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More than 1,500 Physicians Call for Dr. Oz to Resign

marketingsermowpuser — Mon, 27 Apr 2015 19:24:03 +0000

Life’s hard when you’re a doctor. We get it. Of the 40% of American physicians who’ve joined SERMO over the years, we see our members come together on all sorts of topics. In addition to members curb-siding with each other on difficult patient cases (all HIPAA compliant, of course) and sharing ideas around healthcare policy, they regularly discuss EHR frustrations, the latest in drug and therapeutic news, practice management tips and emerging medical technology. And, of course, the topic of their medical peer Dr. Oz has come up in conversation a few times; in fact, last year, SERMO physicians voted him their least favorite celebrity doctor.

With the latest firestorm in the media around Dr Oz, we decided to ask our members if they agreed that Dr. Oz should be removed from his position at Columbia University. The results were definitive..

Of the 2,029 physicians who participated in our poll as to what Dr. Oz should do next, more than 1,500 physicians (78%) voted that he should resign from his faculty position at Columbia University. More than 450 (24%) believe he should have his medical license revoked. The poll is as follows:

Dr Oz should:

57% – resign from his faculty position at Columbia University (1128/1979)

3% – have his medical license revoked (66/1979)

21% – do both, resign from his position at Columbia and have his license revoked (411/1979)

19% – do nothing, I respect Dr Oz as a physician (374/1979)

Dr Oz can’t laugh this claim off as easily as he did on his show. 1,500 physicians is nothing to scoff at. They’re not backed by big food or representing special interest groups, as he claims. These are the clinicians and medical thought leaders across an entire spectrum of specialties and practice backgrounds, from rural generalists to his peers in cardiology. These physicians are speaking up because they care about the information their patients get – PCPs who regularly combat all sorts of misinformation in the marketplace about vaccines and “magic pills”, ER doctors who drop everything to save anyone who’s coming in, with no secret agenda or undue influence from industry , surgeons and other specialists who are caring for people with a wide variety of chronic ailments and are helping manage complex co-morbidities, or pediatricians who calm our fears as parents. These doctors are the researchers who tirelessly work to cure MS and rare diseases (most of which affect children), the family practitioner who fights for patients when their insurance companies deny their claim, and perhaps less visible, they are the doctors advocating for truth and transparency about the information you’re fed from other physicians, their own peers, when they think someone of influence has it wrong.

Think viewers don’t take Dr Oz’s advice as gospel? Think again. One OBGYN shared:

“I have a patient with…menorrhagia, which she has been trying to manage with herbs over the last year. So, while she refuses transfusion for no clear reason (not a {Jehovah’s} Witness), I am trying some tricks to get her ready for hysterectomy. When my nurse called to speak with her about other medical clearance the patient said…that YOU [Dr. Oz] are her managing doctor! So, my question is, where can I call to get her records and can you give her pre-op medical clearance?”

This is not uncommon.

We asked Dr Linda Girgis, SERMO member and Family Medicine physician for her thoughts. She shared:

“As doctors, patients trust us to pass on the best medical advice to them to enable them to make the best healthcare decisions. We have spent many years studying and training to learn the science behind what we are doing. Legally, we are expected to practice within a certain standard of care (what other doctors are doing).

It is not acceptable for doctors to invent their own science. We have researchers and organizations that carry out clinical trials in order to keep patients safe. When we throw out that data, we are ignoring patient safety.”

It wasn’t all negative though. 19% of the SERMO doctors polled respect Dr Oz as a physician. Most of the support voiced was because of his advocacy for GMO labeling. Even his critics called for him to speak on behalf of physicians more, using his celebrity status for good. Other physicians are torn, like one of his Cardiothoracic colleagues…

“I have watched Dr Oz operate and he is a good surgeon, seen him interact with patients and he truely cares about them, and performed well done medical research with him. As a heart/lung surgeon I respect him. However, when I watch his show I just cringe when he talks about a pill containing a combination of herbs/roots/chemicals to solve one or any problems or when he talks about womens’ orgasms! Does he (or anyone) really know what that pill does, it’s side/long term effects are, or alternatives to this pill? No good studies have been done on half those pills, and the other half maybe good science but of questionable or no benefit. Which to believe when he speaks? He is using his good and well deserved surgical reputation to mute any criticism or questioning of the promotions on the “show”. It truely is sad. Shame on Columbia for supporting this bad behaviour. Freedom of speech does allow snake oil salesmen to practice but it should not allow a trusted physician to do the same thing while being a physician or supported by a great medical school. Mehmet- if you really want to promote unproven therapies then resign from Columbia and us the small remaining medical capital. If you want to continue to be a trusted doc, then promote RESEARCH that proves these pills work and tell the truth about these products.”

We also asked SERMO doctors to share questions they’d ask Dr Oz, if given the chance. Then we gave them the chance! These questions were tweeted @DrOz and can be found at #SERMOasksOZ.

Here is a taste of what you’ll find:

It’s not easy to be a doctor and make money any other way because of the level of scrutiny you’re put under. Our doctors understand that better than anyone else. What is unacceptable is when unsubstantiated advice is given to the public, as a physician, for financial gain.

Dr Girgis shared:

“A celebrity doctor should be held to the same standards as all doctors. Maybe even more since they are reaching a larger audience. When someone in that position starts giving advice that is not founded on science and has not been proven safe, it is not in the best interests of the well-being of the health of the viewing population.”

We’d like to invite Dr Oz to come in and do a Q&A with our community. We’re not wielding pitchforks…we’re your colleagues and just want to separate fact from fiction, advocacy from advertisement and ensure that physicians are empowered to deliver the best, clearest, most responsible information we can to patients everywhere.

We discuss this and a myriad of clinical topics inside SERMO. If you’re an M.D. or D.O. in the US or UK, please join us.

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Stress and Depression Increase Heart Risk

marketingsermowpuser — Mon, 27 Apr 2015 12:00:44 +0000

– by Dr. Irving Loh, MD

An interesting article (1) last month in Circulation: Cardiovascular Quality and Outcomes quantified something that has been quite subjective for experienced clinicians when dealing with coronary heart disease patients. When objectively diagnosed with stress and depression, CHD patients had a 48% higher risk of increased MI or death in 2.5 years of followup compared to the low stress and depression cohort. As a profession, it looks like we’re all in big trouble.

This study came out of Columbia University in New York and was lead by Dr. Carmela Alcántara. They examined the profiles of 4487 patients aged 45 or older enrolled in the Reasons for Geographic and Racial Differences in Stroke study and thus were known to have coronary heart disease. From 2003 to 2007, patients were interviewed at home or asked by questionnaires how often during the past week they felt depressed, lonely or sad, or had crying spells. They were also asked how often they felt unable to control important things in their lives, felt overwhelmed, felt confidence in their ability to handle personal problems and felt things were going their way during the past month. The implications of unrecognized or inadequately treated stress and depression can be manifested internally by adverse cardiovascular outcomes or externally as with the co-pilot of the Germanwings tragedy last month.

It was determined that it was the interaction between self-reported stress and depression, rather than just each independently that seemed to be related to the outcome measures, though no clear causal mechanism was discerned. Each of these symptoms separately did not seem to increase risk. Segregation of these factors as clinicians know is hardly a clean science, so their cohabitation in an affected patient is enough to warrant more focused attention on not only the patient’s cardiovascular risk factors, but on mitigating the psychosocial exacerbation of major cardiovascular adverse event risk. We all know about the sophisticated lifestyle and pharmacologic strategies needed to manage the classic cardiovascular risk factors. This study suggests that there may remain significant gaps in psychosocial care that may have similar implications for clinical outcomes. Indeed, coronary heart disease is a process that trends in the older population, and there are inadequately addressed issues in both the medical and sociological arenas that can alleviate the stress and depression that disproportionately afflict the elderly.

A multidisciplinary team approach with targeted care coordination is needed. Our society generally and our healthcare system specifically are not well prepared to effectively manage this scenario, but with a potentially manageable 50% increased risk, perhaps we need to implement concepts like care circles and care coordination tools like Tiatros™ (reader warning: I am a Tiatros™ advisor, so it’s one with which I am familiar, but there are other similar programs as well so no product endorsement should be interpreted or implied) that can help alert the care giver team. More research is required to determine mechanisms and optimal interventions to positively effect outcomes.
References:

1. http://bit.ly/1B1S14d Circulation: Cardiovascular Quality and Outcomes, online March 10, 2015

Bio:

Dr. Irving Kent Loh MD, FACC, FAHA (Epidemiology & Prevention), FCCP, FACP is a board certified internist and sub-specialty board certified cardiac specialist with an emphasis on preventive cardiology. He founded and directs the Ventura Heart Institute, which conducts education, research and preventive cardiovascular programs. Dr. Loh is a former Assistant Professor of Medicine at UCLA School of Medicine. He is Chief Medical Officer and Co-founder of Infermedica, an artificial intelligence company for enhancing clinical decision support for patients and healthcare providers.

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What kills an average of 5 children per day in the US? Child Abuse

marketingsermowpuser — Mon, 20 Apr 2015 12:00:21 +0000

~ by Linda M. Girgis, MD

There is nothing sadder than the death of a child, except maybe a death that was preventable. In the US, an average 5 children die every day as victims of child abuse. While the US leads the world in innovation and technology, it lags behind many other countries in the protection of its children. If you watch the media, people are outraged by a child allowed to play alone in the park, yet no one raises a voice for the children that are abused to death.

Why is it important to talk about child abuse on a medical blog?

The medical community is one layer of defense protecting these children. Yet, doctors, nurses and healthcare workers often fail to identify these kids. Teachers are not finding these children at risk. Society is not seeing the abuse happening.

Preventable deaths aside, why should doctors need to pinpoint these cases? Perhaps, most importantly, one third of abused children go on to become abusers themselves. It is imperative that we break this cycle of violence. Approximately, 14% of men and 36% of women in prison were abused as children. This is double what is observed in the general population. Children who have been abused are 9 times more likely to become involved in criminal activities. They are also 25% more likely to become pregnant as a teenager and engage in more high risk sexual behaviors. Additionally, almost 75% of those receiving treatment for drug abuse report a history of abuse or neglect.

Survivors of child abuse have complications lasting into adulthood. These adults tend to suffer from higher rates of mental health disorders. These include, but are not limited to, depression, personality disorders, anxiety disorders, PTSD, eating disorders, increased risk of suicide, dissociation and sexual difficulties. It has been estimated by at least one source that 50% of those abused as children have 3 or more psychiatric disorders. Many survivors’ lives are defined by frequent crises leading to job dissatisfaction, failed relationships, frequent relocations, and financial setbacks. Many of these adults live in “crisis mode” and this can be quite disheartening and exhausting.

Similarly, these adults face more physical complications than those who were not abused as children. These range through a whole gamut of diseases including diabetes, GI problems, heart disease, certain neurologic disease, etc. The mechanism of why it occurs has several factors. The obvious is that some physical problems begin in childhood as a direct result of the abuse. It has also been postulated that the stress caused by the early abuse alters the immune system and these changes play a role in the later development of these diseases. There have also been studies suggesting that childhood abuse affects the brain structure and the way neurons connect with each other. While the exact etiology is unclear, many studies clearly support that a history of child abuse clearly leads to increased chronic medical problems as adults.

Knowing the devastating consequences of child abuse and neglect, why does society allow it to continue?

For one, it is often very well hidden. The perpetrators are careful to hide their crimes so it is not so easy to detect. It is also something that is so horrible that many people can’t believe this evil exists. It is easier to ignore the signs. But, we can no longer afford to that. Children suffer and die as we stand by. And they suffer into adulthood. We, especially the healthcare workers among us, need to take greater measures to find these kids and save them, not only from the abuse, but the future risks of mental and physical diseases.

Child abuse is not so easily discoverable but any unexplained injuries or bruises should always be questioned. And ask yourself, does the injury match the mechanism of injury? Also, be on the lookout for bruises or burns that match the shape of an object. Conflicting reports from the child and adults should be a red flag. Changes in a child’s behavior are also a clue. Be concerned if you see a child suddenly become anxious, withdrawn or aggressive. Some children even return to earlier behaviors like thumb sucking and bed wetting. Many of these children are afraid to go home and reluctant to leave school. They may appear frightened to go with the abuser. Changes in eating habits or weight can be seen. Sleep problems, such as nightmares, can frequently be observed. These kids may appear unusually tired or fatigued. Lack of personal hygiene is often seen as well. Some of these kids engage in high risk behaviors or inappropriate sexual behaviors. It always better to err on the side of protecting a child than overlooking a case of abuse. If you have the least suspicion, contact CPS and let them investigate.

While the statistics are truly scary, there is nothing more frightening than to be a child living through the abuse. No can imagine what it is like to hide for fear of your life under your bed or learn to tolerate the taste of your own blood in your mouth. I know because I lived that life. Don’t kids deserve to be treated better and kept safe from harm?

We discuss this and a myriad of clinical topics inside SERMO. If you’re an M.D. or D.O. in the US or UK, please join us.

Bio

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University. She has appeared in US News and on NBC Nightly News.

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General Medical Physicians Being Crushed on Both Sides of the Atlantic

marketingsermowpuser — Thu, 16 Apr 2015 12:00:26 +0000

~ by Linda M. Girgis, MD

Being a primary care doctor has never been more difficult. Not only do we have to be knowledgeable about new technologies and medical advances in every field of medicine, we are expected to be “gate-keepers”. In the US system, this model of care was set up by HMOs in an effort to lower healthcare costs. In the UK, physicians are expected to do the same under the National Health Services (NHS). All patients need to see their primary physician before going for specialized care. While this certainly has advantages, it comes with significant oversight and regulations. Primary care doctors on both sides of the Atlantic, in the US and UK, are being crushed under these systems.

In this model of care, medical decisions are increasingly made by third parties, whether a for- profit insurance company, the Medicare/Medicaid program, or the NHS. Doctors feel that giving the best care to patients is becoming an elusive concept. According to a GP in this article in The Guardian, “Everyone necessary for that care co-operated for the good of the patient – they didn’t compete for the benefit of shareholders. Sadly, patients are now right to be suspicious of motives concerning decisions made about them, which until recently, almost uniquely in the world, have been purely in their best clinical interest. Most politicians understand little about general practice, have no idea about the importance of continuity of care and blame GPs for a rise in hospital work, even though this is a direct result of their policies.”

Doctors in the US feel the same. We offer our best care to patients, however, our decisions often get tossed out in the prior authorization process by insurance companies. Many medications never get filled because of insurance company formularies whose guidelines are created, for the most part, by non-physicians. Instead, they are influenced by big pharmaceutical companies. Patients do not see all that goes into these decisions, so the blame falls at the doctors’ feet.

Doctors on both sides of the Atlantic feel that outside forces have too much influence in our medical decisions. This harms patient care and the doctor-patient relationship, which is one of the building blocks of primary care. Control of medicine has been snatched out of ours hands and we feel helpless watching while our systems fail to provide patients with the best care.

According to a recent report by London’s Assembly Health Committee, “a lot of London’s GPs are retiring or not far off it. About 16% of them are aged over 60 compared with 10% nationally. Many are taking early retirement and figures suggest growing numbers are considering emigrating. Meanwhile, GP practices are finding it harder to recruit partners.” The US is seeing a similar situation. Here, there is both a shortage of doctors in training opting to pursue a primary care career and more physicians retiring earlier.

As the population ages, the need for primary care doctors is flourishing. Yet, primary care doctors increasingly bear the brunt of flawed healthcare systems. Shortages already exist on both sides of the Atlantic and this can only grow. Overhauls are desperately required in the US and UK health systems to put quality patient healthcare back at the center of the healthcare equation.

Medicine and technology has never been so advanced as it is today. But, unless we give respect and decision- making powers back to the gate-keepers of healthcare (physicians), we will face a true crisis on both sides of the Atlantic. Healthcare systems need to keep pace with medical practices and join the 21^st Century. Who wants to have the best medical tools in the world, and watch patients suffer for lack of access?

Bio

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The Ultimate Patient Advocate

marketingsermowpuser — Mon, 13 Apr 2015 12:00:22 +0000

~ Kathryn Hughes, MD, FACS

Advocating for patients is a core value in medicine, in patient care. Our legacy as patient advocates dates back to Hippocrates in 500 B.C.E., codified in the oath and teachings that have provided the moral and ethical foundation on which the profession has been built. Even the Code of Conduct for the American College of Surgeons includes as its first principle, “Serve as effective advocates of our patients’ needs.”

Physicians fundamentally care for patients, their families, our communities. We advocate on the small, individual scale for each patient, and we advocate on the large scale for the entire population of patients and society.

The physician is the ultimate patient advocate.

The entire purpose of my profession is to learn about humans—their biology and chemistry, their function in health, and dysfunction in illness and injury. We strive to understand the impact of health or illness and injury on the psyche and on social interactions. To learn about and discover treatments and interventions, and to provide compassion and comfort in applying them. To educate both patients and our society in order to prevent illness and injury, promote health. We are called to speak truth to power in order to accomplish these goals.

The foundation of all this is the relationship and trust between the physician and the patient. Central to this relationship, that trust is the role of the physicians as advocates for their patients.

But now the position of “Patient Advocate” has become ubiquitous among hospitals, insurance companies, and health systems. A Patient Advocate is a (lay) person/entity whose primary role is to protect the patient and their interests, but also to field complaints, advocate on behalf of the patient/family, and even go so far as to assist in decision-making regarding the treatment plan or course of care. They are supposed to help navigate the often complex and confusing healthcare system, and the interactions with doctors, hospitals and insurance companies.

Patient advocacy seems a noble pursuit, and often much needed. Patients and their families are distressed and vulnerable, even in good health; add illness, and the ability to navigate the system and the decision-making can be daunting if not impossible.

All well and good, but I wonder why there is this pressing need for an entire different profession, an additional layer, another buffer between the patient and the physician? Has the core principle of advocacy changed in my profession? Have we abdicated our responsibility, or is it something else? If it has not changed, if we have not abandoned our principles, what is it perceived as lacking?

As Voltaire (or Peter Parker/Spiderman’s Uncle Ben) says, “With great power comes great responsibility.” The powerful responsibility physicians have for the care of their patients remains, but the trust on which it is based has eroded. The bond between physician and patient — and between the medical profession and society — has become strained.

Individual patients, the general public, and the government have all become increasingly wary of physicians. Considerable effort and expense is employed to rein in the perceived power and control wielded by physicians, implying that there is little trust in the ethics, oaths, and codes that we have set for ourselves. Hospitals, healthcare organizations, insurance companies, and various branches of government and regulatory agencies, as well as licensing boards and health departments (not to mention lawyers) have bit by bit surrounded physicians and buried them under mountains of law and regulation, benchmarks and measures and protocols.

Health systems and insurance companies increasingly dehumanize physicians, treating the highly skilled and highly trained professionals like pawns on a chess board, faceless and interchangeable. Physicians drop on and off of “preferred provider” lists in arbitrary and capricious fashion, destroying any relationship and continuity built with the patient. Doctors are presented as interchangeable.

Worse, at times it seems that these groups are driving a wedge in the physician-patient relationship. As a consequence, patient trust and confidence is shaken. It is not much of a leap for the relationship to be framed then as adversarial rather than cooperative. If a doctor is no longer seen as the patient advocate, then of course the void must be filled.

But Patient Advocates generally haven’t the medical training or expertise. They may be also beholden to the system or entity that employs them. The most common and available advocates are generally working for a hospital or insurance company, whose priorities may not entirely align with patient and physician. This is problematic, of course, because it is often the hospital or insurance company the physician must stand up to on behalf of her patient.

It is imperative that physicians continue to shape our evolving healthcare system and promote that which preserves and protects our relationship with our patients. We must insist that we not only take a seat at the table among “stakeholders” in the healthcare system, but show that we are the best and more uniquely qualified to lead the efforts. We must again claim that space between patient and physician and remind not just our patients, but all others that indeed we are their advocates. The physician who fails to serve as an advocate for their patient also fails to serve as a physician to that patient. We must fight for the time we need, fight against the distractions, shore up the trust that has been strained so mightily.

There is nothing in the description of a patient advocate that isn’t already part of what we as physicians commit to do for our patients. We are, therefore, the first and the last patient advocate, their most effective advocate, the ultimate patient advocate.

I advocate for physicians to continue to claim the time and space to be effective advocates for our patients; and to embrace this responsibility, and not abdicate it to others. Taking the lead to work with, but not be replaced by patient advocates.

We discuss this and a myriad of clinical topics inside SERMO. If you’re an M.D. or D.O., please join us.

Dr. Kathryn A. (Kathy) Hughes is a board certified General Surgeon, who has spent the majority of her career in private practice in community hospitals. She is a Fellow of the American College of Surgeons. She is a member of the Association of Women Surgeons, The American Society of Breast Surgeons, and the American Medical Association. She is a member of the Massachusetts Medical Society, and represents the North Essex District in the House of Delegates, and serves on the Committee on Women in Medicine.

She has her B.A. from Mount Holyoke College, and her M.D. degree from The George Washington University School of Medicine and Health Sciences in Washington, DC. She started her Surgical Residency residency with the University of Nevada School of Medicine system before returning to Washington, DC to complete her residency at The George Washington University Hospital program.

She blogs regularly from Behind the Mask.

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SERMO: to talk or not to talk, that is the question

marketingsermowpuser — Wed, 08 Apr 2015 05:30:18 +0000

In March we opened the SERMO doors to physicians in the UK. Much preparation was given to the anticipation of cross-border collaboration, insight-driven real world medicine exchange and unification of doctors in a common cause – to talk medicine. It’s fair to predict that these commendable endeavors will be achieved. But let’s not forget that SERMO is equally about creating a safe place for doctors to simply download, to resuscitate their personal selves from what will always be one of the most demanding professions. In light of this, therefore, amidst the fanfare of altruistic achievement, we were fascinated and pleased to see that the first of the conversations between US and UK physicians was not about health systems, diagnostic guidelines nor a challenging patient case – but to pure socializing and getting-to-know you relationship-building as:

“so what’s with you guys removing all the ‘a’s from the English language?”

There was banter, bonhomie and bonding. There was even time to ask about the correct way to take high tea (at 3pm, with crustless cucumber sandwiches, Earl Grey leaves, and raspberry-laden scones). And then the patient cases started to come.

We know that SERMO is the number one social network for physicians in the US precisely because it allows doctors to be themselves. As Oscar Wilde wrote, “Be yourself, everyone else is taken” and such words of wisdom prevail every day within SERMO. In the first few weeks we have seen 11 percent of the medical community of the UK become members already; like their US counterparts, British doctors are keen to talk. Dialect, colloquialisms, healthcare organizations may differ between regions but the practice of medicine itself still has a common language. We saw one discussion thread where language differences were a barrier (French-English), but once the medical acronyms, lab tests and scientific procedures were detailed, members flocked to help, galvanized by the common medical cause; HCV, HbA1, ECG etc is global terminology – common talk for SERMO members.

Which is why we are excited about what’s now and what’s next. Already we are seeing the power of medical crowdsourcing provide solutions, irregardless of the origin of posting. And the humour segues to humility of physicians diligently transforming real world medicine together. Or should that be humor?

Coming soon on SERMO:

— The UK election; what do the political parties claim as part of their manifesto healthcare promises?

— Different guidelines, same patient: what experience would they have in the UK versus the US?

— Medicine – with an American accent or the Queen’s English; the differences, the similarities

If you’re an M.D. or D.O. in the US or UK, please join us inside SERMO.

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How Meaningful Use Mandates Lost Their Purpose

marketingsermowpuser — Wed, 25 Feb 2015 13:00:46 +0000

~ by Linda M. Girgis, MD

The meaningful use program began as part of the HITECH stimulus bill, part of the initiative to get all healthcare providers on EHR systems. The meaningful use (MU) program was established to provide an incentive for compliance. In the early stages, physicians who met reporting requirements were given a cash bonus. This year, however, doctors are now being penalized if they haven’t qualified. Penalties are being taken out of the reimbursements we receive when we provide medical care to patients.

Many doctors certified for the first two steps of Stage 1 MU but his stumbling blocks with Stage 2. MU2 implementation has been delayed several times due to software issues with poor reporting metrics and hospital IT departments struggling to get their infrastructure up to speed. Hospitals and private practices are pouring money into integration solutions while doctors lament the MU changes are irrelevant to clinical practice. EHRs should improve medical outcomes of patients; many doctors don’t think this objective is being met.

Why do doctors think MU is meaningless to patient care?

The metrics doctors are required to report often bear no relevance to the patient we are treating. For example, we are supposed to record a patient’s smoking status at every visit. It seems ridiculous to most doctors to record smoking status on infants. But, that is an MU requirement.
Pertinent information is often buried in a patients’ record, cluttered by some many metrics that aren’t relevant. This eats into patient/doctor time and can delay treatment. Often the tedious task of checking boxes doesn’t promote good clinical outcomes.
Doctors now spend an unprecedented amount of time just charting. But it’s more about fulfilling MU requirements than recording necessary patient information. Doctors want more face time with patients, not less.
To meet the requirements of MU stage 2, patients need to communicate with their physician through a patient portal. Many doctors had trouble getting their portals active because the software vendors had difficulty interfacing the portal to the practice’s EHR system. Some patients simply do not want to communicate through portals, should we force an unwanted system of communication on them? However, a practice gets dinged if a patient chooses not to use the portals, even among patient populations that don’t have emails such as the very poor and the elderly.

Complying for MU in a large system is difficult, costly and time-consuming. But, hospitals and large networks have whole IT departments with staff devoted to that task. Imagine what it is like for smaller practices, many who are already struggling to stay afloat financially. We do not have IT departments nor extra staff. I have a storage closet with three routers networking all my systems. When one goes down, so does my practice. In order to comply with the first stage, we had to devote one of our staff full-time for several weeks. Our employee was not an extra hand we had on deck, but someone we had to pull from her usual duties. We ran our practice short-handed, and it was stressful for all involved. The bonus we received barely compensated for our lost time with that employee.

Those of us in the white coats, practicing medicine daily, see MU2 as a barrier to improved patient care. While we can see the potential, doctors MUST be more involved in the design. Big data in medicine is a big deal, we hope aggregated information via the EHR system will provide valuable insights in the years to come. But it must be a real-world, workable system that always keeps the patient foremost in mind.

Bio

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Medical Data Breaches: What Should We Do?

marketingsermowpuser — Wed, 18 Feb 2015 18:13:01 +0000

~ by Dr. Irving Loh, MD

Unless you’re a health care practitioner who’s been in a coma or a survivalist just now emerging from a cave, you’re aware of the sophisticated hacker attack on Anthem’s information technology network that exposed about 80 million current and former subscribers. You might think about going back into that cave.

This is the largest known and reported (possibly important caveats) illegal intrusions into a healthcare company (America’s second largest) gaining personal information such as names, addresses, social security numbers, medical IDs, email addresses, income and employment records. Exactly who perpetrated is still unknown, but the usual suspects of state or organized criminal hackers are most likely.

In the letter we received from Anthem’s CEO, Joseph Swedish, the company found no evidence that credit card or personal medical data were compromised, but that is of little solace since hackers have enough to create identity theft headaches for years to come. Personal medical data may be used by criminals to fabricate insurance scams or extort monies from patients with sensitive medical data. State sponsored entities might pay to know the medical history of important individuals. Regardless, these are the trees and the problem is the forest. The data was vulnerable and apparently unencrypted. More on that in a moment.

The Health Information Trust Alliance, a data security collaborative known as HITRUST, reports that Anthem adopted “strong information security controls” and participated in “cyber preparedness exercises” that were “crucial in their ability to detect, analyze, remediate and collaborate swiftly and effectively.”

Wait. The horse did leave the barn. This sounds more like a PR damage control statement.

After recent cyberattacks on Target, Home Depot and Sony, healthcare companies with their huge repositories of sensitive information should have gone into warp drive to secure their data. The most affected state insurance commissioners (CA, NY, OH, GA, etc.) and the U.S. government are now launching a nationwide investigation to focus on whether Anthem heeded earlier warnings about their security weaknesses and whether encryption should have been implemented.

Anthem’s Track Record

Other sectors, such as finance, have upped their security for years, but Anthem faced breaches before:

In 2006, personal information of 200,000 members were stolen from a vendor’s office.
In 2008, the insurer offered free credit monitoring after 128,000 members’ personal data were inadvertently placed online.
In 2013, federal regulators identified an Anthem data breach involving 612,000 customers which prompted a penalty of $1.7 million.
In 2014, the FBI sent out a healthcare industry-wide warning to tighten up their security measures.

Anthem stated encryption would not have blocked the cyberattack as the hackers had obtained a system administrator’s log-in. Fair enough, but the data obtained could have been encrypted at a level that dynamic decryption keys on the other end would be required to make any sense of those stolen data. From the subscriber vantage-point, perhaps higher levels of encryption with more complex passwords, perhaps randomly generated, or biometric markers, need to be in place. A problem with biometric data is that you are stuck with them…if they get hacked (as they may be in the future), you can’t change your fingerprints, retinal scan, or earlobe metrics (OK, our plastic colleagues can mess with the ears).

To its credit, Anthem intends to notify patients with compromised data, and provide credit monitoring and identity protection services at its expense. It is unclear for how long, although California law requires at least one year. Anthem also provided a hotline and website for queries.

Should HIPAA apply?

Alexis de Tocqueville saw in Americans the cultural character trait of fair play. Since the advent of that necessary evil, HIPAA, healthcare practitioners have been subject to large penalties for each proven HIPAA violation. Even without the specific medical data, the personal information compromised by this mega-hack fall under the jurisdiction of HIPAA. Take that penalty times eighty-million, and the Department of HHS will have made a dent in paying down the national debt. And forensic accountants need to make sure that any levied penalties are NOT cleverly passed through to their subscribers, but should come out of company profits and executive bonuses. THAT would go a long way towards ensuring future data security. Write your congressman. Not a phone call or a blast fax, but write…it carries ten times the weight because members of Congress and their staffs are aware of the effort involved in creating it.

What do you think?

Bio:

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Doctor Curmudgeon: Don’t You Dare Say You’re Sorry

marketingsermowpuser — Wed, 11 Feb 2015 13:00:22 +0000

There are things that occur in the simple course of daily living that get my Curmudgeon up. They make me:

Want to holler

Want to reach through the phone and grab the person on the other end

Run to an island without anything more technical than a thatched hut

Find another planet.

I really hate it.

I am busy.

I call some place for tech support.

PERFECTA: “Oh hello, I am Perfecta. I am here to give you perfect service. I am so sorry you are having a problem. I am here for you and I….”

ME (breaking in): “I keep getting a red error notice, loud noise and my digital smart toaster oven shakes whenever I dial ‘toast.'”

PERFECTA: I am so sorry that you are having this problem. I will be sure that you get the help you need. What is your name?”

ME: “Hermione.”

PERFECTA: “Oh, Hermione, I am so happy that you called. I do hope you are having a wonderful day…”

RUDE ME (breaking in): “My toaster oven. Why is it going nuts?”

PERFECTA: “Nuts? Oh, I am sorry. We are not here for nuts. I thought you were calling about your toaster that was having a problem.”

ME (screaming): “I told you about my toaster…remember…red light…shaking…”

PERFECTA (with her sickeningly sweet voice). “Madam, you are screaming. I am sorry. It is not necessary to raise your voice.”

ME (quietly exasperated and back to nail chewing): “Just tell me what to do about my brand new, two week old, expensive toaster.”

PERFECTA: “I am so sorry that you have this difficulty with your toaster. I am so sorry that you get the red error message. I will help you. But, I want you to know that I am really sorry…….”

ME (really screaming now): “Don’t say you’re sorry. Just fix the damn thing.”

PERFECTA: (after a pause): “Madam, you have cursed me. I am sorry, but I will have to report you to…”

Next sound is me slamming the phone against the wall.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So readers, friends, foes, anybody who is out there…

Is there one among you who has not encountered a similar situation?

Is there one among you who knows the secret to handling these kinds of calls better?

If so, please, I implore you…tell me your secrets.

OH yes, I am so so so so so so so so so so so sorry to bother you with this dilemma

The post Doctor Curmudgeon: Don’t You Dare Say You’re Sorry appeared first on Sermo.

Webinar: Physicians and Social Media

marketingsermowpuser — Fri, 30 Jan 2015 15:22:58 +0000

Doctors are in a unique position when it comes to social media. HIPAA concerns, administrative gaffs and more mean a physician’s career can end with just one tweet. Join Dr. Kevin Campbell, MD, FACC and FOX Medical Expert and our SERMO medial advisor Dr. Linda Girgis, MD, (DocLMG) to discuss the potential and pitfalls of social media.

February 10^th, 8:30- 9:30 pm EST

Physicians and Social Media, we’ll discuss:

The six ways physicians use social media
The benefits of social media
How to use social media channels to benefit your career or practice
Proper “Netiquette”
How a blog can benefit your career or practice

You will have the opportunity to ask questions and get answers from our experts!

Dr. Kevin Campbell has over 100,000 Twitter followers and has built a successful career as a cardiologist combining his expertise with television appearances and through social media. He is a regular medical contributor to FOX News. He’ll talk about his successes and what social media means to him.

Dr. Linda Girgis, started a Twitter account 18 months ago and has become one of the most influential doctors on social media. Her presence online has benefited her practice and given her the opportunity to speak on behalf of other physicians about such topics at vaccinations and MOCs. She is currently a columnist with Physicians’ Weekly and has appeared on NBC News and other media outlets.

Join us for a lively and informative discussion!!

Even if you can’t make the live webinar, sign up and we’ll notify you when the video is uploaded and viewable. If you’re an M.D. or D.O. you can read more information inside the community here.

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