Sticky-note medicine

John Taylor: August 27, 20120 Comments

Travel. Wait. Browse emails, avoid dog-eared magazines. Then, weight, blood pressure. The assistant: What are we seeing you for? Eventually, your chart rattles out of its door rack. The hosanna moment – maybe 15 of them with your family doc.

If you’re doc is good, he’s eyeballed today’s vitals vs. the last visit. If you’re an “established” patient, he may recall what he usually scolds you about. But the whirring clock means, forget past history, nagging issues – and whatever new health woe you’re bringing – your visit is like mustering a fourth-quarter, one-minute potential game-winning drive in a hostile football stadium.

I’ve resorted to scratch notes on a pad, hanging sticky-note reminders on a magazine – X-ray, what's up?, Renew, RX. Surgeon, why him? Chinese take-out (mmm, wrong note).

A doctor’s view of our right-quick Hambuger Helper encounter? Author/pediatrician Dr. Robert Needleman told the New York Times why he doesn’t try to be an A-Z brain-dump of advice for his patients: “Because we have so little time, we have to be able to devote our time to the things that will make a difference.”

The hospital CEO’s view, since the feeder system of insurer to MD to hospital is under a Ring of Fire of change? Paul Keckley, executive director of the Deloitte Center for Health Solutions, told Hospitals & Health Networks Magazine:  “Yesterday you dealt with patients, today you deal with consumers; yesterday you dealt with a medical staff, tomorrow you’ve got to deal with organized medical groups. You’re talking about transitioning strategy from growth models to where it’s almost a sustainability model.”

Wait now. Let’s get back to my doc and me. That’s my reality.

Docs are burning out and generally dissatisfied with life much more than workers in other professions, says a study in the Archives of Internal Medicine. And they’re increasingly insensitive with their patients – people become objects, part of the checklist of how many I must turnstile through today before I break-even financially or get closer to opening a surfboard shop in Maui.

Among the worst off are primary care, emergency room and neurological docs. “These are the specialists that are on the front lines of care, the first contact for all comers,” Dr. Colin West, co-author of the study, told HealthLeaders Media. “They’re not able to focus or define their medical practice specifically or narrowly. …. It’s difficult for them to be prepared for what comes next.”

And, me, the patient? With health reform, more folks will have some form of insurance. That means more docs will take them as patients. But there’s no rupturing educational dam of new docs about to engulf all the newbies. New models of care are being developed.

Good outcomes favor the well-prepared, as best you can make yourself. Be laser-specific and succinct when you’re with your doc. If you both like to jawbone politics and sports, meet for breakfast. Use Post-It notes, reminders on napkins, task lists from your IPhone. But if you forget to raise a new or newly exacerbated health problem or if your doc fails to compare a recent test with the one from years ago – hold yourself accountable. The culture of physician invincibility, replete with empathy, is as real as an "Indian Jones" plot.

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