Remembering Dr. Quentin Young

Dr. Quentin D. Young, the legendary activist and doctor died on March 7th 2016 at the age of 92. Obituaries appeared in the New York Times, the Chicago Sun Times , and Chicago Tribune among many other papers. The Physicians for a National Health Program (PNHP) have collected personal tributes in honor of Dr. Young’s life.
Dr. Young was one of the founders of Medical Committee for Human Rights, an advocate of doctors’ right to organize who, according to the New York Times,” was fired as the chairman of the department of medicine at Cook County Hospital for supporting doctors who demanded bargaining rights and better patient care”, a proponent of single payer health care and personal physician to Dr. Martin Luther King.

Dr Young remains an inspiration for all of us who believe that doctors can be on the front line of social justice movements. His expansive concept of the doctor’s role as an advocate is a model for members of our union- Doctors Council. In a 2003 JAMA communication “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance“ Dr. Young and his peers described a vision for health care reform that remains as vital today as it was then. We hope to celebrate his life by restating this diagnosis and vision:

“For physicians, the gratifications of healing give way to anger and alienation in a system that treats sick people as commodities and physicians as investors’ tools. In private practice we waste countless hours on billing and bureaucracy. For the uninsured, we avoid procedures, consultations, and costly medications. In HMOs we walk a tightrope between thrift and penuriousness, under the surveillance of bureaucrats who prod us to abdicate allegiance to patients and to avoid the sickest who may be unprofitable. In academia, we watch as the scholarly traditions of openness and collaboration give way to secrecy and assertions of private ownership of vital ideas—the search for knowledge displaced by a search for intellectual property.”
“Four principles shape this vision of reform:
1. Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to ensure this right. Coverage should not be tied to employment.
2. The right to choose and change one’s physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.
3. Pursuit of corporate profit and personal fortune have no place in caregiving. They create enormous waste and too often warp clinical decision making.
4. In a democracy, the public should set health policies and budgets. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.”

National Doctors Day

March 2016

From Dr. Frank Proscia, President and Dr. Matthews Hurley, 1st Vice President, Doctors Council SEIU

As doctors ourselves, we realize the commitment and sacrifices each of you has made to be a doctor. It took years of school, residency, study and training to be where you are today. The commitment to patient care and the communities you serve that you bring every day and every shift is to be commended.

There is a very special relationship between a doctor and a patient. Too often, others attempt to make decisions for us without the input of doctors and see doctors as a small part of the delivery of patient care. A hospital or clinic is more than just bricks and mortar; it is the doctors who treat patients and make the facility work. Our voices need to be heard today more than ever.

That is why we want to take this opportunity to thank each of you for being a doctor and a member of our union and profession.  You may not be aware, but there is a National Doctors Day celebrated on March 30thevery year.  We believe that every day should be a day to recognize doctors.  

The history of National Doctors Day is an interesting one. The first Doctors Day was observed on March 30, 1933 in Winder, Georgia.  The wife of Dr. Charles B. Almond (Eudora Brown Almond) decided to set aside a day to honor doctors.  This included mailing greeting cards and placing flowers on graves of deceased doctors. National Doctors Day began in 1933 as a local commemoration in Barrow County, Georgia, to celebrate the date on which Dr. Crawford W. Long managed the primary ether sedative for surgery on March 30, 1842. The date for National Doctors Day is the anniversary of the first use of general anesthetic in surgery, as on March 30, 1842 Dr. Long used ether to remove a tumor from a patient’s neck. The red carnation is commonly used as the symbolic flower for National Doctors Day, for the reason that it signifies the qualities of sacrifice, charity, courage, bravery and love.

On March 30, 1958, a Resolution Commemorating Doctors Day was adopted by the United States House of Representatives.  In 1990, legislation was introduced in the House and Senate to establish a national Doctors Day.  Following overwhelming approval by the U.S. Senate and House of Representatives, on October 30, 1990, President George H.W. Bush signed S.J. RES # 366 (which became Public Law 101-473) designating March 30 as “National Doctors Day.”

As stated in a Presidential Proclamation, medicine is a special calling, and those who have chosen this vocation understand the tremendous responsibility it entails. Doctors carry on the quiet work of healing every day in our communities through hard work and sacrifice.

We look forward to continuing to work together with each of you to advance our profession and to ensure our voices are heard.

Doctors Council Supports Continuum of Health Care for People Coming Home from Prisons and Jails

Join Doctors Council in supporting a continuum of health care for people coming home from prisons and jails. We’re asking lawmakers in Albany to allow limited use of Medicaid Pre-Release to cover certain health services during the last 30 days of incarceration for at-risk individuals as they transition back into the community. This change would support individuals with chronic conditions, especially histories of addiction and mental illness; improve public safety through reduced crime, re-arrest and re-incarceration, and support New York’s efforts to provide high-quality, comprehensive care to those needing it most.

Click here to sign the petition: https://www.change.org/p/new-york-state-senate-providing-a-continuum-of-health-care-for-people-coming-home-from-our-prisons-and-jails?recruiter=515956358&utm_campaign=signature_receipt&utm_medium=email&utm_source=share_petition

Victory for Kings County OB-GYN Doctors

From left to right: Drs. Robby Short, Iyad Nader, Cheryl Claxton, Olusegun Ajayi, Melissa Philadelphia, Lisa Ricketts-Holcomb

 

Doctors Council members in OB/GYN at Kings County Hospital recently won a victory enforcing our legal rights through our union.

Doctors were informed by administration that the compensation we had been receiving for many years for work on a holiday would be changed to compensatory time. Administration changed this practice without any consultation or negotiation with the doctors impacted. We contacted Doctors Council and together we met with administration, but they refused to change their decision.

Doctors Council filed an improper practice charge at the Office of Collective Bargaining (OCB) and a hearing was held. Doctors Council members prevailed and we won.

Under the order from the OCB, Kings County was held to have violated the law by unilaterally changing the compensation of the Doctors Council members in OB-GYN for hours worked on a holiday. Kings County was ordered to rescind its action and restore the practice for paying doctors for working on holidays. Under the order, any doctor who suffered a loss would be made whole by Kings County.

This important victory shows the value of being a member and involved in Doctors Council.  When we enforce our rights through our union we can protect our interests. Kings County cannot make such unilateral changes until they negotiate with us and Doctors Council.

Doctors Council has been addressing many issues at Kings County and if you or your colleagues have any issues or questions please get involved and contact us.

Is All this Quality Reporting Making Things Better?

A recent study in Health Affairs attempts to quantify the amount of time doctors spend on reporting quality measures.  According to the article by Casalino, L.P et al


“Primary care physicians spent 3.9 hours per week dealing with quality measures, compared to 1.7, 1.1, and 3.0 hours for cardiologists, orthopedists, and physicians in multispecialty groups, respectively. Primary care practices spent 19.1 hours of physician and staff time per physician per week dealing with quality requirements of external entities; cardiology, orthopedic, and multispecialty practices spent 10.4, 11.3, and 17.6 hours per physician per week, respectively. Time spent varied little by practice size (Appendix A3).8

In perhaps the most worrying aspect of the study, “Only 27 percent believed that current measures were moderately or strongly representative of the quality of care. Just 28 percent used their quality scores to focus their quality improvement activities. “

Of course we all hope that the reporting of quality measures serves to increase the quality of care delivered. These findings might suggest an imbalance in the relationship between quality improvement and reporting.

On reflection, one wonders if the medical profession has become good at quality assurance as opposed to quality improvement.  In addition, while there is value in reporting the numbers, has the practice of medicine become too focused on numbers and as a result, the autonomy of doctors is being eroded or lost?  (All good topics for future blog posts.)

What do you think?

 

Are the White Coat Days Coming to an End?

Paul E. Sax, M.D. explains “If you’re not immersed in the ID or the Infection Control world, you might not be aware that there’s currently quite the controversy about whether doctors should wear white coats.”

The medical question is of course about the danger of infection, but once the doctors’ traditional uniform is threatened larger cultural issues come into play.  For example, what is the patient’s expectation and how does that impact the visit?  How does the doctor maintain his/her authority?

In any visit to the doctor there is a bit of theater involved.  The stage is set and costumes are worn.  But perhaps things are changing.  A recent article by Abigail Zuger M.D “The Costumes That Obscure Doctor and Patient”  suggests that the days of the white coat may be coming to an end.  Dr. Zuger points out that is has been 10 years since the  British Health service cut the traditional white coat .

A literature review by Petrilli CM, Mack M, Petrilli JJ, et al in BMJ Open on the subject finds that while there is some desire on the part of the patient for more formal dress from the doctor, the preference varies so much based on geography, age, culture and tradition that it is hard to draw any uniform conclusions (pun intended).

While some of the discussion on what a doctor should wear is based on the science of infection control much of it is more subjective.  The same is of course true for what the patient wears.  Dr. Zuger writes ”The symbolism surrounding patient gowns is just as fraught. They are cheap, demeaning, undignified and chilly.”

It is interesting that what starts as a question about infection so easy transforms to a question about the human nature of the doctor-patient interaction.  As Dr. Zuger notes:

“We are never more human than when we are dressing and undressing, and yet for our medical care, we have, for some reason, decided to posture in front of one another fully costumed, pretending that, encased in our separate roles, we will get to the bottom of the pain.”

Patient Experience and Quality Care

Doctors are increasingly asked to address patient experience as an important  measurement.  As frontline doctors we put our patients at the center of everything we do, and understanding that a good patient experience is as important as clinical outcomes benefits not only our patients but those who interact with the patient.

While we all support improving the patient experience, it is not so simple to describe the relationship between the self reported patient experience and clinical outcomes. A 2013 study in the Annals of Family Medicine by Llanwarne et al concludes:

“Our findings support the hypothesis that although there are positive associations between clinical quality of care and measures of patient experience, these 2 domains of care quality remain predominantly distinct, with statistically significant but very low correlations. The strongest correlations are between clinical quality and access. Clinical and patient experience domains of quality need to be considered separately when assessing the overall performance of a family practice.”

A 2014 Review Article “Examining the Role of Patient Experience Surveys in measuring Health Care Quality” suggests a complicated picture.  On one hand they write “the empirical evidence indicates that it is possible for health care providers and plans to simultaneously offer better patient experiences and better clinical quality, and that positive patient experiences, best practice clinical processes, lower hospital readmissions, and desirable clinical outcomes are often positively associated across provider organizations. “ But they also explain that “Many of the studies we reviewed, however, reported null associations between patients’ care experiences and clinical processes or outcomes. Lack of association between patient experience measures and clinical outcomes is not necessarily surprising, as clinical process measures have not been demonstrated to be consistently and positively related even to one another.”

A 2014 Debate and Analysis piece in the British Journal of General Practice tries to draw a sharper line between outcomes and Patient Reported Outcomes Measures (PROMs). “However, although patient experience clearly matters, and validated PREMs (patient reported experience measure) provide an invaluable view of this, experience is distinct from outcome. Recent research suggests that the correlation between a positive experience and outcome in general practice, while statistically significant, is actually fairly low.”

 

Something deeper is being discussed when experience and outcome are juxtaposed in this way.  In the American context an underlying issue is how the patient should be viewed in the new health care landscape.  Perhaps the anxiety of using patient experience as a measure mirrors the move from patient to consumer.   Hospitals, like many brands, are worried about attracting and keeping patients.  If the patient is a consumer and the consumer is always right, what does that mean for the professional authority of the doctor?

This seems to be precisely the question in  Alexandra Robbins’ Atlantic Article “The Problem with Satisfied Patients” where the thesis is stated in the subtitle “A misguided attempt to improve healthcare has led some hospitals to focus on making people happy rather than making them well.”  He quotes a Missouri clinical instructor who said “patients can be very satisfied and dead an hour later.”  A scary idea, but does the data warrant this fear?

The reverse side of the “consumer is always right” argument is the fear that hospitals will focus on the experience of the patient and not their health.  Will the incentive move from hard outcomes to subjective experience? Robbins writes “Many hospitals seem to be highly focused on pixie-dusted sleight of hand because they believe they can trick patients into thinking they got better care.”

Of course, as Dr. Ira Nash points out in a critique of the article on KevinMD, the hospitals are not asking the patients to review everything about the quality of their hospital, only the quality and of their experience as a patient, and in this area who is a more of an expert than the patient?

There is a big difference if the challenge to professional authority comes from the hospital and insurance companies or from the patients. The first demands a strong defensive posture and the second demands empathy.  While the use of the patient experience might be manipulated to preserve a “brand”, in itself the patient experience is an important part of the healing process for the doctor to consider.  Putting the patient first is different from manipulating the patient and it is the doctor’s role to keep them separate.