Month: December 2015

Social Media will no longer be a fad very soon. The Tipping Point has already been reached in many industries and mainstream media. The healthcare industry, as always, is a little slow on the uptake, but I do strongly belief that in the next few years we will see clinicians on social media as the norm and not the exception.

Social media will indeed be normal mainstream traditional media. It is going to be another acceptable method for delivering news, opinion and statements. In the past people used to look for official Media releases from reputable news sources. Nowadays, people simply go to Facebook or Twitter to get their news.

Since I completed the Mayo Clinic Social Media Residency, I have had time to think about my social media experience. I have had some time to distill the three purposes and benefits of social media for me as a surgeon.

The difference between social media and traditional media is that social media is a two-way interaction. Therefore my purposes and benefits of social media are also two-way. They’re two sides of the same coin. They’re both active and passive.

Here are my 3 purposes and benefits of social media

1. Engagement (To engage and be engaged)

Networking, sharing of ideas, crowdsourcing, professional connections, and multiple other engagement opportunities occur readily and speedily across social media networks. I have been reached by doctors, patients and professionals alike. Similarly, I have also reached out and connected with many wonderful people. Even people that I do not normally engage with through traditional methods. I am talking here of people from different world views, socioeconomic backgrounds, profession, cultures, religion, sexual orientation, political persuasion, etc. They broaden my mind and heart.

2. Entertainment (To entertain and be entertained)

It’s social after all! I have had so much fun meeting people on social media. One of my personal goals is actually to entertain before educate. I want people to first of all smile or laugh when they meet me on social media. I want others to enjoy my presence as much as I have enjoyed others’ presence through social media.

3. Education (To educate and be educated)

Of course, this is a noble cause. It would be wonderful if clinicians can flood social media with useful, accurate, enlightening, educational materials. I must admit though, I have been educated more than I have educated. I don’t think I have much to add to the sum total of social media knowledge and wisdom, but I know that I have learned far more than I expected through social media.

There you go. Three benefits and purposes of Social Media for this surgeon. How about you? Does engagement, entertainment and education appeal to you?

So says the title of many news articles, which obviously results in some knee jerk panic responses from various members of the community. I’ve been asked for my opinion several times on social media. Here is a summary of the issues. I’m writing as a surgeon in the trenches, not a bureaucrat, committee member or public policy advisor.

Health care is costly. We need to make some cuts somewhere. Looking at old MBS codes and reviewing them is one of many good places to start.

These codes are the way hospitals and surgeons get reimbursed for their services. Each code refers to a particular procedure. One operation may include several codes depending on the procedure and its complexity.

This review is not final. It is only the first draft released for consideration by stakeholders.

Terms of reference: An expert, clinician-led Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce) will be established to lead an accelerated programme of MBS reviews to align MBS funded services with contemporary clinical evidence and improve health outcomes for patients.

Obsolete items are items or services which have no clinical purpose in contemporary practice, the services identified are better covered under other items, or the items are no longer used for the purpose for which they were introduced.

Out of the first five clinical committees, ENT Surgery has submitted 9 codes, numbers or items to be cut from MBS Schedule out of a total of 154 that were discussed.

So, NO, ENT is not being cut. Only some codes are offered up for discussion to be cut.

On studying those items, I would agree that these are obsolete items or items without any clinical evidence.

Let me take an example.

18246: Glossopharyngeal nerve injection.

It’s an anaesthetic injection performed usually at the time of tonsillectomy or OSA surgery involving uvulopalatopharyngoplasty. Some surgeons have used this code to gain an additional $75 or so per injection. Now consider the number of tonsillectomies done in Australia and see how the numbers may add up. Let me note for the record here that I have not seen this as a usual practice by the surgeons I know.

A question was raised in a public discussion, “Wouldn’t this mean that patients are going to lose out and be placed in pain without this injection during tonsillectomy?”

Here’s an explanation by the committee written in the document: The Clinical Committee is of the view that this procedure is no longer part of contemporary clinical practice. This item is almost exclusively performed by ENT specialists and is always claimed as an adjunct to other ENT procedural items, mainly tonsillectomy and uvulopalatopharyngoplasty (UPPP). The Clinical Committee reviewed literature on the use of glossopharyngeal nerve blocks performed for anaesthetic purposes during these procedures which indicated safety issues including serious upper airway obstruction and diminished gag reflex. The Clinical Committee is of the opinion that the item should be removed from the MBS on the basis of these safety concerns and that the data did not indicate that the item is being used for any other purpose such as for the management of neuralgic pain. Where a practitioner performs infiltration of local anaesthetic in association with tonsillectomy or UPPP, this service should be considered as part of the service.

Three key points there:

1. It’s about patient safety
2. It’s not the usual contemporary standards of practice
3. An analgesia technique, if it is part of an operation should really be part of the operation and does not deserve additional funding. In layman’s term: we surgeons shouldn’t get more money for providing analgesia which is part of a procedure.

The other codes are very similar too. They’re obsolete or have been replaced by other more appropriate codes.

We’ve seen 9 out of 154 ENT and Audiological items that are offered up to be cut. These are baby steps. There are thousands more items to be considered.

Of course, these are the ‘low-hanging fruits’ as previously suggested. And already there is much criticism in the community. I can only imagine what would happen if we started with the big ticket numbers like hip replacement, skin cancer excision, appendicectomy, colon or breast cancer surgeries.

I do believe an MBS Review is a necessary step. It’s not the perfect solution, but it’s part of a complex resolution. We need to audit our health service models regularly to ensure we’re delivering a sustainable health service for our Australia. One step at a time.

Link to the actual document here. 

 

I’ve been asked previously what I think is the biggest challenge facing Medicine or Surgery in the future. Many Physicians and Futurists would suggest that personalized medicine, genetic therapy, cancer cure, public health, nanotechnology and many other things are going to form several of the biggest challenges ahead of us.

The more I spend time in Medicine and Surgery, the more I reflect on the future of Medicine, the more I see the struggles of my colleagues, the more I am convinced that there really is only one big challenge to the future of Medicine.

The biggest challenge facing Medicine is this: the challenge of reclaiming its heart.

Medicine is a noisy and ineffective business. It has turned into a mammoth industry with many disjointed components. Patients and doctors alike get lost in the system. What started as a confidential compassionate doctor-patient relationship has evolved into a doctor-google-admin-lawyer-nurse-allied health-patient relationship. I feel I can hear my lawyers and managers speaking into my mind whenever I’m consulting with a patient. Throw in health economics, biotechnology, medicolegal, Department of Health protocols, medical education and patient care becomes fragmented and sluggish. No wonder in this age of Patient Satisfaction Surveys very few patients, and doctors, are actually satisfied with Medicine. Half of all doctors surveyed would not recommend Medicine as a future career.

We need to reclaim and rediscover the heart of Medicine. We need to reclaim its essence and purpose. It is a science of humanity. It is more than a mere science of diseases, it is a science of life. It is the business of helping others. Helping others return to health. Helping others return to function. Helping others lead better lives. ‘Doctor’ comes from the Latin ‘docere’ which means ‘Teacher”. Our primary purpose is to teach patients to live well, in the midst of assisting with their ailments. To this end we do not do it alone, we do it with our fellow healthcare workers who share the same goal. We do it with the nurses, pharmacists, physios, dietitians, speech pathologists, respiratory therapists, counsellors, social workers, pastoral care workers, audiologists and many others.

How to reclaim the heart of medicine in your practice would look different to how it will look in mine. For me, this does not mean more programs, targets or KPIs. For me this means more compassion, more attention, more education, more communication. For me this means better self-care to ensure I am giving to my patients from a healthy space, not an exhausted depleted space. For me this means less positions of authority and more places of collaboration. For me this means returning to the reasons why I did Medicine in the first place. For me this means humanitarian missions, not to change any lives out there but to change my heart in here.

Reclaiming the heart of medicine is not a scientific concept. I doubt it can really be measured. I’m certain however, that our patients know what this means. They know that they’re tired of being treated as a commodity. They know that the heart of medicine has been lost and needs to be resuscitated.

For the sake of our patients and the future of Medicine, let’s reclaim the heart of Medicine. I hope this silly little concept can start a ripple of conversation.