Patient Power March 31, 2008

     This year the hospital experiences of patients will not only be collected but reported.  As a physician rounding on patients in the hospital I often see patient surveys on food trays or on side tables.   In my experience at least 60% of hospital patient care surveys are never completed and when completed they are not effectively analyzed and acted on.  Well I wasn’t the only one asking questions because in 2002 the Hospital Quality Alliance (HQA) was formed, a national public-private collaboration to encourage hospitals to voluntarily collect and report hospital quality performance information.   HQA set out to give consumers three critical elements needed to make good sound decisions about the quality and value of the health care available to them by their local hospitals: quality information, patient satisfaction survey information, and pricing information for specific procedures.

     As such, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey (HCAHPS) was born and is the first national, standardized, publicly reported survey of patient perspectives on care they experience during a hospital stay. Over 2,500 hospitals around the country voluntarily collected information from discharged patients who were treated for multiple diseases and/or conditions between October 2006 and June 2007.    The survey contained 27 questions which were categorized into 3 groups: Summary measures, Individual Hospital measures and Global measures.  The summary measures contained questions about patient communication with nurses and physicians, hospital communication about medications; hospital staff responsiveness, pain management as well as hospital discharge instructions.  Individual measures captured hospital cleanliness and quietness.  Global measures captured overall ratings and a patient’s willingness to recommend friends and family to the hospital. 

     The survey results were released on Friday, March 28^th.  Many patients reported that they had not been treated with courtesy and respect by doctors and nurses; that they had not received adequate pain medication after surgery; and that they did not understand the instructions they received when discharged from the hospital.   To review your local hospital click on the following link: www.hospitalcompare.hhs.gov

What does this say to me:  One of the more alarming things to me is, there is still a significant communication gap between patients and health care providers.  Patients not understanding discharge instructions and not having adequate pain relief are reflections of this.  Inadequate communication between patient and providers has also been proven to increase medical errors that can subsequently lead to increase morbidity and mortality.  Although medical schools have paid more attention to training future doctors on their interpersonal and cultural interactions with patients there is still much work to be done not only on students but on all levels of the health care team. 

     I believe that increasing sensitivity and awareness of patients concerns and needs will improve patient satisfaction as well as the overall quality of their health care.  The work that HQA has initiated is a good first step towards providing the general public the information that they need to make informed decisions that will subsequently force health care providers and/or institutions to make the changes that are needed in their institutions.

Yours in Good Health 

Related links for additional information: 

http://www.hhs.gov/news/press/2008pres/03/20080328a.html 

http://www.nytimes.com/2008/03/29/washington/29hospital.html?_r=1&oref=slogin

Trail Blazering Female Physicians March 28, 2008

 The month of March has just marched right bye me.  March is Women’s History Month and I had elaborate plans for Dr. Smith’s Health Corner.  I prepared several columns, in my head, on Fibroids, Cardiovascular disease, Obesity and HIV/AIDS which I will post at some point in the near future.  However I did not want the month to completely go bye without acknowledging several women physicians.  Our society often takes for granted the contributions of female physicians, and the difficulty that they had paving the way for the new generation.  These women are trail blazers, courageous, intelligent, feisty, care givers, and advocates; but in the end we call them Doctor.  They exemplify many of the characteristics that we all want to see in our medical practitioners; and often they have been the ones to define the role of health care professional.   

In 1849, Elizabeth Blackwell became the first woman to receive an M.D. degree from an American medical school.  Dr.  Blackwell applied to all the medical schools in New York and Philadelphia, and was accepted to Geneva Medical College in Western New York State only after the faculty, assuming that the all-male student body would never agree to a woman joining their ranks, allowed the students to vote on her admission.  As a joke, the students voted “yes” and the rest is history. Dr. Blackwell was born in Bristol, England and moved to America when she was 11 years old.  Her father decided to move for financial reasons and to help abolish slavery.  With the assistance of her sister and another collegiate, Dr. Blackwell opened the New York Infirmary for Women and Children at 64 Bleecker Street in 1857. 

Following in Dr. Blackwell’s footsteps, Rebecca Lee Crumpler became the first African American woman to receive an M.D. degree from the New England Female Medical College in 1864.  She was the one and only African American woman to graduate from the New England Female Medical College, which closed shortly after her graduation in 1873.  Dr. Crumpler was born in 1831 in Delaware and was raised by an aunt in Pennsylvania.  Her aunt spent a lot of her time caring for sick neighbors and likely influenced Dr. Crumpler’s career choice.  Dr. Crumpler’s Book of Medical Discourses, published in 1883, is one of the very first medical publications by an African American author.  No photos or other images of her survive.  The little we know about her comes from her book’s introduction. In itself, her career is a remarkable achievement given a time when very few African Americans were able to gain admittance to medical college, let alone publish.   

Following in Dr. Crumpler’s footsteps, Dr. Janet Mitchell came of age in a different century but faced some of the same challenges as her predecessors.  Dr. Mitchell trained at Howard University and practiced at Harlem Hospital. She is known as a caring physician, a dedicated patient advocate, a loving care giver, a rebel, and, when necessary, a “pain in the ass.”  Janet’s slight frame never stopped her from being outspoken. “The ‘changing face of AIDS’ is bullshit,” she once said. “The communities that traditionally get funding are not the populations that are most affected, but those with political clout.”  

Drs. Blackwell, Crumpler and Mitchell have all demonstrated their intelligence, persistence, toughness, grit, boldness, outspokenness and most of all their love for the care of someone else other than themselves.     As an individual that is female and a physician, I have profited from their efforts; as a society there is much value we can learn by their examples.   

Yours in Good Health   

Related Links:

http://abcnews.go.com/Nightline/story?id=3330807&page=1

http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_73.html  

Match Day Follow-up March 25, 2008

Below is a short article from the ACP regarding the 2008 Residency Match and future trends.  Something to think about.

A record-high number of medical students matched with a residency of their choice last week, but internal medicine saw a decline in the number of U.S. students filling residency programs, according to results released by the National Resident Matching Program.

While the overall number of students matching in internal medicine increased from 4,720 in 2007 to 4,751 this year, the number of slots filled by U.S. medical graduates decreased from 2,680 to 2,660. Overall, internal medicine saw a slight decline in the percentage of slots filled, from 98.4% last year to 97.8%.

“If this trend continues, a shortage of general internists and other primary care physicians will likely develop more rapidly than many now anticipate. Since the education and training of new physicians takes a number of years, this problem must be addressed now to assure access to care and to prevent a crisis in the future,” said Steven E. Weinberger, FACP, ACP Senior Vice President for Medical Education and Publishing.

The match as a whole was the largest ever, with 28,737 applicants, including 15,242 U.S. grads, vying for 22,240 first-year residency positions. Of the U.S. applicants, 94.2% successfully matched and 84.6% got one of their top three program choices. Notable increases this year were seen in the number of international and osteopathic applicants.

Family medicine residencies saw increases in both the number of slots and the percentage filled for the first time in several years. This year, 1,156 (7.6%) of U.S. medical seniors matched in family medicine compared with 7.2% last year. Continuing recent trends, plastic surgery, orthopedic surgery, dermatology, otolaryngology, diagnostic radiology, radiation oncology and general surgery proved to be popular specialties among U.S. medical graduates.

For additional information about the match read the following:

http://www.acponline.org/clinical_information/journals_publications/acp_internist/weekly/2008/3/25/index.html#heparin

http://www.aamc.org/newsroom/pressrel/2008/080320.htm

 

Yours in Good Health

New York State’s Ex-Governor Spitzer Surrendered to his Basic Instincts March 20, 2008

I thought this would be an interesting read given the recent resignation of Ex-Governor Spitzer.  This New York Times article reviews other species interaction with the opposite sex.  Interesting indeed

http://www.nytimes.com/2008/03/18/science/18angi.html? em&ex=1206158400&en=0da4aa1c381879ec&ei=5087%0A

Match Day March 20, 2008

Interesting article about aspiring young physicians.  It begs the question of who will take care of the basic needs of the young, old and in between.

http://www.nytimes.com/2008/03/19/fashion/19beauty.html?em&ex=1206158400&en=867a2c23a3b7a77c&ei=5087%0A