Why aren’t we physicians kinder to ourselves? Why aren’t we kinder to our colleagues? Why aren’t we kinder to our patients? I tend to think the answer to all of the above questions is a disrespect many of us have for what we consider being human.

For some reason, many of us in health care associate our humanity only with what holds us back from being our best. In fact, there is a spectrum of the qualities that make us human. It includes compassion, competence, and strength as much as anger, error, and overwhelm.

Our focus on humanity’s negativity starts in the preclinical years. How will you learn the Krebs cycle if you have to take breaks to eat and pee? The truly excellent student suppresses the basic needs of a mere human and learns to function like a cyborg. When superhuman is the standard, being human is a source of shame.

Unfortunately, dissociation from such fundamental aspects of human existence as sleeping when you are tired makes it challenging to tap into the human traits you perceive as more positive. Ideally, we would take a pause to get back to our humanity when we sense ourselves losing our kindness and compassion. Instead, many of us do, subconsciously and consciously, diminish and dismiss the human traits we previously valued as positive.

Anything that makes you identifiably mortal is viewed as an obstacle to achievement. Vulnerability, along with hunger and adequate hydration, is added to the list of barriers to clinical excellence.

Ironically, this release of what makes you human is considered both necessary and temporary in order to become the best healer possible. You will figure out how to be a human healer once training is complete and you feel more autonomy in your life. The challenge is when all your success strategies are developed in the absence of honoring your humanity; it’s nigh impossible to convince yourself you can maintain your desired level of achievement while being human.

This is the dysfunctional mindset many physicians bring into life after training and have to overcome to establish sustainable well-being. Being well as an attending isn’t about figuring out how to be superhuman in a new setting. It’s about acknowledging, celebrating, and embracing all the things you can accomplish as a human who is a clinician.

To be fair, many health care organizations you join after training perpetuate this superhuman ideal. They have observed generations of the monetary results they want coming from disregarding clinicians’ humanity. Thus, this whole honoring humanity approach is received with trepidation and sometimes contempt.

What I think both clinicians and health care organizations need is a mindset reset. Simply considering that being human is compatible with good care and good business is the first step in being open to the numerous strategies for supporting humanity while maintaining excellence. It’s not about lowering our standards. It’s about doing a holistic re-evaluation of what those standards are yielding over the long term in terms of the mission we all have to be well (mentally, physically, and financially) while doing good.

Jattu Senesie is an obstetrician-gynecologist.

Source: kevinmd.com

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It’s a common saying that the personality of a doctor can be predicted by the personality of the staff member who answers the phone. If the person who answers is pleasant and respectful, then it seems likely that the physician is that way, too. Contemporary approaches to team training affirm this. Respectful outward-facing conduct—meaning how patients are treated—and respectful inward-facing conduct—meaning how medical practice clinicians and staff members interact—co-influence each other. Both increase patient safety and mitigate practice risks.

Mutual respect is the cornerstone of a culture of patient safety. The other three foundational elements are teamwork, human factors engineering, and cultivation of a just culture. These four founding elements of safety culture apply equally to a medical office practice as to a hospital, and the benefits will accrue to an office practice, too: Patient and employee satisfaction, fewer adverse events, and a reduction in practice liability risks.

Mutual respect

Imagine this scenario. You hear the physician with whom you share an office shouting at her medical assistant: “Why did you schedule so many patients this afternoon? You know I can’t see this many patients in a row, finish the charts, answer phone calls, and get home for dinner on time!” A staff member who is treated this way for a minor issue fears getting reprimanded for speaking up at all, even when the stakes are higher. (“Doctor, this patient is allergic to penicillin. Are you sure you want to give them this prescription?”) This example shows how psychological safety—which is present when it is easier for an employee to ask a question or to admit, “I don’t know”—directly contributes to patient safety, and thus to reduced risk of medical malpractice litigation.

Something as mundane as scheduling presents a variety of risks for miscommunication, which can become safety risks, then litigation risks. Therefore, creating a climate of mutual respect in which anyone can ask a question of anyone else benefits the patients and the practice.

Or imagine a staff member taking you aside and saying: “We have an emergency here, and also five patients left today—who can be seen next week, and who needs to be seen tomorrow?”

When rescheduling happens, staff need to be comfortable taking the clinician aside. Clinicians can contribute to both mutual respect and patient safety by ensuring that staff know when they will be in-office and available. This sounds basic, but for practices with multiple sites, for instance, it can be complicated. The more clarity staff members have about provider availability, the fewer appointments they will be rescheduling, which shows respect to both staff members and patients.

Consider consulting the Agency for Healthcare Research and Quality’s (AHRQ’s) “Medical Office Survey on Patient Safety Culture,” which contains a segment regarding office culture, mutual respect, and interprofessional performance.

Teamwork

Imagine that a staff member can’t find a crucial test result but also can’t get anyone’s attention to discuss it, given competing pressing concerns. Even if your practice is small enough that a formal communication system feels excessive, consider implementing some systematic elements. This will help you in case of staffing disruption, emergency, safety issue, or potential interpersonal conflict. When practices formalize certain interactions, everyone does less improvising, and the practice moves closer to becoming a high-performance team.

The following are top tools to improve teamwork, taken from TeamSTEPPS®, the crew resource management model for medicine. TeamSTEPPS has adapted its training model specifically for the office practice. Even without the whole course, the AHRQ’s video series demonstrates principles of teamwork in office practice.

Three core leadership tools

TeamSTEPPS prioritizes three core types of team leadership tools: “Briefs are held for planning purposes; huddles are used for problem solving; and debriefs are used for reflection and process improvement.”

Brief example: A five-minute morning gathering to establish who is coming in for care, what missing test results need to be run down and by whom, and so on, can establish a shared mental model for the day’s workflow.

Huddle example:A huddle is a quick interaction to reinforce or revise a plan. When a practice manager or other key staff member flags the clinician to reorganize patient appointments in light of an emergency, for instance, this may be considered a kind of huddle.

Debrief example: A debrief could be structured as a three-minute day-end or week-end gathering, or perhaps a gathering after a particularly complex care situation, and it should relate to team goals or address particular issues.

Check-back—Critical communication tool

During the busy workday, communications can often be rushed, language garbled, and attention distracted — especially if we are wearing masks. This makes it imperative that we confirm important information has been received, especially when this information may impact patient care, such as the ordering of a test, prescribing of a medication, or scheduling of an appointment with another physician consultant. To assure your message has been received, the recipient should repeat back what you’ve said, just as you might hear when ordering takeout from your favorite restaurant: “Please order a CBC with differential, and an ESR.” “Doctor just to confirm, you want me to order a CBC with diff, and a sed rate for this patient?”

Human factors / System factors

Imagine a patient whose physician says, “Tell the front desk you need to schedule a left-knee arthroscopy.” The patient asks one staff member, who calls the ambulatory surgery center (ASC), where the clerk writes a note before entering the procedure into the OR booking system. By the time the patient arrives for the surgery, the left may have turned into a right. When we add steps to a process, its reliability decreases.

By contrast, imagine that the patient is in the room with the doctor, who can enter the left-knee arthroscopy directly into the ASC scheduling system using an iPad, with the patient watching them do it. One step. Device-based workflows are not a panacea, but cutting down process steps makes our processes more reliable.

Just culture

A paper test result falls behind a desk. Now let’s say an ob/gyn finds themselves, months later, calling a pregnant patient to report a positive result for trichinosis. How did this delay happen?

Cultivating a just culture makes it likelier that this practice could answer that question and improve its systems, because health care professionals who experience psychological safety are much likelier to report potential risks. When employees see that it is safe for them to speak up, and when they see their risk-mitigation ideas being responded to, they will be likelier to report risks in the future.

Just culture means consoling a person who has unintentionally committed an error that any similarly trained person could have made in that situation; coaching a person who has drifted into risky behavior; escalating to disciplinary action for those who persist in taking unacceptable risks; creating systems that mitigate risks for human error; and insisting that any person can ask a question or express a concern to anyone else, regardless of rank, at any time.

To begin their just culture journey, if they haven’t already, practice leaders should ask themselves honestly—or perhaps ask their coworkers via anonymous survey: Are people willing to speak up? Are they afraid to admit they made a mistake? If someone reports a risk, do they hear directly that their report is appreciated—and then do they see that appreciation confirmed via investigation or other action?

These four core principles of safety culture apply across specialty and setting, but the guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

David Feldman, MD, MBA, FACS, is the chief medical officer for the Doctors Company and TDC Group, also serving as executive vice president at Healthcare Risk Advisors (HRA). A renowned patient safety advocate, he has spoken with numerous leaders in the field of patient safety for the new Leading Voices in Healthcare podcast.

Source: https://www.physicianspractice.com/

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I’ve been honored and privileged to have had recent conversations with two courageous women: Betsy Gall and Pamela Marie Hobby.

Pamela met a medical resident who changed the course of her life on October 28, 2019, and Betsy’s life was forever changed exactly one month later, on November 28, 2019.

Betsy wrote a book to share her family’s story. The title grabbed Pamela immediately, as it aligned with what she was building with My Doctor’s Meds, whose mission is to help the healers. Pamela asked if they could connect. They became pen pals and confidants and now talk on what they refer to as “Super Soul Sundays,” discussing various ways to support clinician wellness.

Here are their stories.

Betsy Gall

My name is Betsy Gall, and I recently wrote a book about love, physician suicide, and finding comfort and purpose in the aftermath. It is titled The Illusion of The Perfect Profession.

First and foremost, my goal in sharing our story is to raise awareness so no other family has to go through what we have gone through. By raising awareness, I hope health care organizations, hospital administrators, other physicians, their families, and friends, as well as the public, understand why physician suicide can happen and know what to look for if a physician is struggling. Our story is just one story, but there are countless others.

I also hope that by sharing our story, we can help normalize talking about mental health issues because I know from the bottom of my heart that if my husband had sought and accepted help, this wouldn’t have happened.

I am not a mental health care professional. I am a real estate agent, landlord, and investor. I like to remodel homes and make them beautiful. Matthew and I used to joke and compare notes about our days at the office. My work is mostly fun and happy, while his work as an oncologist is always serious and sometimes sad. Our discussions always put everything into perspective for me.

I am not an expert on physician suicide, but sadly, I was married to a physician who died by suicide. Matthew was under constant pressure. Decreasing reimbursements, administration issues, declining salary, political garbage, EMR systems that were difficult to navigate, constant surveys regarding performance: It was a lot!

Taking care of the terminally ill can be extremely stressful just in itself. Being on-call was always an issue; I have yet to meet a doctor who enjoys taking calls. On top of all that, I have found that people expect doctors to have all of the answers all of the time; they are always on call, and that’s a heavy load for a person to handle. Matthew was always willing to help friends and family and give his opinion, but it never ends. Sometimes you just want to come home and chill, but that is not the norm for most doctors. Matthew frequently said, “I love my patients, but I hate my job.”

After a job-related move to North Carolina, Matthew did the unthinkable and took his own life on Thanksgiving Day of 2019. It has left our family shattered and asking, “How could this happen?” I have come to find out that, unfortunately, it actually happens quite frequently. We lose a doctor a day to suicide. It is heartbreaking, and we all need to work together to change the broken system!

Pamela Marie Hobby

The mission of the company I founded, My Doctor’s Meds, found me in the fall of 2019. Upon telling my story to a pediatric resident, sharing all the ways I was grateful to medical professionals for saving my life, I urged him to keep going. Showing him my childhood pictures of treatment for leukemia, he asked if I was really this vibrant adult in front of him. Suddenly, the hope began to leave his eyes. Darkness crept in as he covered his mouth, saying, “Sometimes I’m afraid I’m becoming numb to it all.” The hopelessness I saw scared me. How was it possible that he was showing early devastating signs of burnout while embarking on a life of helping others?

My husband said, “Outside of doctors and nurses, who understands the burdens that clinicians bear for society? Well, patients do.” So we set out to help!

The carousel analogy: The doctor and patient step onto the “carousel ride” with all the ups and downs of diagnosis, treatment, and outcomes. All are invested in the journey. Favorably or unfavorably, the patient steps off the ride, leaving the doctor alone, without knowing how the family is doing or how the patient’s life continues after.

A clinician could care for thousands during their career, but because of HIPAA, one thing remains the same: The patient gets “off the ride.”

While out to dinner with my cardiologist friend, he couldn’t stop staring at a family across the restaurant. Seemingly unable to take his eyes off them, he said with a smile, “He looks good! I performed open heart surgery on him. Look at his beautiful family enjoying dinner!” There was a deep yearning to know more.

Why are we not trying it all? Let’s move policy like the Dr. Lorna Breen Heroes Foundation! Let’s have the courage to write a book like Betsy Gall’s The Illusion of the Perfect Profession! Let’s send monthly thank-you/check-in emails to our doctors like Kim Downey.

Perhaps an antidote to all of the science is dipping a toe into the well of creativity and humanity, by telling our stories, by laying our hearts bare, by saying thank you.

I challenge everyone to step back onto the ride and close the loop on the clinician/patient bond. Seek out your former clinicians and ask them how they are doing. Let them know how you are doing and say, “Thank you!” Turn it back into the kind of carousel we all long for – a moment to watch the world go by on the elephant’s back, music playing, with the wind in our hair.

Kim Downey is a physical therapist.

Source: kevinmd.com

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In writing and teaching about physician careers, I’ve explored themes like job satisfaction, burnout, professional development, and well-being. A recurring phrase that arises in conversations, at conferences, and in online forums is the so-called “rat race” of medical practice.

“I need to find a way out of this rat race.”

“This rat race wasn’t what I signed up for when I chose medicine.”

“I’m tired of the rat race and need to find a way out.”

You get the idea.

I encounter the term “rat race” far too frequently. Let’s talk about why this phrase gets used so often and what we can do about it, with a focus on my favorite topic — unconventional and nonclinical careers for physicians!

What Is the rat race?

For many in the workforce (both physicians and nonphysicians), the term “rat race” captures frustration with their professional lives. It signifies a routine where, despite hard work and long hours, they feel stuck.

The routine is grueling. You never truly feel like you’re advancing towards any fulfilling goal. It can include a feeling of perpetual competition and an endless chase for achievements that seem to lead nowhere.

The “rat race” is a cycle of being busy and feeling exhausted. It leaves little time for personal interests, relationships, or relaxation.

Among doctors, this feeling of being in a rat race often stems from a combination of high-stress practice environments, the demanding nature of patient care, and the administrative burdens that come with medical practice. The causes go beyond the medical profession and health care industry. The broader work culture in the US sometimes encourages a “rat race” mindset by emphasizing busyness rather than productivity.

Dangers of a rat race mentality

Having the mentality of being in a rat race contradicts what it means to be a physician.

After years of difficult and expensive training to earn our degrees and certifications, succumbing to this mindset disappoints both ourselves and our profession.

Initially, the rat race feeling may seem merely stressful and bothersome. But it ultimately leads to job dissatisfaction, a sense of unfulfillment, and disengagement at work. These issues lay the groundwork for burnout, and they even compel some physicians to consider leaving medicine.

This signals the need to closely examine our job choices and career trajectories, urging us to thoughtfully evaluate the range of jobs, settings, and employment types available to us. Avoiding the rat race mindset requires proactive measures.

Avoiding the rat race mindset

Avoiding a rat race mindset requires conscious effort. You may need to revisit your work approach and redefine success. Consider these strategies to shift your mentality:

Redefine success. We often focus on external success indicators like high income, promotions, or publications. Reflect on what truly matters in your career, whether it’s patient satisfaction, sufficient income for financial goals while maintaining work-life balance, or something else.

Set boundaries. You need time for rest, personal relationships, and pleasure. Work shouldn’t consume all your time. If it does, assert boundaries. You may even want to consider changing jobs.

Find a supportive community. The rat race mindset can be contagious. Surround yourself with colleagues who share your values and have a positive outlook.

Advocate for change. Aim for systemic changes in your workplace or the medical community to combat the rat race mentality. Engage with local, state, or national medical societies.

Expand your scope of career options. I’m particularly passionate about this strategy, which many physicians overlook in addressing stress and burnout. I’ll explore this further in the next section.

Combatting the rat race with an unconventional career

Throughout medical training, there is a lot of emphasis on two major career decisions:

1. Which medical specialty to pursue
2. Whether to go into private practice or accept an employed position

Most students and early-career physicians picture themselves working in an acute care hospital or in a traditional outpatient primary care or specialty practice. Little importance is placed on considering other practice settings and various job structures, patient demographics, employer types, and compensation models. Less conventional jobs and career paths are fitting for many physicians’ personalities and interests.

Expanding your career horizons and job prospects to include unconventional options can be an effective way to avoid the rat race mentality.

Unconventional careers can take various forms:

Working in an unconventional practice setting. Consider exploring unconventional practice settings beyond the typical hospital or clinic. Environments like nursing homes, mobile units, cruise ships, public health departments, and industrial sites often grant more autonomy and might align with your interests.

Treating a unique patient population. Consider exploring unconventional practice settings beyond the typical hospital or clinic. Environments like nursing homes, mobile units, cruise ships, public health departments, and industrial sites often grant more autonomy and might align with your interests, offering a refreshing change.

Selecting jobs with ample flexibility. Opting for jobs with flexibility, such as locum tenens, part-time consulting, telemedicine, or startup roles, can greatly alleviate stress and improve work-life balance.

Consider alternative practice and payment models. Adopting alternative practice and payment models, such as direct primary care, concierge medicine, or cash-pay systems, can streamline operations and enhance patient interactions, freeing you from insurance and administrative overload.

Balancing patient care with nonclinical work. High-pressure clinical environments are stressful for many doctors. Nonclinical jobs can offer an escape. Dedicating a portion of your time to nonclinical activities or transitioning entirely to roles in health insurance, pharmaceuticals, medical writing, or consulting can both diversify your career and decrease stress.

Options like these can lead to more engagement and balance, effectively helping you avoid the rat race.

Sylvie Stacy is a preventive medicine physician and the author of 50 Nonclinical Careers for Physicians: Fulfilling, Meaningful, and Lucrative Alternatives to Direct Patient Care.

Source: kevinmd.com

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Most people experiencing homelessness have mental health disorders, according to a systematic review and meta-analysis.

In an examination of studies that included nearly 50,000 participants, the current prevalence of mental health disorders among people experiencing homelessness was 67% and the lifetime prevalence was 77%.

“The relationship is likely bidirectional, where experiencing homelessness may exacerbate mental health symptoms or where having a mental health disorder may increase an individual’s risk for experiencing homelessness,” lead author Rebecca Barry, PhD, a postdoctoral fellow at the University of Calgary in Calgary, Alberta, Canada, told Medscape Medical News. 

 

“There are also likely stressors that increase both risk for homelessness and risk for developing mental health disorders. This study examines prevalence but does not examine causal relationships,” she said.

The findings were published on April 17, 2024, in JAMA Psychiatry.

 

 

A Growing Problem 

To determine the current and lifetime prevalence of mental health disorders among the homeless population, the researchers analyzed 85 studies that examined this question in participants aged ≥ 18 years. The review included 48,414 participants, including 11,154 (23%) women and 37,260 (77%) men.

The lifetime prevalence of mental health disorders was significantly higher in men experiencing homelessness (86%) than in women (69%). The most common mental health disorder was substance use disorder (44%), followed by antisocial personality disorder (26%), major depression (19%), bipolar disorder (8%), and schizophrenia (7%). 

The prevalence of current and lifetime mental health disorders among the homeless population was higher than that that observed in the general population (13%-15% and 12%-47%, respectively).

The results resembled those of a previous review that estimated that 76% of people experiencing homelessness living in high-income countries have mental health disorders.

 

“Even though our results are not surprising, they still are drawing attention to this issue because it is a big problem in Canada, the United States, Europe, and other places,” senior author Dallas Seitz, MD, PhD, professor of psychiatry at the University of Calgary’s Cumming School of Medicine, told Medscape Medical News. “The problem is concerning, and it’s not getting better. Addiction and mental health problems are becoming more common among people who are homeless.” 

The bottom line is that people need affordable housing and mental health support, said Seitz. “It’s a housing problem and a health problem, and we need adequate resources to find better ways for those two systems to collaborate. There are public safety concerns, and we have to try and bring services to people experiencing homelessness. You have to come and meet people where they’re at. You have to try and establish a trusting relationship so that we can get people on the path to recovery.” 

‘It’s Really About Income’ 

Commenting on the findings for Medscape Medical News, Stephen Hwang, MD, professor of medicine at the University of Toronto, Toronto, Ontario, Canada, said, “There have been previous studies of this type, but it is good to have an updated one.” Hwang, who is also chair in Homelessness, Housing, and Health at St. Michael’s Hospital, did not participate in the research. 

The findings must be understood in the proper context, he added. For one thing, grouping together all mental health disorders and giving a single prevalence figure can be misleading. “They are including in that category a diverse group of conditions. Substance use disorder, personality disorder, schizophrenia, and depression are all lumped together. The 67% prevalence seems very high, but it is a combination of many different conditions. I just don’t want people to look at that number and think that this means that everyone is a substance user or everyone has schizophrenia,” said Hwang. 

Also, some readers might interpret the findings to mean that mental problems are the reason people are homeless, he added. “That would be an incorrect interpretation because what this study is showing is that people with mental health disorders have a higher risk for becoming homeless. It doesn’t mean that it caused their homelessness. What really causes homelessness is a lack of affordable housing,” said Hwang.

“In a city or community where housing is very expensive, there’s not enough for everyone to be housed, there is a lot of competition for housing, and there’s not enough affordable housing for a number of reasons, we know that people with mental health conditions and substance use disorders will be among the first to lose their housing,” he said.

“It’s really about income. There are many reasons why a person cannot afford housing. So, not being able to earn enough money to afford it because you have a mental health disorder or substance use disorder is a common underlying reason for homelessness.”

 

Hwang also pointed out that people with mental illness who can access support, either through family members or through mental health care, and who also have the income to afford such services do not become homeless.

“Schizophrenia is seen in every population of the world at a rate of 1%. But you travel to certain cities and you see people who appear to have schizophrenia wandering the streets, and you go to other cities in the world and you don’t see anyone who looks like they’re homeless and have schizophrenia,” he said. 

“It’s not because there are fewer people with schizophrenia in those cities or countries; it’s because people with schizophrenia are treated differently. The rate of homelessness is determined not by how many people have that condition [eg, schizophrenia] but by how we treat those people and how we set up our society to either support or not support people who have disabilities.” 

The study was funded by the Precision Care With Information, Science and Experience – Mental Health grant funded by the Calgary Health Foundation. Barry is supported by the Harley Hotchkiss Samuel Weiss Postdoctoral Fellowship awarded by the Hotchkiss Brain Institute at the University of Calgary. Barry reported having no relevant financial relationships. Seitz reported grants from Calgary Health Foundation during the conduct of the study as well as grants from University Health Foundation, the Canadian Institutes of Health Research, the Public Health Agency of Canada, the Alzheimer’s Association, and the Hotchkiss Brain Institute. He received honoraria for guideline development from the Canadian Coalition for Seniors Mental Health outside the submitted work. Hwang reported no relevant financial relationships. 

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As I stepped into the hospital waiting room, the anxious eyes of family members greeted me, their worry palpable as they awaited news about their ailing patriarch. Quickly, I introduced myself and delved into the heart of the matter.

“I wanted to talk to you about your father’s condition. It’s not easy news, but I need to be honest with you. Despite our efforts, your father’s brain suffered irreparable damage during the cardiac arrest. Even if we continue life support, he won’t recover. It’s a difficult decision, but I strongly recommend withdrawing life support to let him pass with dignity,” I stated.

“How dare you! You’re telling me to pull the plug on my dad? You don’t know anything! He’s a fighter; he’ll pull through!” responded the patient’s older son angrily, acting as the spokesperson for the family.

“I understand this is incredibly hard to hear, sir, but I assure you, we’ve exhausted all options. Continuing life support would only prolong his suffering without any hope of recovery,” I reassured.

“No, you’re wrong! You’re just trying to save money or clear up beds in your hospital. You doctors always think you know everything, but you don’t care about us! You just want to play God and decide who lives and who dies!” Mr. Johnson (not real name) exclaimed, his frustration palpable.

Struggling to maintain my composure, I responded, “Mr. Johnson, I understand you’re upset, and I empathize with your situation. But I can assure you, my only concern is your father’s well-being. We’re here to provide the best care possible, and in this case, that means letting him go peacefully.”

Mr. Johnson, now in tears and yelling at the top of his voice, insisted, “No! I won’t do it! I won’t let you kill my dad! You can’t force me to make this decision!”

A few days ago, I encountered the situation described in the dialogue above in my medical practice. It was a profoundly intricate case that illuminated the precarious equilibrium between medical ethics and familial skepticism entrenched within the American health care apparatus.

A patient ushered in following a cardiac arrest at his residence presented a labyrinthine scenario. Despite valiant endeavors by the emergency medical team, who exhaustively engaged in over an hour of cardiopulmonary resuscitation (CPR) to resuscitate him, it became glaringly apparent to our medical team that his prognosis was dismal. Even in the improbable event of his survival, the specter of irreversible brain damage loomed ominously, as affirmed by subsequent neurological assessments.

The rational trajectory dictated the cessation of life-sustaining measures to grant the patient a dignified passage. However, the response from the family diverged starkly from medical counsel. Despite our earnest efforts to elucidate the futility of perpetuating medical intervention, the family staunchly resisted. Their mistrust of the health care system was palpable, fueled by an ingrained belief in its inherent untrustworthiness. This sentiment, regrettably, is not uncommon, particularly among Black and Brown communities in the United States, where historical inequities have sown seeds of deep-seated suspicion.

A historical perspective offers illumination of the origins of this pervasive mistrust. Dr. Joseph Mengele, infamously known as the “Angel of Death,” perpetrated abominable experiments on prisoners at Auschwitz during the Holocaust. His barbarous and unethical conduct encompassed subjecting individuals, predominantly Jews, to torturous medical experiments devoid of consent. Dr. Mengele’s transgressions ranged from conducting surgeries bereft of anesthesia to administering harmful substances to observe their effects.

Similarly, the Tuskegee syphilis experiments orchestrated by the United States government entailed withholding treatment from African American men afflicted with syphilis for decades, despite the availability of efficacious remedies. These experiments contravened basic human rights, exploited vulnerable populations, and engendered immense suffering and loss of life.

Such egregious violations of medical ethics and human rights have wrought profound and enduring repercussions on public trust in the health care milieu, particularly within Black and brown communities in the United States. These atrocities have perpetuated a legacy of mistrust and skepticism toward health care practitioners and institutions, with many minority communities rightfully perceiving betrayal and neglect by those tasked with safeguarding and nurturing them.

These unconscionable breaches of trust have instilled a profound wariness toward Western medicine, undermining the fundamental tenets of the Hippocratic Oath. The Hippocratic Oath, an esteemed pledge undertaken by physicians early in our careers, serves as a guiding beacon of ethical conduct within the medical fraternity.

Emphasizing principles of patient-centered care, confidentiality, and the imperative to avert harm, it embodies the moral compass guiding medical practitioners in fulfilling their responsibilities. However, the lamentable reality persists that some practitioners flout these sanctified ideals, perpetuating harm instead of facilitating healing.

Yet, unethical practices are not the sole catalysts for the escalating distrust in Western medicine. In an era characterized by ideological polarization and rampant dissemination of misinformation by subversive elements, truth has become a lamentable casualty. Even the most straightforward medical scenarios are susceptible to entanglement in conspiracy theories. We have also encountered pastors and other religious leaders who ignorantly or sometimes deliberately misinform their congregants and advise them to seek divine intervention instead of medical help.

Physicians confront the intersection of medical ethics and distrust at a pivotal juncture. Striking a balance between upholding the principles of beneficence and non-maleficence and respecting patient autonomy and cultural nuances presents a convoluted ethical quandary. It necessitates a nuanced approach acknowledging the validity of historical grievances while striving to rebuild trust through transparency, empathy, and cultural humility.

As guardians entrusted with the welfare of our patients, we must confront these challenges forthrightly. By fostering open discourse, dismantling access barriers, and upholding the loftiest ethical standards, we can endeavor toward a health care framework grounded in trust, compassion, and integrity. Only then can we honor the solemn oath we have sworn—to do no harm and to stand as unwavering champions for the health and dignity of all.

Osmund Agbo is a pulmonary physician.

Source: kevinmd.com

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There’s been something of a funding fiasco at NHS Practitioner Health. 

An announcement to cut funding for new patients in secondary care received such a backlash that the NHS was forced to reverse its decision. 

NHS Practitioner Health provides a free, confidential service for doctors and dentists with a mental health or addiction issue. The U-turn underlines the importance of mental healthcare for NHS staff and the value placed on the service.

 

The need for mental healthcare for medics has not diminished post-pandemic. In fact, a recent poll (April 17) for NHS Charities Togethe r showed that more than three in four NHS staff have struggled with a mental health condition in the last year. 

The Initial Announcement

The announcement made on the NHS Practitioner Health website on April 12 said that NHS England was “undertaking a review of the staff support for mental health across all staff groups to consider long term sustainable goals. On this basis we have agreed to stop new registrations for secondary care patients”

 

 

The notice was met with dismay and disbelief. The BMA  called it “deeply concerning”. Its workforce lead, Dr Latifa Patel, said on its website: “This is a short-sighted financial decision with potentially harmful consequences for both doctors and patients.”

 

Co-chair of The Doctors’ Association UK (DAUK), Dr Helen Fernandes, told Medscape News UK: “I was astounded. It seemed a very arbitrary, unsafe, and cruel decision.”

Many health organisations, unions, charities, and individual doctors took to social media in an uproar. An open letter written to the Health Secretary and NHS CEO by Dr Rachel Clarke and Dr Natalie Silvey on behalf of all NHS staff complaining about the cut received more than 15,000 signatures.

Susannah Basile, head of external affairs at the charity Doctors in Distress, told Medscape News UK: “My initial reaction was shock followed by concern. We know that healthcare staff are burnt out. We know one doctor takes their own life every 3 weeks; one nurse every week. And to pull a secondary care mental health service which is arguably the only viable one for people to attend in confidence seemed really shocking.” 

 

U-Turn

Many doctors took to social media to praise the service they had been given from NHS Practitioner Health. 

“So many people came out and said: ‘Practitioner Health has given me treatment’ or ‘Practitioner Health has saved my life’,” said Basile. “I don’t know if the NHS underestimated the impact it had and maybe made them realise the implications of the decision.” 

Three days later the decision was reversed. The Health Secretary Victoria Atkins posted on X saying: “We have heard the concerns of NHS staff in recent days. You deserve the right support. After meeting with the NHS I am pleased that this important service will be maintained for both existing and new patients.”

NHSPH confirmed the news on its website. Dr Navina Evans, NHS England’s chief workforce officer said: “Following discussions with Practitioner Health on their current service for secondary care doctors, dentists and senior NHS staff, we have jointly agreed to extend the service by 12 months for both new and existing patients, while we carry out a wider review to ensure that all NHS staff groups have the mental health support they need.”

On the change of heart, Fernandes said: “I think that weight of response from across the medical profession was an important factor.”

Praise for NHSPH

The debacle over defunding has demonstrated how much support there is for NHSPH and how necessary it is.

“Practicing in the NHS currently is hard. It’s under-resourced, overstretched, there’s little job security, people are treated poorly by employers and government, and Practitioner Health is a lifeline of support for those doctors who aren’t coping with these stressful situations,” explained Fernandes.

When the initial funding cut was announced, there were suggestions that people could get alternative support from their GP, occupational health department, or employee assistance programmes.

 

But Basile explained: “There’s a huge stigma among healthcare workers [about] accessing support for their own mental health. It’s unrealistic to suggest that doctors should go to their own employer and admit they are struggling, or to go to their GP. What if they are a GP and that is their colleague? The benefits of Practitioner Health or Doctors in Distress is that they are totally confidential and anonymous. That was what was so moving about the number of doctors coming out on X saying they had been supported.”

The Future

Was this a rogue defunding decision that was quickly rectified or part of a larger cost-cutting exercise?

The service for secondary care patients has only been given a 12-month extension. Funding for primary care staff, like GPs, has also only been extended until the end of March 2025. The NHS said it is carrying out “a wider review of mental health support for all NHS staff.”

 

So could this be simply a year-long stay of execution for NHSPH? 

“We sincerely hope not, and that it remains a permanent service. It seems a relatively small amount of money to spend to keep thousands of doctors over the years in their workplace,” said Fernandes.

“You just have to look at the NHS staff survey to show that people need it. NHSPH needs to be made permanent. I think the NHS should speak to clinicians, people working in the NHS and charities like us, to get a broad view of what’s needed,” added Basile.

 

In a statement on X, the BMA said: “We now need assurance that the review will lead to equal or better provision of mental health support in the future.” 

Another organisation that wants guarantees about mental health support for NHS staff is the British Psychological Society. Its President-elect, Dr Roman Raczka, told Medscape News UK: ” The evidence is clear that long-term investment at scale in staff mental health support is needed and funding needs to be ringfenced and protected. We haven’t yet had any further detail from NHS England as to the full scope of the review and timescales, however we will be paying close attention and hope there will be the opportunity for the British Psychological Society to be able to input into the review.”

The NHS has been trying to give assurances. CEO Amanda Pritchard posted on X: “We will review the mental health offer for all staff so that we have the right services that reach the whole workforce that are sustainable for the future.” 

Susannah Basile hopes that really is the case. “NHS England needs to put the mental health of its healthcare workforce front and centre and not see it as an added extra. It needs to be an essential part. Many people are leaving the profession due to poor mental health. If you look after your staff, you will have a happier and healthier workforce.”

Siobhan Harris has been a health and medical journalist for WebMD/Medscape since 2009. She has a law degree from the University of Sheffield and a postgraduate diploma in journalism. She has also worked as a national/international news journalist at ITN, BBC, and BFBS Forces News.

Source: medscape.com

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American healthcare is in disarray and in dire need of repair. Nearly every healthcare worker agrees that there is uncertainty about the future of healthcare in America. Medicare cuts are looming in our future, and private payors are likely to follow the lead of Medicare and decrease reimbursements. This is compounded by rising costs of overhead expenses. The result is that doctors are being squeezed, and their incomes may decrease. That’s the bad news. The good news is that there are opportunities for doctors to become more productive, to see more patients, and to avoid the erosion of their incomes. Many of these ideas can easily be implemented in any office, with minimal or no expenses and without adding additional staff. This article will review ten suggestions that have been tested in my and other practices and may help make us more efficient, more productive, and, yes, more profitable.

1. Develop a time management philosophy and make staff and patients aware of your desire to maximize your time during the office. It all starts with a commitment to being an on-time physician. The doctor must commit first to this concept and then obtain the commitment of the staff that being on time, becoming efficient, and being more productive is vital to the success of the practice. You can’t have a staff trying to be on time if the doctor(s) don’t embrace the same philosophy. You may want to create this in writing and have everyone sign the commitment. This topic deserves frequent mention at staff meetings as a constant reminder of the importance of time management, which ensures that it is a goal vital to the practice’s success.

2. Have everything you need ready. This includes equipment, supplies, pathology, lab reports, and imaging studies before the doctor sees the patient. Doctors can’t be efficient if they don’t have everything they need at the point of contact with the patient. We all know about the delays that can take place if the doctor plans to do a procedure and doesn’t have the right tools to accomplish the procedure. The same applies if the doctor needs the results of a CT scan or a pathology report to discuss with the patient regarding their medical care. All these issues can be resolved using checklists placed on the chart or in the EMR. These checklists can be reviewed the day before the patients’ appointments, and any missing reports or equipment can be obtained before the patient is placed in the exam room. There is no downtime when the doctor is eyeball-to-eyeball with the patient.

3. The doctor must start on time. Although this is consistent with adopting the philosophy in point number 1, this is the implementation process and having the doctor walk the talk. If the patients are to be seen at 9:00, the doctor must arrive before that start time and be ready to commence with patient care at 9:00. There is a better time to look at emails or return phone calls. If the doctor doesn’t arrive until 9:30, you can be sure delays and interruptions will occur. As a result, patients who have later appointments will be seen 45-60 minutes after their designated appointment times. This leads to anxiety and frustration among the staff and lowers patient satisfaction and the doctor’s online reputation. You might also inform patients that you are trying to be on time and request that they arrive 5-10 minutes before their appointment. BTW, this only works if the doctor is on time.

4. Avoid interruptions. There should be no interruptions when doctors are involved in patient care. I suggest creating a written policy of exceptions to this rule. Acceptable interruptions include calls from the emergency room, the intensive care unit, or the operating\recovery room. I suggest not taking calls from your stockbroker, insurance agent, spouse, or children. Each physician must decide if you will take calls from a colleague or from referring physicians. I recommend that your receptionist tell the doctor who is calling you that you are with a patient, and you will interrupt them if it is an emergency. Otherwise, the doctor will return the call when he is between patients. Most doctors calling to speak to a colleague will accept this response and will not request that you be interrupted.

5. Instruct new patients to arrive 20-30 minutes before their appointment to fill out paperwork or complete the paperwork online if your website provides the forms for patient demographics and a healthcare questionnaire. This approach makes it possible to avoid delays if patients complete their paperwork in the reception area. The receptionist should inform patients that this paperwork must be filled out before being escorted to the exam room. Consider explaining to the patient what will happen during the first exam, such as x-rays or blood tests, or providing a urine specimen so that there are no surprises for the patient upon arrival. You might also want to estimate how long the visit will last so the patient can plan their schedule before or after the doctor’s appointment.

6. Managing patients that take longer than the allotted time. It is common to have a patient who requires more time than you allotted. You are presented with a decision as you would like to provide that patient with additional time. Still, you don’t want to be late for patients scheduled after the patient who needs extra time. I suggest that you mention to the patient that you understand that they need additional time; however, you would like to be on time for the patients who have later appointments. You can offer the patient to make another appointment, come at the end of the day when you will have open-ended time to spend with the patient or offer to call the patient at home to answer their additional concerns or questions. Patients will rarely object to one of these options.

7. Cushion your schedule to allow the doctor to take a short break or catch up if there are delays or patients take longer than expected. It helps if you have a 5-10-minute cushion each hour. It can be used to see an urgency or emergency, return phone calls, or complete paperwork. Doing so makes you more likely to remain on schedule for the subsequent hour.

8. Obtain prior authorizations before the patient’s appointment. Nothing can be more frustrating than having a patient occupy a seat in the reception area because they don’t have authorization from their primary care physician or insurance carrier. Obtaining approval can take 30-60 minutes. This delay can create havoc with your schedule. This delay can be avoided by telling the patient that they are responsible for obtaining the authorization and that failure to obtain the authorization will result in a delay in being seen by the doctor.

9. Allow for emergencies and urgencies. Every physician will have one or two patients who call and request a same-day appointment. In the past, I have told these patients to come in, and we will “work them in.” As a result, inserting these emergencies or urgencies will throw off your schedule and make you late for appointments at the end of the morning or at the end of the day. You can alleviate this situation by having time slots that are left open in the mid-morning and mid-afternoon.

10. Estimate how long each visit will take. Follow-up and post-op patients require less time than a new patient. It may be challenging to determine how long a visit is needed for a newly diagnosed cancer patient. Consider seeing this patient at the end of the day to be thorough and answer all their questions.

Bottom Line: Being on time for patient appointments is crucial for establishing trust, maintaining efficiency, and promoting a positive patient experience. Seeing patients on time is an effective marketing strategy. Patients expect to be seen on time by the dentist, the stockbroker, the lawyer, the hairdresser, and their physician. Suppose you develop the reputation of being an on-time physician. In that case, you will have a more enjoyable practice, less stress, less risk for burnout, and even arrive home in time for dinner.

Source: https://www.physicianspractice.com/

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Patience is a notoriously hard skill to master. When working in health care, your patience is constantly tested, a lesson I have repeatedly learned in my time as a medical assistant in a large orthopedic surgery practice. Whether it is taking the time to reexplain instructions to a patient when I know am running behind in clinic, waiting on hold with another doctor’s office to obtain pertinent information regarding a mutual patient, or helping an elderly patient complete new patient paperwork on the ever-daunting-check-in tablets, patience is a regular part of my day.

Helen (fictitious name) is a patient who taught me many lessons about patience. She called our office to speak with me personally every day, often multiple times a day, for three months straight. During this period of time, I talked to Helen more often than my family or closest friends. Often, she called with questions that I had addressed verbally and in written form many times, while other times, she seemed to just want to chat. Every day I mentally prepared myself for our daily conversation and then calmly re-reviewed her many questions and concerns with her. Helen forced me to get creative, constantly coming up with novel ways to explain her instructions and protocols to her in order to help her better understand. She inspired me to make new handouts with patient instructions and to rework the handouts that had been made previously to increase clarity and decrease patient confusion. These new materials, my improved patient communication skills, and increased patience have benefitted and will continue to benefit countless patients after Helen.

As frustrating as working with patients directly can be at times, working with other health care facilities can be even more challenging. In my current role, I frequently must communicate with other specialists and primary care doctors for preoperative questions about patients and rehabilitation facilities that care for our elderly post-operative patients. Communicating with other health care entities typically involves a series of call transfers and holds, which hopefully result in connecting with the correct person. We all know that when we are busy, waiting on hold can test your patience. This is heightened when trying to communicate urgent information or when multitasking by making phone calls between patients in a busy clinic. From these experiences, I have learned the importance of clear, concise, and specific communication to promote the best outcomes for the patient and to decrease the need for further clarifying conversations. I have also learned the importance of detailed and explicit documentation to ensure that the conversation can be referenced in the future by myself or anyone else who may receive a follow-up call and to decrease the need to rehash the entire chain of communication from the physician to myself, to the facility, to the patient.

As the field of health care becomes more complex, with constant pressure to increase efficiency, we owe each other and our patients our patience and grace. I know that my ability to practice patience with patients enhances not only their visit experience but also their health outcomes. This makes me feel like I am making a real difference and inspires me to constantly strive to be as understanding, kind, and patient as possible with patients.

Natalie Enyedi is a premedical student.

Source: kevinmd.com

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