicine. With World War II, the age of specialization began to flourish. In the two decades following the war, the number of specialists and subspecialists increased at a phenomenal rate, while the number of generalists declined dramatically. The public became increasingly vocal about the fragmentation of their care and the shortage of personal physicians who could provide initial, continuing and comprehensive care. Thus began the reorientation of medicine back to personal, primary care. The concept of the generalist was reborn with the establishment of family medicine as medicine's twentieth specialty.

Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.

In the dimension of process, the family physician functions as the patient's means of entry into the health care system and as the physician of first contact in most situations is in a unique position to form a bond with the patient. The family physician's care is both personal and comprehensive and not limited by age, sex, organ system or type of problem, be it biological, behavioral or social. This care is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion. When referral is indicated, the family physician refers the patient to other specialists or caregivers but remains the coordinator of the patient’s health care. This prevents fragmentation of that care in both the outpatient and inpatient settings. The family physician serves as the patient’s advocate in dealing with other medical professionals, third party payers, employers and others and as such is a cost-effective coordinator of the patient’s health services.

Although all family physicians share a core of information, the dimensions of knowledge and skill vary with the individual family physician. Patient needs differ in various geographic areas, and the content of the family physician's practice varies accordingly. For example, the knowledge and skills useful to a family physician practicing in an inner city may vary from those needed by a family physician with a rural practice. Furthermore, the scope of an individual family physician's practice changes over time, evolving as competency in current skills is maintained and new knowledge and skill are obtained through continuing medical education. This growth in medical information also confers on the family physician a responsibility for the assessment of new medical technology and for participation in resolving ethical dilemmas brought about by these technological advances.

In summary, the family physician of today is rooted in the historical generalist tradition. The specialty is three dimensional, combining knowledge and skill with a unique process. The patient-physician relationship in the context of the family is central to this process and distinguishes family medicine from other specialties. Above all, the scope of family medicine is dynamic, expanding, and evolutionary.(1992) (2011 COD)".... from the AAFP

The personal experience of the students allows them to discern how well their dream and their sense of the specialty of Family Medicine align.  It's not for everyone, but it is the specialty for many.

Saturday, November 22, 2014

Chicken Pox, Vioxx and Goldilocks - The Song



Healthcare Healthcare Everywhere                     by Pat Jonas, MD

Chicken Pox, Vioxx and Goldilocks- Healthcare Just for you
A shot, a drug and a fairy tale, it’s just like a zoo
And if you have insurance, you won’t pay the bill
Just go into CVS, you can get your fill

CHORUS:
     Healthcare, healthcare everywhere, more than what we need
     Cat scans, ER’s, MRI’s, Chemo used like tea
     More is better, “Let’s be sure”, “You’re a friend of mine.”
     Let me see your wrist ID to bill you one more time.

Barcode reader in my hand leads to good health care
Patients lying in the bed will notice that I’m there
“Yes! A nurse someone who cares, perhaps I won’t be killed”
“OK, I can hear your cares, after you’ve been billed”

Family Doctor, what is that? Someone we don’t need.
ER, that’s the place to go when I start to bleed
Just bill my insurance, please, for more and more health care
Co-pay’s all I need to pay for everything that’s there.


I recently gave a talk titled "Chicken Pox, Vioxx and Goldilocks:  Avoiding Avoidable Care" at the Institute of Holistic Leadership Annual Symposium (see previous blog post with that title).  Included was this song which we sang together.  Just a spoof on some aspects of healthcare.  The tune is similar to the Mr. Clean song (but not quite).  Enjoy.