Samantha Graves-Brownell’s Post

Micro behaviors impact: "In the group in which the doctor sat to converse, patient satisfaction was significantly higher, with an overall difference of 3.9% (P = .02). Patients felt that the information provided was better (72% vs 52%; P =.03), and their confidence in the proposed care was also higher (58% vs 35%; P = .01). On the other hand, no significant difference appeared between the two groups regarding the information retained by the patient (doctor's name and reason for hospitalization) or the doctor's behavior."

This ninth edition of the Textbook of Family Medicine, edited by Drs. Robert E. Rakel and David P. Rakel, remains your #1 choice for complete guidance on the principles of family medicine, primary care in the community, and all aspects of clinical practice. Ideal for both residents and practicing physicians, this medical reference book includes evidence-based, practical information to optimize patient care and prepare you for the ABFM exam. A clean, quick-reference layout makes it easy for you to put information to work immediately in your practice. Key Features Gain a new understanding of the patient-centered medical home and how to achieve this status in outpatient clinics. Make the most effective care decisions with help from "Evidence vs. Harm" icons that guide you through key treatments of common medical conditions. Take advantage of today's most useful online resources with a convenient list of outstanding clinical websites. Quickly spot "Best Evidence Recommendations" with special boxes located throughout the text, and glean helpful tips on diagnosis and therapy from "Key Points" boxes found on every page.For orders and offers please contact us at office@booksen.ro or 0739110120.

Several of the rated physician groups that supply anesthesia, radiology, emergency medicine, or other physician services at hospitals are experiencing challenges including wage inflation for physicians, reimbursement pressure from government payors, only tepid reimbursement increases from commercial insurers, and in some instances, collection challenges for out-of-network claims due to the No Surprises Act (NSA). Read our full report here: https://okt.to/feCakx

Implemented our first insitu sim today on our QI project of delirium identification and management by healthcare staff. It was a unique experience blending approaches used for theatre based sim with insitu simulation and included aspects of ongoing inservicing education. Thankful to our dementia and geriatric advanced practice nurses for collaborating with me on this and being present for the debrief as content experts. Key takeaways for the healthcare staff: ➡️Recognize new onset confusion even in the context of dementia or cognitive diseases. ➡️Complete a confusion assessment method tool for new onset delirium before communicating with MD ➡️Use of SBAR report ➡️Use of the delirium order set by MDs to ensure proper investigation of causes. 3 more simulations to complete over the next 2 months, then we will pull metrics from our EMR to assess for translation of knowledge and skills around delirium identification & management and compare to the baseline. We hope to have a positive effect on patient care.

In the quiet of the clinic where peace should reign Lurks a beast that drives physicians insane.  An inbox towering, a hairy ape so sly Peering over shoulders with a watchful eye. It starts each morning with a digital roar,  Messages pouring in, more and more.  A flood of tasks, never-ending, so grim,  The ape grins wide, in the shadow it’s dim. Doctors chart and scribble, their minds in a race,  Yet the ape won’t vanish, keeping a stern face.  A reminder of duties, of endless alerts, Of patients in need, and bureaucratic hurts. With every click and tap, the ape seems to swell,  A constant companion in this electronic hell. But the day arrived when the struggle did cease,  The doctor found solace and a sense of peace.  By using the Four D's, the ape did dissolve. Using David Allen’s method, the problem was solved. Delete the needless, Delegate to share the load, Defer for later, Do what's owed. --------------------------- The Take: Consider applying these 4 D’s from David Allen’s Getting Things Done methodology to managing your EHR message box. · Do It – if it’s a task that can be completed in two minutes or less, then just knock it out. · Delete It – not all messages need a response. Lose the guilt and embrace the glee of the magical delete key. Also, setup auto-delete option on your EHR messages that removes them once you’ve replied or forwarded them. · Defer It –for tasks you need to do yourself but would take longer than 2 minutes, either you need more information to take action or that significant medical decision-making is required. Either forward the message to your staff to gather that information or book the person an appointment to afford you that protected time. · Delegate It – if it’s a task that doesn’t require an MD or DO degree to perform, forward the message with simple instructions to your staff. ---------------------------- Recommendations for going deeper: 1. David Allen's method - https://lnkd.in/gakSanyN 2. David Allen's 4Ds broken down - https://lnkd.in/gxcryv-W ---------------------------- Poem written with assistance of AI. Any resemblance to actual persons is not intended. Resemblance to most physicians’ struggles is whole-heartedly intended. Part of the Doc Quicktake (DQT) series, articles readable in 3min or less for the busy professional to stimulate thought and growth.

I believe this article is really lacking something essential - and that would be the downsides of this method - such as labs not getting read or if there is mistake in the first generation of team notes these mistakes get passed down. As for myself providers at Swedish Medical Center in Seattle repeatedly relied on pass-downs rather than look up information on their computers. A positive result for staph was not noted by any providers for five weeks. An attempt to be admitted into the ER for a second time was denied because "all labs looked good" - well the wound culture had been resulted since the first visit - thus all labs no longer looked good. Five weeks later I had Sepsis and Osteomyelitis and faced an amputation because nearly a dozen providers relying on this pass-down system had not read my labs. All through the medical record I could see how providers had not bothered to look up the simplest of information - such as what I had been prescribed - they often just guessed. I nearly died because of this aversion to reading labs, charts, and notes. A doctor had written that the patient "hasn't taken any antibiotics yet" (because they weren't prescribed) and the next doctor rendered this as "he doesn't take his antibiotics") Though I clearly could not be non-compliant with medication that had not been prescribed this falsehood nevertheless was then written again and again in my chart (unbeknownst to me.) Anyhow - regardless of my experiences - the downsides of adopting team-notes should be discussed. There are reasons why hospitals should hesitate to implement such a method or at least have providers review critical labs each and every time they see a patient. Certainly more work was added in my case - the work necessary to chop off part of my foot due to the hospital's complete and utter negligence in needing to save some time. We need a diagnosis. We should be informed of our lab results and not the opposite of the results (such as "all labs looked good" when they didn't.) Nurses did not even seem to be aware of my discharge instructions. I point to those instructions and say they told me to wash this wound every day with soap and water - yet the nurse still says - in a pedantic note "oh I don't think we would have told you to do that." Clearly not believing me and also clearly not having read the progress notes instructing me to do just that.

The following professional standard was approved by the College’s governing Council composed of physicians and public members: Professional Standards Regarding the Responsibility for Post-Surgical Care. https://lnkd.in/eh_Djmtp The standard was developed in response to requests from physicians for the need for clear guidance regarding responsibilities concerning post-surgical care. The standard acknowledges the importance of clear communication as follows: The delivery of post-surgical care must put the needs of the patient first. Furthermore, the responsibility for post-operative care of patients must be clear to the patient and the medical team. It has long been a source of tension and uncertainty within medicine, generating friction between physicians performing an operation or procedure, primary care providers, and emergency departments. As a result of uncertainty and inconsistent practice, patients are often confused as to who is responsible for their post-operative care.

💥GPs in England have initiated a work-to-rule action, capping the number of patients they are willing to see due to a dispute over funding levels💥 The British Medical Association (BMA) has advised its members to limit appointments to 25 per day, although some GPs typically see over 40 patients. This action could have several implications: ⌚Patient Access and Wait Times: By restricting appointments, patients may face longer wait times and increased pressure on emergency services. A&E departments could experience higher demand and patient discharges from hospitals might slow down. ✉️Referrals and Planned Treatments: The work-to-rule action could disrupt referrals into hospitals for planned treatments (such as hip and knee operations). Guidelines on rationing treatments may also be ignored, affecting patients in need. ☎️Communication Challenges: Patients may struggle to access GPs, especially if proactive communication isn’t provided. Uncertainty about whether a surgery is open could deter people from seeking help. 👩⚕️GP Practices Under Strain: The BMA suggests various actions for GPs, including limiting patient numbers. However, the situation remains complex, as only a third of GPs are BMA members eligible to vote. In summary, while the work-to-rule action doesn’t formally count as industrial action, it highlights the challenges faced by GPs and their patients Hannah Alban Misha Shah Jo Berry Joe O’Gorman Nicola Medici Jenny Panes https://lnkd.in/eJ4cHzvR

Happy Monday! During my hospital shift yesterday, one of my coworkers shared an article with me that had been published in The New Yorker a month ago. The article discusses ECMO (Extracorporeal Membrane Oxygenation) and its impact on healthcare. Having spent most of my nursing career in critical care, I've become very familiar with this treatment. I've seen patients cannulated with ECMO during cardiac arrests and worked with those who survived COVID-19 because of it. While some patients make miraculous recoveries, others remain in limbo. When managed properly and combined with other modalities, this treatment can sustain life for an extended period of time, which brings me to question its ethical implications. As healthcare providers in the US, we often push the envelope a bit too far. However, it's also how groundbreaking treatments like ECMO are developed. Over the years, I've witnessed how much we can push medical boundaries. Although I fully support medical advancements, they should never compromise quality of life for quantity. Many patients do not have the opportunity to make an educated choice when it comes to this type of treatment because they can never understand what life looks like tethered to a machine without any real possibility of recovery until they experience it firsthand. The link to the article is in my comments. I would love to hear your thoughts on this issue. #icunurse #lnc #trialattorney #medicalmalpractice #patientadvocacy #ethics

Hospital leaders: how can you support aging physicians and protect patient safety? Lessons from 29 institutional leaders on late-career practitioner policies in my new study with colleagues from Univ of Washington & Harvard Med. https://lnkd.in/g_xX33Dt