Coming soon!


First, I want to apologize to all of my readers. I have taken the last year off as a sabbatical and to catch up on old projects. On a more positive note, I have dedicated much of the last two months to performing an independent analysis of some of the more popular medical transcription companies with my readers. The results of this research have truly been eye-opening and I am excited to share this with my readers in the next few weeks as I finalize the analysis.

While most would think that every medical transcription company is like all the others, this is not true! I created a set of different criteria (such as customer service, technology, and accuracy) for five of medical transcription companies most popular with my readers, and then, having interviewed clients from each company as well incorporating as my own independent research into each of these companies, I ranked them from best to worst. My next blog post (soon, I promise!) will explore a little bit more of my methodology.

If any of my readers have any insight into this topic, I would love to hear from you.

Casting Call


It's certainly been a while since my last post and I apologize for falling off the face of the earth! Procastinating can be quite a slippery slope. Actually, things have been very hectic for me lately and unfortunately my blogging was sacrificed as a result.


This post is a writers casting call. I'm looking for some help from my readers. Any ideas that you'd like to discuss? The state of the healthcare system is very precarious these days, where do you think it's going? I'm curious to see if a new administration might really make a difference as has been claimed.


So this is the soap-box, open-mic offering. Feel free to respond to my emails or post any thoughts that have been on your minds lately. I'd love to stir up the pot a little bit; you readers always have such enlightening insight.


I would be especially excited if anyone would like to do some guest-writing as well. Any musings that you've got - let's share!!! I've got a nice-sized audience with wonderful readers, so you could really get your thoughts out there.


Thank you, I hope this finds you all very well.

You Must Be on Drugs

My good friend Mark used to shill for a big pharmaceutical company. He never liked the work much, but he was a good salesman and it paid his bills. He finally had to quit because he felt the tactics being suggested to him and the pressure being applied were too much. He would shake his head and say we are an overmedicated culture.

I thought of him as I read a review of Melody Petersen's "Our Daily Meds," a provocative new book that provides some teeth to my friend Mark's claim. By her reckoning, Americans increased their spending on prescription drugs by 17 times from 1980-2003. She notes the way the elderly are overprescribed, taking drugs that counter the reactions of each other in an endless spiral.

It's an open secret within our profession. The doctors I work for are very scrupulous about this issue, and display a strong conscience. One of the older members of our practice loves to tell the story of how he went on a drug company junket early in his career, and how everyone grumbled because it wasn't in a sunny climate. Apparently, they didn't care about the drugs or their effects so much as they did the cloudy weather.

My friend Mark felt that people were being encouraged to take medication for a variety of marginal ailments. He thought the more health-conscious our culture became, the more they were willing to seek out any panacea for what supposedly ailed them. In his mind, it obscured the real sickness out there and fostered a drug-dependent consumer culture.

Which, for him, meant boom times. But something in him wasn't up to the task. The more success he achieved--and he had a six-figure income, which wasn't bad considering he never graduated high school--the more empty he felt inside. Finally, he'd had enough. No one thing precipitated his decision, but rather it was the accumulation of a career's worth of anxiety.

The review of Melody Petersen's new book notes a very simple litmus test for whether or not a doctor has been courted by a pharmaceutical company: are their pens and tissue boxes covered with drug ads? (I was never more glad that we purchased our own pens and tissues!)

Have any of you heard of Ms. Petersen's new book? What is your experience with pharmaceutical companies? Do you think prescription drugs are out of control? As always, I would love to hear from you.

Nerd Wanted

A few months ago we bit the bullet and began a search for a full-time IT person. Technology is moving so fast, and we were having too many communication problems with the company we were using. Finding someone who would cater to our specific needs seemed like the next logical step, but of course that was easier said than done.

The first person we found was extremely tech-savvy, but lacked interpersonal skills. In the extreme. He couldn't even make eye contact. Luckily, he left for a better job offer almost immediately.

The next candidate we hired part-time on a trial basis. They were referred to us by a fellow employee, and at first he seemed ideal in that he knew his stuff and could communicate effectively. Unfortunately, he was overburdened with a difficult family life and we caught him sleeping in his office more than once.

As with most things, I learned through painful trial-and-error, so my next step was to establish a solid criteria for the IT person we were looking for:

1. Salary - I researched what the local rates were and established a criteria for a competitive salary. To attract top talent in the IT field, you have to make it worth their while.



2. Job Requirements - I put in writing what we were looking for in an IT person. What our system requirements were, and what innovations we were hoping to make. Also, I summarized past problems and recurring issues.



3. The Future - I wrote down some goals and baselines I hoped the IT person would establish over the course of the first year or so, making it clear that the position would only expand as we incorporate more technology.



4. Training - I made it clear that we would gladly allow the IT person some latitude in furthering their education and attending seminars or workshops related to their field. Also, any education the staff needed to keep pace with changes would be duly considered.

The third time seems to be the charm. The woman we hired is extremely gifted when it comes to the technical, but she also has a warm, down-to-earth personality. She explains things in a direct, easy way free of jargon and attitude. She also worked part-time as a nurse's aide in college, so she has some knowledge of the medical field.

Like most practices, we're striving to become as paperless as possible, so I think having an in-house IT person is a smart move. The more intricate and involved we become in tech matters, the more important it becomes to have someone who is specific to our needs and wants.

What about your practice? Do you have your own IT person or do you outsource that work? I'd love to hear your perspective.

A Spoonful of Sugar

A doctor I work with asked if I had done a blog about giving patients bad news. She said it was on her mind lately. She had to tell someone they had a life-threatening illness and the experience kind of shook her up. "I've given bad news before," she told me. "But the older I get, the harder it becomes. Isn't that strange?"

She told me her mentor was a terrific communicator, and that she learned a lot from just watching him interact with his patients. We sat down and I asked her to give me a rough list of things she felt were important regarding the topic. Here is what she came up with:

1. Quiet room - Make sure the place where you talk to the patient is relatively quiet and safe from interruption. Turn off your phone or beeper. Give them your full attention.


2. What do they know? - It's always good to get a handle on what the patient is thinking before providing any in-depth explanation. Sometimes their point of view is colored by false information that can easily be dispensed with at the start. You need to ask.


3. What do they want to know? - Sometimes a patient wants everything spelled out in detail, and sometimes not. Try to ascertain how much you need to say, and be mindful of their comfort level. Often, they want a family member present to verify and confirm information. Be open to their needs.


4. Keep it simple - Remember that your patient didn't go to medical school, and talk to them in a direct, but simple manner that lays out the facts without overwhelming them.


5. Listen - Give the patient time to react. Don't force the issue. Let it sink in. Let them ask whatever questions come to mind. Just...listen.


6. Conclude firmly - Don't make the patient feel rushed. After you lay out the treatment options and have exhausted their curiosity, reassure them that you will be there in the future. Some doctors give out their personal cell phone number, but we have a policy against that in our practice. What we do offer is to have a staff member follow up with a phone call in a day or two. Patients appreciate the extra effort.

I thanked the doctor for sharing her insight, and she confided that her recent experience with giving bad news had gone poorly. The patient became aggressive and started blaming his family for his problems. "I had to remember that he was distraught," she said. "And that we were on the same side."

Apparently, she let him rant for a few minutes, and he finally relaxed and admitted that it didn't matter. What was important was how they were going to move forward. Sometimes patience is rewarded.

I'm sure many of you have an opinion about this. If you'd like to share your perspective in the comments, I'd welcome it. Thanks.

Ratings



I have previously written about online ratings services for doctors. I do a lot of work on the internet in my off-hours, and I know just how vapid and pernicious bad commentary is, so I am highly skeptical of any service that gives an anonymous forum where people can vent about medical care.



I'm sure it is empowering to many people who can feel intimidated when dealing with a medical professional, but I think it leaves a lot to be desired. After all, no patient is perfect. Many don't properly communicate their problems or follow their doctor's instructions.



Now insurance companies are getting into the ratings game, which is all part of their supposed quest for efficiency and customer service. I have to wonder where all of this judgment-passing is leading? Doesn't it create a climate of fear for the medical community?



A doctor friend of mine who works for another practice met me for lunch the other day. He was beside himself with worry, having just received a negative review online. He's a pediatrician and somebody accused him falsely of prescribing an adult medication for their sick child. He had no idea who the patient was, and couldn't recall any recent patient dissatisfaction.



He's a sensitive sort, and my kids all went to him, so I know he is a caring professional. I worked with him early in my career and I've never known any doctor who was so patient and lacking in the usual ego that can get in the way of good treatment. A few negative words on the internet and his entire career meant nothing to him--he was devastated.



"I'd like to think people take all of that with a grain of salt," he said, finally. "But the fact is I know it's there. Somebody cared enough to write it."



It's a good thing for doctors for to be aware and question their decision-making. It makes them better at their job. However, there's a point at which a course of action or a diagnosis has to happen, and sometimes mistakes will be made. The fallibility inherent in the process is what gives the medical profession a certain nobility. Every decision is a potential risk of reputation.



I'd give anything to ease my doctor friend's sorrow. He contacted the website and they are supposedly going to remove the false accusation. In time, I'm sure we'll both laugh about it. In time.



As always, I'd love to hear your thoughts. Do any of you have experience with online ratings?

Addicted

I'm a trusting person by nature, and so it wouldn't naturally occur to me that someone I work with might steal drugs to feed their addiction or sell to others. Sure, I've caught a few people doing this in the past, but there is something Polyanna-esque about my worldview that allows me to revert back to trusting people shortly afterward.

I'm feeling particularly vulnerable regarding this since a dear friend and co-worker got caught this week. Another co-worker privately told me that she confessed over a few beers one night after work that she was addicted to pills. Once I was made aware of the problem, it was just a matter of waiting.

The resulting confrontation was awful. She was in full denial and claimed she was being set up. She left without collecting her things or even a wave. Five years of working together gone in a heartbeat.

In retrospect, there were warning signs. I just chose to ignore them. Here, for your benefit, are some things you might want to look for:

1. Are they reliable? Is the employee calling in sick more frequently? Are they arriving late and leaving early?



2. How efficient are they? Are they becoming sloppy in their work habits? Taking shortcuts and drawing complaints from co-workers or even patients?



3. What about their appearance? Are they looking more disheveled lately? How about their speech--is it noticeably faster or slower? Any weight or mood changes?

I realize, looking this over, that there were some glaring differences in the woman at work. She once had been so open and easy to get along with, and in past 6 months or so, she had become more secretive and stand-offish.

Still, I knew she had gone through a painful divorce and I strongly believe in giving people latitude to work out their problems. Her work was still of a professional enough level that I even told some people to back off when they criticized her for being short with them. I explained that she was going through a rough patch and would eventually work things out. I still hope that's true.

Any stories or insight you'd care to share would be more than welcome. I appreciate you listening to mine.