Doctors, Not Scientists

"As medical students they were filled full with information on biochemistry, anatomy, physiology, and other sciences, but information does not a scientist make—otherwise, you could become a scientist by watching the Discovery channel." ~ Richard Smith former editor of the BMJ

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Why is there a paucity of thorough patient reviews of their doctors? Is it because doctors are hypersensitive to criticism?

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For $2 a Star, an Online Retailer Gets 5-Star Product Reviews

How long has the NYT been asleep? Of course, retailers post fake reviews. Check out Amazon Marketplace or Amazon.com for unknown authors for examples in the wild. A small "lit." review will show that even "professionals" like physicians do it -- or their minions. Yelp! does an impressive job of filtering out suspect reviews. Like these three 5-Star Reviews for a physician practice, that should, IMO, have had disclosures. One reviewer happens to have the same name and city as the manager's spouse. Another reviewer, has the same name as someone who works there and gave a favorable rating by name to several of the rank and file employees. And the last reviewer meets a random guy on the bus who tells him he should come to his workplace for medical care. Amazingly, he has a good friend with the same name as the reviewer. Then again, maybe it's all a coincidence. Or a theory, like the existence of Bigfoot.

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Consequences of doctors pretending to be scientists

The New England Journal of Medicine is celebrating 200 years of its inflexible, expensive and elitist publication. The canon is few in number, thereby limiting the outflow of information. "It is an ideal system for sharing knowledge, said the quantum physicist Michael Nielsen, only 'if you’re stuck with 17th-century technology.'"

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"Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly."

Allan J. Coukell, pharmacist and consumer advocate at the Pew Charitable Trusts

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Most ... physicians privately admit that many of their decisions are based on intuition rather than on detailed cost-benefit analysis. In public, of course, it's different. To stand up in court and say you made a decision based on what your thumb or gut told you is to invite damages. [D]octors go to some lengths to suppress or disguise the role that intuition plays in their work.

All Hail the Hunch—and Damn the Details

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How to handle workplace bullies

An unfortunate story from the Chicago Tribune about an hospital employee being bullied by nurses:

A secretary at a large Chicago-area hospital, she'd endured years of harsh treatment at the hands of a clique of nurses that basically ran her floor. The nurses referred to another secretary, a very large woman, as "fatty" and "fat-[butt]." They yelled at the secretary herself and scolded her when she stood up to them: "Watch your tone with me."

Fortunately, she doesn't work in Morton Grove, where professional management is non-existent.

"Every time someone is called 'fatty' you happen to be in the vicinity. And that's empirical evidence, by the way."

Anyway, I hope this woman gets help soon, because healthcare providers aren't nearly as altruistic as they portray themselves.

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Board Certified. You don't say.

Look at that, all of the physicians at this practice are board certified in Internal Medicine. But what does it mean to be board certified? Who makes the decision that someone should be board certified? And why doesn’t this practice’s website give us some more information about the board that certified their doctors?

One prominent board is the American Board of Medical Specialties. When a doctor is said to be “board certified” the ABMS is the one that most often comes to mind. In order to get more information about this conundrum, I checked the roster of the practice’s seven doctors against the database at the ABMS website and I learned that only five of their doctors are listed there as board certified in Internal Medicine.

I believe that there must be another explanation. Maybe the other two doctors are board certified by a county board in a rural part of the state? I really don’t know but I’ll be sure to take another look at this. Incidentally, the ABMS website provides access to this database, telephone assistance, and more resources to the public for free to help patients make better choices as consumers in choosing their healthcare providers.

It turns out, that doctors who specialize in Internal Medicine, can be listed and certified with another board. The two other doctors were found on the Web at the American Board of Internal Medicine.

Certificates awarded in Internal Medicine prior to 1990 do not require renewal. However, ABIM encourages all diplomates voluntarily to renew certificates relevant to their practice.

"Ruh-roh!" ~ Astro

That's right Astro. Those two sentences mean that these two doctors have been "grandfathered in" and are no longer required to renew their certificates. But the AMA likes to say doctors are scientists, so I'm sure they are probably hitting the books. You think?

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Hospital rounds

INT. HOSPITAL - PATIENT'S ROOM

          A patient is lying in her bed, seemingly agitated. A homunculus in a white coat is standing by the bed.

                              PATIENT

                    Doctor, I was talking with my niece, and she tells me that these pills aren't right for me.

                              DOCTOR

          Tosses his prescription pad at the old lady

                    If you know so much, you can write your own prescription.

          

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One icy morning

Receptionist: Good morning! Welcome to the practice, how are you today?

Patient: I just fell in the parking lot. I think I broke my wrist.

Receptionist: Yes, it's slippery outside.

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Physician empathy can affect patient outcomes

Well-timed, empathic responses from physician to patients, according to a study in the Canadian Medical Association Journal, can result in happier and more compliant patients. Unfortunately, it would seem the importance of this "soft skill" is lost on most providers in the real world.

In the journal article, Dr. Robert Buckman of the University of Toronto, and colleagues wrote:

Currently, there is insufficient emphasis and time apportioned to teaching the empathic response in medical school, postgraduate training and continuing medical education.

Similar work has been done before on a larger scale and found that the patient rank health outcomes near the bottom as the key measures of satisfaction with the patient experience. In other words, and this may be a shock to the world, but in health care, it really isn't all about the provider.

This study is astutely referenced in Tom Peters' book, The Little BIG Things:

An extensive 225-hospital, 140-thousand patient survey by Press Ganey identified 15 factors which shaped patient satisfaction. The startling results: "Not a single one of the top 15 sources of patient satisfaction had to do with the patient's health outcome. All 15, in effect, were related to the quality of the patient's interactions with hospital staff—and employee satisfaction among staff members."

Employee satisfaction is important to patient satisfaction? Who ever heard of such a thing? Anyway, if you happen to be a patient at Doctors of the North Shore and you are looking for genuine empathy, I believe the organization's "empathy chip" is not seated properly. You see, there was an employee there that made mention of having a disabililty covered by the ADA. Well, a little more that an hour later, that employee was discharged. How convenient. I think some people might say, too convenient. 

In the aftermath, one long-time employee noted

I know ... how difficult it can be here.

It's only my opinion, but if a medical practice can have such a reaction to a disease from an employee, how well can any patient expect to fair?