Guest guest Posted August 23, 2012 Report Share Posted August 23, 2012 Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2012 Report Share Posted August 23, 2012 I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2012 Report Share Posted August 23, 2012 Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking "At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients" (or something like that) and found a striking consistency "about the twelfth patient."Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day.This would not necessarily result in a primary care shortage if the payment model shifted from "visit with doctor = revenue" to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care.Gordon I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue "individualized decision making", I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2012 Report Share Posted August 23, 2012 We should submit and post our stories to the Health and Justice project's primary care conversation: http://www.causes.com/causes/767047-health-justice-project/actions/1675663 Just another way to get our voices heard by more people. , MD Palm Desert, California Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2012 Report Share Posted August 23, 2012 Agreed, with try to stay at about 10-12 a day and average about that. Some days, when by myself and in the middle of ski season, I have seen 20-25 but that is sporatic, not daily. We just found out that we are one of the CPCI grant practices for Colorado. This is a Medicare, BC, Aetna, Cigna, Rocky Mountain health plan, and United health plan agreeemnt to pay for all those things that we do. So we will receive about $20/patient/month; like the old capitation system along with the FFS payments that will continue. With that, we should be able to limit our volume and do the coordination of care and other PCMH stuff. We are trying to decide to decide whether we are hiring a coach, a coordinator, upgrade our portal or just continue. Will let you know what were doing. From: [ ] On Behalf Of L. Gordon [gmoore@...] Sent: Thursday, August 23, 2012 11:20 AM To: Subject: Re: doctor burn out Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking " At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients " (or something like that) and found a striking consistency " about the twelfth patient. " Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day. This would not necessarily result in a primary care shortage if the payment model shifted from " visit with doctor = revenue " to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care. Gordon I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue: http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPH Geriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AM Subject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 CONGRATS Jim!! Well done! From: [mailto: ] On Behalf Of Kennedy, JimSent: Thursday, August 23, 2012 5:52 PMTo: Subject: RE: doctor burn out Agreed, with try to stay at about 10-12 a day and average about that. Some days, when by myself and in the middle of ski season, I have seen 20-25 but that is sporatic, not daily. We just found out that we are one of the CPCI grant practices for Colorado. This is a Medicare, BC, Aetna, Cigna, Rocky Mountain health plan, and United health plan agreeemnt to pay for all those things that we do. So we will receive about $20/patient/month; like the old capitation system along with the FFS payments that will continue. With that, we should be able to limit our volume and do the coordination of care and other PCMH stuff. We are trying to decide to decide whether we are hiring a coach, a coordinator, upgrade our portal or just continue. Will let you know what were doing. From: [ ] On Behalf Of L. Gordon [gmoore@...]Sent: Thursday, August 23, 2012 11:20 AMTo: Subject: Re: doctor burn out Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking " At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients " (or something like that) and found a striking consistency " about the twelfth patient. " Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day. This would not necessarily result in a primary care shortage if the payment model shifted from " visit with doctor = revenue " to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care. Gordon I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%.Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html BenRecent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 congratulations Jim, that is really cool. Cote To: Sent: Thursday, August 23, 2012 4:52:28 PMSubject: RE: doctor burn out Agreed, with try to stay at about 10-12 a day and average about that. Some days, when by myself and in the middle of ski season, I have seen 20-25 but that is sporatic, not daily. We just found out that we are one of the CPCI grant practices for Colorado. This is a Medicare, BC, Aetna, Cigna, Rocky Mountain health plan, and United health plan agreeemnt to pay for all those things that we do. So we will receive about $20/patient/month; like the old capitation system along with the FFS payments that will continue. With that, we should be able to limit our volume and do the coordination of care and other PCMH stuff. We are trying to decide to decide whether we are hiring a coach, a coordinator, upgrade our portal or just continue. Will let you know what were doing. From: [ ] On Behalf Of L. Gordon [gmoore@...]Sent: Thursday, August 23, 2012 11:20 AMTo: Subject: Re: doctor burn out Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking "At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients" (or something like that) and found a striking consistency "about the twelfth patient." Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day. This would not necessarily result in a primary care shortage if the payment model shifted from "visit with doctor = revenue" to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care. Gordon I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue "individualized decision making", I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue: http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 Great article leslie. Very enlightening I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 *fantastic* article. I'd heard of the Israeli-judge story before, but hadn't seen the NYT article or processed the implications. Wow--lots to think about.Thank you!Ken Great article leslie. Very enlightening I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue "individualized decision making", I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 wicked cool Jim I was wondering if any IMPs inthe 7 areas went for this Please let us know how it goes/ how the paperwork is. any outcomes you can keep track of(like the doctors' satisfaction... )Can you come to CAmp this year? Agreed, with try to stay at about 10-12 a day and average about that. Some days, when by myself and in the middle of ski season, I have seen 20-25 but that is sporatic, not daily. We just found out that we are one of the CPCI grant practices for Colorado. This is a Medicare, BC, Aetna, Cigna, Rocky Mountain health plan, and United health plan agreeemnt to pay for all those things that we do. So we will receive about $20/patient/month; like the old capitation system along with the FFS payments that will continue. With that, we should be able to limit our volume and do the coordination of care and other PCMH stuff. We are trying to decide to decide whether we are hiring a coach, a coordinator, upgrade our portal or just continue. Will let you know what were doing. From: [ ] On Behalf Of L. Gordon [gmoore@...] Sent: Thursday, August 23, 2012 11:20 AM To: Subject: Re: doctor burn out Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking " At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients " (or something like that) and found a striking consistency " about the twelfth patient. " Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day. This would not necessarily result in a primary care shortage if the payment model shifted from " visit with doctor = revenue " to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care. Gordon I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue: http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPH Geriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AM Subject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 Agree! Definitely worth the read. Seems like a great research project to study the toll of individual decision making on primary care doctors. I have never really thought about the potential benefit to the psyche of doctors in using protocols and lists (like Atul Gawande talks about in The Checklist Manifesto), but makes sense. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com *fantastic* article. I'd heard of the Israeli-judge story before, but hadn't seen the NYT article or processed the implications. Wow--lots to think about.Thank you! Ken Great article leslie. Very enlightening I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 “The best decision makers,” Baumeister says, “are the ones who know when not to trust themselves.” Sharon Agree! Definitely worth the read. Seems like a great research project to study the toll of individual decision making on primary care doctors. I have never really thought about the potential benefit to the psyche of doctors in using protocols and lists (like Atul Gawande talks about in The Checklist Manifesto), but makes sense. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com *fantastic* article. I'd heard of the Israeli-judge story before, but hadn't seen the NYT article or processed the implications. Wow--lots to think about.Thank you! Ken Great article leslie. Very enlightening I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 This reminds me of the "Dunning-Kruger effect" which states that those who are incompetent are too incompetent to know that they are incompetent, and overestimate their own abilities. So if you don't have any doubts at all, maybe you actually aren't as good as you think you are . . .http://en.wikipedia.org/wiki/Dunning–Kruger_effect SetoSouth Pasadena, CA “The best decision makers,” Baumeister says, “are the ones who know when not to trust themselves.” Sharon Agree! Definitely worth the read. Seems like a great research project to study the toll of individual decision making on primary care doctors. I have never really thought about the potential benefit to the psyche of doctors in using protocols and lists (like Atul Gawande talks about in The Checklist Manifesto), but makes sense. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com *fantastic* article. I'd heard of the Israeli-judge story before, but hadn't seen the NYT article or processed the implications. Wow--lots to think about.Thank you! Ken Great article leslie. Very enlightening I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue "individualized decision making", I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 yes, and then as Gordon pointed out, along with our increasingly complex medical decision-making, we want to provide empathy and emotional connection. Plus we sometimes have to manage the patient's upset (about their life, about the wait, about the insurance company, or often all the above), and THEN we are trying to negotiate a mutually acceptable treatment plan. i really think we need to find a way to clearly articulate what is involved in what we are expected to do. then we might be in a better position to advocate for what we need, in order to provide the care that we, the patients, and the system want us to provide. another idea i have is to start making YouTube videos on some of those common clinical issues that JAMA experts tell us how to manage...get a sample patient, walk through the proposed history and physical and individualized decision making, and demonstrate how it is never going to be feasible within a 15 minute visit. they should stop recommending we do the impossible. it is demoralizing to feel that you are constantly failing.-- Kernisan, MD MPHGeriatrics Agree! Definitely worth the read. Seems like a great research project to study the toll of individual decision making on primary care doctors. I have never really thought about the potential benefit to the psyche of doctors in using protocols and lists (like Atul Gawande talks about in The Checklist Manifesto), but makes sense. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com *fantastic* article. I'd heard of the Israeli-judge story before, but hadn't seen the NYT article or processed the implications. Wow--lots to think about.Thank you! Ken Great article leslie. Very enlightening I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2012 Report Share Posted August 24, 2012 a great example is all the prostate cancer screening info out there these days " every patient should discuss this with their doctor and make an informed decision about what is best for them " articles say that as if that's a piece of cake, problem solvedthankfully my IMP setup gives me the time to do that but we are the overwhelming minority yes, and then as Gordon pointed out, along with our increasingly complex medical decision-making, we want to provide empathy and emotional connection. Plus we sometimes have to manage the patient's upset (about their life, about the wait, about the insurance company, or often all the above), and THEN we are trying to negotiate a mutually acceptable treatment plan. i really think we need to find a way to clearly articulate what is involved in what we are expected to do. then we might be in a better position to advocate for what we need, in order to provide the care that we, the patients, and the system want us to provide. another idea i have is to start making YouTube videos on some of those common clinical issues that JAMA experts tell us how to manage...get a sample patient, walk through the proposed history and physical and individualized decision making, and demonstrate how it is never going to be feasible within a 15 minute visit. they should stop recommending we do the impossible. it is demoralizing to feel that you are constantly failing.-- Kernisan, MD MPHGeriatrics Agree! Definitely worth the read. Seems like a great research project to study the toll of individual decision making on primary care doctors. I have never really thought about the potential benefit to the psyche of doctors in using protocols and lists (like Atul Gawande talks about in The Checklist Manifesto), but makes sense. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com *fantastic* article. I'd heard of the Israeli-judge story before, but hadn't seen the NYT article or processed the implications. Wow--lots to think about.Thank you! Ken Great article leslie. Very enlightening I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie-- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2012 Report Share Posted August 25, 2012 Yes! That was Guinn in New Mexico and I believe most doctors experienced empathy burnout around 10-12 patients. After that we just start tuning out. BTW - I don't see her on the IMP map. I hope she didn't burnout . . . Gordon, this also reminds me of the 20% increase in polyps detected during colonoscopies BEFORE 11:00 am. Yes. Doctors are not robots. ~ Pamela > > > > > > Duh! But what will we do about it? > > > > Cote > > > > > > > > > > > > To: > > Sent: Thursday, August 23, 2012 9:04:22 AM > > Subject: doctor burn out > > > > > > > > > > CNN is running this story today on physician burnout. About 40%. > > Front line primary care people about 60%. > > > > > > http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html > > > > Ben > > RECENT ACTIVITY: > > Visit Your Group > > > > Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use > > . > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2012 Report Share Posted August 25, 2012 Thats great, Jim. Can you forward me a link to your practice website so I can learn more about your practice?Frederick Elliott MDFuture IMP 2013Buffalo, NY CONGRATS Jim!! Well done! From: [mailto: ] On Behalf Of Kennedy, JimSent: Thursday, August 23, 2012 5:52 PMTo: Subject: RE: doctor burn out Agreed, with try to stay at about 10-12 a day and average about that. Some days, when by myself and in the middle of ski season, I have seen 20-25 but that is sporatic, not daily. We just found out that we are one of the CPCI grant practices for Colorado. This is a Medicare, BC, Aetna, Cigna, Rocky Mountain health plan, and United health plan agreeemnt to pay for all those things that we do. So we will receive about $20/patient/month; like the old capitation system along with the FFS payments that will continue. With that, we should be able to limit our volume and do the coordination of care and other PCMH stuff. We are trying to decide to decide whether we are hiring a coach, a coordinator, upgrade our portal or just continue. Will let you know what were doing. From: [ ] On Behalf Of L. Gordon [gmoore@...]Sent: Thursday, August 23, 2012 11:20 AMTo: Subject: Re: doctor burn out Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking "At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients" (or something like that) and found a striking consistency "about the twelfth patient." Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day. This would not necessarily result in a primary care shortage if the payment model shifted from "visit with doctor = revenue" to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care. Gordon I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue "individualized decision making", I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue:http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPHGeriatrics Duh! But what will we do about it? Cote To: Sent: Thursday, August 23, 2012 9:04:22 AMSubject: doctor burn out CNN is running this story today on physician burnout. About 40%.Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html BenRecent Activity: Visit Your Group Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use. Reply to sender | Reply to group | Reply via web post | Start a New Topic Messages in this topic (10) Recent Activity: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2012 Report Share Posted August 25, 2012 byerspeakfamilymedicine.com ________________________________________ From: [ ] On Behalf Of Frederick Elliott [fmichaelelliott@...] Sent: Friday, August 24, 2012 7:58 PM To: Subject: Re: doctor burn out Thats great, Jim. Can you forward me a link to your practice website so I can learn more about your practice? Frederick Elliott MD Future IMP 2013 Buffalo, NY On Aug 23, 2012, at 8:18 PM, " Dr. Brady " <drbrady@...<mailto:drbrady@...\ l.com>> wrote: CONGRATS Jim!! Well done! From: <mailto: \ > [mailto: ] On Behalf Of Kennedy, Jim Sent: Thursday, August 23, 2012 5:52 PM To: <mailto: \ > Subject: RE: doctor burn out Agreed, with try to stay at about 10-12 a day and average about that. Some days, when by myself and in the middle of ski season, I have seen 20-25 but that is sporatic, not daily. We just found out that we are one of the CPCI grant practices for Colorado. This is a Medicare, BC, Aetna, Cigna, Rocky Mountain health plan, and United health plan agreeemnt to pay for all those things that we do. So we will receive about $20/patient/month; like the old capitation system along with the FFS payments that will continue. With that, we should be able to limit our volume and do the coordination of care and other PCMH stuff. We are trying to decide to decide whether we are hiring a coach, a coordinator, upgrade our portal or just continue. Will let you know what were doing. ________________________________ From: <mailto: \ > [ <mailto:@...\ m>] On Behalf Of L. Gordon [gmoore@...] Sent: Thursday, August 23, 2012 11:20 AM To: <mailto: \ > Subject: Re: doctor burn out Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking " At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients " (or something like that) and found a striking consistency " about the twelfth patient. " Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day. This would not necessarily result in a primary care shortage if the payment model shifted from " visit with doctor = revenue " to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care. Gordon On Aug 23, 2012, at 10:06 AM, leslie kernisan > wrote: I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue: http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.h\ tml?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPH Geriatrics On Thu, Aug 23, 2012 at 7:25 AM, > wrote: Duh! But what will we do about it? Cote ________________________________ > To: <mailto: \ > Sent: Thursday, August 23, 2012 9:04:22 AM Subject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group<http://groups.yahoo.com/group/;_ylc=X3oDMTJldmVyNGNnBF\ 9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwN2dGwEc2xrA3ZnaH\ AEc3RpbWUDMTM0NTcyNjQ2Nw--> Switch to: Text-Only<mailto:-traditional ?subject=Change\ +Delivery+Format:+Traditional>, Daily Digest<mailto:-digest ?subject=Email+Delivery\ :+Digest> • Unsubscribe<mailto:-unsubscribe ?subject=Unsu\ bscribe> • Terms of Use<http://docs.yahoo.com/info/terms/> .. 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Guest guest Posted August 25, 2012 Report Share Posted August 25, 2012 I actually like the youtube idea. I spent 30 min. today, again, with a 62=1,year old patient/friend of mine talking about PSA's. He also knows many urologists who espouse the standard line. No way to come to satifaction, we all feel caught in the middle. Many years ago now, C E Koop, was producing these interactive video disks, which I believe never were known about or caught on. They had discussions of topics like this, that were suppose to be in offices to allow patients to watch interactive discussion between doc and patient. Maybe we should recreate. ________________________________________ From: [ ] On Behalf Of leslie kernisan [lkernisan@...] Sent: Friday, August 24, 2012 1:23 PM To: Subject: Re: doctor burn out yes, and then as Gordon pointed out, along with our increasingly complex medical decision-making, we want to provide empathy and emotional connection. Plus we sometimes have to manage the patient's upset (about their life, about the wait, about the insurance company, or often all the above), and THEN we are trying to negotiate a mutually acceptable treatment plan. i really think we need to find a way to clearly articulate what is involved in what we are expected to do. then we might be in a better position to advocate for what we need, in order to provide the care that we, the patients, and the system want us to provide. another idea i have is to start making YouTube videos on some of those common clinical issues that JAMA experts tell us how to manage...get a sample patient, walk through the proposed history and physical and individualized decision making, and demonstrate how it is never going to be feasible within a 15 minute visit. they should stop recommending we do the impossible. it is demoralizing to feel that you are constantly failing. -- Kernisan, MD MPH Geriatrics On Fri, Aug 24, 2012 at 11:45 AM, Sharon McCoy > wrote: Agree! Definitely worth the read. Seems like a great research project to study the toll of individual decision making on primary care doctors. I have never really thought about the potential benefit to the psyche of doctors in using protocols and lists (like Atul Gawande talks about in The Checklist Manifesto), but makes sense. Sharon Sharon McCoy MD Renaissance Family Medicine 10 McClintock Court; Irvine, CA 92617 PH: (949)387-5504<tel:%28949%29387-5504> Fax: (949)281-2197<tel:%28949%29281-2197> Toll free phone/fax: <tel:> www.SharonMD.com<http://www.SharonMD.com> On Fri, Aug 24, 2012 at 6:14 AM, Ken Stone > wrote: *fantastic* article. I'd heard of the Israeli-judge story before, but hadn't seen the NYT article or processed the implications. Wow--lots to think about. Thank you! Ken On Aug 24, 2012, at 12:01 AM, Gordon > wrote: Great article leslie. Very enlightening On Aug 23, 2012 11:06 AM, " leslie kernisan " > wrote: I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue: http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.h\ tml?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPH Geriatrics On Thu, Aug 23, 2012 at 7:25 AM, > wrote: Duh! But what will we do about it? Cote ________________________________ > To: <mailto: \ > Sent: Thursday, August 23, 2012 9:04:22 AM Subject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group<http://groups.yahoo.com/group/;_ylc=X3oDMTJldmVyNGNnBF\ 9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwN2dGwEc2xrA3ZnaH\ AEc3RpbWUDMTM0NTcyNjQ2Nw--> <http://groups.yahoo.com/;_ylc=X3oDMTJka212b202BF9TAzk3NDc2NTkwBGdycElkAzkzNjA5M\ TQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwNmdHIEc2xrA2dmcARzdGltZQMxMzQ1NzI2NDY3> Switch to: Text-Only<mailto:-traditional ?subject=Change\ +Delivery+Format:+Traditional>, Daily Digest<mailto:-digest ?subject=Email+Delivery\ :+Digest> • Unsubscribe<mailto:-unsubscribe ?subject=Unsu\ bscribe> • Terms of Use<http://docs.yahoo.com/info/terms/> .. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2012 Report Share Posted August 25, 2012 Will do Jean. Can't come to camp, have a ABFM meeting and my daughter/partner is taking some time off with her twins. ________________________________________ From: [ ] On Behalf Of [jnantonucci@...] Sent: Friday, August 24, 2012 7:18 AM To: Subject: Re: doctor burn out wicked cool Jim I was wondering if any IMPs inthe 7 areas went for this Please let us know how it goes/ how the paperwork is. any outcomes you can keep track of(like the doctors' satisfaction... ) Can you come to CAmp this year? On Thu, Aug 23, 2012 at 5:52 PM, Kennedy, Jim > wrote: Agreed, with try to stay at about 10-12 a day and average about that. Some days, when by myself and in the middle of ski season, I have seen 20-25 but that is sporatic, not daily. We just found out that we are one of the CPCI grant practices for Colorado. This is a Medicare, BC, Aetna, Cigna, Rocky Mountain health plan, and United health plan agreeemnt to pay for all those things that we do. So we will receive about $20/patient/month; like the old capitation system along with the FFS payments that will continue. With that, we should be able to limit our volume and do the coordination of care and other PCMH stuff. We are trying to decide to decide whether we are hiring a coach, a coordinator, upgrade our portal or just continue. Will let you know what were doing. ________________________________ From: <mailto: \ > [ <mailto:@...\ m>] On Behalf Of L. Gordon [gmoore@...] Sent: Thursday, August 23, 2012 11:20 AM To: <mailto: \ > Subject: Re: doctor burn out Prior to joining this listserv, a colleague did an informal survey of the docs in her community asking " At what point in your day do you feel that you're pretty much drained of your ability to empathize with your patients " (or something like that) and found a striking consistency " about the twelfth patient. " Presuming for a moment that this is a universal finding one is naturally drawn to the conclusion that we ought to limit ourselves to 12 patients per day. This would not necessarily result in a primary care shortage if the payment model shifted from " visit with doctor = revenue " to other models focused more on population outcomes and presuming that primary care received adequate funding to engage in the full scope of work of good primary care. Gordon On Aug 23, 2012, at 10:06 AM, leslie kernisan > wrote: I'm not sure exactly what to do about it, but this issue needs to be part of the public conversation about improving care. Every time I read an article that concludes by recommending that clinicians pursue " individualized decision making " , I think about the mental toll that takes. Not that we shouldn't do it, but it has to be recognized. There is lots of literature now in psychology about the mental tolls of decision-making, but as far as I know it has not really been connected to our work in primary care. If I had a challenging medical situation, I would want the first appointment of the day, because towards the end the doctors are at best tired, at worst completely fried. This is a good NYT article on decision fatigue: http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.h\ tml?pagewanted=all Also, much longer but very interesting is Kahneman's book on Thinking Fast and Slow, good for thinking about cognitive work but also good for thinking about interpreting numbers and data, which is what we are supposed to get patients to do to a certain extent. All that care coordination with the ACAs that they are expecting: we need them to realize that this takes a certain kind of cognitive energy, so they will need to help us on the burnout front if they want us to take it on. leslie -- Kernisan, MD MPH Geriatrics On Thu, Aug 23, 2012 at 7:25 AM, > wrote: Duh! But what will we do about it? Cote ________________________________ > To: <mailto: \ > Sent: Thursday, August 23, 2012 9:04:22 AM Subject: doctor burn out CNN is running this story today on physician burnout. About 40%. Front line primary care people about 60%. http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html Ben Recent Activity: Visit Your Group<http://groups.yahoo.com/group/;_ylc=X3oDMTJldmVyNGNnBF\ 9TAzk3MzU5NzE0BGdycElkAzkzNjA5MTQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwN2dGwEc2xrA3ZnaH\ AEc3RpbWUDMTM0NTcyNjQ2Nw--> <http://groups.yahoo.com/;_ylc=X3oDMTJka212b202BF9TAzk3NDc2NTkwBGdycElkAzkzNjA5M\ TQEZ3Jwc3BJZAMxNzA1MDYxMzI3BHNlYwNmdHIEc2xrA2dmcARzdGltZQMxMzQ1NzI2NDY3> Switch to: Text-Only<mailto:-traditional ?subject=Change\ +Delivery+Format:+Traditional>, Daily Digest<mailto:-digest ?subject=Email+Delivery\ :+Digest> • Unsubscribe<mailto:-unsubscribe ?subject=Unsu\ bscribe> • Terms of Use<http://docs.yahoo.com/info/terms/> .. -- MD ph fax <http://> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2012 Report Share Posted August 25, 2012 I hate to keep beating a dead horse, but how much of burnout is due to treating a patient, but having to deal with a third party for both payment and treatment guidelines? I agree about 12-15 per day makes a nice patient load. But you won't ever survive as a viable business within today's healthcare payment system. Steve stown. > > > > > > > > > Duh! But what will we do about it? > > > > > > Cote > > > > > > > > > > > > > > > From: " Ben Brewer " <brewermd98@> > > > To: > > > Sent: Thursday, August 23, 2012 9:04:22 AM > > > Subject: doctor burn out > > > > > > > > > > > > > > > CNN is running this story today on physician burnout. About 40%. > > > Front line primary care people about 60%. > > > > > > > > > http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html > > > > > > Ben > > > RECENT ACTIVITY: > > > Visit Your Group > > > > > > Switch to: Text-Only, Daily Digest • Unsubscribe • Terms of Use > > > . > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2012 Report Share Posted August 25, 2012 I mis wrote my previous post. I have no burnout from patients. I enjoy my interaction with them. I had approached burnout with third parties. I removed them. I do what I believe to be best for each patient and have no third party whispering in my ear or threatening me. My point is that an IMP should never get burned out, unless the IMP is restricted from doing what they want, which is usually by the third party. I went into FP so I could control my own destiny. I believe that is shared by many on this list. If FP's can regain control of the system, we would have an overflow, as opposed to a fake shortage. Steve stown. > > > > > > > > > > > > Duh! But what will we do about it? > > > > > > > > Cote > > > > > > > > > > > > > > > > > > > > From: " Ben Brewer " <brewermd98@> > > > > To: > <mailto:%40yahoogroups.com> > > > > Sent: Thursday, August 23, 2012 9:04:22 AM > > > > Subject: doctor burn out > > > > > > > > > > > > > > > > > > > > CNN is running this story today on physician burnout. About 40%. > > > > Front line primary care people about 60%. > > > > > > > > > > > > http://www.cnn.com/2012/08/23/health/time-doctor-burnout/index.html > > > > > > > > Ben > > > > RECENT ACTIVITY: > > > > Visit Your Group > > > > > > > > Switch to: Text-Only, Daily Digest . Unsubscribe . Terms of Use > > > > . > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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