A few days ago, just after dawn, while I was out walking the dog, our home phone rang and my wife answered it. She's used to my pager, cell phone, and home phone ringing at all hours, and so she was not all that surprised when an unidentified voice said,"We're looking for the methadone dose for patient John Q. Smith." She told him I was out of the house at the moment, ...

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At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual? At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result ...

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Sixty is the number of patients left on our schedules at the end of the day on Monday this week, people who never showed up, what we call no-show appointments. This number does not include those patients who did reach our practice to reschedule (these are counted separately), but simply those who never made it in for their scheduled appointments. While we are a very busy practice, and this is not ...

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I recently took a three hour online course on something I learned to do when I was a medical student. And I thought it was something I had been doing fairly well for the past 20 years.

New regulations have come down requiring all practitioners to take a CME-certified course on safe and effective management of opiates for acute and chronic pain. This has clearly ...

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Down in Baltimore for a meeting, long days full of plenary sessions and workshops, awards ceremonies and poster sessions. Recycled hotel air, bad coffee, great camaraderie. Lots of new ideas, lots of new ways of looking at things, lots of reinventing the wheel, lots of hope for change. Lots of sessions about how to improve the environment for learners, how to engage medical students, how to build a curriculum, how to ...

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The phones, the phones, the phones. Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can't lick, a continual thorn in the side of our practice, something that's hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.

Without ...

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Long ago, before our hospital changed over to a nearly complete hospitalist model, the faculty at our internal medicine practice served as the attending of record for all of our own patients, as well as the patients of the residents we supervised, when those patients were admitted to the inpatient services across the street. When we would arrive in the morning, we would look at the admission list, note that one ...

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"I can do that?" During a recent morning practice session, a resident was presenting a patient who had had several episodes of syncope which culminated in a trip to the emergency room. She had a brief stay there, and on the discharge plan was written "follow-up with PCP and with cardiology."

We went through her history and physical examination, we talked about how to further ...

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As part of trying to figure out where telehealth and video visits fit into the primary care setting, this week I got an amazing tour from the director of our emergency department, during which he showed me the program they've developed over the past year. An incredible system, they take patients from triage who report to the emergency department with nonemergent issues, and move them to a consultation room off to ...

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In these strange days of unsure future health care policies, shrinking budgets, and significant belt-tightening, as we look for ways to improve access for our patients, we need to reevaluate how we to get them into care, making sure we see them in a timely and efficient manner. We have always said that in this topsy-turvy time, in the crazy state of health care, what we really need is more primary ...

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shutterstock_177270461 The insurance companies have discovered a new way to give me a headache. About a month ago, a number of providers in our practice received an email with instructions about a new task to which we had been assigned. Apparently, we were supposed to log on to some website, create an account, and fill out a SOAP note on about a dozen of ...

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I recently spent time at the New York eHealth Collaborative's Digital Health conference. The meeting was full of interesting seminars, informational sessions, presentations on innovative technology looming on the horizon, and talk about the future digital face of health care. The hallways outside the conference rooms were full of administrators, legislators, consultants, and representatives of companies building and designing new resources to help transform the health care system as they see it. Over and ...

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Information is everything, communication is the key. Recently, we were contacted by the medical director of a subspecialist fellow's practice at one of our affiliated hospitals. She wanted to discuss ways to improve communication between our practices, and expressed considerable frustration about the information received in consultation requests from the providers in our practice sending patients their way. She noted that they had "read-only" access to our electronic health record (through an information-sharing ...

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Today was (almost) the last straw. If you've read this column before, you've listened to my diatribes about the insanity of the forms we are required to fill out, the wasted efforts, the missed opportunities, the duplicative care. This one today takes the cake. Going through my mail this morning, trying to clean up the work on my desk before I head off for a (hopefully) few days of jury duty, ...

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A sleeping dragon awakes. At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO. The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then "attribute" their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and ...

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It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket. They call these messages "system notices." OK, maybe that's an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic ...

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shutterstock_155857724 I just got a taste of improved access, and I gotta tell you, it sapped my energy. It reminds me of the old standup comic one-liner, "I just flew in from Vegas, and boy, are my arms tired." Today was the department of medicine housestaff picnic (pretty much a guarantee to cause the weather to change from clear skies to rain), and so ...

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shutterstock_81515077 I was on call last night. Don't get me wrong, this is not as bad as it sounds. With over 20 partners sharing evening call, and residents getting the calls first, we do not have it bad at all. And certainly nothing like my obstetrician friends, who seem to go in every time they are on call for labor and delivery and then ...

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One hundred forty-nine messages. This is what I return to on my first day back from vacation. Many of them were marked with a little red arrow, indicating a high-priority phone message. Recharging with a little time off is a darn good thing, something we all need, and something which has been shown to help all of us be better at what we do. All of us, no matter what our jobs are. ...

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Just the other day I received a somewhat anxious-sounding phone message from a patient of mine, approximately 72 hours after her office visit with me, and about 24 hours after I had already gone over all of her lab results from the visit with her. She sounded quite distressed, and said she'd received a message from someone, but could not really understand what they were saying. She said she was finally ...

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