Want to highlight this link and recommend it to anyone who is curious about what I mean when I refer to reduced physician autonomy, and how that contributes to job satisfaction. It's something I am thinking about a lot as I move towards residency applications.Originally Posted by Nephrology
From the linked article:
"Competence was once viewed as having a deep fund of medical knowledge and exercising clinical judgment appropriately with each patient. Under recent health care reforms, it has been redefined as compliance with various metrics, many of which are not evidence-based. Competence has also become a matter of checking off boxes in the EHR and satisfying insurers’ demands by quickly placing a note in the record for billing purposes, even if it’s incomplete or erroneous. In defense, many doctors now add a disclaimer that the note has not been proofread and to “disregard any errors.”
Relatedness is the psychological feeling that one belongs, has interpersonal attachments, and is connected to the social organization. Doctors want to give patients the time and support they need, and they want the system to value and recognize their efforts to provide this kind of care. While much lip service is given to “patient-centered care,” many doctors feel that the system is increasingly driven by money and metrics, with rewards for professionals who embrace these priorities."
PREACH ON!!!
Regarding this, and the last post, a good friend of ours just pulled the plug on their 28-year ER doc career over this. Retired young, at the end of April. Might pick up some shifts here and there if it gets worse, but with the ERs empty, and 10 C19s in all the hospitals, may as well go with the original plan, and GTFO. Time to write that book that’s been on the back burner. This is someone that had some good years left, but since the boss doesn’t care about experience anymore, they’re out.
Papua New Guinea is a curious case. As of this moment, we have a pretty low number of confirmed cases, with no serious effects or deaths, even though the virus has been here since at least mid March.
Social distancing? PNGians don't do distancing. Isolation? The Highlands Highway has pretty much been running this whole time.
There may be something to the whole 'live outdoors' thing after all. Or maybe betelnut is the cure?
"You win 100% of the fights you avoid. If you're not there when it happens, you don't lose." - William Aprill
"I've owned a guitar for 31 years and that sure hasn't made me a musician, let alone an expert. It's made me a guy who owns a guitar."- BBI
https://fox8.com/news/coronavirus/a-...n-a-face-mask/
A security guard is shot and killed after telling customer to put on a face mask
Posted: May 4, 2020 / 03:21 PM EDT / Updated: May 4, 2020 / 03:21 PM EDT
FLINT, Michigan- (CNN) — A security guard at a Family Dollar store in Flint, Michigan, was shot and killed after telling a customer to wear a state-mandated face mask, police said.
Calvin Munerlyn, 43, died at a local hospital after he was shot in the head Friday, said Michigan State Police Lt. David Kaiser.
The shooter and a second suspect remain at large, Kaiser told CNN on Monday.
Witnesses at the store told police that Munerlyn got into a verbal altercation with a woman because she was not wearing a mask, said Genesee County prosecutor David Leyton. Surveillance video confirms the incident, Leyton said.
Under an executive order from Michigan Gov. Gretchen Whitmer, all retail employees and customers have to wear a mask.
Footage also shows that immediately after the altercation, the woman left in an SUV.
But about 20 minutes later, the SUV returned.
Two men entered the store and one of them yelled at Munerlyn about disrespecting his wife, Leyton said. The other man then shot the security guard.
An absolute tragedy. As a retailer we have been very careful with our language with both the mask and anti-mask people. We follow the state's current mandates, nothing less, nothing more, at this point.
I saw this coming before it reached today's level. The first clue for me was the rise of HMO's. A second clue was insurance companies becoming militant to the extent that that they began to dictate some medical decision making. A third was the government's intruding into business of medicine. Medicare and Medicaid rules are examples. When family doctors were denied privilege to practice in hospitals which now use hospitalists exclusively, the role and authority of family docs were diminished. Eventually their knowledge level decreased because today they practice medicine only in their offices. They no longer are involved in making medical decisions once their patients become hospitalized. Their training is not as comprehensive as it once was.
You may find this interesting if you haven't already read it.
https://medium.com/@ra.hobday/corona...c-509151dc8065
Oh boy, I remember when the term Hospitalist was coined. Either the very end of my residency training or first year or so of junior faculty position. In fact, I had an interest in it and gave several presentations at divisional meetings about it, maybe even a grand rounds (memory isn't that good). Of course back then there were some who thought that the concept would never take off, be a flash in the pan, and others who were quite excited about it.
I thought it had benefits and would work, but I never imagined it would have gone like wildfire like it did.
Never thought that it would affect FP program training, but I can see how it could now.
I'm also not convinced we are training our hospitalists well. I can remember about 10 years ago looking at an inpatient's chart in our hospital and the hospitalist's orders were something like:
1. if patient develops chest pain-consult cardiology
2. if patient develops shortness of breath-consult pulmonary
3. if urine output drops <x cc/hr-consult nephrology
4. if temp > 101.5- consult Infectious Diseases.
I was like damn!, what is the hospitalist responsible for?????
Of course you can't overgeneralize, but I've seen similar since.
cc
Edited to add:
I should mention that one of the problems with hospitalist in my opinion is that they are some of the most overworked Physicians on the planet. That certainly doesn't help things
Last edited by ccmdfd; 05-05-2020 at 07:06 AM.
Not to mention that these days, hospital IM does almost no procedures, outside of the well-defined turf of IM subspecialties (Cards GI etc). Surgery or anesthesia gets consulted for thoractostomies, pericardiocenteses, even therapeutic taps for ascites. Anesthesia or ER (whoever is running code team - also its own entity) will do emergent airways on the floor. Because this is how academic hospitals are run, IM residency graduates don't do procedures in training, so if they are the only provider around when they're in community practice they are in trouble if someone needs an ETT or a chest tube.
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