When good is not good enough

[GeneralVeers]

Thanks, but Whitecoat deserves the credit. His post is at the level investigative reporting. Why isn't ACEP, SAEM, AAEM and the AMA doing this leg work exposing these conflicts of interest involving patient satisfaction policies that profit venture capitalists, while harming patients and doctors alike? Why isn't the "media" doing it?

The media has barely any understanding of how healthcare works, what doctors do, and what an Emergency Department is. To expect them to understand the nuances of patient satisfaction is asking too much.

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[Birdstrike]

The media has barely any understanding of how healthcare works, what doctors do, and what an Emergency Department is. To expect them to understand the nuances of patient satisfaction is asking too much.

That doesn't leave organized Medicine off the hook. They understand each and every little nuance, yet they look the other way. We are the new media, and Whitecoat sets a good example. The difference: he's doing it for free like you and I, unlike other celebro-docs (you know the names).

Why is that?



http://archinte.jamanetwork.com/Mobile/article.aspx?doi=10.1001/archinternmed.2011.1662&papetoc

JAMA:

"Conclusion- In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality."

 

[GeneralVeers]

That doesn't leave organized Medicine off the hook. They understand each and every little nuance, yet they look the other way. We are the new media, and Whitecoat sets a good example. The difference: he's doing it for free like you and I, unlike other celebro-docs (you know the names).

Why is that?

We look the other way because the people with the vested interest, the owners of the large CMGs make a profit off of having as many contracts as possible. They're happy to drink the patient satisfaction Kool-aid and force all of their minions to do likewise, just so long as they keep getting more contracts and make a fortune off the work of others. If you're a lowly pit doc in one of these groups, just try to speak out against Press-Ganey and see what happens to you.

 

[Birdstrike]

We look the other way because the people with the vested interest, the owners of the large CMGs make a profit off of having as many contracts as possible. They're happy to drink the patient satisfaction Kool-aid and force all of their minions to do likewise, just so long as they keep getting more contracts and make a fortune off the work of others. If you're a lowly pit doc in one of these groups, just try to speak out against Press-Ganey and see what happens to you.

Aw, come on. Let a few of 'em swing and miss before you knock it right over the fence on the first pitch. Geez.

 

[GeneralVeers]

Aw, come on. Let a few of 'em swing and miss before you knock it right over the fence on the first pitch. Geez.

Might as well get right to the problem!

 

[Birdstrike]

Here's a great article by two Emergency Physicians, Dr. Knox Todd and Dr. Monica Wattana:


"Patient satisfaction surveys such as Press-Ganey, are flawed metrics for the Emergency Department..."

"...it is important to examine the long-term consequences of utilizing surveys based on patient satisfaction to gauge physician core competence."

"The negative attributes and inherent consequences may not only harm the individual patient, but also have broader ill effects on population health due to the increase in prescription opioids for misuse and abuse."

Wattana, M. K. and Todd, K. H. (2013), Patient Satisfaction Surveys and Treatment of Pain in the Emergency Department (ED) Setting. Pain Medicine, 14:*968–969. doi:*10.1111/pme.12170_2


Good work Dr. Todd and Dr. Wattana.

 

[deleted109597]

And Knox is a fairly compassionate doc, so he isn't one of those "kill em all and let God sort em out" kind of guys. To see him get in on this is nice.

Won't make any difference, as the CMGs do it because the suits at the hospitals want it.

 

[Birdstrike]

Funny, but so true, about the mockery that "patient satisfaction" and businessmen have made of Medicine and doctoring.


"Physician Shoots Off A Few Adderall Prescriptions To Improve Yelp Rating

REDDING, CA—Noting that his practice’s rating on the business review website had dipped to just 3.5 stars, local primary care provider Dr. Frank Hawley reportedly dashed off several Adderall prescriptions Monday to give his Yelp average a needed boost. “I keep a pretty close eye on my reviews, and whenever I see my number fall below four stars I just write out a few extra Adderall or Dexedrine scripts and it’s back up in no time,” said Hawley, adding that he usually ups the dosage to 30 milligrams and makes sure to prescribe two refills to ensure he stays near the top of the local general practice rankings. “Patients are always happy when I sign that prescription slip and hand it to them—it’s pretty much a guaranteed five-star rating. In a business that survives by word of mouth, good reviews are absolutely essential.” In addition, Hawley confirmed he hasn’t advised a single patient to exercise regularly or maintain a healthy diet since 2011, saying he learned his lesson after receiving a devastating one-star review."


http://www.theonion.com/articles/physician-shoots-off-a-few-adderall-prescriptions,35718/

 

[golghiapparatus]

Gotta love The Onion....

 

[Daiphon]

Funny, but so true, about the mockery that "patient satisfaction" and businessmen have made of Medicine and doctoring.


"Physician Shoots Off A Few Adderall Prescriptions To Improve Yelp Rating

REDDING, CA—Noting that his practice’s rating on the business review website had dipped to just 3.5 stars, local primary care provider Dr. Frank Hawley reportedly dashed off several Adderall prescriptions Monday to give his Yelp average a needed boost. “I keep a pretty close eye on my reviews, and whenever I see my number fall below four stars I just write out a few extra Adderall or Dexedrine scripts and it’s back up in no time,” said Hawley, adding that he usually ups the dosage to 30 milligrams and makes sure to prescribe two refills to ensure he stays near the top of the local general practice rankings. “Patients are always happy when I sign that prescription slip and hand it to them—it’s pretty much a guaranteed five-star rating. In a business that survives by word of mouth, good reviews are absolutely essential.” In addition, Hawley confirmed he hasn’t advised a single patient to exercise regularly or maintain a healthy diet since 2011, saying he learned his lesson after receiving a devastating one-star review."


http://www.theonion.com/articles/physician-shoots-off-a-few-adderall-prescriptions,35718/

When did the Onion start writing real stories? d;-)

 

[Birdstrike]

We Just Might Be Getting Somewhere

This is pretty remarkable. Below is a link to a letter written by two US Senators, just one month ago, to Marilyn Tavenner specifically about patient satisfaction surveys contributing to the prescription drug abuse epidemic in the USA. In the letter, they mention several examples of EM physicians in particular who were influenced negatively by patient satisfaction surveys, and were pressured inappropriately by them, including vicodin "goody bags" being given out to improve scores. They also specifically mention HCAHPS, which is Medicare's own patient satisfaction program. All in all, it's pretty remarkable how openly and blatantly these Senators seem to acknowledge how harmful and misguided these surveys, and their profit centered application, are. Guys, there's hope:

http://drwhitecoat.com/wp-content/uploads/Grassley-Feinstein-Letter-to-CMS-2014.pdf

 

[TrumpetDoc]

Wonder if there was a response?


Thumb typed from iPhone using Tapatalk

 

[Birdstrike]

"She died thirsty! Ice chips matter when it comes to patient satisfaction"

http://www.kevinmd.com/blog/2014/12/died-thirsty-ice-chips-matter-comes-patient-satisfaction.html

Interesting viewpoint. What do you think, do "ice chips matter"?

 

[Arcan57]

Yes, they matter as did dozens of other factors in the care of the patient mentioned in that article. The fact that the patient ultimately died forces everything through a retrospectoscope that artificially devalues the medical interventions that the patient underwent in an attempt to save her life. If you were to have asked the husband whether ice chips were more important than trying to save his wife's life in the moment, we all know what the answer would be. The fact that he's tormented by the thought of his wife dying thirsty says less about the care in the ED than about the importance of offering resources for grief counseling.

In a world with unlimited resources, meeting a patient's emotional needs becomes a critical action. Maybe when America finishes splitting into a two-tiered system, the rich will have facilities where every person checking into the ED is assigned an educated patient-care advocate who is there to provide emotional counseling and attend to creature comforts. Maybe those facilities will provide huge subsidies to the doctors so that they can staff at a level that allows for deep-dives into pt's emotional states. Maybe those facilities will budget such that they have excess experienced nursing staff at all times so that a patient's needs are never neglected due to the more pressing needs of another patient. I wouldn't be able to afford to receive that level of care, but that doesn't mean we shouldn't aspire to it. And where our aspirations fall short, we will always have mandates to pick up the slack.

Back in the world I practice, we rely on high school and old lady volunteers for creature comforts because our techs are constantly busy drawing blood because we have difficulty keeping experienced nurses and new nursing grads tend to have minimal phlebotomy skills. Our nurses work hard but have to spend inordinate amounts of time fighting a system that seems designed to keep them doing their jobs. Rm 22 with severe renal colic is going to wait 50 min for their analgesic because the nurse still needs to finish documenting the Braden score on the ambulatory chest pain patient that just left rm 23, along with the other core measures, risk mitigation, and patient satisfaction initiatives that comprise the 30 min of mandatory box clicking on our admitted patients. The majority of our staff cares and works hard at meeting our patient's needs. We commonly fail to do this in dozens of small ways, mostly because we're avoiding failing in big ways.

 

[Psai]

...just looked up what a braden score is on wiki and it looks like an enormous waste of time. in the time it takes to assess and calculate that useless score, why not just turn the patient (not client) every 2 hours?

 

[deuist]

...just looked up what a braden score is on wiki and it looks like an enormous waste of time. in the time it takes to assess and calculate that useless score, why not just turn the patient (not client) every 2 hours?

You are not thinking like a useless, metric-counting, clipboard boss. Simply turning the patient every two hours doesn't look good on paper. You need a Braden score the point to someone's risk of skin breakdown so that attorneys and quality assurance folks have something to look at when the patient gets a decubitus ulcer three days after admission.

 

[Birdstrike]

"Patient satisfaction in the ER. Oh yes, this doctor went there"


http://www.kevinmd.com/blog/2015/01...t-satisfaction-scores-look-like.html#comments

 

[Old_Mil]

Thanks, but Whitecoat deserves the credit. His post is at the level investigative reporting. Why isn't ACEP, SAEM, AAEM and the AMA doing this leg work exposing these conflicts of interest involving patient satisfaction policies that profit venture capitalists, while harming patients and doctors alike? Why isn't the media...

Well, it's probably because the AMA has become a for profit corporation that sells codes, ACEP is a joint venture of Team Health and EmCare, and the media thinks we are Hannibal wannabees who amputate for profit. Guess we haven't been accused of eating body parts yet.

 

[Birdstrike]

Not getting the patient "satisfaction" you want quick enough, in the ER? No problem. Just set the department sprinklers off with a lighter! Problem solved:

"Woman frustrated with ER wait time sets off sprinklers

By Sheeka Strickland
(Morganton, N.C.)--A woman frustrated with long wait times in a hospital emergency room held a lighter to a sprinkler, dousing the entire ER in water, according to police.

A police report says "copious amounts of water" flooded the emergency room. The responding officer called the scene "chaotic and disastrous" when he got there, as employees rushed to move patients from the ER to a conference area.

Police say Katlyn Milligan, 20, told them she'd been in Carolinas HealthCare System - Blue Ridge in Morganton, North Carolina for at least 90 minutes, waiting for her mother's girlfriend to be treated for a back problem.

They say that Milligan said she grew impatient, so she went to the women's bathroom, turned a trash can upside down, stood on it, and held a lighter to a sprinkler for at least a minute.

Water damage caused ceiling tiles to crumble in the hospital.

After the sprinklers went off, doctors admitted Milligan to the ER to check her for exposure to stagnated water from the sprinkler. Once she was discharged, police took her into custody.

Milligan was charged with burning personal property, damage to personal property, and molesting a fire extinguishing system. She was arrested, and given a $5,000 secured bond.

Milligan told police she'd been charged in Florida before for making a bomb threat.

When reached for comment she said, “I'm sorry I don't want to be bothered.”"

http://www.myfoxny.com/story/29298046/sprinklers-breached

 

[Arcan57]

God bless Florida for figuring a way to factor into the story. I wonder if exposure to stagnate water occurred via one of the techs or security guards trying to drown her in the toilet.