Audience Fourth Year Medical Students
WORKING NOTES:
This is not a talk about the landscape of the practice of medicine. From the $ perspective
From a Historical perspective in 1983 still today health care finance is major topic.
We have all heard of the ACA –Affordable Care Act that will trim 200 billion over next 10 yrs. (slide -1,2) Because what medical practice is today may and probably will be very different by time you are licensed to practice your art. SGR Sustainable Growth Rate
More and more emphasis on payment based on ‘quality of care’ provided –evidenced based –
so you’ll hear the new mantra-“Value Based Purchasing” . COLD FACTS (slide 3)
Staffing plays right into that. Workforce salaries is the larges tissue in current EM practice.
At the ACEP meeting this fall several major groups in CA discussed the fact that 40% of their visits last year were seen by PAs.
Between MD & DOs -1750 emergency physicians will graduate AND in 3 yrs it will be 2000 per yr.
Legal aspect (slide 3)
By the way if you have not seen it “Malpractice Risk According to Physician Specialty” Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D. N Engl J Med 2011; 365:629-636 August 18, 2011—-N Engl J Med 2011; 365:629-636
NOR the Business –provider profiles
(Slide 4-MD/Dos #s) Bureau Labor statistics 2010-2011
STAFF (Slide 5 PA NP#s)
I do not know if there still will be solo NP in private practice and
Take Care clinic’s at Walgreens (slide4-photo-1)and
groceries like Fresh & Easy (slide5,6 -photo 2,3). W curb side road advertising
In a strip mall (slide 7,8, 9-photo 3,4,5 ).At least hours allow for a ‘life’
Let’s face it –we proceed in a sea of uncertainty.
most talks do not start w what they are not about however I’m at bit unorthodox
But rather THIS is a talk about you and the art of medicine, you have knowledge (the science) that you practice and your canvas/instrument is another human being life.
Some possibly many of us have reduced the people we care for to facticity.
We miss everything that makes them unique & interesting.
Inherent to a good medical practitioner is the presence of a strongbox containing values needed to care for another’s life.
by listening to this talk- I’d like you each to arrive at what you must place in this cache.
Format will be interactive-no fancy enhanced hand help device w buttons to press —-just simple show of hands. NO Audience response platforms
ALSO I Can tell if awake
– I venture to say w/o getting much argument that the science of medicine has become the leading edge of medical care. –Practice has become the treating of results from lab tests imaging studies and the like.
??????How many of you have been to see a healthcare provider for an illness or injury in last 6 months? Ok pretty healthy good
-?????Accompanied someone to seek medical care?
??????How many of you felt a good history and examination of the patient was done?
-Did you feel like you were being spoken to en masse Orwellian in tone and was there discourse?
Current Realities:
You sit alone completing a packet of information either mailed in advance of appt/emailed or filled out in waiting room.
This is in place of talking to a educated health care provider? Viola the HX recorded as gospel
??????How many of you want to be treated by a person that never touched/ that is examined -you? Spent less than 3 minutes talking to
?????Was dismissive? Do you have patience for the ill informed, poor communicator, crying, tearful person?
You need to examine your personal life and your patience level to decide if you are a good listener. How many have been told in last 6 mos they are good listeners or been thanked for listening ??
People no matter their level education know their bodies-one’s body does talk to you it is a matter of listening and as a caregiver you need all the help you can get SO LISTEN to the individual-may save you irradiating them or making an incorrect DX all because of impatience
I come down to my patient’s level to bring them up towards mine-i.e. I explain some basic medical facts as to how body ‘talks to us’/ functions/ signs/ sx and enlist them ‘empower ‘- current buzz word-
Recall u want to help people? –And how do you plan on doing that?
If you do not sit down make eye contact with your fellow human being-
REMEMBER it could be you in pain or bleeding!
MEDICINE is not only a profession of science & a business BUT MOST importantly one of service! Being on the ‘the bleeding edge’ is easier than the ‘compassionate edge
So you now have a sense of how good poor a listener u are, how much effort you can muster to deal with a frighten abuse person, or an elderly grieving man.
?????Have you ever attended a dying person and witnessed their last breath?
Death is hardest on those that remain so compassion is mandatory in the art of medicine strongbox.
This is not a ‘bleeding heart’ talk, it is a realistic consideration of what you are getting into. Interpersonal jerks, rudeness insensitivity professional are more often involved in lawsuits. That negative behavior tilts the decision towards legal recourse. Studies as recent as ____ show this.
Medical practice wither rationed or not & even if malpractice lawyers go away YOU, each of you will be entrusted with the quality of another’s life. You need to know your ‘inscape’-the unique inner nature of a person.
-mass market of tools for medical professional (photo Medical ethics for Dummies)Media already are on this theme slide 10, 11
Guides: summary
I want you to honestly exam your conscious and realize why you went into medicine?
Okay not the money is general widely known
Not to ecru debt akin to Lehman Brothers
–general public is smarter than ever and yes a little knowledge is dangerous but that’s where you come in. Come down to their knowledge level to bring them up towards yours.
–staff you are associated with tells others about you-if not I words by actions, expressions and gestures.
-to a hurting human being u are a stranger esp. in Emergency setting, do not treat a person like a piece of meat or a income generating vehicle.
– Talking to pt. we tend to explain in our medical lingo-words we use are also in lay vocabulary and are interpreted in lay terms example-EXAMPLE stent …
-treat the patient, not the test results-some tend to relieve on ancillary tests, so why listen to the lungs, why do a through lung exam? Well it is a medical fact imaging studies lag ausculatory findings of pneumonia. Furthermore Cx film lag behind ausculatory resolution of pneumonia. So hear before the film.
– Why do a detailed neuropathy eval on a Diabetic when you can order an EMG. Remember Careful lying on of the hands can help ID malingers rather than just spending $ on tests.
END
Follow the Golden Rule Treat someone the way you wanted to be treated
So repeatedly looking at the clock, repeatedly interrupting patients, focusing more on you than the patient, talking rudely, making poor eye contact, etc.
Physical examination is very helpful both physiologically, and clinically
Only reason do go into medicine is to make a difference in someone’s quality of life
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