Comments on: It happens all the Time http://distractible.org/2008/04/04/it-happens-all-the-time/ Thoughts of a moderately strange (yet not harmful) primary care physician. Thu, 09 Sep 2010 20:49:00 +0000 hourly 1 http://wordpress.org/?v=3.0.1 By: Sid Schwab http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1135 Sid Schwab Tue, 08 Apr 2008 21:22:49 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1135 Whatever else may be true about the concept, this is a good argument in favor of EMR. In my former clinic, which is entirely over to it, the frustrations you describe wouldn't happen. Others would. But not those. Whatever else may be true about the concept, this is a good argument in favor of EMR. In my former clinic, which is entirely over to it, the frustrations you describe wouldn’t happen. Others would. But not those.

]]> By: Rob http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1129 Rob Sun, 06 Apr 2008 19:44:02 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1129 I actually did not catch the smart-ass-ness of your response. I agree that there is lots of need to communicate both ways. We have tried, but the specialists don't want to check e-mails even if it is to their benefit. I actually did not catch the smart-ass-ness of your response. I agree that there is lots of need to communicate both ways. We have tried, but the specialists don’t want to check e-mails even if it is to their benefit.

]]> By: Ian Furst http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1128 Ian Furst Sun, 06 Apr 2008 15:07:16 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1128 didn't think my response through very well Rob -- posted a mea culpa over at my site with a link back -- re changing referral patterns - even though we've been early adopters of IT/EMR I've caused someone to change because of bad communication. specifically dropped emails (into spam/virus filters). It's tough to get it perfect especially when you are dealing with various digital/analog forms of communication. We get referrals by fax/email/letter/voice/voice mail (>13,000 per year). As far as I'm concerned the email is the best because it never leaves our EMR and we can see exactly how the referral was made and when. Any, sorry for the smart-ass response -- hopefully the post will make up for it. Ian. <a href="http://www.waittimes.blogspot.com/" rel="nofollow">www.waittimes.blogspot.com</a> didn’t think my response through very well Rob — posted a mea culpa over at my site with a link back — re changing referral patterns – even though we’ve been early adopters of IT/EMR I’ve caused someone to change because of bad communication. specifically dropped emails (into spam/virus filters). It’s tough to get it perfect especially when you are dealing with various digital/analog forms of communication. We get referrals by fax/email/letter/voice/voice mail (>13,000 per year). As far as I’m concerned the email is the best because it never leaves our EMR and we can see exactly how the referral was made and when. Any, sorry for the smart-ass response — hopefully the post will make up for it. Ian.
http://www.waittimes.blogspot.com

]]> By: Rob http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1125 Rob Sun, 06 Apr 2008 01:08:49 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1125 Do you think a bank would ever miss a transaction withdrawn from another bank's ATM machine? Banks have a far more sophisticated information system. There is nothing of the sort in healthcare. IT is pathetic. Yes, Ian, EMR helps us in our own situation - quite a bit. At least I know that it isn't my staff that didn't file the consult yet. We are very efficient in getting things into the EMR and quick to add them when we know they are missing. We have changed our referral patterns, by the way, based on specialists' ability to communicate. This patient was exceptional in how many happened at once. Do you think a bank would ever miss a transaction withdrawn from another bank’s ATM machine? Banks have a far more sophisticated information system. There is nothing of the sort in healthcare. IT is pathetic. Yes, Ian, EMR helps us in our own situation – quite a bit. At least I know that it isn’t my staff that didn’t file the consult yet. We are very efficient in getting things into the EMR and quick to add them when we know they are missing. We have changed our referral patterns, by the way, based on specialists’ ability to communicate. This patient was exceptional in how many happened at once.

]]> By: tiffany http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1124 tiffany Sun, 06 Apr 2008 01:04:25 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1124 Why does this happen? It is a world wide problem. We have the same issues here, where the paediatrician is supposed to be co ordinating everything but the other specialists do not communicate properly. So when we go to the paed for follow up, we often know more than he does. Is it hard to send results? Why does this happen? It is a world wide problem.
We have the same issues here, where the paediatrician is supposed to be co ordinating everything but the other specialists do not communicate properly. So when we go to the paed for follow up, we often know more than he does. Is it hard to send results?

]]> By: Toni Brayer, MD http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1123 Toni Brayer, MD Sat, 05 Apr 2008 23:09:36 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1123 There are so many issues here, it is hard to know where to start. First the lack of coordination of care is the fault of the specialists who are ordering tests and sending the patient on to their friends. Then there is no report back to the primary care doctor so he can be even remotely informed of what is going on. Third there is the issue of wasteful tests without coordination. Finally there is the issue of the patient wanting some coordination or at least communication that is not going to happen! No wonder primary care is moribund. Talk about dissatisfying! There are so many issues here, it is hard to know where to start. First the lack of coordination of care is the fault of the specialists who are ordering tests and sending the patient on to their friends. Then there is no report back to the primary care doctor so he can be even remotely informed of what is going on. Third there is the issue of wasteful tests without coordination. Finally there is the issue of the patient wanting some coordination or at least communication that is not going to happen! No wonder primary care is moribund. Talk about dissatisfying!

]]> By: Ian Furst http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1122 Ian Furst Sat, 05 Apr 2008 21:57:52 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1122 I read the post and keep thinking about standing in front of patient, frantically reading the chart and telling the biospy came back normal. They say "I know, you told me two years ago". oops. EMR's going to solve all this -- right? :-) BTW Dr. Rob -- if you feel it appropriate would you add me to you're blog roll? Ian. <a href="http://www.waittimes.blogspot.com/" rel="nofollow">www.waittimes.blogspot.com</a> I read the post and keep thinking about standing in front of patient, frantically reading the chart and telling the biospy came back normal. They say “I know, you told me two years ago”. oops. EMR’s going to solve all this — right? :-)

BTW Dr. Rob — if you feel it appropriate would you add me to you’re blog roll?

Ian.
http://www.waittimes.blogspot.com

]]> By: Dr. Smak http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1119 Dr. Smak Sat, 05 Apr 2008 21:30:21 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1119 Ugh. This post made my head hurt. You forgot the part where she says, "The GI doc put me on Protonix, and he says that you need to get a prior authorization for me." And the ironic thing is that I'm the one that feels guilty for wasting this patient's time and her insurance company's money, since I have nothing more to add. Ugh.

This post made my head hurt.

You forgot the part where she says, “The GI doc put me on Protonix, and he says that you need to get a prior authorization for me.”

And the ironic thing is that I’m the one that feels guilty for wasting this patient’s time and her insurance company’s money, since I have nothing more to add.

]]> By: Rob http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1117 Rob Sat, 05 Apr 2008 02:08:05 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1117 Medical home would work if it was a partnership between businesses and doctors. If I go to a business and give them the opportunity to: 1. Keep their employees healthier through accountable prevention 2. Keep their costs down as the management of care would not include the insurance companies. 3. The doctors used medical technology so that patients did not have to leave work to get simple medical problems dealt with. This would make businesses very happy and they would encourage their employees to use this. Employees would be empowered with more medical information and access than they have ever had. Finally, physicians would be happy because the businesses would pay them directly for this. It may sound like a stretch, but we are laying the foundation for such a venture. The only losers in this are the insurance companies (who are reduced to simply offer insurance), and those physicians who stay on the sinking ship the longest. Medical home would work if it was a partnership between businesses and doctors. If I go to a business and give them the opportunity to:
1. Keep their employees healthier through accountable prevention
2. Keep their costs down as the management of care would not include the insurance companies.
3. The doctors used medical technology so that patients did not have to leave work to get simple medical problems dealt with.

This would make businesses very happy and they would encourage their employees to use this. Employees would be empowered with more medical information and access than they have ever had. Finally, physicians would be happy because the businesses would pay them directly for this. It may sound like a stretch, but we are laying the foundation for such a venture. The only losers in this are the insurance companies (who are reduced to simply offer insurance), and those physicians who stay on the sinking ship the longest.

]]> By: Dr. Val http://distractible.org/2008/04/04/it-happens-all-the-time/comment-page-1/#comment-1116 Dr. Val Sat, 05 Apr 2008 01:52:31 +0000 http://distractible.org/2008/04/04/it-happens-all-the-time/#comment-1116 I suspect that most patients will not comply with the medical home concept that is fundamental to the success of primary care and cost containment. What can we do? I suspect that most patients will not comply with the medical home concept that is fundamental to the success of primary care and cost containment. What can we do?

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