What's wrong with this picture? - VI part II

O.K. Maybe I'm going overboard with this drippy-hands thing, but here it is again.



This cutlery has been washed and laid out to dry right underneath the paper-towel dispenser! I know I dripped all over them when I grabbed some towel.

This is in the kitchen of the OR lounge. Yes, the Operating Room, where they're supposed to know a little something about contamination, proper handling technique, etc. Sheesh!

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What's wrong with this picture? - VI

Can you spot it?



Well, yuck. Someone's left their drinks under the paper towel dispenser!

Which is fine if you don't mind someone dripping soapy water, hair and general effluvia into your cola. I know I'm trying to cut down on effluvia.



On the ward, I notice that boxes of exam gloves are often left next to the sink, under the towel dispenser. Nothing says "I love you" better than a box of dripping wet plastic gloves.

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Advanced Access in Qreview

HQC Qreview newsletter has an article about our Advanced Access project.

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My Compliments

You remember what I think about RateMDs, right? I hadn't checked my listing for a while, so I took a look recently. Two comments from November made me cringe.

They aren't negative comments . In fact, they're downright flattering. Yet, they make me uncomfortable.

Please don't think this is false modesty. I appreciate a genuine compliment as much as anyone. I want to do a good job for my patients and I enjoy hearing that they've had a positive experience.

But, I live with myself all day and I'm aware of all the times when I don't do a good job. Being impatient with someone's questions (see comment 1/9/07), taking too long to return phone calls... it's a long list. Maybe it's perverse, but compliments often highlight those failings. (Or should I call them "opportunities for improvement"?)

But, hey, if you're planning to compliment me, don't worry that I'll be upset. Just go ahead and flatter me. I'll deal with it.

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EHR? ASAP!

Canada Health Infoway promoted electronic health records (EHR) in the Globe and Mail this weekend (online here). CEO Richard Alvarez says Canadians should "demand" EHRs. If the public only knew how ridiculously wasteful the current system is, "demand" would be putting it lightly.

I've explored the concept of muda in my Advanced Access blog, but here's some examples of wasted time, energy and money from one day in my practice.

7 a.m. hospital rounds: 4 patients to discharge after prostate surgery. Same instructions written out manually on 4 charts. An electronic system would allow routine orders to be bundled together and added to a patient's digital chart with a single mouse click. (Please let me log into this system with a fingerprint or retinal scan. Don't make me go through password purgatory!)

A man with blood in his urine needs a kidney ultrasound. I fill out the requisition and indicate the clinical problem. Hope the radiologist can read my handwriting. Once again, common tasks should be automated.

8 a.m. Seeing a man with a kidney stone. He had an X-ray done yesterday in his home town, 1.5 hours away. I have a verbal report, but his doctor didn't send the films so I can't review the study myself. Our new PACS (on-line X-ray storage system) went live last week, so I can access any films done in Saskatoon, but it doesn't give province-wide access yet. I have to repeat the X-ray in order to make a diagnosis and recommend treatment. Muda tally: Waste of his time, my time, X-ray technologist's time, extra dose of X-rays and cost to the taxpayer.

10 a.m. Elderly man referred to see me because he's having difficulty passing his urine. Family doctor's letter is, shall we say, brief. No indication of other medical history, medications, allergies or results of previous tests. I ask about his medications. He's on a blue pill and a little white one. No idea what the names are. Helpfully, he says that his doctor should have a record of all his pills. No doubt his doctor does. A universal EHR would mean I could access all his history, medications and test results instantly, saving time and reducing chance for mistakes or faulty memory.

11 a.m Review lab results received today. We use an electronic medical record program in our office. (It's basic, but is a huge improvement over hunting through paper charts.) Our health region's lab has its results in electronic form. Sounds like a match made in heaven, huh? Hey, Lab, why don't you just electronic those results right over to us?

Well, they can't. Actually, they can, because they do it for other doctors' offices in our region, but they can't do it for us. I've asked several times and the reason seems to be that they don't have the proper (insert random, unconvincing technobabble here) for our program and we'll just have to wait our turn to get connected. It's been about 2 years now.

In the meantime, they fax us the results and we scan them into our system. It's a crazy Rube Goldberg machine. Not only does this waste my staff's time, there's a huge opportunity cost. Because the lab results only exist in our system as scanned pictures, the system doesn't really "know" what the results are. We can't follow results (such as PSA levels) over time without having to manually enter every single result. We can't search for abnormal results. We could be doing so much more with this information.

These examples are just about shuffling data around. That's peanuts! An EHR could harness computer-assisted decision-making, show current evidence-based best practice, alert me to medication interactions, help patients be more informed and involved in their care, the list goes on...

I want my EHR!

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Yummy dessert or frat prank?

It's holiday potluck time in the X-ray department! Everyone sign up to bring their favorite dish.



Umm, Shelley, I'm going to pass on the pumpkin dump. It looks delicious, but my doctor told me not to eat anything that sounds like a trick you play on the groom after he passes out at his stag party.

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Cherry-picker or visionary?

Is Jay Parkinson at the leading edge of innovative medical care? Or is he a cherry-picking, cream-skimming squeegee-doc? Whatever your opinion, it's fascinating to see the media attention around this newly-minted doctor's unorthodox practice model.

First, visit Dr. Parkinson's website. Even if you find yourself skeptical about his practice model, you have to agree that the website design absolutely nails it. It's uncluttered, engaging and absolutely true-to-brand.

While you're there, check out "The News". This story went viral when Dr. Parkinson started his practice in September. The Wired article is a nice, brief summary. The Chicago Tribune has an interview with the doctor, but the comments posted afterward are very interesting. Dr. P gets into a posting slap-fight with some other docs. Nasty. (I liked it!)

An interview on HIStalk summarizes his business plan.

Dr. Parkinson restricts his practice to 18-40 year-olds - a notoriously healthy age group, no matter his protestations that they do get ill. He also plans not to perform pelvic exams, no doubt for medicolegal reasons. (Difficult to carry a female chaperone with him as he zips around New York on his scooter.)

But, wouldn't a full assessment of a young female with lower abdominal pain usually include a pelvic exam? Perhaps patients need to be pre-screened to see if they fall into his preferred pathology-demographic as well as his preferred age range. (He also talks about practicing preventative medicine. Umm, Pap smear, anyone?)

The media has made much of how radical a departure Dr. Parkinson's practice is from mainstream medicine. The problem with his idea is this: It's not radical enough!

There's nothing new here. Same day appointments? Advanced Access/Clinical office redesign. Email your doctor? Hardly ground-breaking. Housecalls? Come on.

Dr. Parkinson, your plan is too generic, too easy to copy. What distinguishes you from any other Tom, Dick or Sally (yes, Sally - Pelvic Exams R Us!) who wants to give it a shot? If it is a viable scheme, then copy-cats will be popping up like weeds. New York's streets will be thick with Vespa-mounted Docs-in-a-Box, racing each other up high-rise stairs, desperate to over-service the worried well.

In business, imitation is the sincerest form of bankruptcy.

As Tom Peters would say: Re-imagine, Dr. Parkinson, re-imagine!

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