Showing posts with label Doctor-Patient Relationship. Show all posts
Showing posts with label Doctor-Patient Relationship. Show all posts

Friday, May 27, 2011

More primary care tied to lower death rates | Reuters

Seniors living in areas with more primary care have slightly lower death rates and are less likely to end up in the hospital with a preventable disease, U.S. researchers have found.

In contrast to some earlier studies, which have yielded mixed results, the new work looked at how much primary care was actually delivered to patients -- not just how many primary care physicians were in a certain area.

"The magic is not in how many primary care physicians there are, it is what they do," said Dr. Barbara Starfield of the Primary Care Policy Center at Johns Hopkins University in Baltimore, who was not involved in the study.

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Tuesday, May 24, 2011

Airlines Rely on Traveling Doctors to Answer Emergency Calls - NYTimes.com

Dr. Matthew Rhoa is still haunted by one of his lowest moments as a physician. Several years ago, on the first leg of an international flight, he was just settling in for a nap when a flight attendant came on the public address system to ask, “Is there a doctor on the plane?”

Dr. Rhoa, who lives in San Francisco, didn’t push his call button. “As a gynecologist, I always waited for another doctor,” he said. “There’s never a need for a Pap smear at 30,000 feet.”

He fell asleep, only to be awakened an hour later by a second call for medical help. This time he answered, and at the back of the plane he found two anxious parents with their 18-month-old toddler, who had a cast on her broken leg and was crying inconsolably.

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Sunday, May 1, 2011

What Nurses Wish You Knew - Philadelphia Magazine - phillymag.com

No matter what health-care reform winds up looking like, one thing’s certain: Nurses will play a bigger role than ever, taking over duties from doctors, moving out of hospitals and into the community, looking after frail aging boomers, leading the push to keep costs down and improve outcomes. So this seemed the perfect time for a consult with the people who really run health care in Philadelphia. As one nurse told us, “Doctors only think they’re the quarterbacks.” Here’s what nurses had to say about their work, their patients, life and death, and those little white caps they used to wear.

1 // It’s okay to buzz // Really. Go ahead. Room too cold? Need a pillow? Got a question about your meds? Use the buzzer; that’s why they put it there. “My 82-year-old mother was just in the hospital for a stroke,” says Presbyterian Hospital’s Michael Becker, “and she said, ‘I can only hit the buzzer two times a day.’ I asked, ‘Why is that?’ and she said, ‘Because they’re going to get tired of seeing me.’ I said, “No, no, Mom, it doesn’t work that way.’” If somebody’s pushing the buzzer all the time, nurses know there’s a deeper issue and work to address it.

2 // You don’t have to be afraid // Nurses understand that patients often don’t speak up because they feel vulnerable. But when we don’t voice our thoughts, they have no way of knowing what needs improvement—until the patient-satisfaction survey arrives after the fact. And they hate finding out there was something they could have fixed if they’d known about it. “It’s natural to be fearful,” says Pennsylvania Hospital’s Mary Del Guidice, “because you’re lying in bed with all these faces looking down at you. But don’t be afraid of us.”

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Saturday, April 2, 2011

More Physicians Say No to Endless Workdays - NYTimes.com

Even as a girl, Dr. Kate Dewar seemed destined to inherit the small-town medical practice of her grandfather and father. At 4, she could explain how to insert a pulmonary catheter. At 12, she could suture a gash. And when she entered medical school, she and her father talked eagerly about practicing together.

But when she finishes residency this summer, Dr. Dewar, 31, will not be going home. Instead, she will take a job as a salaried emergency room doctor at a hospital in Elmira, N.Y., two hours away. An important reason is that she prefers the fast pace and interesting puzzles of emergency medicine, but another reason is that on Feb. 7 she gave birth to twins, and she cannot imagine raising them while working as hard as her father did.

“My father tried really hard to get home, but work always got in the way,” Dr. Dewar said. “Even on Christmas morning, we would have to wait to open our presents until Dad was done rounding at the hospital.”

Dr. Dewar’s change of heart demonstrates the significant changes in American medicine that are transforming the way patients get care.

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Wednesday, March 2, 2011

How patients and doctors can improve the primary care office visit

Consumer Reports recently released a survey of both patients and primary care doctors, regarding their perceptions of each other.

Some interesting findings, as summarized by the WSJ’s Health Blog:

On the issue of respect and appreciation, 70% of doctors said they were getting less of it from patients than when they started practicing. For patients, meantime, the more they reported being treated respectfully and listened to, the more satisfied they were with their physician.

Respect matters. Treating health professionals in a courteous manner definitely helps when receiving medical care. On the flip side, physicians also need to respect patents, as it positively impacts patient satisfaction.  Both parties need to improve in this area.

Doctors said insurance paperwork topped their list of things that interfere with their ability to provide the best possible care. Financial pressure was No. 2.

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Monday, February 28, 2011

The internet gives patients and caregivers access not only to information, but also to each other. | Pew Internet & American Life Project

Many Americans turn to friends and family for support and advice when they have a health problem. This report shows how people’s networks are expanding to include online peers, particularly in the crucible of rare disease. Health professionals remain the central source of information for most Americans, but "peer-to-peer healthcare" is a significant supplement.

This report is based in part on a national telephone survey of 3,001 adults which captures an estimate of how widespread this activity is in the U.S. All numerical data included in the report is based on the telephone survey. The other part of the analysis is based on an online survey of 2,156 members of the National Organization for Rare Disorders (NORD) who wrote short essays about their use of the internet in caring for themselves or for their loved ones.

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Clinical Nursing Case Studies on: The Nurse Friendly

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Editors Note: The urls to these cases are Permanent and Will Not Change. Feel free to link to any case you feel is helpful. We've been contacted by several schools who are using them as assignments for their nursing students, feel free to do the same. To host any of our cases on your website or reproduce them in your publications, please contact Andrew Lopez, RN.

Each case will be reviewed and supplemented with clinical and legal resources from the web. Legal Nurse Consultants and Nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material. If you have related materials and would like us to link to or use them as resources, kindly contact us.

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Current Case:

Physician Dismisses Nursing Assessments, Question of Nursing Advocacy.
Rowe v. Sisters of Pallottine Missionary Society, 2001 WL 1585453 S.E.2e – WV
Summary: The patient was involved in a motorcycle accident in which his bike fell onto and injured his left leg. When the nurses assessing the patient could not detect a pulse in that leg, an ominous sign of circulatory failure. The physician when notified chose to dismiss this fact and discharge the patient. The patient would return soon after with worsening symptoms that would require emergency surgery. Should the nurses have initially pressed for further action, treatment?
http://www.nursefriendly.com/041013

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Legal Eagle Eye Newsletter for the Nursing Profession:"Legal Eagle Eye Newsletter for the Nursing Profession was started in 1992 and has been published monthly ever since. Originally it was called Legal Eagle Eye Newsletter for Nursing Management, then changed to Legal Eagle Eye Newsletter for the Nursing Profession. The readers of Legal Eagle Eye Newsletter for the Nursing Profession are busy professionals in clinical nursing, nursing management, healthcare quality assurance and healthcare risk management. The newsletter focuses on nurses' professional negligence, employment, discrimination and licensing issues."

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Legal Eagle Eye Newsletter for the Nursing Profession:"Legal Eagle Eye Newsletter for the Nursing Profession was started in 1992 and has been published monthly ever since. Originally it was called Legal Eagle Eye Newsletter for Nursing Management, then changed to Legal Eagle Eye Newsletter for the Nursing Profession. The readers of Legal Eagle Eye Newsletter for the Nursing Profession are busy professionals in clinical nursing, nursing management, healthcare quality assurance and healthcare risk management. The newsletter focuses on nurses' professional negligence, employment, discrimination and licensing issues."

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Using Case Study Methodology in Nursing Research by Donna M. Zucker:"The purpose of this paper is to illustrate a research method that may contribute a unique and valuable method of eliciting phenomena of interest to nursing. Case study method can be used as a creative alternative to traditional approaches to description, emphasizing the patient's perspective as central to the process. This manuscript will define case study method, and discuss various case study designs. Approaches and tactics from a variety of disciplines, and theoretical or philosophical perspectives are discussed with an emphasis on method and analysis. The bulk of the manuscript outlines the stages used in a case study of men with chronic coronary heart disease (CHD), as well as presenting a case study protocol. Implications for its usefulness in nursing research, practice, and theory generation are discussed."
http://www.nova.edu/ssss/QR/QR6-2/zucker.html

A Nursing Primer On The Law: Being Named In A Lawsuit, by Joe A. Flores, JD, FNP, MSN, CCRN, Malenursemagazine:"Being named in a lawsuit can be an extremely stressful event for any nurse. The litigation process can cause devastating damage to a nurse's self-concept and to the nurse's practice. In the past suing the hospital and the doctor were generally the usual manner to obtain relief for someone bringing a lawsuit. However, now more than ever, the new order in the health care arena has made the nurse an integral part of delivering care to patients. The nurse has been delegated more responsibility and is also more accountability for the actions of licensed and unlicensed staff. This role has provided for increased autonomy as well as increased accountability. To make matters more complicated, the nursing shortage and limited resources have been a factor in nurses being increasingly involved in medical malpractice lawsuits."
Jerry R Lucas, RN
MaleNurseMagazine.com
10510 South State Hwy 3
Deputy, IN 47230
Phone: 812-352-1293 cell: 812-701-9014
Jerry.RN@verizon.net
http://www.malenursemagazine.com/lawsuit.html

Nursing Malpractice: Protect Yourself. What to do when you’re the subject of a board of nursing complaint. American Journal of Nursing:"Q. I’ve just learned that a complaint against me has been filed with my state board of nursing. What should I expect? A. Complaints to a state board of nursing (BON) can be initiated by other health care providers, patients and their family members, and health care institutions. Once a complaint is lodged, an investigator—who may or may not be a nurse—is sent to the site to gather information about the incident. BON investigators can obtain and review medical records, drug logs, personnel records, and incident reports, as well as take depositions or call in potential witnesses for questioning. If the case concerns drug abuse or another matter pertaining to one’s physical fitness to practice, most states also have the right to ask you to have a physical examination conducted by your health care provider."
Lippincott, Williams and Wilkins toll-free at 1-800-627-0484
http://www.nursingworld.org/AJN/2001/dec/Wrights.htm

Nursing Malpractice: Implications for Clinical Practice and Nursing Education Janet Pitts Beckmann, Ph.D., R.N., Galen Press:"Protect yourself by reading this book! The increasing number of nursing malpractice cases is affecting clinical practice and nursing education. After describing a typical malpractice suit, the author details sixty actual cases, each categorized by the underlying cause of the malpractice, such as medication administration and equipment use. Also provides recommendations for reducing the occurrence of malpractice and improving nursing education."
Galen Press, Ltd.
P.O. Box 64400-WB Tucson, AZ 85728-4400 USA
Call toll-free: 1-800-442-5369 (1-800-4-GALEN-9) Fax: (520) 529-6459 Tel: (520) 577-8363 sales@galenpress.com
http://www.galenpress.com/00320.html

Nursing Malpractice by Patricia W. Iyer (Editor), Amazon.com:"A reference for attorneys and claims adjustors investigating a nursing malpractice claim. Covers the spectrum of the nursing process, from patient admittance to lawsuit, reveals typical ways in which nurses try to cover up their mistakes, and shows how nurses are caught in difficult positions between insurance company lawyers and hospital procedures. Details the defendant nurse's daily routine, whether as a surgical nurse or nurse-supervisor in a nursing home setting. Material is in sections on nursing practice and documentation; common areas of nursing liability, such as pediatric, emergency, critical care, and psychiatric nursing; and litigation of nursing malpractice claims. Specific topics include trial consulting, the role of the forensic economist in nursing malpractice actions, and today's health care environment. Includes a drug and chemical name index. Iyer is a legal nurse consultant and a medical surgical nurse expert witness.Book News, Inc.®, Portland, OR --This text refers to the Hardcover edition."
http://www.amazon.com/

Nursing Malpractice: What You Should Know, By Jennifer Larson, Nursezone.com:"If you think that the worst thing that could happen in a hospital is the accidental death or injury of a patient, you’re right. But sometimes sentinel events are followed by another dreaded event: a lawsuit. Do you know what you need to know to protect yourself from being sued for malpractice? Are you prepared in the event that you receive a letter from a patient’s attorney? Joe Flores, a nurse practitioner and practicing attorney, recommends that new nurses educate themselves as soon as they start their first nursing job. “I would strongly recommend that a nurse determine what the policies and procedures are at her individual facility and determine what type of preceptor program is in place,” said Flores, who works for a law firm in Corpus Christi, Texas."
NurseZone.com
12400 High Bluff Drive San Diego, CA 92130
Phone: (877) 585-5010 Fax: (866) 732-4535
E-mail: contact@NurseZone.com
http://www.nursezone.com/stories/SpotlightOnNurses.asp?articleID=9901

Nursing Malpractice Liability and Risk Management, By Charles C. Sharpe:"Students and professional nurses at any level of clinical practice will find this book to be a vital resource on the basic legal concepts and principles of malpractice, liability, and risk management, and their implications for the profession. The book also provides detailed strategies for dealing with these issues. The content is also highly relevant to practitioners in all other health care and legal disciplines that collaborate in the delivery of health care. Issues discussed include the expanding and evolving roles for professional nurses and the concomitant legal accountability and risk for liability, the increasing incidence of nurses named as defendants in malpractice lawsuits, anticipated changes in our health care delivery system, and breakthroughs in science and technology that will present new legal questions. The book also includes material on other important facets of today's nursing practice, including the growing phenomenon of tele-nursing, the essentials of malpractice insurance, and the legal significance of documentation and patients' medical records. It helps the reader identify the nurse at risk for a malpractice suit and the characteristics of the patient likely to sue. The appendices provide information on state laws concerned with access to medical records, a list of useful websites, a list of state boards of nursing, and a glossary of important terms."
http://www.goodreads.com/book/show/5673547-nursing-malpractice

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Nurses' Station:"The idea for the Nurses' Station Catalog was conceived in 1989. After searching the marketplace in response to customer inquiries, it became obvious that there were no catalogs of this type serving the nursing profession. To be sure, there were several catalogs offering nurse's uniforms and a smattering of professional items. But there weren't any catalogs at the time offering a range of gifts, clothing, professional items, name badges, shoes and scrubs for nurses. It took two years of hard work to gather samples and put a together a catalog of the most unique and high-quality items for nurses."
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Social Media - How to Use Social Media to Choose a Doctor

We patients have only a few tools at our disposal to choose the right doctor for us. Most of those tools provide very cut and dried basics like licensing, board certification, even malpractice.

It has always been difficult to gain a glimpse into a doctor's attitudes or personality without meeting that doctor and getting to know him or her. Friends might tell us a doctor is "nice" - but smart patients know that doesn't mean a doctor is competent.

Along comes social media - Facebook, Twitter, YouTube, LinkedIn and other programs online that allow us to connect with other people - including doctors. Social media allows us to learn more about a doctor's personality and attitudes, his or her approach to their work and more.

With a little detective work, picking up clues here and there, smart patients use social medial to help them research and choose their doctors.

Some might tell you that you can get this kind of information from doctors' ratings sites. But I'm not a fan. They are too restricted, and are too often populated only by disgruntled patients. So give social media a try, hopefully to find more balance.

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Monday, February 14, 2011

Patient Stories May Improve Health, NYTimes.com

The only reservation that he mentioned was the same one all the other patients had — he feared that death would come before the perfect organ.

But during one visit just before he finally got the transplant, he confessed that he had been grappling with another concern, one so overwhelming he had even considered withdrawing from the waiting list. He worried that he would not be strong enough mentally and physically to survive a transplant.

In desperation, he told me, he had contacted several patients who had already undergone a transplant. “That’s what made me believe I’d be O.K.,” he said. “You doctors have answered all of my questions, but what I really needed was to hear the stories about transplant from people like me.”

Patients and doctors have long understood the power of telling and listening to personal narratives. Whether among patients in peer support groups or between doctors and patients in the exam room or even between doctors during consultations, stories are an essential part of how we communicate, interpret experiences and incorporate new information into our lives.

Despite the ubiquitousness of storytelling in medicine, research on its effects in the clinical setting has remained relatively thin. While important, a vast majority of studies have been anecdotal , offering up neither data nor statistics but rather — you guessed it — stories to back up the authors’ claims.

Now The Annals of Internal Medicine has published the results of a provocative new trial examining the effects of storytelling on patients with high blood pressure. And it appears that at least for one group of patients, listening to personal narratives helped control high blood pressure as effectively as the addition of more medications.

Monitoring the blood pressure of nearly 300 African-American patients who lived in urban areas and had known hypertension, the researchers at three-month intervals gave half the patients videos of similar patients telling stories about their own experiences. The rest of the patients received videos of more generic and impersonal health announcements on topics like dealing with stress. While all the patients who received the storytelling DVD had better blood pressure control on average, those who started out with uncontrolled hypertension were able to achieve and maintain a drop as significant as it had been for patients in previous trials testing drug regimens.

“Telling and listening to stories is the way we make sense of our lives,” said Dr. Thomas K. Houston, lead author of the study and a researcher at the University of Massachusetts Medical School in Worcester and the Veterans Affairs medical center in Bedford, Mass. “That natural tendency may have the potential to alter behavior and improve health.”

Experts in this emerging field of narrative communication say that storytelling effectively counteracts the initial denial that can arise when a patient learns of a new diagnosis or is asked to change deeply ingrained behaviors. Patients may react to this news by thinking, “This is not directly related to me,” or “My experience is different.” Stories help break down that denial by engaging the listener, often through some degree of identification with the storyteller or one of the characters.

“The magic of stories lies in the relatedness they foster,” Dr. Houston said. “Marketers have known this for a long time, which is why you see so many stories in advertisements.”

In health care, storytelling may have its greatest impact on patients who distrust the medical system or who have difficulty understanding or acting on health information because they may find personal narratives easier to digest. Stories may also help those patients who struggle with more “silent” chronic diseases, like diabetes or high blood pressure. In these cases, stories can help patients realize the importance of addressing a disease that has few obvious or immediate symptoms. “These types of patients and diseases may be a particular ‘sweet spot’ for storytelling,” Dr. Houston noted.

This particular benefit from stories comes as welcome news not only for patients but also for doctors, who are increasingly reimbursed based on patient outcomes. “There’s only so much the doctor can do, so providers are looking for innovative ways to help their patients,” Dr. Houston said. While more research still needs to be done, the possibilities for integrating storytelling into clinical practice are numerous. In one possible situation, which is not all that dissimilar from popular dating sites, doctors and patients would be able to access Web sites that would match patients to videos of similar patients recounting their own experiences with the same disease.

Dr. Houston is currently involved in several more studies that will examine the broader use of storytelling in patient care and delineate ways in which it can best be integrated. Nonetheless, he remains certain of one thing: Sharing narratives can be a powerful tool for doctors and patients.

“Storytelling is human,” Dr. Houston said. “We learn through stories, and we use them to make sense of our lives. It’s a natural extension to think that we could use stories to improve our health.”

Join the discussion on the Well blog, Healing Through Storytelling.”

Click on the link to read the full story.

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Friday, February 11, 2011

Balancing infection control with the patient experience, KevinMD.com

by Kevin Pho, MD

Hospitals have recently been stepping up their infection control procedures, in the wake of news about iatrogenic infections afflicting patients when they are admitted.

Doctors are increasingly wearing a variety of protective garb — gowns, gloves and masks — while seeing patients.

In an interesting New York Times column, Pauline Chen wonders how this affects the doctor-patient relationship.

She cites a study from the Annals of Family Medicine, which concluded that,

fear of contagion among physicians, studies have shown, can compromise the quality of care delivered. When compared with patients not in isolation, those individuals on contact precautions have fewer interactions with clinicians, more delays in care, decreased satisfaction and greater incidences of depression and anxiety. These differences translate into more noninfectious complications like falls and pressure ulcers and an increase of as much at 100 percent in the overall incidence of adverse events.

Hospitals are in a no-win situation here. On one hand, they have to do all they can to minimize the risk of healthcare-acquired infections, but on the other, doctors need to strive for a closer bond with patients — which protective garb sometimes can impede.

More research is clearly needed to determine how much protection is actually needed to prevent the spread of infectious disease.

For instance, Dr. Chen cites studies where,

researchers at the Medical College of Virginia in Richmond found that the rate of infection was identical whether health care workers wore gowns and gloves with only the patients in isolation or whether they wore only gloves with all patients.

So there’s some evidence that being overly protective may not necessarily help.

The key is finding the right balance between infection control and preserving the physician-patient relationship. With rapidly advancing, and sometimes impersonal, technology, combined with the legitimate fear of hospital-acquired contagion, it’s easy to forget about the patient experience during their hospital stay.

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