HALLWAY MEDICINE: The new panacea for our limited healthcare dollars

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Firstly, no one wants to remove the ALC patients. They are ALC for a reason. They have an Alternative Lease arrangement in the Community whereby they live in hospital instead of in long term care or on the streets. The only change for ALC patients will be that they will become hospital employees. The can work in the information booth or they can register new patients or collect money from the parking lots or evening security detail or pushing buttons on the elevator.

Next we will triple our overall beds by re-purposing “wasteful” areas of the hospital. This is the brilliance of hallway beds. It will be gradual starting in logical areas.

Hallway beds for emergency patients are already being done. But we can eliminate the waiting rooms and just place gurneys there for patient care. Hallway beds can be used for low acuity procedures like tonsillectomy, kidney stone lithotripsy, birthing, colonoscopy and appendectomy. Look all you need is some IV anesthesia or a spinal block and you are good to go. Some of these hallway beds could be in the bathroom to help with washing the newborns or the surgical equipment afterwards or disposing of the kidney stones. Hallway beds can be used for cataract surgery. Most of these can be done under local anesthesia. In fact, if you move these patients into the Tim Hortons in the hospital and they take your order before the procedure starts and then the patient gets the hot piping brew when their eye is being bandaged all within 8 minutes. Hallway beds can be used for post-operative care as well. They need to mobilize and feed these patients so move them into the cafeteria in their gurneys. Big open space for physiotherapy, lots of light, supportive camaraderie, and nice food is exactly what the doctor ordered for these patients. Perfect. Now we can refurbish the post-operative care to cancer therapy or radiation suites. We can do xrays or CT in the same area as the radiation therapy for cancer patients. Two for one. Gift shops are a perfect area for taking blood and doing ultrasound and echocardiograms. You need to distract patients and they can buy gifts from the hospital marketing department. A hospital gown (deluxe edition with the bum covered) with the slogan “I didn’t cry when I got my blood taken and used Apple pay”. We can move patients into the administrative offices and they can manage the patient advocacy area. We can move patients into the entrance foyer which will make visiting with patients so much easier. We can move patients into the parking lots in the spring to early autumn. They need the fresh air and vitamin D from the sunshine which will improve recovery. We can move patients into the ambulance bays to to give them pre-medication anesthesia like exhaust fumes prior to operations.

So many opportunities in hallway medicine.

Why should we spend more dollars on healthcare when there is so much untapped resources in the system now?

 

 

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14 years of postgraduate training to become… an EMPLOYEE of my patients.

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“I am running out of medications and I need an appointment today”

“My insurance company needs a doctor’s note for my orthotics, I need an urgent appointment between 1-2pm today” and my staff answers on the phone “But sir it is 1145am right now and we don’t have any appointments. You can come to the evening walk in clinic tonight from 5-8pm” so the patient answers “That is not possible. Your clinic never has appointments when I need them and now I will have to go to a walk in clinic. What good is a family doctor?”

“The specialist does not have my referral yet” and my staff answers “You saw the doctor two days ago and the referral was sent last night. These things take time” and the patient answers “What incompetence!”

“My son has been suffering with a diaper rash for 2 months and cannot get an appointment at your office” and my staff answers “When did you leave a request for an appointment” and the patient answers “I have been calling for weeks and received no replies” and my staff answers “Did you leave a message on the answering machine?” and the patient retorts “No one picks up the phone so no point leaving a message. I think I will need to go to the Emergency department.”

“There is an error on my prescription. I need all my Percocet dispensed at one time and they are only giving me a week at a time. Can you correct this?”

“I lost my requisition and need a new one faxed to the ultrasound place. I am here now”

“You’re charging $20 for a sick note? My old doctor used to do this for free? Doesn’t OHIP pay you $100 for the visit? Can’t you just charge them?”

“My research shows I need an MRI, a concussion specialist, and time off of work for 3months for this injury. Can you work that out for me?”

And it goes on and on and on. Anger. Arrogance. Demands. High expectations. Unwillingness to listen.

No communication. No civility. No respect.

The world of patient-doctor relationship has changed. It has become the world of McDonalds Medicine. Order what you want. Change it however you think is best. Get service whenever it’s convenient to you.

It doesn’t matter who else is sick. It doesn’t matter who else has waited and for how long. It doesn’t matter what’s the right thing to do. It doesn’t matter that decision is wasteful or harmful or useless. It doesn’t matter what your ————-(other healthcare practitioner, neighbor, friend) has told you to do.

Thanks to a new mantra of entitled all-encompassing healthcare for all people in all circumstances without exception, to Google Medicine exemplary diagnostics capability, and to ex Health Minister Eric Hobbins 3 year attack on physicians in Ontario…

I am now an employee of my patients.

Thank goodness I am not bitter. LOL

 

BOB the SHEEP (Is he a sheep or much, much more?)

1739_1BOB the sheep was a representative of the Sheep Grazers Association (SGA). He was a hard working and thoughtful member of the flock. He was born a Sheep Grazer, his father and grandfather was a Sheep Grazer and his son was being trimmed to follow in his hoof steps as a Sheep Grazer. BOB was a bit different than his colleagues. He was curious. He wanted to know more and share more. He saw the world bigger than the pasture and the barn. He applied and got into the Sheep Shearing Association (SSA) and the Wolves’ BBQ Association (WBBQA).

The first made sense. The Sheep Shearers and the Sheep Grazers had a good relationship over many generations. They often worked together. There never was a Sheep in the SSA, but there was opportunity for relationship building by having BOB represent the sheep with the sheep shearers. Dialogue and respect were bound to be developed.

Being a member of the WBBQA was shocking! Wolves were the mortal enemies of sheep. Why would BOB want to know what the wolves wanted? Who cares? BOB said, “If you don’t know what your enemies do, how do you know how to adapt, how to use resources differently, how to concentrate on a new strategy, how to learn to undermine the wolves, and so on? KNOW THY ENEMY. It is probably more important to know your enemy than your friend. Friends adapt to you; enemies adapt against you”.

Will you be the sheep that thinks like other sheep or will you be the sheep that thinks DIFFERENTLY?

The Three little pigs and THE BIG BAD WOLF —-A TWISTED FAIRY TALE that tells more than the TRUTH

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Once there were three little pigs who graduated from medical school.

The first pig was honest and kind and upfront about everything and had no conflicts of interest and concentrated on looking after her patients. She made her medical practice with straw. Why would anything or anyone try to hurt a doctor who was looking after patients? Then the big bad wolf came and huffed with fee cuts and puffed with legislative changes and DESTROYED the naïve first pig’s medical practice.

The second pig was sneaky and underhanded. She created disharmony with the other doctors. She complained about everything. She stood up at the conferences and created doubt about transparency and underhanded dealings and tried to vie for power herself. She constantly sent messages to anyone who would listen to her. She tried to talk with the WOLF and work out side deals for herself. And she made her house with sticks. Why would the wolf hurt her because she was strengthening the wolf’s agenda? Then the big bad wolf who knew she was duplicitous and more of a wolf than even him huffed with feeding her misinformation and puffed with fake media opportunities and slowly DESTROYED her future as a respected DOCTOR.

The third pig was ethical but strategic. She knew she needed to understand the wolf. She needed to work with him. She needed to understand why he made his decisions and what he needed to succeed and most importantly get his respect and offer advice that benefited all doctors and all patients. It was a hard balancing act. Many of her colleagues said she was a puppet of the big bad wolf and had conflicts of interest. The second pig was the most jealous and wanted to DESTROY her colleague’s REPUTATION. But the third pig learned how to strengthen her medical practice. She provided good advice to her colleagues and built her practice with bricks. Then when the big bad wolf came his huffs were too weak for the brick house and his puffs were gentler because he liked the third pig and wanted to continue working with her.

Which pig will you be?

If you can’t hear them, they don’t exist…

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#CanadaWAITS is the new hashtag by Globe & Mail’s health columnist Andre Picard highlighting the peaceful and apologetic Canadians that don’t mind waiting in line for socialized healthcare. Canadians love to wait.

If we see a line, we line up. “What is at the end? Who knows? It’s a line in Canada. We must wait. “

Eight months to see an autism specialist, 4.5 years for a neurologist, 12 years for a family doctor. No worries. I have waited longer.

“Sorry I have been in this line for so long that I lost bladder and bowel function. Let me clean that up. It’s my fault for not being patient enough.”

Ever since Winnie and Hostas picked up those noise cancelling headphones, they reduced their stress and improved their sleep. Healthcare is not an issue anymore. YEAH THE GREAT HOSTAS! No one is complaining. CAN’T HEAR THEM. No one is worried about what the doctors and nurses of the province having been crying about for years. FAT CATS. No one is suffering. NO HASHTAGS.

In fact, we are so lucky we have state covered health care that works very well in emergencies and extreme circumstances that no one cares about the day to day disabilities, the opioid/addiction crisis, and the plague of mental illness, the lost years, the lost productivity, and the lost lives.

If you can’t hear them suffering then their problems don’t exist.

Thank goodness. We have such leadership and empathy in our leaders.

REFERENCE: http://www.huffingtonpost.ca/sohail-gandhi/politicians-ignored-doctors-calls-to-fix-health-care-will-they-listen-to-a-hashtag_a_23266755/

REFERENCE: http://www.huffingtonpost.ca/2017/11/03/canada-doctor-patient-wait-times_a_23266026/

 

 

 

ONE BIG DEAL

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Finally, after generations of bickering, ballooning debt, and making promises that no government could actually keep, the Minister of Health of this province has done what no other politician has done before. He has created a massive surplus in the annual provincial budget (approximately $75B), will pay off the $288B provincial debt (within 4 years) and, most importantly, turned his greatest opponents to allies in his path to be the province’s next Premier and eventual Prime Minister of Canada.

“I know many politicians have failed in this complex calculation, but I am a Rhodes Scholar. I don’t shy away from making BIG decisions. In fact, I have spent my whole life preparing to take over, sorry, improve the world around me”, the Minister said with a straight face to room full of reporters today. He took no questions.

Many critics cannot understand how giving away the LCBO and marijuana dispensing rights to both the Public Teachers Union and the province’s Medical Association to manage will help the province and not harm his voters. But very few have the intellectual prowess of this star politician.

“There is no way that educators and doctors will compromise their ethics”, the Health Minister said. “So why not give them all the revenues from booze and weed?”

Simply put, his idea is to stop funding health care (approximately $52B) and public education (approximately $26B) starting on July 1, 2017.

“Heck! It’s Canada Day so let’s celebrate!”

The teachers and physicians will collect all the profits for alcohol and marijuana sales moving forward. At present there will need to be some catch up growth since alcohol sales only make less than $2B/year, but we are not selling all the LCBO locations, we are giving it to them, so that needs to be factored in as well. The doctors and teachers in the province may need to work in the LCBO’s in the beginning to get their sales figures up but they are all very hard workers and willing to go the extra mile. They may even co-brand their LCBO’s with their schools and their medical clinics and their hospitals. They may even include these services with house calls or summer school classes. You get a “B” you get a beer. You get an “A” you get an apple brandy. They can charge whatever they want, they can set any rules, they can include it in baby formula, or they can demand that every medicine in the province has alcohol in it. The also get the revenue from liquor licenses. This is a great, great deal for them. The sky is the limit. BUT THEY MUST COMPLETELY FUND HEALTHCARE AND PUBLIC EDUCATION FOR EVERYONE IN THE PROVINCE. Whatever their profit is theirs to split any way they want. Of course, they still need to work part time volunteer hours as teachers and doctors and run all the hospitals and pay for all the tests that everyone wants. Let us be clear, there is going to be little difference from now in regards to the world class quality for education and healthcare in this province BUT THERE IS ONE BIG DIFFERENCE in which doctors and teachers are no longer restricted by government control in their fields WHATSOEVER.

“Look it’s going to be their little business and I am happy for them”, the Health Minister exclaimed with a toothy grin. “I have thrown in the marijuana business as an inducement! Who knows how much potential revenue that could make for them? I just want this to work out for everyone.”

THE NEW DEAL – moving healthcare downstream to the user. Thinking beyond regionalization to personalization

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We will move responsibility of healthcare from the province down to each individual. After graduating high school and reaching the age of adulthood, each citizen of Ontario is responsible for their own healthcare. This novel yet unstudied health care policy will provide timely access to the right person at the right time  and most importantly eliminate all health care providers, all hospitals, all keeping of medical records from the provincial purview.

Our motto: You, our special citizen (voter), will have unfettered access to every healthcare need, every procedure, and every medication you would like.

The patient is the best person to determine what their healthcare needs are.

Imagine the beauty of choosing your own testing, your own diagnosis, your own treatment, your own operation, and your own rehabilitation. No putting up with making appointments. No more putting up with medical jargon that you don’t understand. No more waiting in a waiting room. Your provincial taxes that will only modestly be increased will provide all of the following benefits listed below without charge.

You will be given full access to Google BYOFP (Be Your Own Family Physician) to determine what ails you. And the best news is that there is no charge for this service. No charge for doctor’s notes. No charges for parking at hospitals.

You will receive free access to the Google BYOPH (Be Your Own Pharmacist) and order what you require including dosing, quantity, and length of prescription. It will be delivered free. Why should you not try medications if you think they may help you?

You will have access to Google BYOPA (Be Your Own Paramedic) when you are involved in trauma and trained to start your own IV’s, arrange your own blood transfusions, and defibrillate yourself. Why do you need to be transported to a hospital and then be charged for the ambulance ride?

You will have free access to Google BYOPS (Be Your Own Psychiatrist) for your mental health issues to manage your own electroconvulsive therapy, prescribe your own neuropsychopharmacology, and do your own cognitive behavioural therapy. Why shouldn’t you have the latest medical diagnoses? Hypochondriasis is very hip these days. Your friends have it, why shouldn’t you?

You will have free access to Google BYOS (Be Your Own Surgeon) at surgical kiosks when you need your own screening colonoscopy, or your own brain surgery to shunt extra fluid, or an acute appendectomy. These multispeciality kiosks will be able to perform hangnail surgery to baby delivery to complicated organ transplants. Just read the options carefully prior to the sedation since we cannot offer refunds for a service that is free. These kiosks will be conveniently located at all pharmacies, casinos, gas stations, and liquor stores. Eventually we will have a home unit for your convenience. There will be no charge for using the service. At the same sites we will have blood testing kiosks (who says you cannot check for a rare disease), diagnostic imaging kiosks for x-rays to MRI’s (who says you cannot have an MRI for a stubbed toe), and interventional radiology kiosks (for dealing with coiling of aneurysms).

THE NEW DEAL is all about empowering you, our voter!

Enjoy exceptional personalized healthcare.

KATEY the CEO of the Popsicle stand

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This was Katey’s big chance!

Finally after years of managing the garbage of discarded Popsicle sticks then taping together the stand and then transporting the Popsicles from the corner store, she was in charge! But to really be in charge she needed puppets: people that could stand in front of the Popsicle stand that she could manipulate behind the scenes and they will step aside in times of glory or recognition and blame them when things went bad. Just like the previous CEO!

She chose Debbie to be in charge of the media spin, Ricky to be in charge of the Band-Aids from the splinters in the sticks, Bobbie to maintain the stand, and Charlie to collect the moolah.

She sold away part of the stand to the ice cream man who had real freezers that she thought she could borrow and lower her costs. But he wanted to charge her. She knew the Popsicles could not be kept cold so she let them melt and sold them as room temperature paletas for a higher price. So she sent Debbie out in the neighborhood to convince her customers that melted paletas were better than ice cold ice cream. And to appease the ice cream man she gave him a piece of her earnings. She gave everyone working for her a raise and everyone against her the media razzmatazz using alternative facts to paint them as pariahs.

Ricky had to shut up all the bleeding hearts. They wanted the sticks to be made safely, without splinters, and every time they got hurt they wanted a Band-Aid. What do you think? Band-Aids grow in Ontario?

Bobbie told her repeatedly that the stand was falling apart. “Use more duct tape and be quiet Bobbie”, she would say.

Charlie told her that she was losing moolah everyday. “I don’t care about that!” Katey didn’t listen. She would extract money from the bleeding hearts by charging for Band-Aids, raising the cost of refrigeration, take a fee when allowing the ice cold ice cream to be sold in the nearby grocery stores and compete against the ice cream man, and give all the really poor folk free melted paletas. The key was to concentrate on appearance more than substance.

How do you think she became CEO? Control the message!

It was better to use her old stock than buy new stock. It was better to spend more on advertising than actually investing on the Popsicle stand. She was untouchable. She could upset the customers for 3 years and then woo them all back in the last year before the next CEO vote.They had no long term memories and were easily managed.

Eventually she would have to remove the splinters and hand out Band-Aids. Eventually she would have to actually fix the Popsicle stand with wood and screws. Eventually the customers would realize melted paletas were just warm pop and were worth nothing. Eventually she would run out of money. But when the truth was known, she would be retired. She would be sitting on a golden Popsicle stand somewhere in the Bahamas. Laughing.

Oh this was Katey’s big chance to shine!

OSWALD the LUCKY RABBIT (incumbent) vs. MICKEY MOUSE (upstart)

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Oswald the Lucky Rabbit was the incumbent. He had spent considerable time playing gags, accepting injuries to make others laugh, and being truly entertaining. He was peppy, saucy, and venturesome. He and his girlfriend, Ortensia, were the darlings of the cartoon world. Even Felix the Cat was willing to allow Oswald to be the “leader”. He had done nothing wrong.

But the world was changing around him.

Mickey was an upstart. When he first came out he had no voice, unlike Oswald. He left his girlfriend Minnie at the dock in his second film, not as chivalrous as Oswald. He abused animals and made them play music against their will. Pete and Donald Duck challenged him often. It was debatable whether he would amount to anything.

But the world was changing around him.

Sometimes your skills and talents do not match the needs of your time. Sometimes what you offer is no longer appreciated. Sometimes being a leader requires you to step down and let others lead.

Oswald allowed Mickey to become the king of the cartoon world.

Was this the right thing to do?

Alternative Facts:Translating Trumpian Tales of True Talent

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We have gone through so many true leaders in Health Care over the years. I look back fondly at how things have progressed…

Furious George was an “attack poodle” that started the Wait Times Strategy and Aging at Home. His plan was to help ensure that there was a reduction in the wait time to age in your own home. He reduced the time from 315 days to get home health care services to 309 days. Progress!

Heavy David the Smoker took over and ensured that Smart Systems were developed to spend health care dollars on everything but patients. Why would you spend it on patients? There was money for office renovations, Tic Tacs, and long liquid lunches. Heaven on earth!

Then then Mean Grandmother took over. Boy was she smart with her big Doctorate and big ideas! She was integral to ensuring that we had big flying ORANGE ambulances that paid big directors to stay home and not be listed on the sunshine list. Totally defensible!

But I saved the best for last: Rhodes Scholar. Order of Canada. A Saviour to children in Africa. A member of the brotherhood and sisterhood. Angry Red was the answer to all of our prayers! He wanted to be in charge of everything in the health care system. Why would you want anyone else to help when you can do everything on your own? He is auditing all doctors salaries, he is in charge of all home care services, he is in charge of disciplining all doctors, he is in charge of all office hours, all sick leave, and is able to look into every patient chart in the province. Wow, that guy is truly a hard worker. Too bad everyone is so jealous of his good looks and credentials.

I wonder how things could possibly improve given our awesome ranking on the OECD health care indices.