Tag Archives: MD

Quadruple Aim: Care of the Physician

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Quadruple Aim

By Bernadette Keefe MD and Matthew Katz MD

The classic ‘triple aim’ for healthcare is a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. IHI asserts that new designs must be developed to simultaneously pursue three dimensions which we call the ‘Triple Aim’:

  • Improving the patient experience of care (including quality and satisfaction)
  • Improving the health of populations, and
  • Reducing the per capita cost of health care

Numerous publications suggest that the list be expanded to a ‘Quadruple Aim’ to include: Improving the Care of and Experience of The Provider (ie MDs/other HCPs).

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A Beautiful Question: Questioning in Healthcare

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questioningBernadette Keefe MD

A person skilled in the art of questioning is a person who can prevent questions from being suppressed by the dominant opinion. – Hanz-Georg Gademer

It was just after New Years 2015 when an an article by Warren Berger entitled “Forget Resolutions, Whatʼs Your Beautiful Question” caught my eye. In it, the author (see his book “A More Beautiful Question” 2014) suggests that instead of making New Years resolutions (ie: aspirational statements) we should formulate our own ʻbeautiful questionʼ. With questioning firmly top of mind, I started noticing game-changing endeavors that began with one fresh, simple question.

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the annual physical

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The Argument: Ditch The Annual

Every year, adults face the issues of is it “time to get a check up”? Do I really want to get my annual physical? Do I need to have a checkup? Well now, even your doctor is saying the same thing! A chorus of physicians have weighed over the past several years (especially after the Cochrane Report was released). The consensus has been, for the most part: ditch the annual physical if you are healthy and have no medical symptoms.

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flip the complaint

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rose bush in bloom

We can complain because rose bushes have thorns or we can rejoice because thorn bushes have roses. – Abraham Lincoln

Human beings seem hardwired to complain. To breathe is to complain, it seems. No one on earth is immune to complaints, or complaining! Unfortunately, the landscape can be so inundated with criticism, the more serious issues may be overshadowed, and left without the necessary ‘space’ for meaningful discussion.

In the healthcare arena, superficial complaints, which are a dime a dozen, are mixed in with well founded complaints. In the past, physicians usually held the most power in healthcare. Now there are many stakeholders, each viewing themselves as having a lot to lose (or gain). With the new empowerment of patients (called ‘consumers’ by some), and increasing power of government and industry, comes more engagement, more disagreements, and more opportunities to make suggestions or criticize.

Empowered customers are more demanding than ever….One of the ways businesses provide value is by doing the little things right…and that includes handling complaints. – Stan Phelps

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the art and skill of listening

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Listening

The skill to listen and to give ourselves the time/space to reflect on what we observe is central to a good life. Quality listening allows personal and professional growth, sustains our relationships and promotes learning. Without the ability to listen, we place ourselves out of range of others, and thus unable to gain valuable insights from them, or to provide help and answer needs. For a fulfilling personal and professional life we must acquire the skill of honed, effective listening.

Although most of us recognize the value of listening, human nature possesses a strong impulse to share, and, even, to be first to speak and to voice our opinion! Despite both a need and desire to listen, humans have a nearly irrepressible urge to interrupt in order to share their own point. Such impulses can, and do, crowd out the other personsʼ words, insights and desires whereby they may never be heard.

Listening in Healthcare

Recently the topic of listening has been getting a major public airing in discussions regarding doctor/patient communications. Continue reading →

slow medicine – not can we afford it, but how can we not?

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The_Doctor_Luke_FildesBernadette Keefe MD

The Unease

Over the past few decades there has been an increasing disquiet among doctors and patients. Prior to the late 1970s (pre CT/MRI era) other than basic blood work and plain xrays, there was little in the way of testing for disease. However physicians were well equipped with a robust heritage of  patient bedside history-taking and examination skills. Adept physicians in elucidating a pertinent historical record and performing patient examinations were brilliant diagnosticians. Lavishly written patient narratives and exquisite physical examinations filled voluminous charts.

The late 1970s ushered in organized medicine, HMOs, regulations and abundant technological and medical advances. This potent combination resulted in a tremendous escalation in the volume and pace of healthcare. Physicians, once loved for their bedside manner and comfort (1950’s-1960’s) found, from 1980s-present that they were so rushed and burnt out they had little empathy to spare. Patients picked up on this and, coupled with little time to ask questions and (now) electronic medical records consuming their doctor’s attention, stopped feeling cared for. They stifled their questions and stopped buying into the therapies being proposed for them. (Note: Perceived lack of empathy has been shown to adversely affect clinical outcomes.)

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