Internistenconsult : 8 minuten per patient in de VS

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Inhakend op je citaat over de overbodige ambtenaar: viewtopic.php?f=3&t=6834 :

Als artsen staken, sterven er minder mensen!

Ik wilde toch weer even een serieuze noot toevoegen, anders wordt het hier nog te melig en dat is misschien niet de bedoeling op deze site?
Of zullen we toch maar weer even naar de luchtige zoete kletskoekjes teruggaan? viewtopic.php?f=3&t=1875

Als je nog wat meer trek hebt in zware kost: hebben we ook dit nog in de aanbieding: http://justmeint1health.wordpress.com/2 ... eople-die/

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Arts met EPD ziet minder non-verbale communicatie bij patiënt.

Uit Amerikaans onderzoek is [...] gebleken dat artsen die met een EPD werken minder oogcontact hebben met de patiënt.

http://www.mednet.nl/nieuws/id7605-arts ... tient.html

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Filmcut uit film Synecdoche New York:

https://dl.dropboxusercontent.com/u/145 ... w-York.mp4

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Mondige patiënten soms genegeerd

1 1374 Nursing
Patiënten die in het ziekenhuis hun mond open trekken en voor zichzelf opkomen, worden soms genegeerd door zorgverleners. Ook moeten deze mondige patiënten oppassen dat ze niet worden gekort op zorg, omdat ze vaak worden weggezet als ‘lastig en veeleisend’. Dat blijkt uit het rapport ‘Sterke verhalen uit het ziekenhuis’ van het Rathenau Instituut.
Mondige patiënten soms genegeerd

Uit het onderzoek komt ook naar voren dat patiënten vinden dat verpleegkundigen en artsen te weinig tijd en empathie hebben voor emotie. Verder voelen ze zich vaak slecht geïnformeerd over procedures, diagnoses en behandelingen.

Medisch perspectief
De belangrijkste reden dat patiënten zich genegeerd voelen is volgens rapport dat het medisch perspectief van de zorgverleners voorop staat. Daarnaast is weinig ruimte voor een actieve patiënt. Veel mensen die in het dagelijks leven mondig zijn, voelen zich onmondig in het ziekenhuis. Dat heeft vooral te maken met de organisatie van de zorg en met de houding van sommige zorgprofessionals.

http://www.nursing.nl/Verpleegkundigen/ ... -1491128W/

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EU rules on doctors' working hours puts patients at risk, report finds
Rules which ban junior doctors for working more than 48 hours a week are damaging patient care and more staff should be encouraged to opt out, a report has found
British 'stiff upper lip' costing lives as patients delay seeing doctor with cancer symptoms
One in six Britons were embarrassment about going to the doctor with a symptom that might be serious compared with one in 17 in Denmark. Photo: ALAMY

By Sarah Knapton, Science Correspondent

03 Apr 2014

Junior doctors should be encouraged to opt out of the European Working Time Directive because it is damaging patient care and putting patients at risk of late diagnosis and delayed treatment, a major report has found.

In November Jeremy Hunt, the Health Secretary, appointed an independent taskforce to look at the impact of the EWTD on patient care and the training of doctors.

Under EU law, junior doctors can only work 48 hours a week and must have rest periods to make up for being on call overnight, even if they were asleep the whole time.

It means that clinics and outpatient appointments are regularly cancelled because there are not enough doctors to take them. The report found that vital consultations were being missed which was delaying diagnosis and treatment.

There is also less continuity in care, with some patients seeing four or five different doctors a day because of the rota patterns.
Related Articles

The EU Working Time Directive in detail
09 Jun 2010

Working Time directive restricts work of doctors, official EU review finds
22 Jul 2013

EU regulations stopping doctors getting trained, warns top surgeon
28 Jan 2013

Health experts are also concerned that junior doctors will not be as well trained in future because they have not had enough ‘hands-on’ time on wards or in operating theatres.

The Royal College of Surgeons found that junior surgeons training under the new working guidelines will have 128 fewer days of experience by the time they qualify as specialists.

Yesterday the taskforce, which was headed up by Professor Norman Williams president of the RCS, recommended that doctors should be encouraged to opt out of restricted hours and given extra training away from wards.

“The inflexibility of the directive is having deleterious effects on training and patient care in some specialities and there is a need for solutions,” said Prof Williams

“One option which deserves further exploration might be to separate the training and education of trainee doctors from their work on the wards.

“This will help strike the right balance between delivering patient care and ensuring that junior doctors are able to acquire the knowledge and skills they need to become specialists of the future.”

Prof Williams recommended encouraging ‘widespread use of the individual opt-out’

The European Working Time Directive has been unpopular since it was implemented fully for doctors in 2011. Although it was meant to prevent medical errors being made by fatigued doctors many felt that it was damaging patient care through a lack of continuity.

Junior doctors are allowed to opt out but many trusts discourage the practice because they are reluctant to pay overtime. Trainees complain they feel forced to break the rules in order to become good consultants or falsify time sheets.

The report revealed that nearly 80 per cent of trainee neurosurgeons are forced to work longer hours just to keep up with training and workloads.

“The Working Time Directive has cause greater problems for some specialities than others,” the report authors found.

“Training and education in some acute specialties has proved very difficult to implement with the constraints of the directive preventing trainees from achieving the skills and experience required for their speciality.”

The Royal College of Physicians told the report authors that they were concerned about the ‘disruption in continuity of care’ for patients and the number of clinics cancelled because of a lack of staff.

The Royal College of Radiologists complained that appointments were frequently cancelled to comply with the regulations.

Health Secretary Jeremy Hunt said “The government commissioned this important work because we share the longstanding concerns of doctors and patients about the impact of the implementation of the Directive on patient care and doctors’ training.

“I am very grateful to the Royal College of Surgeons and other members of the expert panel for the way they have explored these issues and presented constructive solutions to address them.

“We look forward to working with doctors and patient groups to take them forward.”

RCP president Sir Richard Thompson said:"The RCP welcomes this report as a step forward in improving the training opportunities and working lives of junior doctors.

"Our own RCP surveys show that junior doctors are dissatisfied with their training, including in the continuity of care, which is often fragmented due to the restrictions placed on them by the European Working Time Regulations and the New Deal contract.

"We particularly welcome the recommendation to distinguish better between the service and education elements of doctors’ contracts, and this must be taken into account in the current renegotiation of the contract."

http://www.telegraph.co.uk/health/healt ... finds.html

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04.14.14How Being a Doctor Became the Most Miserable Profession
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?

By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level of sheer unhappiness amongst physicians is on the rise.

Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.

Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retire as quickly as possible. Physician MBA programs—that promise doctors a way into management—are flourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician. Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.

Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.

Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals are on the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.

But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.

Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.

In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.

It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.

But what is a bit of a wonder is how things got this bad.

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with a popular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors. Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone.

http://www.thedailybeast.com/articles/2 ... ssion.html