Ebola in Dallas

Robert Bell rmsbell200 at YAHOO.COM
Wed Oct 8 15:45:55 UTC 2014


Fine thoughts.

Presumably why so many HCPs are hanging it up. Just too stressful. Do we have figures on this?  A physician living close by has retired early. He said he may do some teaching.

There may be the possibilty of technology helping with efficiencies in time. 

Also, elimination of waste and redistribution of dollars in the system might help. But I cannot see that happening easily without different funding and payment systems.

Now we have to see if Insurance companies can do the job well. 

A lot of pressures in the system as we evolve.

Rob Bell

Sent from my iPad

On Oct 8, 2014, at 6:14 AM, "Shapiro, Barbara" <Barbara.Shapiro at UHHOSPITALS.ORG> wrote:

> Yes, I've heard this expression "work smarter" many times, but what does it really mean. There's no substitute for sitting with a patient and getting their history. For a neurologist, this can take a considerable amount of time. I work as fast and as 'smart' as I can, but there's no substitute for a good, thorough history, and a good thorough exam.  While I'm doing that, I'm trying to fulfill all of the "meaningful use" criteria on the electronic record, to keep the government happy, and be nice and cheerful and respectful of patients, and not rush them, so that when the Press Gainey survey comes out, I can make sure I'm at the top level, so the hospital doesn't penalize me for not being at the 100th percentile. Then I have to make sure to print out a summary of the encounterfor the patient before they leave my office. This all takes time. There's no getting around it, no 'smart' strategy that lessens the time to do all of these things, if you want to be a good clinician.  
> 
> Barbara E. Shapiro, M.D.,Ph.D.
> 
> Associate Professor of Neurology
> 
> UHCMC/CWRU
> 
> Neurological Institute
> 
> 11100 Euclid Avenue
> 
> Cleveland, OH  44106-5098
> 
> 
> 
> (216) 844-7768  phone
> 
> (216) 983-0792  fax
> 
> 
> 
> Confidential Quality Assurance Peer Review Report Privileged Pursuant to O.R.C. Section 2305.24,2305.25,2305.251 and 2305.252
> 
> ________________________________________
> From: Hoffer, Edward P.,M.D. [EHOFFER at mgh.harvard.edu]
> Sent: Wednesday, October 08, 2014 8:02 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG; Shapiro, Barbara
> Subject: RE: [IMPROVEDX] Ebola in Dallas
> 
> Throw more money at the problem?  When we in the US already spend more than any other country in the world on medical care?  It ain’t gonna happen!
> We need to work smarter and cut out the fat before we can expect to get resources to do what is really needed.
> 
> Edward P Hoffer MD
> Massachusetts General Hospital/Harvard Medical School
> 
> From: Shapiro, Barbara [mailto:Barbara.Shapiro at UHHOSPITALS.ORG]
> Sent: Wednesday, October 08, 2014 7:43 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: Re: [IMPROVEDX] Ebola in Dallas
> 
> You are correct. But so far society has shown us that nobody is willing to give us the resources we really need. It's cost benefit. What more needs to happen before society wakes up and we, as physicians, start getting the resources we need. I'm guessing the ER docs in Texas just didn't have the time to think through the situation - they certainly knew this was a febrile man who had just come from Liberia - my ten year old would have figured this out! But in the busy, crazy fog of the ER, they basically missed it.
> 
> 
> Barbara E. Shapiro, M.D.,Ph.D.
> University Hospitals Case Medical Center
> 
> 
> 
> From: David Meyers
> Sent: 10/7/14, 8:18 PM
> To: Society to Improve Diagnosis in Medicine
> Subject: Re: [IMPROVEDX] Ebola in Dallas
> In the end, some type of analysis of the facts will get at many of the contributing causes and corrections in the Dallas ebola case - knowledge deficits, failure to recognize the pattern, EHR issues, biases which always figure in decision-making, additional training, implementing protocols, etc.  But suppose a contributing factor IS the busy, harried, distracted ED staff who didn't have time to put all of the info together and make the right decision after thinking carefully about it, and instead acted as best they could under the circumstances - what Bob Wears has called the "tragedy of adaptability".  This is a recurring theme in a lot of diagnostic and other medical errors.  Are we, and more importantly the hospital CEO/CFOs and health insurers and maybe ultimately society prepared to make and pay for changes such as additional staff, more useful EHRs and other resources or the radical restructuring of clinical work which may be needed to fix these problems.  Perhaps the IOM will address this in their report on diagnostic error next year.
> 
> To unsubscribe from the IMPROVEDX:
> mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> 
> Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> 
> 
> 
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com<mailto:Lorri at ZPM1.com>, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
> To unsubscribe from the IMPROVEDX list, click the following link:<br>
> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
> </p>
> 
> Visit us at www.UHhospitals.org<http://www.UHhospitals.org>.
> 
> The enclosed information is STRICTLY CONFIDENTIAL and is intended for the
> use of the addressee only. University Hospitals and its affiliates disclaim
> any responsibility for unauthorized disclosure of this information to anyone
> other than the addressee.
> 
> Federal and Ohio law protect patient medical information, including
> psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions,
> alcohol, and/or drug_dependence or abuse disclosed in this email. Federal
> regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and
> 3701.243 prohibit disclosure of this information without the specific
> written consent of the person to whom it pertains, or as otherwise permitted
> by law.
> 
> ________________________________
> 
> Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> 
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG>
> 
> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com<mailto:Lorri at ZPM1.com>, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> 
> The information in this e-mail is intended only for the person to whom it is
> addressed. If you believe this e-mail was sent to you in error and the e-mail
> contains patient information, please contact the Partners Compliance HelpLine at
> http://www.partners.org/complianceline . If the e-mail was sent to you in error
> but does not contain patient information, please contact the sender and properly
> dispose of the e-mail.
> 
> 
> 
> 
> 
> Visit us at www.UHhospitals.org.
> 
> The enclosed information is STRICTLY CONFIDENTIAL and is intended for the
> use of the addressee only. University Hospitals and its affiliates disclaim
> any responsibility for unauthorized disclosure of this information to anyone
> other than the addressee.
> 
> Federal and Ohio law protect patient medical information, including
> psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions,
> alcohol, and/or drug_dependence or abuse disclosed in this email. Federal
> regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and
> 3701.243 prohibit disclosure of this information without the specific
> written consent of the person to whom it pertains, or as otherwise permitted
> by law.
> 
> 
> 
> 
> 
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
> To unsubscribe from the IMPROVEDX list, click the following link:<br>
> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
> </p>










More information about the Test mailing list