Dr. Lansdowne's Word Press

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Author: plansdow

Methodist Physicians join Mayo Clinic to tackle Opioid Crisis

I suspect you may have already read or heard some “bad news” today.  This post is full of “good news,” even if it is a really harsh subject.

The AMA says that the Opioid Epidemic is “turning around,” according to Medscape write Megan Brooks.1  And according to the AMA’s report, leadership and action by physicians is helping.2  Further, there was a 22% decline in the number of opioid prescriptions written from 2013 to 2017.  The same article sites a report by data company IQVIA that shows the same 22% decrease for Texas.3

Of course, there’s still more to be done.  That is why I want to let you know about a unique opportunity that is coming up in September.  Methodist Mansfield Medical Center is going to host a tele-conference roundtable  – a kind of “grand rounds” – with Mayo Clinic on opioid prescribing, Thursday, September 13th at noon, (our usual physician’s journal club time).

This is a one-of-a-kind pilot program with the Mayo Clinic; the first time this has been done!  Opioid prescribing and the potential detrimental side of opioid use affects us all, and I want to encourage anyone who can possibly attend to do so.  Not to mention that this will be a really unique opportunity for MMMC!

For the discussion and question & answer session, we will be joined by a panel of expert physicians from the Mayo Clinic, including: 

Casey Clements, M.D., Ph.D., Emergency Medicine Services Consultant

Halena Gazelka, M.D., Anesthesiologist, Periop Medicine Consultant

Holly Geyer, M.D., Hospitalist, Mayo Arizona

 

The panel discussion will be based on a podcast by Dr. Casey Clements, “Opioid Edition: Acute Prescribing: Emergency Room Prescribing.”  This is episode five, of an eight part series.  The podcast, just 23 minutes long, is available now on iTunes, and I encourage you to listen in advance (link).

According to iTunes, in this episode Dr. Casey Clements, an emergency physician and practice leader, who works in the opioid stewardship program at Mayo Clinic-Rochester, shares his insights on opioid therapy from the Emergency Department perspective.  In the sixth episode, Dr. Clements discusses what to do if you suspect opioid use disorder or addiction, and shares his insights on treating opioid misuse in the emergency setting.

I hope many of you will plan to attend.  Room announcement and other details will be forthcoming.  Feel free to contact me with any questions.   Please check Twitter @doctorsserving or the MMMC physician’s only group on Facebook for announcements.

See you in September!

 

Paul Lansdowne, MD

 

1https://www.medscape.com/viewarticle/897847

2https://www.end-opioid-epidemic.org/wp-content/uploads/2018/05/AMA-2018-Opioid-Report-FINAL.pdf

3https://www.texmed.org/uploadedFiles/Current/2016_Public_Health/Opioids/IQVIA%20Opioid%20state%20and%20payer%20views%202017%20FINAL.PDF

You had me at “Hello, my name is Doctor….”

Doctors,

You may know about Methodist Mansfield Medical Center’s Patient and Family Advisory Council which began meeting in August, 2017.  The aim of the Council (PFAC) is to enable collaboration between patients and family members (about a dozen community members), hospital leadership, and staff.  PFACs allow patients and families to have a formal avenue to provide input into various processes that impact patient care and services in order to improve care delivery and meet hospital quality and patient experience target goals.  In short, PFACs allow patients and families “to advocate for their care by sharing their input.”

The conversation of the January PFAC meeting centered around physician communication with discussion about the HCAHPS “physician domain” questions and the hospital discharge process.  I want to share with you the comments relevant to the physician experience that came to light from the January Patient and Family Advisory Council meeting.  This email and post is being sent to the entire medical staff, sub-specialists, and consultants, and I hope it will stimulate some conversation at our various department and section meetings.

Broadly two themes emerged from our January meeting:

  • Patients want to know that we care about them
  • They want things explained so they can understand

 

CARE (and RESPECT)

Right off, the community members said they wanted us to know that they are impressed by the fact that our physicians make the effort to fully meet patient’s needs and expectations, and that the community perception of MMMC has always been very positive.

That said, they want their physicians to be helpful, comforting, and understanding.  When they come to the hospital they want to feel welcomed, and fully valued.  For example, they don’t want to feel like they are being bothersome when they go out to the desk to ask a question.

They said that when you come in to the hospital or E.D. room, you’ve got to be prepared to spend time and answer questions.  They expect their primary doctors and consultants to know what is going on.  They want to know that you have read the chart or communicated with the other doctors involved in their care.

Also, one question they almost always want to know: When are you coming back?  And they have a suggestion: Use the whiteboard!

 

EXPLAIN

Another theme involved having things explained in a way that patients and their families can understand, and they want to know what to expect each step of the way.  Patients prefer to have things explained up front: “I don’t want to ask you questions…I want you to tell me exactly what’s going on.”  As one member expressed: “you may do a good job, but you need to explain it so I can understand it.”

Another “huge issue” was clear communication regarding medications, especially if a patient is going home with big changes to their medication regimen.  They said it needs to be explained clearly, both verbally and written, and again, they suggested using the white board.

To summarize in their words: “explain”, “show pictures”, “spend time,”  “help me to understand exactly what was going on with mom’s heart,” and use simple terms like “it’s a heart problem,” or “it’s a water pill.”

 

PFAC, HCAHP, WTW?

These messages are very consistent with what you might hear from national patient advocacy organizations like the Southlake based Beryl Institute, and those organizations known for service excellence, like the Studer Group, or Cleveland Clinic.  Importantly, these are also the themes that the Methodist system is focusing on for patient care, and that we are working on right here at Mansfield; take for example the introduction of the Physician Code, and the “Three Things” that can make a difference:

  • Introduce yourself every time you see patients.
  • Show patients that you listened to them and are concerned.
  • Show patients that you took the time needed to help them understand.

 

Some issues raised by patients fall more to the responsibility of the hospital.  Like improving the discharge process, connecting better with patient’s primary care physicians and making it easier for patients to follow up with them and specialists after discharge; and constantly striving to improve the patient’s understanding of medications.  However, in all this, the “hospital” side of the equation needs our input and ideas.

The next PFAC meeting is in April.  Members will be expecting to have some follow up and they’ll want to hear what we’ve done with this information.  So, again, I hope this feedback from the community will spark some good conversation, even if it’s just in the physician’s lounge — maybe that’s the best place for it.  In the meantime, try out these “Three Things,” see if you think they make a difference, and let me know.

Thanks,

Paul Lansdowne, MD

A Promise to Our Patients

This month, Methodist Health System will debut a new effort in patient experience.  This initiative is based upon the reality that patient care and outcomes are improved, and the idea that Methodist can distinguish itself, by providing a better patient experience.

Physicians across the system have been involved in developing the “MHS Physicians’ Promise:”

We are devoted to caring for our patients and their families.  Earning their trust is important to us, and we will do our best to treat everyone with compassion, respect, and empathy.

Along with our nurses and staff, we will show how we value every patient by:

                Inspiring them to be active participants in their care

                Explaining medical conditions thoroughly

                Helping them make shared decisions about their treatment

                Teaching them about health and wellness.

You will also be hearing about concrete steps you can take each time you interact with a patient.   For starters, we’ve chosen to focus on “Three Things” you can do to make a difference:

                Introducing yourself every time you see patients.

                Show patients that you listened to them and are concerned.

                Showing patients that you took the time needed to help them understand.

As part of this new paradigm at Methodist, coaching will be available for physicians who want or need some additional help in those areas of the patient experience that they find difficult.

We want these ideas to reach all of the physicians at Methodist Mansfield, and you will be hearing about this from your Department Chairs and Heads of Sections at your upcoming department meeting and section meeting.  I want to encourage all of us to strive to make these ideas a part of our daily practice.  You will be seeing some new material (posters, cards, etc.), designed to familiarize patients and family members with these ideas, and to serve as reminders to physicians.  Also, I will be using @doctorsserving on Twitter to help share this information as well.

Please feel free to call me if you have any questions or if I can be of any help.  I welcome your feedback and any suggestions.  Thank you!  I love being a part of our Methodist Mansfield family!

Three Good Things

Sometimes you come across something so worthwhile you just have to share it.  My wife first shared this idea with me some time ago.  I came across it again just recently.

Bryan Sexton, PhD, with Duke School of Medicine, shared his research on the Three Good Things concept, in a blog at Duke Today (https://today.duke.edu/2016/02/resilience).

What is it?  In short: better sleep, better relationships, better work, better life!  According to Dr. Sexton, promoting positive thoughts and building resilience can be as easy as writing down three things that happened during that day that went well and your role in the positive outcome.  Best results for the exercise come after 14 consecutive entries, and the results can last for more than a year!  Dr. Sexton compares the results to using Prozac.

Almost too easy, right?  Here is former American Psychological Association president Martin Seligman, PhD, explaining in a one minute video: https://youtu.be/ZOGAp9dw8Ac.

Want to see more, here is Dr. Sexton in a short video that includes the research and data that supports this claim: https://www.youtube.com/watch?v=hZ4aT_RVHCs.

My notebook is already on my nightstand, waiting for me to start.  Let’s try it together.

New Opportunity!

On October 1, I will be leaving my traditional office based practice for a position as an Obstetrics and Gynecology hospitalist at Methodist Mansfield Medical Center.  Although I am very excited about this opportunity to be a part of an new program, it is with mixed emotions that I announce I’m discontinuing my office practice and leaving WHSNT (also on October 1st).  It has been a great pleasure providing for my patients’ health care needs over the years, but as of October 1, I will no longer be available to see patients in a clinic setting.  I will be maintaining my website (drlansdowne.com) and facebook (drlansdowne), so check back for frequent updates!  I’m looking forward to blogging and having a little more time to blog!  I have greatly valued the relationships I have built over the years with my patients and thank everyone for the loyalty and friendship.