Doctoring Health Care Reform Social Media/Writing/Blogging

Eight useful tips for caregivers in a new healthcare environment — Guest post

After reporting recently on how current healthcare reform efforts are extracting humanity from the patient-caregiver interaction, I decided to review other posts I have written on the matter. I found this guest post by Dr. Edward J. Schloss (Twitter ID @EJSMD), medical director of cardiac electrophysiology at Christ Hospital in Cincinnati, OH. It was originally published here in January, but is so useful and so well-aligned with my feelings, I am going to re-post it today. (My favorite is #8.)

One of the many rewards of writing a blog is making friends. Jay and I started as ‘social media’ friends but now we are just friends. We share many of the same interests: electrophysiology, endurance sports (Jay is runner), writing (see his many guest posts on Cardiobrief) and of course, we both strive to master the obvious. Jay is respected in the electrophysiology world for his attention to detail, thoughtfulness and dedication to patients.

These tips were written in response to a post on Healthcare reform’s disruptive effects on doctors. Although Jay’s words speak directly to doctors, I believe they are congruent with the goals of this blog–to educate, to give a look behind the curtain, to archive useful information and ultimately, yes, to do some good.

Tips for survival in the new healthcare environment

By Dr Jay Schloss,

1. Good Tech: It’s time to admit much of your job is now data entry. If that’s the case, you should arm yourself with the best technology to make this job palatable. For me that means using my own computer. I have a very fast Apple MacBook Air that I run on the hospital WiFi network. This comes with me from room to room. There are no log-in/log-outs as I move. Keystroke macros automate many tasks. Reboots and crashes are rare. I’m facing the patient when I’m working and I never have to worry about finding a free workstation. In my office, I’m working at a stand-up desk ( This keeps my legs fresh and back straight. In the hospital, I’m working standing, seated, in patient room, in the elevator, in the cafeteria, wherever I want.

2. Minimize the BS: Don’t confuse box checking with delivery of health care. Sail through the BS as quickly as you can. Save your creative juices for the parts of your documentation that people actually read. Don’t waste your time making things look perfect. Just focus on meeting regulatory compliance and not setting yourself up for a lawsuit.

3. Delegate: No way you can do all of this yourself. Cultivate relationships with high quality individuals and delegate tasks. Your job is to be the quarterback, not the whole team.

4. Don’t Bill for Everything: Sometimes it’s appropriate to give away billing, as long as you provide high quality care. If you’re pressed for time, skip all the painful documentation. Assess the problem, communicate what you know to the patient and the referring doctor, write a quick note and don’t bill anything. You are serving your mission to provide high quality care and saving the health care system a few bucks at the same time.

5. Mobilize Support for Change: Do your job, but don’t take all this lying down. Doctors got into this mess by not speaking up. If we continue to roll over, it’s only going to get worse. Make yourself a positive agent of change. Speak up in emails, meetings, and hall conversations with administrators. Get a voice in social media. Start a blog. Write a few tweets. Because most of your colleagues are as passive as deer in the path a truck, your voice can be heard.

6. Find a Professional Outlet: As our work becomes more and more devalued, it’s easy to start feeling unimportant. All of us thrive on achievement and approval. If direct patient care is losing some of it’s meaning, add something else. Step up involvement in research, do some consulting (give away the money if you are concerned about conflicts of interest), give a talk, do charity work, write some blog comments.

7. Hold Fast to Your Values as a Doctor: No matter how bad it gets, do not . . . I mean DO NOT let go of your values as a caregiver. The people evaluating you may not value the same things you do. You know that quality metrics do not ensure quality. Keep doing the extra stuff that regulators don’t notice or measure. If that means seeing fewer patients, then so be it. Each patient you treat needs to have you at your best.

8. Take Refuge with your Patients: Even on the crappiest of crap days, a good face to face patient interaction can change everything. In the exam room, with the door closed, the rest of the world can melt away. Nothing feels better than making this connection, and knowing you have changed someone’s life. This is the part of healthcare delivery no one can touch. I doubt our regulators have any clue what I’m talking about here, and that’s OK. It will be our little secret that we guard until the end.

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