Craig Sammit, MD, MBA, president and CEO of Dean Health System in Madison, WI, discusses his two-year effort to identify and develop more physicians for leadership roles within the organization.
A new study finds a significant decline in psychotherapy practiced by U.S. psychiatrists. The expanded use of pills and insurance policies that favor short office visits are among the reasons, said researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore. Today's psychiatrists get reimbursed by insurance companies at a lower rate for a 45-minute psychotherapy visit than for three 15-minute medication visits, researchers noted.
As millions of Americans head into old age, the number of geriatricians is in decline, according to this report from National Public Radio. The current system doesn't value cognitive-based care that focuses on prevention, so geriatricians are some of the lowest paid physicians, according to the report. The result is the number of geriatricians has dropped 22% from eight years ago.
A family physician in Northern Ontario has used a lottery to determine which patients would be ejected from his overloaded practice. Ken Runciman, MD, says he reluctantly eliminated about 100 patients in two separate draws to avoid having to provide assembly-line service or extend already onerous work hours. It was not the first time such methods have been employed to determine medical service in Canada: This year alone a new family practice in Newfoundland held a lottery to pick its caseload from among thousands of applicants, and an Edmonton doctor selected names randomly to pare 500 people from his heavy caseload.
A recent outbreak of the C difficile bug has claimed the lives of eight more patients in Northern Ireland, bringing the total number of deaths to 60. According to healthcare leaders there, a side effect of various powerful antibiotics is an increased rate of C diff infection.
Nanosilver is becoming a popular in items like electric shavers and bedsheets, and is being touted as an antibacterial product despite a lack of evidence of its antimicrobial abilities. Amid growing concerns over the product, the EPA has agreed that items using nanosilver must now be proven to pose no health risks to people or the environment.
With heavy pressure on physicians and hospitals to improve patient safety, more are beginning to publicly disclose and apologize for medical errors. Some states are even now mandating that some form of disclosure be offered to patients in such situations.
Physicians have a lot to deal with in today's increasingly complicated and bureaucratic healthcare system—reimbursement cuts, new technologies, quality measures, insurance contracts, compliance, pay for performance. Unfortunately, that sometimes leaves little time to focus on the most important piece of the puzzle: the patient.
Patients are getting overlooked all too often, according to an article in last week's New York Times that proclaimed the "once-revered doctor-patient relationship is on the rocks."
Many Americans simply no longer trust their doctors. Studies suggest one in four think their physicians expose them to unnecessary risk, and anecdotally many patients feel unheard and bitter.
Part of the blame lies, as usual, with the larger healthcare environment. Reimbursement cuts, doctor shortages, and rising costs make it hard for physicians to run a financially successful practice. So many cram in more patient visits and turn their practices into medical assembly lines.
At the same time, consumerism is taking hold in the patient population, and Americans are raising their expectations about medical care. Patients enter doctors' offices better informed and with more options for care than in the past. As the two trends converge, the relationship suffers.
But shouldn't physicians take some personal responsibility for the damaged relationship?
I certainly can't begrudge physicians for dedicating time to some of the more daunting challenges of running a practice. But declining reimbursement isn't necessarily a good excuse for a poor bedside manner.
Surely there's more physicians can do within the constraints of the system to make patients happy.
That's something I've considered a lot in the last few months as I've been editing the latest book in our Physician Entrepreneurs series about the quality patient experience. I sent the book's author, Wendy Leebov, EdD, the New York Times piece because she deals with this topic every day (she literally wrote the book on the subject) and I was curious what she thought.
The problem, she says, boils down to one issue: Communication. It's not that doctors don't care about patients anymore; it's just that they often don't have the time (or sometimes the skills) to get their messages across.
"Communication skills are really more critical than ever," she says. "With all the access people have to information and different perspectives, they don't want the doctor to just tell them what they need. They want to be engaged. When physicians try to get on with it because they have very little time, patients perceive this as physician not wanting their engagement."
Learning those communication skills can be as worthwhile as business management training or other leadership development because ultimately, the broken relationship is a bigger detriment to physicians than to patients.
Patient satisfaction is crucial to practice success, and its influence is only going to grow. Poor communication skills can hurt payer rankings, patient volume, and even quality—patients are less likely to adhere to medication plans and treatment options when dissatisfied with their doctor.
It's easy enough to blame the healthcare system and rationalize how the doctor-patient relationship broke in the first place. But no matter who broke it, the burden to repair the relationship lies squarely on physicians' shoulders.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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Nearly 60% of healthcare workers do not practice regular hand-washing techniques while on duty, despite policies to do so. Hospital leaders say that while hand washing can be time-consuming, it's essential to patients' safety, and it's up to everyone to ensure that it's done properly.
The California HealthCare Foundation will contribute $10 million to a low-interest loan pool created to help clinics for the low income and uninsured provide care during the state's budget crisis. The fund now totals $24 million. Other contributors include Catholic Healthcare West, Sutter Health, the Nonprofit Finance Fund, NCB Capital Impact, the California Primary Care Association Loan Fund, and the Mercy Partnership Fund.
