Nov. 19, 2020 | Vol. XI | Issue 47
The Art of Listening: Beyond the Chief Complaint
A Country Doctor Writes:

A doctor's schedule as typical EMR templates see it only has Visit Types: New Patient, 15-minute, 30-minute. But as clinicians we like to know more than that.

One patient may have a brand-new worrisome problem we must start evaluating from scratch, while another is just coming in for a quick recheck. Those are diametrically opposite tasks that require very different types of effort.

Some visits require that test results or consultant reports be available, or the whole visit would be a waste of time. How could you possibly plan your day or prioritize appointment requests without knowing more specifically why the patient needs to be seen?

So, as doctors, we usually want our daily schedules to have "Chief Complaints" in each appointment slot, like "3-month diabetes follow-up", "knee pain" or "possible dementia." That helps everybody in the office plan their day.
I always bristled at "not feeling well" because that is too nonspecific. After all, that could be something that would have been better handled with a 911 call. But there is also a danger in being too simplistic when classifying what people come in for.
Becoming Homebound
Katherine Ornstein, Melissa Garrido and Katelyn Ferreira write in Public Health Post:

The Covid-19 pandemic has resulted in millions of Americans becoming homebound - having limited social contacts and accessing medical care, groceries, and other needs from within their homes. But for many older Americans, being homebound (i.e., never or rarely leaving home) is already the norm.  Our previous work estimated that, in 2011, two million older Americans were homebound-more than the number of people who live in nursing homes.

Homebound adults often have multiple chronic illnesses, difficulties with activities like bathing and dressing, high rates of depression, and few people on whom they can rely for assistance. They also have a higher risk of death than non-homebound individuals with similar characteristics.

Healthcare Access: Tested during the COVID crisis, it faces challenges in the post-pandemic world 
The University of Miami Patti and Allan Herbert Business School presented its ninth annual Business of Healthcare conference virtually on Friday, October 30. This program is produced annually by the Miami Herbert Business School Center for Health Management and Policy. The business school is renowned for its Health Executive MBA, the highest ranked (by U.S. News & World Report), longest running health executive MBA in the region. Aside from opening/closing remarks and scheduled breaks, the conference consisted of three principal segments labeled Keynote Panels:
  • After the Pandemic: Building a Better Normal
  • Health Care Access, People & Policy, COVID-19 & Beyond
  • Diversity & Inclusion: Providers, Patients & Community
The second segment of the program, focusing on health care access, featured a panel of Matthew D. Eyles, President and Chief Operating Officer, America's Health Insurance Plans; Joseph Fifer, President and Chief Executive Officer, Healthcare Financial Management Association; Halee Fischer-Wright, MD, President and Chief Executive Officer, Medical Group Management Association; Ernest Grant, President, American Nurses Association; Barbara L. McAneny, MD, Former President, American Medical Association, Chief Executive Officer, New Mexico Oncology Hematology Consultants, Ltd. and Richard J. Pollack, President and Chief Executive Officer, American Hospital Association. This segment of the conference was moderated by Pat Geraghty, President and Chief Executive Officer, Florida Blue and GuideWell. Of the three Keynote Panels, this presentation featured the largest and most diverse group of speakers.
The Hospital System Behemoths and Bureaucracy
Chapter 8 #HealthcareFromTheTrenches - The Hospital System Behemoths and Bureaucracy 
Dr. Alejandro Badia - Miami, FL 
The move of orthopedic care away from the hospital to urgent care centers, and perhaps to specialized orthopedic urgent care has been demonstrated, although in somewhat lethargic fashion due to the behemoth size of the industry. 

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