Wednesday, June 10, 2015

"Good Doctors..."

In a Facebook group that focuses on health care costs, today there was a post that got me ranting and raving.  I did this a little on FB, but since particular topic happens to be one of my old favorite blog topics, I figured I might as well write a blog post. 

Basically, this person questioned the wisdom of the age-old words "just find a good doctor," and more or less questioned whether this was even possible in this age of EHRs, administrative bureaucracy, and guidelines. I would, and in fact did argue, that finding a "good doctor" is almost definitely possible.

Below is the expanded version of my rant: 

First of all, there are plenty of "good doctors" to be found. Competent, compassionate people who care about their patients. I know this because I have been lucky enough to see several of them over the years--both primary care doctors and specialists. Doctors who explain and teach, and who listen carefully and examine thoroughly. They provide good care despite the challenges of EHRs, the constant urges from HMOs and administrators to see more patients in less time, the hurdles associated with MOC and TJC and all of the other bureaucracy.  

It is possible to find a "good doctor," but it may not be easy, depending on geographic location and whether insurance network is narrow or broad. Also, doctors that are widely considered "good' may have large patient panels and may not be taking new patients. There are a multitude of doctor-rating sites with information about doctors, but word of mouth still seems much more helpful to find a doctor whose 'bedside manner' fits a patient's needs and wants. Because there are so many intangibles whether a doctor looks you in the eye rather than staring at the computer, whether a doctor takes the time to draw a picture of complicated anatomy for you, or whether a doctor gives you his/her home number just in case you need it. These kinds of things can't be measured very well by rating sites and patient satisfaction surveys (in fact, patient satisfaction surveys are a whole separate issue).

Contrary to what the original FB poster seemed to believe, I think it is definitely possible for people to still find "good doctors." Because most doctors are good people who are in the profession to do good and help people.

Sunday, May 17, 2015


Tonight two public health and health policy forces are conspiring to make me want to sit down and type a blog post:  public health school graduations and the current political environment.

It's that time of year when many public health students are graduating.  With MPHs, PhDs, DrPHs, and various other initials after their names.  Some of these are veteran professionals who have just completed degrees, while others are brand new graduates.

These graduates have one thing in common:  they have all chosen a very, very challenging time to be public health professionals!  Especially those graduating in my home state.  I'll keep my mouth shut on this other than to say that the legislative environment is rather unfavorable to public health at the moment.  Other states also have challenges in terms of budgets, legislation, non-Medicaid expansion, etc.  The ACA, as exciting as it is, also presents new and ongoing complications for  public health professionals.

The public health graduates have another thing in common:  they'll all be fixing.  Fixing people and communities that are cracking, have hairline fractures, or  are completely broken.   Fixing processes and procedures.  Fixing ill-thought out legislative bills and laws through advocacy.  Fixing our health system.  Examples of how public health professionals fix things:   performing restaurant inspections to make sure food is prepared safely--and facilitating changes when it's now.   Giving immunizations to people of all ages who have no other affordable access..  Implementing obesity and diabetes prevention programs in communities where such programs don't exist.  Streamlining ACA insurance procedures to make them more user-friendly,  

Paul Farmer wrote a book To Repair the World, which contains transcripts of his wonderful commencement speeches from medical schools, public health schools, etc.  I completely love the title...because that's what public health is all about.  Repairing.  Fixing.  Strengthening.  Rebuilding.
Public health professionals are well-trained to do fix. They have the nuts and bolts--basic public health knowledge, the wrench--for arm-twisting, the duct tape--for quickly patching up crises, the measuring tools--for data and evaluation, and perhaps most importantly, the hammer for hammering consistently with a strong, powerful advocacy voice.

And there is plenty for public health professionals to fix in our system!

Monday, April 20, 2015

Talk vs. Walk

I haven't blogged for a while, partially because I have been busy, and partially due to "blogger's block."  There were a few ideas going through my head of things to write about, that for various reasons got discarded.  National Public Health Week?  Nope, everyone and their brother was writing about it.  The Medicare doc fix (MACRA)?  Nope, because others did a much better job than I ever could at spelling out the far-reaching details of this new bill-turned-law.  Politics and health policy happenings in my own state?  Nope, too hard to be even remotely tactful, and better to keep my mouth shut on that for now.    

The topic that has bubbled in the back of my mind for the past few weeks, though, made the blogging cut.  Here goes.

I like to talk. Just ask my brothers.  What do I like to talk most about?  Medicine, public health, health policy, and anything related.  I can go on about these subjects for a long time, as anyone who knows me knows  all too well.

Lately, though, I'm kind of fed up with some of the talking that goes on in and about public health and health policy.  Why?  Because it doesn't lead to action, to tangible changes that make a difference for real people.  Sometimes it seems like talking for the sake of talking (or, worse, meeting for the sake of meeting).  This bothers me.

Don't get me wrong.  I strongly believe that dialogue and conversation, brainstorming and planning and advocating out loud are important in public health and health policy.  They are central and critical...when the end goal involves action.  Action can mean many things...legislative advocacy, program implementation, creation of new materials, planning conferences, etc.  But talking without an end goal involving real change?  "Talking the talk" without planning on "walking the walk" toward honest-to-goodness change that will make a difference for people?

My National Public Health Week promise to myself is that when I am with others "talking the talk,"  I will try as hard as I can to make sure we also "walk the walk."  That we focus on an end goal of real change, and the action steps needed to achieve it.  Because public health and health policy are not just about "talking the talk".  They're about "walking the walk" toward real real changes that will improve health.  

Monday, March 30, 2015

Looking Back, Looking Forward...

Next week is National Public Health Week (NPHW).  In previous years of blogging, I've made a point of writing a post each day.  For a variety of reasons, that will not be happening this year...but at least this one NPHW post will.

I like to make lists.  Grocery lists, Christmas lists...and public health lists.  Since "officially" becoming part of public health over ten years ago when I graduated with my MPH, these are a few of the things I've seen:

1.  The passage of the ACA, and the subsequent Supreme Court decision to uphold it.  Definitely the most far-reaching public health happening, and hands down the coolest policy thing I have seen.

2.   SARS, Ebola, H1N1, regular influenza, etc.  Signs that our world is indeed global and that these diseases know no boundaries...and testaments to the intelligence and skill of the public health professionals who handle these epidemics, some of whom are friends and colleagues.

3.  The recent Disneyland measles epidemic, a sharp reminder that immunizations are
a public health triumph....and that more people should get them.

4.    Too many uninsured people (i.e. undocumented immigrants) who have difficulty accessing and paying for care...proof positive that public health still needs to protect and serve vulnerable populations.

5.  Some passionate, effective, powerful public health advocates, who are committed to speaking up and making a differnece.

And no public health list would be complete without includingthings that I hope to see in the future:

1.  The ACA solid and strong, with a King v. Burwell decision that upholds it as is, and without any Congressional repeals or actions to weaken the law.

2.  Fewer vaccine-preventable diseases, and more people who are fully immunized.  My public health friends and colleagues who do epidemics have plenty of material for their knowledge and skills without Measles, etc that could largely be avoided..

3.  More public health professionals who have been trained to advocate, who feel that moral imperative to speak up,  who make advocacy part of their personal and professional lives.

4.  Health care and coverage that are affordable and accessible for all people in our country...wherever they were born, whatever their age, whatever their needs.

5.  More people whose right to health--a right codified in international law--is fulfilled.  People who have access to clean water and safe food, people who earn enough money to stay out of poverty, people who are safe from war and violence, people who can get quality health care when needed.

Happy National Public Health Week!

Sunday, March 22, 2015

The Computer in the Room...

Recently, I was a patient.  Like many patients, I was in an exam room with...a computer. Which was meant for physicians and staff to access Electronic Medical Records (EMRs).  On one hand, I was glad that the EMR provided the history I didn't know well, and that the doctor could access it quickly.  On the other hand, I felt like the computer screen received as much, if not more, attention than I did as the actual patient in the room.

In a previous life when I interpreted, I worked with a bunch of health care providers, who had different ways of handling the computer-in-the-room.  Some managed to keep their attention on the patient while seemingly effortlessly also glancing at and typing on the computer from time to time.  Others were generally glued to the screen.  It varied.

In light of my recent patient EMR experience, I absolutely love the quote that has been floating around the Internet (Medscape article and various Tweets), courtesy of Abraham Verghese, a fantastic doctor-author.  Dr. Verghese spoke at the recent American College of Cardiology conference, and reportedly said "The EMR has nothing to do with your heart, or your patient's heart." 

Wow.  Just wow.  I happen to think this powerful quote should be framed and posted in highly visible locations (i.e. physician/staff lunchroom walls) in almost every clinic, hospital, health center, medical school, nursing school, etc.  As a reminder that the EMR is not the be all-end all of patient care.  As a reminder that the patient and provider are at the center of the health care equation, not the EMR.  
A great New York Times article began with a funny story, about a hospital's print ad, in a journal, to recruit physicians, which stated "no EMR."  This is meant to be a selling point for the hospital.  After I finished laughing, I started thinking more seriously.  Yes, I can probably think of some physicians who would prefer to practice in the world of paper, not EMRs, at a place like this hospital.   And some patients might as well.  Would I go back to pure paper as a patient?  No. The EMR does have being a great memory that reminds my doctors with alerts when it's time for certain exams and tests.  Along with this EMR, though, I want...doctors who look into my eyes rather than just looking at the monitor, doctors who listen closely to what I say rather than just scanning their notes in the EMR from previous visits, doctors who pay more attention to the patient than to the comnputer in the room.  Doctor who follow Abraham Verghese's wise advice.