Archive for September 2011

Eight things I learned from my tonsillectomy

By Janet Hurley, M.D.

Having been a patient not too long ago, I am convinced that doctors should be patients more often.  As we continue to talk more in health care about “patient-centeredness” and the “patient experience,” I have a few thoughts on things I learned during my convalescence period after a tonsillectomy in 2009.

1)       My surgeon, my anesthesiologist, and the surgical center staff were GREAT.  As providers, the things we do become routine to us, but to patients they are extraordinary. Taking the time to explain a procedure carefully and thoughtfully can make a big difference.

2)      Follow directions.  Patient handouts have important information in them and the treatment team knows what they’re doing.  I must remember to listen to their advice and review the patient materials when I have questions.

3)      Don’t be your own doctor!  If you have questions about medications or symptoms, ASK SOMEONE ELSE.  You may choose to be a highly educated patient, but not your own doctor.

4)      I am not too tough for pain medications.  While I dislike the mental fogginess they create, I had to keep in mind steps I prescribe to my patients—maintain better hydration, better nutrition, and keep my throat moist—to make myself more comfortable.

5)      I will never even think about accessing my Electronic Medical Record from home until fully off narcotics.  Impairment was obvious. 

6)      When on narcotics, I communicate better with my fingers than my tongue. You can’t rush recovery, even when you know you have important work to do. E-mail communication with others kept me connected when my speech was slurred and my throat hurt.

7)      I have great clinic coverage partners.  I had no worries about who would check my messages, approve refill requests, and see my patients when I was out.  We must remember that good patient care during such times requires that we receive help from our colleagues.

8)     Don’t undervalue the significance of family and friends.  I am grateful to my husband who took care of our kids and took care of me, and the friends and neighbors who looked for ways to help out during my recovery.  It’s okay to lean on those closest to you in times of need!

Janet Hurley, M.D., is a family physician at Trinity Clinic in Whitehouse, Texas.

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Developments in Medicare physician pay…plus the backup plan

Now that the 12 members of the Joint Select Committee on Deficit Reduction have begun meeting to develop a plan to trim at least $1.2 trillion in federal spending, advocacy groups and politicos have ramped up their effort to influence what goes on to and what stays off of the chopping block.

Since our last blog post, AAFP has taken significant steps to encourage the supercommittee to avoid making damaging cuts to Medicare and graduate medical education. AAFP met with representatives from seven medical societies and seven professional organizations on Sept. 7 to develop a unified strategy for the house of medicine, with AAFP still holding strong to the position that the SGR should be repealed or, barring that, the committee should enact a five-year Medicare payment fix that includes a 3-percent higher payment rate for primary care physicians.

During this week’s Congress of Delegates meeting, AAFP launched a grassroots campaign that calls for AAFP Delegates and other members to send a letter to their Congressional representatives asking for immediate repeal of the SGR. AAFP already sent its own letter to the “super 12” on Aug. 10 outlining its asks, and the 12 AAFP state chapters in which a supercommittee member lives requested meetings with their super person during the Congressional recess that extended through Labor Day. Texas is, of course, home to committee co-chair U.S. Rep. Jeb Hensarling, and Doug Curran, M.D., TAFP past president, current TMA board member, and constituent from Athens, has a meeting scheduled with the representative in the next couple of weeks.

Additionally, AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco said in an interview with Family Practice News digital network that the Academy will produce videos featuring “real family physicians who describe the real impact of these cuts for their practices,” in the hope that the videos go viral and incite larger action.

Most important, Goertz told AAFP members in the FPN video interview that physicians need to step up and take action. “Don’t go to sleep on this issue. We’ve been fighting this for 10 years. Don’t get fatigued about contacting those who represent you.”

“This is a big, big deal. A 29.5-percent cut in a payer source, particularly in Medicare, is going to put some practices out of business in some locations. So mobilize yourself, contact your elected officials, and if you feel comfortable with it, make sure you involve your patients because your patients are going to be the ones who unfortunately will suffer the outcomes.”

AAFP and other experts have acknowledged that the supercommittee may not address the SGR in their budget plan – because once again it may be too big an issue to tackle along with all of the other considerations. Hence, AAFP’s request for a five-year fix and 3-percent pay bump for primary care.

Another SGR-replacement idea released recently by the Medicare Payment Advisory Commission would implement a 10-year fix at a cost of around $200 billion. Though MedPAC’s plan would just replace one form of automatic payment cuts with different automatic payment cuts, it does include protections for primary care.

Kaiser Health News reports on their blog: “Reimbursements for primary care physicians would be frozen for 10 years, and specialists would see a reduction in payments for three years, at which time their rates would also be frozen.”

As Goertz said in an interview with AAFP News Now, “This is a game in evolution, and there are going to be some twists and turns.”

Hang on.

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