Wednesday, September 21, 2016

Patient Satisfaction

As I did inpatient rounds today, I was struck by something new in the hospital.
Came across numerous phone/tablet charging docks near the elevators, family rooms etc.
These appeared new. All in the name of patient satisfaction.
The newer hot topic in USA Medicine.
That somehow, one of our jobs (as a doctor, clinic or medical system) was to satisfy the patient. Not that I would intentionally wish to dissatisfy them- however it's important to realize that patients are not customers or guests.
The doctor-patient relationship isn't one based on PR; this is not a service industry (though we are here to serve in a way).

So when systems or doctors start to get assessed based on patient satisfaction, this is where things may potentially go wrong. For some years now, more and more systems based their remuneration, at least in part, on how satisfied patients are. This is also becoming a metric for how insurors/Medicare reimburse providers. I know for me, part of my performance bonus is based on satisfaction scores.

The problem is, the patient sometimes not in the position to decide what's best for him or her medically. And may rate a doctor as such. Examples we see regularly:
- The patient who sees a GP for a viral upper respiratory infection- who leaves the clinic mad because he did not get antibiotics
- The patient who goes to the ER, wanting to leave with prescriptions for opiate medications
- The patient who does not want to be discharged despite being medically fit- because he "didn't feel like it yet". (While there are 10 patients in the ER waiting for inpatient beds)
- Closer to home- something I face weekly- the patient with normal testosterone or thyroid or growth hormone, wanting to be put on these hormonal agents for symptomatic benefit
- Or the inpatient I see who just got over his diabetic ketoacidosis, who is mad because he is on a diabetic diet, and feels that he should have unlimited amounts of carbs

Indeed, there are studies showing an inverse relationship- patient satisfaction scores are related to poorer outcomes- higher morbidity or mortality, longer hospitalization, higher cost of healthcare.

And if so why is there such a push to emphasize satisfaction scores? As Dr. Mayo once said, the needs of the patients come first. Not the wants of the patient.

Somehow, in the convulated world of politics and bureaucracy, we lost sight of what's more important. And so, the hospitals are spending more money installing iphone docking stations, provider bigger parking ramps, free valet parking, coming up with extravagant menus for patients. While nurses have a high rate of turnover because they are underpaid. Or the hospital tries to cut costs by forcing formulary medications on patients.

Saturday, September 17, 2016

An expensive hobby

You can probably tell by now. I've am astro-geek. I love all Sci-fi, space, Star Trek, Star Wars etc. I've had this fascination since I was a child. Indeed, there was a time when I wanted to be an astronaut- nevermind that Malaysia did not have a space program (do we, now? Or is it more like a space tourism program?).
One day when I was about 10, I was given a simple 40 mm refractor telescope by dad's boss who got tired of this. Then, it might as well have been the Hubble! You could see the craters on the moon! You could use it to project an image of the sun and watch the sunspots. It was great.
Anyway, life and school and budgetary constraints made me neglect that hobby. The one big treat I gave myself was purchasing a hard cover copy of Hawking's A Brief History of Time (now, if you want a book that will drive you made, go read that).
Fast forward a few decades. I still catch myself looking up, yearning, wondering. My wife knew that. My wife also knew I had a loadful of crap in the garage, including some almost new winter tires I bought for the Porsche which I used only 1 season. It was now taking up space. And playing the little devil on the shoulder, she suggested "why don't you sell your tires and use that money to buy that telescope you've been dreaming of?".
That was good encouragement. I sold the wheel/tire package for $500. And bought the Celestron Nexstar 4SE Maksutov Cassegrain computerized telescope.
Problem was, like any hobby, it starts to become a parasite. It asks for more. And so, over the last 2-3 years, my collection has grown; so has the cost.

$499 Nexstar 4SE. But oooh, the batteries don't last very long for long tracking/viewing sessions. And so next came...
$20 AC adaptor. Now that I'm viewing, why not take some pictures? Well, I'll need a T-ring...
$22 T-ring for Nikon SLR. But I'm shaking the camera too much. Maybe I should get a shutter release cable
$10 Shutter release cable. Hmm, pictures are so-so. I've read that you can also use video- take a 30 second video of solar system objects, then stack them into a photo.

$160 Celestron Neximage camera. Great shots! Loving the images of Saturn and Jupiter. But dang it, I need a laptop to be portable and to operate the camera.
$300 HP laptop (basic specs- use only for the webcam). Have been quite happy with this. But I wish I had more zoom. Maybe I should get a Barlow lens.

$75 Celestron Xcel 3x Barlow lens. Triples the zoom of your telescope. Have been very happy with this setup. But am wanting to branch out and take other pictures. Maybe I should try taking pictures of the sun. I'll need a solar filter to not blind myself....
$12 Solar filter. What next. I'd love to take DSO (Deep Sky Objects) but my altazimuth mount, as easy it is to use, simply cannot compensate for Earth's rotation. Do I really want to take the next big step and get a larger scope with a German equatorial mount???
(2 years of contemplating later) $1599 Celestron 8" Schmidt Cassegrain telescope with AVX equatorial mount. This thing is huge! Built like a tank and heavy like one too. But very stable, and allows me to finally attempt exposures up to 90 seconds long. But, I need a polar finderscope to properly polar align the mount.
$42 Celestron CG5 polar finderscope. On a good day, I get great shots. But on most days, I'm still getting field rotation and star streaks with shots over 60 seconds. Not getting good shots of faint galaxies and nebulas. How the pros do it is they use a separate scope with an autoguider, hooked to a computer, to guide the main scope with precision.
$340 Orion Magnificent Mini Guidescope package. It's still in the mail- to arrive in 2 days. Alas, when will this parasite stop sucking money out of me??
(I did catch myself salivating over the Starizona Hyperstar lens, which would let you take a 30 second shot of a nebula, in better quality than spending 30 mins doing long exposures. But this would cost $899, and the corresponding Atik camera would cost $1359. So I mentally told them to go to hell)
(for now :P )

Monday, September 05, 2016

Blog Party

One thing I like about our neighbourhood is how we all get along. Quite a few families at our stage in life- 30-40 year olds with kids about the same age. We have numerous gatherings and social events every so often.
And so, one activities that my wife, the unofficial social chair of the block, organized was the block party. This was something she's wanted to do for years, since her family did these when she was growing up. So we decided to hold the very first one, and boy, was it fun.
To close the street completely, we had to do a few things.
- Get signatures of the residents- at least 90% of homeowners have to agree
- Outline a party plan, and seek the approval of the city and fire department
- Rent barricades to close off both ends of the street

Thankfully, all the residents agreed this would be fun, and with that we were off!
We had the block closed off for 5 hours on a weekend; the kids could roam around, bike and scooter up and down the road to their heart's desire, without any parent yelling for them to get ff the street!
We had several bounce houses and carnival games set up. Had a long table in the middle of the street for food.
And Kris even got a sno-cone guy to come and set up a table- that was a  hit amongst the kids, and the adults! We even had sno-cones of the, err, 'adult' variety. Which contributed to a more merry evening.
As a bonus, she had the fire department send a firetruck for a visit. The kids went bananas when the firemen came, blaring their sirens- they got to climb into the firetruck and check out their equipment. We only recently found out that the fire department does this as a community service, and it's nice to meet your local firemen and show your appreciation for the work they do.

Anyway; it was a swell evening, and the first of an annual neighbourhood event, I'm sure.