Something happened. Medicare patients are now admitted to hospitals by strangers, discharged in 2.2, or so, days and readmitted 20-30% of the time within 30 days. Both admissions are paid by Medicare. Sounds like a good business model if you like to maximize profits.
We family doctors used to admit them ourselves if they needed it. They might be in for four days, but not readmitted. We wrote or gave the admitting orders for hospitalization and orders every day in the hospital. At the time of discharge, we wrote the list of discharge medications and the prescriptions for any new ones. The patient saw us in our office in 3-7 days to clarify their progress. The admitting history and physical was our work, as was the discharge summary.
What happened? We left private practice, opting for employment with reduced hours and responsibilities. Hospitalists were invented as a consequence, to have someone to do the inpatient work in hospitals. Five or six new processes are used to replace what we used to do, as the system strives for the quality we used to have.
Replacing Family Physicians has been very profitable for many. Now it's going to get expensive, as the government initiates penalties for re-admission within 30 days. Profit is the quest of the Medical Industrial Complex, but America is paying dearly with, by some accounts, 195,000 deaths yearly generated by medical errors. What happened?
Is it fixable?
Thursday, October 27, 2011
Tuesday, October 18, 2011
Dr Synonymous Show: Social Media Geezer
At the Family Medicine Education Consortium, Inc. (FMEC, Inc.) Annual Meeting in Danvers, MA four of us will present: "Social Media Nuts and Bolts: For Geeks to Geezers". It creates an opportunity to reflect on my social media "career" and skills. This blog post is an overview of much of the content of my part of the presentation. I will talk about it on my Dr Synonymous Blog Talk Radio Show Tuesday October 18 live from 8-9 PM ET, by clicking on the link below. After that time, the show can be heard as a podcast by clicking on the same link.
The Dr Synonymous Show
My show starts with a welcome, an introduction and a disclaimer. Who am I? What can you expect/ not expect from the show?
I'm Pat Jonas, MD, a Family Physician in Beavercreek, Ohio.
Background of my show and blog name- Dr Synonymous. A.P. Jonas ("I am Apple Pie Jonas, synonymous with motherhood and the American Flag")
"Helping YOU to be synonymous with your best health!"
I love being a Family Physician. I love Family Medicine. I wanted to write about Family Medicine and couldn't really get it done when I was in an academic or pseudo-academic setting. Now in private practice and through on-going affiliation with people in FMEC, The Center for Innovation in Family and Community Health (CIFCH) and The Ohio Academy of Family Physicians (OAFP), I write something almost daily. I have two blogs, one about Family Medicine, Dr Synonymous and one about life in the small town and community in which I grew up, Set Our Hearts at Liberty.
Patient blogs are the first part of my broadcast each Tuesday. Without patients, doctors are useless, so I like to honor patients through my writings and my show. A list of individual patient blogs that I read regularly is on my Google Reader, including Warm Socks Warm Socks, Pissed Off Patient Pissed Off Patient, Dr Fatty Finds Fitness Dr Fatty Finds Fitness, Sea Spray Sea Spray-Its a Wonderful Life, RA Warrior RA Warrior and others. Group blogs representing specific types of patients are included on my show, including The Genetic Alliance The Genetic Alliance/, Grieving Dads Grieving Dads, 100 Best Sites for Fibromyalgia, etc.
Medical student blogs are next, often including Future of Family Medicine and Adjacent Possible Medicine.
Physician blogs follow, often including Common Sense Family Doctor and AFP Community Blog both by Kenny Lin, MD, and The Singing Pen of Dr Jen. by Jennifer Middleton, MD. Lastly, I include my post(s) from Dr Synonymous.
Mike Sevilla, MD (aka, The King of Family Medicine social media) was a major role model for me to learn about social media. I followed him on Doctor Anonymous and Family Medicine Rocks/ on his blog and on Blog Talk Radio. He helped me to understand how to play, learn and teach through social media. Facebook was my first social media entry point, followed by LinkedIn, Twitter, My Space, Blog Talk Radio, UStream, Military.com, OSMA, etc. on to Google +.
Twitter.com/@apjonas is where I learned about Twitter and Tweeting followed by Tweetchats (first by #hcsm on Sunday nights, then #MDChat, then by starting up #FMChat with @MikeSevilla, @mdstudent31-now @BernieMD31, @RichmondDoc and hosting the chat once).
LinkedIn caught my membership in 2006, but I didn't populate it with my information until 2009 and integrated it with my tweets and blog in 2010. Now I use it for professional connections across many career fields, including Family Medicine, hospital, college and medical school connections.
I'm speaking about these items and more as a legitimate "Social Media Geezer" on The Dr Synonymous Show, this blog post, on Twitter, LinkedIn and in Danvers, MA this weekend. I hope you'll join me.
The Dr Synonymous Show
My show starts with a welcome, an introduction and a disclaimer. Who am I? What can you expect/ not expect from the show?
I'm Pat Jonas, MD, a Family Physician in Beavercreek, Ohio.
Background of my show and blog name- Dr Synonymous. A.P. Jonas ("I am Apple Pie Jonas, synonymous with motherhood and the American Flag")
"Helping YOU to be synonymous with your best health!"
I love being a Family Physician. I love Family Medicine. I wanted to write about Family Medicine and couldn't really get it done when I was in an academic or pseudo-academic setting. Now in private practice and through on-going affiliation with people in FMEC, The Center for Innovation in Family and Community Health (CIFCH) and The Ohio Academy of Family Physicians (OAFP), I write something almost daily. I have two blogs, one about Family Medicine, Dr Synonymous and one about life in the small town and community in which I grew up, Set Our Hearts at Liberty.
Patient blogs are the first part of my broadcast each Tuesday. Without patients, doctors are useless, so I like to honor patients through my writings and my show. A list of individual patient blogs that I read regularly is on my Google Reader, including Warm Socks Warm Socks, Pissed Off Patient Pissed Off Patient, Dr Fatty Finds Fitness Dr Fatty Finds Fitness, Sea Spray Sea Spray-Its a Wonderful Life, RA Warrior RA Warrior and others. Group blogs representing specific types of patients are included on my show, including The Genetic Alliance The Genetic Alliance/, Grieving Dads Grieving Dads, 100 Best Sites for Fibromyalgia, etc.
Medical student blogs are next, often including Future of Family Medicine and Adjacent Possible Medicine.
Physician blogs follow, often including Common Sense Family Doctor and AFP Community Blog both by Kenny Lin, MD, and The Singing Pen of Dr Jen. by Jennifer Middleton, MD. Lastly, I include my post(s) from Dr Synonymous.
Mike Sevilla, MD (aka, The King of Family Medicine social media) was a major role model for me to learn about social media. I followed him on Doctor Anonymous and Family Medicine Rocks/ on his blog and on Blog Talk Radio. He helped me to understand how to play, learn and teach through social media. Facebook was my first social media entry point, followed by LinkedIn, Twitter, My Space, Blog Talk Radio, UStream, Military.com, OSMA, etc. on to Google +.
Twitter.com/@apjonas is where I learned about Twitter and Tweeting followed by Tweetchats (first by #hcsm on Sunday nights, then #MDChat, then by starting up #FMChat with @MikeSevilla, @mdstudent31-now @BernieMD31, @RichmondDoc and hosting the chat once).
LinkedIn caught my membership in 2006, but I didn't populate it with my information until 2009 and integrated it with my tweets and blog in 2010. Now I use it for professional connections across many career fields, including Family Medicine, hospital, college and medical school connections.
I'm speaking about these items and more as a legitimate "Social Media Geezer" on The Dr Synonymous Show, this blog post, on Twitter, LinkedIn and in Danvers, MA this weekend. I hope you'll join me.
Saturday, October 15, 2011
Family Medicine: Observations by a Family Doctor
Observations by a Family Doctor in my office: Shingles in retired parent giving Chicken Pox to adult offspring. Strep throat presenting as conjunctivitis. Diabetic addicted to starches causing increasing HgbA1c. Low Vitamin D3 levels in over 50% of patients tested in my practice. Renal Insufficiency in a lot of patients after treatment for edema of legs with diuretic. Lisinopril causing a lot of people to cough or to have elevated potassium.
Warts, papillomas, skin tags, cuts and abrasions abounding as the weather becomes more tolerable. Sinus congestion with mucous excess from "ragweed day" on August 15 until the first frost.
Some aging couples are so close as to be almost inseparable. When one of them dies, the other becomes empty and miserable, sometimes leading to the demise of that person. Loneliness isn't good for human health. James Lynch wrote a book about this subject titled, The Medical Consequences of Loneliness, which validates the title well. People need people. People need responses from other people.
Children like to imagine and play, if given the chance. We have a child's kitchen/cooking station with oven, microwave, plastic food items and a baby in one large exam room. Three to ten year old children tend to actively engage in play around the kitchen activities. Some children manifest a deep caring for others with an intense desire to share. After age twelve, it's rare to see or hear of these traits in the children I see. A clear exception is the home schooled children. They continue to engage, plan, imagine and speak of it somehow in the course of a well child exam.
Two or three times a month I see a "stay at home" Mom. Once every four months, I see a "stay at home" Dad.
Just a few observations. People are always interesting, even in a Family Doctor's office.
Warts, papillomas, skin tags, cuts and abrasions abounding as the weather becomes more tolerable. Sinus congestion with mucous excess from "ragweed day" on August 15 until the first frost.
Some aging couples are so close as to be almost inseparable. When one of them dies, the other becomes empty and miserable, sometimes leading to the demise of that person. Loneliness isn't good for human health. James Lynch wrote a book about this subject titled, The Medical Consequences of Loneliness, which validates the title well. People need people. People need responses from other people.
Children like to imagine and play, if given the chance. We have a child's kitchen/cooking station with oven, microwave, plastic food items and a baby in one large exam room. Three to ten year old children tend to actively engage in play around the kitchen activities. Some children manifest a deep caring for others with an intense desire to share. After age twelve, it's rare to see or hear of these traits in the children I see. A clear exception is the home schooled children. They continue to engage, plan, imagine and speak of it somehow in the course of a well child exam.
Two or three times a month I see a "stay at home" Mom. Once every four months, I see a "stay at home" Dad.
Just a few observations. People are always interesting, even in a Family Doctor's office.
Friday, October 14, 2011
Family Medicine: Patience
Patient 1. Married to the pushy fellow who only comes in when forced to see the doctor to get his prescriptions. That's right, he is just using the doctor, he doesn't want me to think, just write and don't talk (but we hope for an opening to be helpful and we're helping his wife). Usually, if we stay committed to his well-being, we'll get to know each other a bit and we'll connect. Patience.
Patient 2. Oops, she forgot her husband, supposed to be two persons coming in today, but husband, barely able to function after cancer surgery one year ago opts not to come along. What to do? I thought we were responding well to his fatigue with disability recommendation and parking placards for disability parking. I want to see him, examine him and recommend strategies to get the realignment with his life that he was desiring. Patience.
Patient 3. I open chart, see vitals and chief complaint: HTN, Allergies, Cholesterol. Abnormal EMG and NCV. Does he have diabetes ? He tells a huge story about a work situation which is being cared for by an occupational medicine physician. OK. Can we clarify what your reason was for making this appointment? We need mutual agreement on his goal for this visit. OK, the purpose is his concern that his test result means that he's becoming a diabetic. "When is your next health oriented regular office visit?", I ask. I'm trying to clarify our focus and boundaries for this visit. We'll get there. Patience.
One patient at a time, we learn to have patience. Patience for our patients.
Patient 2. Oops, she forgot her husband, supposed to be two persons coming in today, but husband, barely able to function after cancer surgery one year ago opts not to come along. What to do? I thought we were responding well to his fatigue with disability recommendation and parking placards for disability parking. I want to see him, examine him and recommend strategies to get the realignment with his life that he was desiring. Patience.
Patient 3. I open chart, see vitals and chief complaint: HTN, Allergies, Cholesterol. Abnormal EMG and NCV. Does he have diabetes ? He tells a huge story about a work situation which is being cared for by an occupational medicine physician. OK. Can we clarify what your reason was for making this appointment? We need mutual agreement on his goal for this visit. OK, the purpose is his concern that his test result means that he's becoming a diabetic. "When is your next health oriented regular office visit?", I ask. I'm trying to clarify our focus and boundaries for this visit. We'll get there. Patience.
One patient at a time, we learn to have patience. Patience for our patients.
Wednesday, October 12, 2011
Family Medicine: Simplifying Complex Decisions for Complex People
While interacting with my first patient of the day, a knock at the door interrupts us. "Dr., there's a doctor on the line from the hospital." I excuse myself from the patient engagement and take the phone line off hold, noticing the quick greeting by the hospitalist caring for one of the sickest people in my practice. We have a discussion about the dire prognosis and challenge of getting the patient to engage in a discussion about end of life decision making. My patient already would qualify for hospice services, but she blocked the discussion about end of life decisions when I brought it up three or four times previously.
My hospitalist friend and I agree on a plan for my patient to consider. I've spoken with him on several occasions about challenging patients and clinical decision making. He's very enthusiastic and intelligent, which I appreciate, as do my patients. And he cares about them as people.
Since we can't be everywhere at one time, we have to share medical decision making with others, especially including the patient. How does that happen when they're exhausted and confused in a hospital bed? How might we humanely move ahead with an end of life discussion when the patient might be delirious and the personal physician has handed off the acute care of the patient to the hospitalist? How might the complexity of the patient-physician relationship over several years be transmitted into the discussions between patient and hospitalist?
It's difficult, but it's what humans do in our complexity- be human as the major simplifying strategy. Humanity serves as a simplifying concept in situations such as this. We care and we share in the context of our mutual humanity.
My hospitalist friend and I agree on a plan for my patient to consider. I've spoken with him on several occasions about challenging patients and clinical decision making. He's very enthusiastic and intelligent, which I appreciate, as do my patients. And he cares about them as people.
Since we can't be everywhere at one time, we have to share medical decision making with others, especially including the patient. How does that happen when they're exhausted and confused in a hospital bed? How might we humanely move ahead with an end of life discussion when the patient might be delirious and the personal physician has handed off the acute care of the patient to the hospitalist? How might the complexity of the patient-physician relationship over several years be transmitted into the discussions between patient and hospitalist?
It's difficult, but it's what humans do in our complexity- be human as the major simplifying strategy. Humanity serves as a simplifying concept in situations such as this. We care and we share in the context of our mutual humanity.
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