The Essence of Experience in Leadership

The great illusion of leadership is to think that man can be lead out of the desert by someone who has never been there. . .

Electronic Health Record challenges . . .

One of the challenges of using an electronic health record (EHR) is that of communication and order generation with ancillary services.  Medicare has mandated conversion to the use of electronic prescribing and commercial insurance has followed suit. The challenge is that as we are all becoming more paperless, ancillary services are no longer accepting prescriptions that don't have an "actual signature".  Medicare as also mandated that every order be "physically signed" which is becoming impossible with use of EHR.

This hasn't posed a problem with Medicare or with the commercial insurances, but it has begun to drive a wedge between the patient and his or her physician. We send a prescription electronically and the ancillary service kicks it back because it isn't "actually signed on paper."  Patient's feel our office is not doing its job correctly because the ancillary services told him that he "orders were signed correctly."  We are doing our job and having to duplicate services.  Everyone gets irritated all the way around the process.
Because we as a society are used to getting "our burger our our way" within a two-and-a-half minute window, my staff frequently gets an ear-full. Screaming and cursing at the doctor's office staff is not the way to get things done or aid your cause.
The burden that is created by the mandate for EHR use causes a significant change in the office flow.  It takes a good 6-12 months for a physician's to improve efficiency when the whole office flow changes.  My office is not alone in this problem.  We just recently changed our electronic health care record and significant process changes were made which has caused us delay and efficiency drops while we accommodate the new flows and attempt to write orders that were signed with electronic signatures with "actual wet signatures."
I have been using electronic health records for over 11 years.  The process isn't getting any easier, unfortunately. If you are a patient, or an ancillary service, please be patient with your doctor's office.  We are becoming as regulated as the airlines . . . who knows  . . . you may soon need to pass through a TSA scanner before you can enter my office.  Wouldn't that be exciting?!

Meet Brutus

Meet my friend Brutus . . . !

It's coming . . . mark my words. 15,000 IRS agents looking at your healthcare information as it flows through CMS. 

Change

The challenge in life is to adjust to changing times while still holding true to unchanging principles . . .

Journaling Thoughts . . .

A man would do well  to carry a pencil in his pocket, and write down the thoughts of the moment. Those that come unsought for are commonly the most valuable, and should be secured, because they seldom return.
Francis Bacon

(Anyone who's name ends in bacon ought to be listened to!)

Mother's Day

Life does not come with an instruction manual . . .

It comes instead with a mother.

Characteristics of Great Leaders . . .

1. JUST DO IT.

• A leader's most powerful ally is his or her own example.  
• Leaders don't just talk about doing something; they do it.

Influence

Money motivates neither the best people nor the best in people.  It can move the body and influence the mind, but it cannot touch the heart or move the spirit; that is reserved for belief, principle, and morality.

The Microbiome of the Gut: Medicine's Final Frontier?

I have been fascinated by a new school of technology that has revealed itself to us in the last few years presented by Suzanne Devkota, PhD, at the recent ASBP Conference. There are 100 trillion bacterial cells in our bodies (more than the number of cells that make up our body). Recently bacterial 16s ribosomal genes have been identified that give us a very fast, specific and quantitative identification of the bacteria in the stomach and gut.  It gives us a new gene map of the gastrointestinal system. This identification process not only allows us to look at the current bacteria in the gut, but lets us look at bacteria present in the guts of our ancestors.  It also gives us insight into how we metabolize food and how these bacteria can be helpful in the treatment of disease.

There are thousands of bacteria in our bodies that live symbiotically with us of which we were never aware. Landmark papers have been released about these bacteria and their effects begining in 2001.  Most of these papers have focused on how these bacteria affect obesity. There are three very interesting benefits I found important.

1. The spectrum of bacteria in our gut affects how we metabolize and break down different foods in our diet. It also influences our health. 

2. Mothers transfer the microbiomes early on through the method of birth.  There are very specific bacteria that confer specific beneficial or harmful immunity to a person's body.

3. These bacteria have the ability to perform Lateral Gene Transfer. Bacteria have the ability to share genes "laterally," to their neighbor, that confer antibiotic resistance, immunity or action. 

What is also important is that these microbes can process dietary fibers more effectively leading to increased formation of glucose and free fatty acids and triglycerides.  This can be the reasons that some people gain weight from the same fiber intake that others don't. These bacteria can also increases Lipoprotien Lipase, the enzyme in the body that stimulates increased fat storage. 

Another fascinating piece of information relating to this field of study reveals that certain bacteria found in patient's with type II diabetes causes a "gut leakiness  that arises predisposing many to various forms of bowel inflammation. 

The types of fat we eat actually have an effect on the bacteria colonies and upon the degree of "leakiness" in the GI system.  This may be why so many patient feel like they have "gluten" intolerance or gastrointestinal inflammation.

Omega 3 fatty acids have been found to help protect the bacteria and the "leakiness" in the GI system.  

We still have much to learn in this area and much to gain as we apply what we are learning. 

Stay tuned . . .

The Real ....

More Bacon Please . . .

Imperfect People

Great Thatcherisms . . .

An amazing lady passed away yesterday, the former research chemist turned barrister and then later, British Prime Minister serving from 1979 to 1990. She was nick-named the "Iron Lady" because of her uncompromising political views and leadership style.  In honor of the passing of the great Iron Lady, Margaret Thatcher, here are 16 of the best Thatcherisms:

"ON GETTING THINGS DONE:


“If you want something said, ask a man. If you want something done, ask a woman.”

“If you just set out to be liked, you would be prepared to compromise on anything at any time, and yu would achieve nothing.”

“I’m extraordinarily patient provided I get my own way in the end.”

"AN IRON PRIME MINISTER:


“Where there is discord, may we bring harmony. Where there is error, may we bring truth. Where there is doubt, may we bring faith. And where there is despair, may we bring hope.”

“I am in politics because of the conflict between good and evil, and I believe that in the end good will triumph.”

“Do you think you would ever have heard of Christianity if the Apostles had gone out and said, ‘I believe in consensus?’”

“Standing in the middle of the road is very dangerous; you get knocked down by the traffic from both sides.”

"ON HER CRITICS:


“If my critics saw me walking over the Thames they would say it was because I couldn’t swim.”

"ON THE START OF THE FALKLAND WARS:


“Defeat? I do not recognize the meaning of the word.”

"ON GOVERNMENT:


“We want a society where people are free to make choices, to make mistakes, to be generous and compassionate. This is what we mean by a moral society; not a society where the state is responsible for everything, and no one is responsible for the state.”

"ON HUMANITY, SOCIETY, & FEMINISM:


“The woman’s mission is not to enhance the masculine spirit, but to express the feminine; hers is not to preserve a man-made world, but to create a human world by the infusion of the feminine element into all of its activities.”

“I owe nothing to Women’s Lib.”

“Being powerful is like being a lady. If you have to tell people you are, you aren’t.”

"ON AMERICA:


“Europe will never be like America. Europe is a product of history. America is a product of philosophy.”

"ON SOCIALISM:


“Socialist governments traditionally do make a financial mess. They always run out of other people’s money. It’s quite characteristic of them.”

“And what a prize we have to fight for: no less than the chance to banish from our land the dark divisive clouds of Marxist socialism."

(taken from the article by Becket Adams on TheBlaze.com)

Family Physician Burnout . . .

A national survey published in the Archives of Family Medicine in 2012 reported that US physicians suffer more burnout than other American workers.[1] Some 45.8% of physicians were experiencing at least 1 symptom of burnout: loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.
Medscape conducted a survey and family physicians were given the same criteria. The response was discouraging: 43% responded that they were burned out. The 2 specialties with the highest percentage of burnout were those that dealt with severely ill patients: emergency medicine and critical care. Family physicians were in third place.



What is causing the burnout? Following table lists the causes found in the study.



In the Archives article,[1] the authors sum up the very challenging problem of physician burnout: "Collectively, the findings...indicate that (1) the prevalence of burnout among US physicians is at an alarming level, (2) physicians in specialties at the front line of care access (emergency medicine, general Family Medicine, and family medicine) are at greatest risk, (3) physicians work longer hours and have greater struggles with work-life integration than other US workers, and (4) after adjusting for hours worked per week, higher levels of education and professional degrees seem to reduce the risk for burnout in fields outside of medicine, whereas a degree in medicine (MD or DO) increases the risk. These results suggest that the experience of burnout among physicians does not simply mirror larger societal trends."

What to do? The finding suggest that physicians should participate in and advocate for changes in work that give them more control over there ability to help and interact with patients. They should become involved in advocating for health reforms that will return a greater level of control to physicians and their patients. These would include payment for value and greater patient participation in decision-making about care. Reorganizing primary care practices to allow more time for complex patients and recognition by insurers that excessive hassle is bad for patients and physician are also vital. These changes should lead to more satisfied patients and physicians and less burnout,[3] .

References:
1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physician relative to the general US population. Arch Intern Med. 2012;172:1377-1385. http://archinte.jamanetwork.com/article.aspx?articleid=1351351 Accessed February 7, 2013.
2.http://www.medscape.com/features/slideshow/lifestyle/2013/family-medicine?src=wnl_edit_specol#2
3. Centor RM, Morrow RW, Poses RM, et al. Doc burnout -- worse than other workers'. Medscape Roundtable in Primary Care. November 13, 2012. http://www.medscape.com/viewarticle/774013 Accessed February 20, 2013.

Where Do You Get Your Advice?

I DO ALL MY OWN STUNTS!

I've determined that life is not a journey to the grave with the intention of arriving safely in a dainty and well-preserved condition. But, my life's journey is, rather, to be fully enjoyed, thoroughly used up, totally worn out and I intend to be found skidding broadsided into heaven and when landing I will proclaim, "WOW, WHAT A RIDE!"

My orthopedic surgeon, just grinned and recommended I avoid bungee jumping or hang gliding . . .

Confidence

One of the greatest success in life is the confidence that comes from understanding shared in sincere conversation between two people.

My Friend The Doctor . . .

My sister (an up and coming author), Robyn Oler, recently published a wonderful children's book entitled "My Friend the Doctor", published by Tate Publishing.  She admits the book is based on my medical office and the experiences of her daughter in the doctor's office.  She has done another fabulous job!

The new book is a wonderful addition to any children's book library and, in my biased opinion, I highly recommend you buy your copy today.  You can order it online here.

Keep up the good work, Robyn!

Today's Thoughts . . .

Patriotism is easy to understand in America: it means looking out for yourself when looking out for your country. - Calvin Coolidge

He who floats with the current, who does not guide himself according to higher principles, who has no ideal, no convictions-such a man is a mere article of the world's furniture - a thing moved, instead of a living and moving being - an echo, not a voice.

Speech . . .

There are many things I believe . . . that I shall never say; however, I shall never say the things that I do not believe.