Wednesday, April 17, 2013
Physicians could learn from nurse handoffs, expert says
Few physicians will disagree that with more patient handoffs comes a greater risk for medical error. There is less agreement about how to best manage this risk, however—especially in the era of duty-hour restrictions that have required shorter shifts and, as a result, more handoffs.
Dr. Kedar Mate, vice president of the Institute for Healthcare Improvement (IHI), believes doctors should take notes from their nursing counterparts and implement a more structured handoff process. More standardized handoffs should take place at the patient's bedside and include a conversation in which the departing doctor passes along pertinent information to the physician just starting his or her shift, he states in a recent article in Modern Healthcare.
This exchange should ideally happen with a family member or caregiver present and include the patient's name, the problems with which the patient is dealing, the status of the treatment, what should happen during the next 24 hours and the challenges the patient is facing in getting to that point.
This structured system includes recognizing that handoffs are, in fact, a process that can be improved. Dr. Mate characterizes the old method of patient handoffs as "largely chaotic."
He understands that implementing such a system might be accompanied by some push-back. "The old guard might be threatened and feel this is a waste of time or not part of what it means to be a doctor," he says.
The AMA has created a resource page available to all residents and fellows to help them improve their patient hand-offs.
Prospects dimming for some high-income specialties
Radiology used to be a specialty that promised the best lifestyle for the least grueling work. While radiologists still make twice as much as family doctors, the specialty is on the list of those with incomes in steepest decline, according to a recent report in The New York Times.
Mean income for radiologists dropped 10 percent between 2010 and 2011: from $350,000 down to $315,000.
All specialties generally have faced the same downward factors, including deep Medicare cuts, cut-rate competition driven by technology, doubts about the health value of over-testing and the policy trend to emphasize primary care.
Radiologists also face competition from teleradiology companies that read diagnostic images remotely. "From a cost-cutting perspective and from a quality perspective, you can have a lot more people reading X-rays remotely than you can inside the hospital," explains Steven Clark, a spokesman for St. Barnabas hospital, which is eliminating its radiology training program to expand primary-care residencies.
"The times of graduating from medical school and driving a Porsche are done," said Dana Lowenthal, DO, a first-year radiology resident and fourth-generation doctor. "It was never easy, but there was a light at the end of the tunnel. This is new territory."
View the AMA's "Choosing a Medical Specialty" resource guide (AMA member login required) for information about radiology, family practice and the spectrum of the other medical specialties. Not an AMA member? Join today to gain access to this and other valuable resources.
Plan to attend AMA-RFS annual meeting
The AMA Resident and Fellow Section (RFS) will host its 37th annual meeting June 13–15 at the Hyatt Regency Chicago to discuss and shape policy on a variety of issues in health care.
Visit the AMA-RFS 2013 annual meeting Web page for information about meeting activities, registration and deadlines.
Residents and fellows who are AMA members can submit resolutions on policy topics important to them. Resolutions are due May 3. View the AMA-RFS instructions for tips on writing an effective resolution.