Monday, September 26, 2011

Physician Creativity and Patient Collaboration

September 26, 2011 - While reading On Leadership, by Donald J. Palmisano, MD, JD, I ran across this passage in Chapter 9, “Creativity and Acquiring the State of Mind Necessary for Success.”

“You can’t limited by the way things are currently done. New discoveries and adoption of new technologies occur because some people elect to try a different way in the hopes of finding a different way.”

Palmisano goes on to say creativity requires the three C’s: Critical thinking, Communication, and Collaboration.

Nothing in medicine is usually accomplished without collaboration with the patient. Never has this been more evident in this age of patients empowered by the Internet who wish to participate in their own diagnosis and treatment.

The best example I can think of this phenomenon is the Instant Medical History, a set of computer algorithms developed by Allen Wenner, MD, a family physician in Columbia, South Carolina.

Over ten years ago, Allen saw a patient with vague symptoms and dry eyes. He referred her to a local academic center where a medical student with time to spare made the diagnosis of Sjogren’s Syndrome, now is in the news because the same diagnosis has been made on Venus Williams, the tennis star.

Allen pondered why he had missed the diagnosis. He had not had enough time to consider it and therefore the diagnosis had never crossed his mind.

Why Nots

So Allen asked himself a few why nots? Asking the question “Why not?” is an essential ingredient of creativity. Creativity is nothing more or less than challenging the status quo – the usual way of doing things.

Why not collaborate with the patient by having them enter their own medical history?

Why not program the medical history based on the patient’s age, gender, chief complaint, and symptoms?

Why not use this elemental information to create a systematic approach to differential diagnosis?

Why not have the patient enter their own demographic data, complaints, symptoms, and personal and family history?

Why not have the patient do this data entry from home on their personal computer or in the reception area on a laptop?

Why not convert this information into an easily read narrative?

Why not have the patient enter the exam room with this narrative in hand?

• Why not
have the doctor enter his findings, add them to the narrative with his own observations, and why not convert the collective information into electronic record of the visit?

Why not use this complete electronnic record as the basis for coding for the patient visit and for the content of referral letters to other doctors and to the hospital?

• Lastly, why not give the text of this electronic record to the patient before they leave the office?

Allen reasoned that this alternative approach to the medical record would save time – it does, about 6 to 8 minutes per patient. He further reasoned that this record would reduce the chances of misunderstandings and even malpractice suits by making clear what was done and why?

For more on this, Google the Instant Medical History or Prime Software. The website explains this creative, collaborative, communicative process in more technical terms as follows:

“Instant Medical History, patient interview software, interviews patients to begin gathering the subjective history prior to the encounter.

Branching logic enables patients to progress quickly through adjustable questionnaires from an extensive medical knowledge base. Sophisticated technology enables this information to transfer to EMRs. Physician productivity increases because as much as sixty percent of the medical data necessary to complete the visit note can be provided by patients and automatically documented in medical terminology through the Internet, in exam rooms, or in waiting areas before the visit.

Our vision is to become an indispensable part of the way patients and physicians communicate. Our solutions are used by physicians each day to facilitate physician-patient communication in a variety of practice settings. Our software has been recognized by vendor associations, consultants, and industry peers as an invaluable component of medical history software and the future of health care.”

Tweet: Doctors: To make your time more productive and your diagnoses more accurate, have the patient enter their own information and history.

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