Month: January 2010

New patients— Are you prepared for your visit? What does your physician want to know ? What should you ask?

I’m really looking forward to the moment in the future when the only part of this advice includes the questions and not to bring hard copies of your medical history.

jayparkinsonmd:

hjluks:

Physicians are under pressure to see patients in a timely,  effective, and efficient manner. Take a little time, organize your thoughts, come prepared and your visit could be much more productive.

What to bring:

  • Pad and pen… you will likely receive recommendations and many patients forget them as soon as they leave the office.
  • A list of your medical problems
  • A list of your medications
  • A list of your prior surgeries
  • A copy of pertinent studies (MRI, X-ray, etc)
  • A copy of pertinent medical records (valuable for second opinions).

Dress appropriately.  The physician will need to see the area of concern.

Organize your thoughts:  A new orthopedic history will include…

  • When did the problem start?
  • What were you doing?
  • Have you started taking any new medications?
  • Have you changed your exercise program?
  • What makes the pain worse?
  • What makes the pain better?
  • Do you have pain at night?
  • Does it awaken you?
  • Any numbness, tingling or weakness?
  • Any morning stiffness?
  • Pain getting up from a seated position?
  • Pain walking on hills?
  • Shoulder patients consider what motion causes your symptoms.
  • Do you have any mechanical symptoms (catching, locking, clicking, etc)?
  • Do you have any instability (does the joint feel loose)?
  • Do you have any swelling?
  • How does the pain affect your quality of life?
  • What have you tried so far to obtain relief (physical therapy, injections, medications, exercise, etc)?

After the exam and discussion of the findings, your doctor will likely present you with alternatives….some thoughts you should have.

  • What are the possible diagnoses?
  • Is further testing necessary (If the test will not change the plan of care, then it is possible that you do not require further tests)?
  • Is an MRI or expensive imaging necessary (many times it is not)?
  • What are the non-surgical, surgical alternatives available to treat my condition?
  • What are the possible risks, side effects of the treatment?
  • What will happen if I choose not to have surgery?
  • What does the literature or research recommend (many physicians still practice based on anecdotal experience [which might be appropriate, depending on the situation])

Specific considerations for surgical patients.

  • What are reasonably forseeable risks of the surgical procedure?
  • What are the realistic goals of the procedure (relief of pain, functional improvement, etc)?
  • What is my “expected recovery time (recovery means different things to different people… be VERY CLEAR about your goals)
  • When can I use my arm/leg?
  • When can I l use my arm/leg for activities of daily living?
  • When can I use my arm/leg against resistance (lifting objects or putting weight on your leg)?
  • When can I drive?
  • Do you know what I do for a living? When can I return to work?

Hopefully this will help you on your next visit….

of course you understand that this does not constitute medical advice and you should only use this as a guide to improve your preparation for a visit to an orthopedic surgeon or any physician for that matter.

We’ve had the same basic design for tray tables for 40 to 50 years. It doesn’t work. The table is not easily moved. There are questions of control, clutter and contamination. And a huge problem revolves around who ‘owns’ the table at any particular time of the day.

In the early morning, the attending nurse ‘owns’ the table, using it for medicine or treatment devices necessary at that time. Then, food service ‘owns’ the table for placement of the meal. Later, the patient ‘owns’ the table for personal items.

It’s a back and forth all day long. There’s a meal and then there’s a urinal on the table. I always liken the hospital tray table to the ‘table’ you have when a passenger on an airplane. If the meal tray is still there, and you’re done with the meal on the airplane, you’re cramped. You need that space. It’s annoying. And just like the airplane experience, we are forced to tolerate the hospital tray-table experience. We need something better.

Charles Puchta, director of the Center for Aging with Dignity in UC’s College of Nursing, on a hospital tray redesign being undertaken by University of Cincinnati design students.  Love this stuff.

Resolve to Fail

I’ve long been a fan of the Tom Peters mantra “fail faster."  It points out that those who fail more often are apt to try more stuff and if you try more stuff you’re likely to find more success.

But I’ve struggled with its healthcare applicability.  We don’t need more failure in healthcare, we need less (e.g., the IHI’s 5 Million Lives Campaign).  In fact, we need perfection.

Still healthcare moves slow.  There aren’t enough people out there trying new stuff and I think that’s because people are afraid of making decisions because they’re afraid of the failure.  Failure is bad place in the healthcare psyche.

Perfection is fast becoming the necessity of quality healthcare.  As paradoxical as this may be, the only way we’re getting there is if we resolve to fail more often.  Not on the patient outcome side, but on the process ("how we get to those best outcomes”) side.  To become perfect we need to try more stuff.  If it works keep doing it; if not, by all means hit the brakes.  Look at the success of the checklist or the time out.  But how many things were tried before reaching those tools?  I’m guessing quite a few, the least of which was a reliance upon humans alone to not make mistakes.  That clearly didn’t work so someone tried something else.

I’m convinced the only path to perfection includes a whole lot of failure.

Seth wrote of Tim Burton’s success last week.  An interesting note about the projects that Tim has worked on: many of them failed.

Tim got his ideas out the door, to the people who decided what to do with them. And more often than not, they shot down his ideas. That’s okay. He shipped.

More stuff tried = more failure = more forward motion.  Jen wrote:

If I haven’t failed at at least 1 of my current projects per quarter I’m not pushing myself enough. It’s not easy to admit, but I’ll keep failing to keep learning how to be happy and fulfilled and ‘successful.’

Eric Karjaluoto on failure, or the lack thereof; it’s a fact of life:

We’re taught our whole lives to avoid failure, with the exception of a few business writers who will wax poetic about learning more from failure than success. While the latter is a little bright eyed, the former is simply unrealistic. Everything fails, and mostly in “less than profound” ways. Look around you; everything you see will at some point fail. It’s just a matter of time. Your toaster, your razor, your computer, your electric company, your government, perhaps even your planet: things break all around us.

Stop running from failure.  In fact, resolve to fail.  It’s progress.

Molasses-like progress

Communication, or the lack there of, is a big problem in healthcare organizations.  The multi-disciplinary nature of healthcare delivery is largely responsible for that.  We need input from everyone to make decisions.

That’s also why change can seem so slow (Rather, that is why change is so slow).  So instead of trying to include everyone, should we just include those who are necessary?

This is a difficult conundrum.  I’ve long been an advocate of lots of communication.  The effectiveness of that communication is the important measure, however, not the volume.

An article by Joel Spolsky on Inc. explains the perils of too much communication: molasses-like progress.

That’s Rep. Carol Shea-Porter from New Hampshire.  She says:

We go to the ladies room—the Republican women and the Democratic women—and we just roll our eyes at what’s being said out there. And a Republican woman said while we were fighting over the health-care bill, ‘If we sent the men home, we could get this done this weekend.

She’s probably right.