Six Rules of Doctor Etiquette

From the Wall Street Journal Health Blog:

Kahn, who lays out the idea in this week’s New England Journal of Medicine, cites the work of Peter Pronovost, a Johns Hopkins doc who came up with a straightforward checklist to reduce infections in the ICU. “The results of this simple intervention were swift and dramatically effective,” Kahn writes, adding that similar checklists might go a long way toward improving doctor-patient relations.

As an example, Kahn suggests this checklist, which would apply to the first-time encounter between a doctor and a hospitalized patient:

1. Ask permission to enter the room; wait for an answer.

2. Introduce yourself, showing ID badge.

3. Shake hands (wear glove if needed).

4. Sit down. Smile if appropriate.

5. Briefly explain your role on the team.

6. Ask the patient how he or she is feeling about being in the hospital.

Cultural Competency Continuing Education

From Medscape (free subscription required):

Cultural Competency in Healthcare: A Clinical Review and Video Vignettes From the National Medical Association

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Define cultural competence and the rationale for practicing as a culturally competent healthcare professional
  • Implement/practice strategies for reducing practitioners’ own biases and misconceptions when encountering patients of a differing cultural background
  • Identify when a language barrier is present and an interpreter is needed
  • Recognize the advantages and disadvantages of trained vs untrained interpreters

Betting That a House Call Is Cheaper Than a Trip to the ER

From the Wall Street Journal Health Blog:

You twist your ankle, or you get a nasty flu and spike a high fever. It doesn’t feel like a life-and-death situation, but it’s pretty bad the middle of the night, or you can’t get in to see your doctor. So you head for the emergency room.

Not only is this unpleasant and inconvenient; it also sends the cost of treating that fever through the roof.

Enter Carena, a little company out in Seattle, that’s betting that self-insured companies can save money by having employees skip some trips to the ER and get a house call from a family doc instead.

The company’s big break came a few years back, when it cut a deal to do house calls for most of Microsoft’s 85,000 Seattle-area employees. Now it’s looking to expand the business, and recently got a contract that covers some 45,000 employees of the Commonwealth of Kentucky. (The company also has a smaller, separate business providing on-site care for employees.)

It works like this: A sick or injured employee calls a nurse line. More than half the time, the employee will be told the situation isn’t an emergency, and can wait for a trip to the doctor or the urgent care center. About 10% of the people who call are told to head for the ER immediately. But that leaves about 20-25% of the calls, where the patient shouldn’t wait but doesn’t need the high-intensity, high-cost care of the ER.

In those cases, Carena sends a doctor to the employee’s house for a house call. (The docs work exclusively for Carena, and make about what a private practice family doc makes.)