Urology Associates Website II

Yesterday, I had a phone call from Jay Mercer. He's an Ottawa family physician and leader of the CMA's physician website project. He read my post about our Urology Associates website, and saw my request for ideas on what content we should include.

He had some great suggestions on how other physicians have been using the Mydoctor websites. I'll be testing these out on my practice website.

I'd like to supply information for referring physicians as well as patients. In particular, I'm interested in an online tool that will standardize referrals for common conditions and remind physicians what information and testing will be useful before their patient's visit with me.

Jay also mentioned that there is a contest next month for the most improved website. Seeing as we're starting from zero, we should have a good shot at the prize!

How about helping me out with some of your ideas... Maybe we could split the prize?

Read More......

A Tale of Two Consults

I received an interesting consult this week. It read "I think I'll let this man describe his own symptoms to you."

I sometimes get referral letters that carry brevity to the extreme: "BPH" and "ED" come to mind. One referring doc occasionally sends a one letter consult: "P". I don't know if he means "prostate problems" or "difficulty P-ing". I'm sure this brevity is meant to be witty.

But, this is the first time I've received a referral that essentially said "Surprise!"

A referral letter doesn't need to be lengthy, but it should convey a few essentials such as the nature and urgency of the problem, past medical history and pertinent test results. From this, I can decide how quickly I need to see the patient and what other tests I should be arranging for her.

In Saskatchewan, it's not unusual for someone to drive 3 or 4 hours for their consultation with me, so I try to coordinate necessary testing to take place on the same day as the office visit with me so as to spare patients extra trips. If I don't have the necessary information in the referral letter, my patients pay the price (literally).

Adequate information in a referral letter also lets me schedule a suitable appointment duration. Our usual visits are booked for 15 minutes. If I anticipate a more complex problem, I'll book from 30 to 60 minutes.

Consider another patient I saw this week. This man's family physician sent a referral letter indicating a complicated problem that had been going on for over a year. He detailed previous treatments and pertinent test results. From that letter, I could tell that 15 minutes would not be adequate, so I booked 45. At the end of the visit, the man asked me how long I usually spent doing a consultation. I explained that I would usually spend 15 minutes, but that his doctor's thorough referral letter prompted me to arrange a longer visit. He replied that this was the longest time he had spend with a doctor and seemed quite pleased not to be rushed through the visit.

He was satisfied. I was happy not to feel rushed (I hate to keep my next patients waiting). All the necessary test results were available, so I didn't have to track down results and then phone the man with my final opinion. Efficient!

Thank you to my family physician colleagues who routinely send appropriate information in their referrals. The time you spend composing that letter saves time and expense for your patient, and makes their visit with me more productive and satisfying.

Read More......

Survey results - September 17-24

8 surveys went out last week. Only 2 responses. Time for a change in plans...

Click here for survey results.

Read More......

Urology Associates Website

Our practice website is up. It's extremely bare-bones, but it's a start. We're using the "Websites for Dummies" template supplied by the Canadian Medical Association business management group, Practice Solutions. We thought it best to go with something simple rather than be stuck trying to manage a complicated website on our own.

Now we need content. What would you like to see on a physician's website?

Here are our initial thoughts:

Office hours

Location and driving directions with links to a map

Information about common procedures (for us, cystoscopy and vasectomy)

Physicians' names and brief bios

Any suggestions?

Read More......

Tech notes II

This is for the real gadget freaks!

I've got comment moderation enabled on the blog. Translation: If you leave a comment (please do!) after any of the posts, Blogger emails it to me and I have to OK it being published. I wanted this option so as to delete unwanted spam and inappropriate language (you know who you are, potty-mouths).

Previously, I would get the email on my PDA (Palm Treo 650) while I was out and about. I then had to find Internet access in order to allow the comment to be posted. But today, I had a minor breakthrough!

The Treo 650 has an Internet browser called Blazer. I haven't used it much as it always seemed very slow. I got an email today about a comment under "1-800-How's my doctoring?". Clicking on the "Publish it" link in the email took me to the Blogger log-in page where I can access this blog and authorize the comment. Sweet!

I've already experimented with "mobile" posting directly from my PDA but this "discovery" makes the whole works mobile. Not impressed? Well, you were warned - this was for gadget freaks only!

Read More......

Welcome HQC-ers!

I shamelessly plugged Plain Brown Wrapper in my Advanced Access blog. If you surfed over from Health Quality Council, welcome! I hope you'll poke around a bit. I started up PBW to support my patient satisfaction survey project (see below), but I found that blogging is mildly addictive.

I'll still be reporting our progress with Advanced Access on the HQC blog, but I wanted to explore some other areas and try other schemes. I'm grateful for all of you who are loyal readers about Advanced Access, and I'd like to tap your experience and expertise in this blog. Please leave comments and suggestions after any posts that catch your interest.

Read More......

RateMDs: Saint or Satan?

Physicians who know about RateMDs are rarely neutral about it. Physicians who don't know about RateMDs... well, watch out, docs!

RateMDs is an online information exchange where anyone can anonymously post comments about a (North American) physician. There are similar sites for rating lawyers, high school teachers, university profs, etc.

RateMDs sparked my online patient satisfaction survey. Here's why:


Physician rating sites have existed as long as there have been physicians. These sites used to be called coffee row, the backyard fence, and your cousin's friend who knows someone who knows someone. The information was there, but was informal and relatively inaccessible unless you were "connected". Now, the Internet makes everyone connected, and they're sharing information.

Browse through RateMDs (c'mon, you know you want to), and you'll see why some physicians are upset about being rated. There are some pretty frank comments. Some may be accurate and deserved. Others may be vindictive and slanderous. We have no way of knowing. Perhaps looking at the pattern of comments gives a reliable picture of each physician's demeanor. I'd like to think so, but comments and ratings for individual physicians vary quite widely in some cases. One person with a vendetta could leave multiple posts slagging the doc. A physician could salt his own page with glowing praise.

There are weaknesses with the RateMDs model, but the idea is here to stay. I think we should embrace the idea, improve the model and turn it to the benefit of our patients. After all, what physician doesn't want honest, frank feedback on his or her performance?

Ha, ha! Of course, I'm being facetious! I'm a lot more comfortable not hearing about my weaknesses and bad habits, and I'm sure many other physicians feel the same way. If I know my performance is substandard, the logical and professional response is: try to improve. And that means... Change! Before physicians decide to ask for feedback from our patients, we need to commit to making the changes that the responses suggest.

I want to solicit patients' opinions about my performance, but I also want to draw on their experience and insight to make constructive suggestions on how I can improve. To that end, I made my own post (April 17, 2007) on RateMDs encouraging people to comment on how I can improve my medical practice.

As you see on my RateMDs page, there haven't been many responses to that request. As such, I decided to start my own personal rating service. I'm requesting patients to take a web-based survey about their experience in my office. In the spirit of openness, I'll post a link to the survey responses on my blog.

How can you be sure that I haven't polished up or even completely faked the survey results? Right now, you can't. But, I welcome any suggestions on how I could set this up so I can't be accused of fabricating results. (At the moment, I feel I need to review the responses before posting them just in case a patient has included private personal or medical information that should not become public knowledge.)


Any suggestions?

Read More......

Survey results - September 10-14

Survey says...

10 surveys went out on last Tuesday and Wednesday. 3 responses back. Here's the link to see the results.

I was hoping for a 50% response. I'll try more surveys tomorrow and Thursday.

FYI: At question 3, if the patient answers that the appointment was made by the specialist (me) as a scheduled recall visit, then the survey skips question 4 about how long they had to wait for the appointment.

Read More......

Tech notes I

I don't like having to scroll through yards of posts to find one of interest. I prefer the expand/collapse ("read more...") buttons found on many blogs.

I discovered that Blogger doesn't have that function, so I've tried adding a hack to the template. Thanks to Hackosphere.

Hope I don't pay the price for messing around with HTML that I don't understand.

Read More......

Sneak Peek

I sneaked a peek at the survey results: 3 responses! (10 surveys went out)

The survey stays open until early next week. I'll post the results after that.

Read More......

"Sorry about this slide"

I went to a great Grand Rounds presentation this morning. Controversial topic, good discussion, lots of ideas for further investigation. Only one thing marred it for me - the Powerpoint Phrase of Doom:

"Sorry about this slide."

PPD is usually followed by "This slide is a little busy" or "I know this doesn't show up well". Here's what you are really saying with PPD:

I understand the principles of appropriate construction of audiovisual aids.

I realize that this slide does not satisfy those principles.

I couldn't be bothered to redesign this slide to make it more valuable to you, my audience.

The old 35mm acetate slides were expensive and time-consuming to create. Audiences were more accepting of poorly-designed slides, understanding that you couldn't just whip up a new one at a moment's notice.

Powerpoint changes that. Presenters have complete control of slide layout and can edit right up to the moment the presentation starts (and even on the fly during the presentation). Too much information for one slide? No problem - break it up into 2 slides. Or 5. Digital is free!

Presentation Zen is a great resource for all things Powerpoint.

Friends don't let friends use PPD.

Read More......

Plays well with others (?)

Had an interesting conversation with an OR nurse earlier this week. She was upset about something that had happened in the theatre she was working in. (Not my theatre, but it easily could have been.) In addition to the planned major surgery, the patient unexpectedly required an additional minor procedure done that was within the general ability of the surgeon, but not within his area of expertise. When that additional procedure didn't seem to be going well (and eventually required calling in another surgeon), she was at a loss over how to suggest that the attempts be stopped and the other surgeon be called in sooner. There was some minor injury from the attempts, but that should heal without ill effect.

So, why couldn't she just speak up and voice her concern for the safety of the patient?

It's because the OR culture won out.

There is a definite hierarchy in health care generally, but it is very rigid in the operating room. From the top down: Doctor (surgeon slightly edges out anaesthetist), nurse, patient. Orders flow one direction. Suggestions coming up the other way are not always well-received. The nurse didn't feel safe in making a comment because she was afraid of being verbally abused in return.

Sometimes, the surgeon needs to overrule everyone else, based on his/her training, experience and ultimate responsibility for the patient's outcome. But there are many times where other OR staff's judgement and experience make them aware of risks to patient safety. If they are afraid to speak up, patients suffer harm. The silent staff will be upset and feel guilty that they didn't advocate on behalf of their patient.

Solutions?

Educate OR staff (?role-playing, ?simulations) how to tactfully (yet firmly) express a safety concern to the surgeon

Convince surgeons that their patients may have a better outcome if everyone on the OR team is welcomed as an active participant in patient safety and quality improvement initiatives

Let all the crotchety old surgeons retire and train the new ones to play well with others

Any suggestions?

Read More......

Getting started

The first survey forms are going out this afternoon. We'll give out 5 today and 5 tomorrow. They're a test run to see if anyone responds. The surveys we're using for our Advanced Access project are a paper-based survey and we ask patients to complete them before they leave the office. Our response rate is pretty close to 100%. Let's see how it goes for these internet-based surveys.

Here's the text of the survey:

How was your visit with us?

Thank you for taking the time to complete this Internet survey. It should take about 5 minutes.

I want my patients to have the best experience possible at my office. I hope to improve by finding out about your experience.

Enter this address into your internet browser: http://kishorevis.blogspot.com/

You'll find the link to survey in the upper right corner of the web page ("Plain Brown Wrapper" blog)

This survey is: Week of XXXX

After you click to start the survey, you'll be asked for a password.

The password is : XXXXXXX

This password is to ensure that people who visited me this week will complete the correct survey. It will not identify you personally.

If you have trouble completing the survey, please leave a message on the web page.

Thanks again.

Kishore Visvanathan, MD
306-653-3255

I may need to tweak this to improve responses, but I wanted to get the project started and make changes on the fly. (PDSA for you Quality Improvement wonks!)

Anyone have any suggestions on how to improve this letter?

Read More......

1-800-How's my doctoring?

Am I doing my work well? Are my patients satisfied with the service I provide? I've been practicing urology for 15 years with no formal feedback on my performance. Like anyone, I appreciate a pat on the back or kind word for a job well done, but I'd also like to hear about the areas I can improve on.

My interest in surveying patients started with another project we have underway in my office. In our urology practice, my partners and I wanted to shorten our appointment waiting times. Click here to find out about our "Advanced Access" project. (The story starts at the bottom of the page.)

An important part of the Advanced Access project is getting feedback from our patients. We currently use the same survey that I'll be using here, but the results are pooled. That is, we don't record which physician got which responses. I want to measure my own personal results.

I also want to share my results and that's why I've started this blog. Once the first week's results are collected, I'll post a link to make them available to you.

Why share the results? I'll have more to say about this in future posts, but if you are familiar with RateMDs, you already have an idea of what the future holds for physicians regarding feedback on performance.

I'm a little nervous about how this is going to work. It's an experiment in openness and collaboration. I have no control over how my patients respond to the survey. If the results make me uncomfortable, my only recourse will be to decide not to share them. Let's see how brave I'll be.

It's also the first time I've used web-based software this extensively. The first week will be a test to see if everything works properly. If you have problems with the patient survey, please post a comment on this blog and I'll try to fix it.

Wish me luck!

Read More......