Erich Burnett

After 15 years in practice, the family physician from Arkansas found himself frustrated not with medicine, but with waiting rooms full of patients with impaired glucose levels and hypertension, high cholesterol and obesity, and by his inability to bring about lasting change. 

"I felt at times like I was just giving out one pill after another and not doing anything to cure the disease," he says. "I was just losing a little of my joy because I didn't have anything to offer these people." 

Hagaman found a new way to share that message when his practice began offering nutritional counseling group sessions in March, led by three health educators and two nurses. The results? Almost 500 patients have already dropped more than 4,000 pounds and transformed the way they manage their disorders. 

"The weight loss has been good, but the fact that people are coming off their medications-for diabetes, hypertension, high cholesterol-that's just phenomenal," says Hagaman, who closely follows his patients' progress. "It's changed my outlook to where I think I could now go another 15 or 20 years and enjoy what I'm doing." 

We would like to help you share in his optimism. Beginning this issue and continuing through November, 

, along with Advanstar Communications' other Life Sciences publications and their web portal, 

, will deliver "Cardiometabolic Disorders & Weight: Action for Outcomes," a series of in-depth coverage designed to help you manage your patients' disorders more effectively. 

, you can explore a wide range of related content at 

									http://ModernMedicine.com/cardiometabolic

, created with the expertise of Advanstar's Life Sciences publications. (Learn more about each publication on the next page.) 

"It seems like all of our attention toward healthcare is on putting more money and more attention on these end-stage diseases, rather than taking those end-stage diseases and trying to prevent them," says Hagaman. "We get more bang for our buck if we try to make people healthier and eliminate some of those cardiometabolic risks." 

We hope you'll join us in taking action to improve your patients' outcomes. 

Articles

Beginning this issue and continuing through November, Medical Economics will deliver "Cardiometabolic Disorders & Weight: Action for Outcomes," a series of in-depth coverage designed to help you manage your patients' disorders more effectively.

Viewpoint: Help your patients make a difference in their own lives

"In the old days, before evidence-based medicine was so important and before there were thousands of drugs on the market, doctors just 

," says Weiss, a family physician in Youngstown, Ohio. "I always imagined that when I became a physician, I would just 

Turns out you can know a lot, but nobody can know everything. So Weiss has always taken full advantage of the technology at her disposal, using a portable electronic device during patient visits to keep a world of information at her fingertips. But she also found herself curious-and a little self-conscious-every time she needed to consult the device in the presence of patients. Did they question her knowledge base? she wondered. Did they resent her PDA? 

Perhaps most important: 31 percent of patients were 

 satisfied with their visit because the doctor used a handheld device, and 67 percent weren't affected at all. 

What did Weiss learn? That most patients don't think about her use of technology nearly as much as she does-and that those who do are glad she has it. 

The key, as always, is in the quality of your communication: The study also revealed that patients were more satisfied with their doctors' use of technology when doctors took the time to explain what they were doing with it. 

Weiss heeds that advice, fully describing every use of technology in the exam room-even turning her laptop screen toward each patient so that they can look at it together. And so the devices that help her to "know everything" also fortify her patient relationships. 

"The longer I'm doing this, the more I realize how much I don't know," she says. "And the more I'm comfortable with what I don't know." 

Patients are more satisfied with their doctors' use of technology when doctors took the time to explain what they were doing with it.

Viewpoint: What do patients think about doctors' use of technology?

Are you an 18-second doctor? Your patients certainly hope not.  

Eighteen seconds is the amount of time, on average, that patients are permitted to talk before the physician-that's 

, quite possibly-interrupts them, according to a study by the Albert Einstein College of Medicine in New York. Is 18 seconds enough time to fully understand your patient's concern? 

Consider it in another way: Could you, in 18 seconds or less, sufficiently describe how your broken car is not getting you where you need to go? It takes that long just to properly replicate the 

 sound that's taunting you from under the hood. 

In this issue, we examine the differences a few years can make between older and younger physicians. But it's also a good time to ponder the difference a few 

 can make between an engaged doctor and a rushed one. Younger doctors, perhaps not surprisingly, tend to interrupt their patients more quickly than their older peers, according to the Albert Einstein research. 

"When I see a patient for the first time, when I knock on that door, I think 

" says Stephen Beeson, MD, a family practitioner and medical adviser for the Studer Group, a healthcare consulting firm. "If you don't make that change in your thinking, you're just doing a series of tasks." 

One key way to accomplish this, says Beeson, is to make time for non-medical conversation. Show you care about the 

, not merely the valuable time she's consuming. 

Speaking in a session at the American Academy of Family Physicians' Scientific Assembly in his hometown of San Diego, Beeson recounted the tale of a female patient who had mentioned her beloved dog named Muffin to a member of the office staff. That person passed the information on to Beeson, who made a point of asking about Muffin during his consult. What followed was an extended dog discourse-and an indelible new bond between patient and physician. 

				"I wondered what had happened to my career that I'm spending 15 minutes talking about a dog named Muffin," Beeson recalls, "but it was a fundamental step in establishing that relationship."

Beeson recommends allowing the patient's agenda and concerns to drive the visit-not for 18 seconds, but for as long as it takes to get her thoughts conveyed clearly. Let her know you understand by repeating what she says back to her. It shows that you're listening and that you care. "One thing you never want to do is question the authority of a patient complaint," says Beeson. 

Likewise, Beeson advocates making follow-up calls to check on patients you've recently seen; his 400-physician medical group makes 10,000 such calls each month. Every call expresses an unmistakable sense of commitment to his patients-and has earned him the business of entire neighborhoods through word-of-mouth. 

You can make an even greater difference in the lives of your patients by encouraging your staff to value these same traits. Don't allow them to shout out a patient's name at the door, as though she's the next contestant on 

. As Beeson puts it: "I want you taking her arm under your arm and talking about her dog named Muffin." 

It may cost you a few minutes of conversation, but could reward you with a lifelong relationship. And that, says Beeson, is the beauty of practicing medicine. "Our ability to make a difference in the lives of our patients-nobody can take that away from you." 

Taking time to talk with a patient may cost you a few minutes of conversation, but could reward you with a lifelong relationship.

Viewpoint: A little more conversation

That was a lovely essay for me before going off to work ("A matter of trust," January 9, 2009). After all the cynical letters to the editor in which we talk about being beaten-down family physicians, and after all the practice management tips to eke out a living, it's nice to see an uplifting article about the doctor-patient relationship and a nice ending to an ethical quandary. I was choked-up! 

I read Dr. Jeff Pearson's article "The pen is mightier" (From the Board, December 19, 2008) with amusement and shame at my fellow physicians. I have seen such displays at medical conferences more often than I care to recall. Why professionals behave in such a degrading manner defies my understanding. Are we so poor that we must fight like famine victims for food? Indeed, it can be amusing, but it does nothing to enhance our already tarnished image. 

I laughed when I read your piece on "freebies" and physicians. Years ago, as a dental rep, I worked the New York Dental Show many times. We were warned to be on the lookout for docs and their spouses when they hit the display area. It was worse than a one-hour sale at Macy's! 

Dentists would literally run their arms across the counter, scooping and dragging whatever they could get into their waiting bags. Pens, pads-everything was fair game. 

Worst of all was the last day of the convention, when they would literally steal the regular-size bottles of Scope from the counter. A 64-ounce bottle of mouthwash is quite large. It didn't matter; they-as well as anything else not nailed down-were history. Thanks for the remembrance. It was quite a display of human nature. 

I enjoyed the article "An upswing in downcoding?" (December 5, 2008). I had an episode in my office similar to the one shared by Dr. Rivera-Hidalgo. I dropped the insurance company before it was able to scrutinize and downcode 80 additional charts, resulting in considerable inconvenience for my patients. 

Before doing so, I spoke to the medical director to justify my charting. I explained that patients come in for one complaint and then add "while I'm here..." or "can you take a look at this..." in addition to their original reason for the appointment. This I gladly do, since I am a family practitioner. 

I may not have the time or the luxury to write extensive notes, but I do address the additional problems with a proper diagnosis and plan. According to the insurer and the medical director, this does not justify what I charge. It is difficult to believe that I can address three separate problems and cannot get paid $68 (extended visit).  

The most blatant disregard for patients came when the insurer failed to notify them that I opted out. After 60 days, I had more than 300 patients looking for doctors. 

The medical director said I could extend my discharge date so that I could continue care for patients until they were reassigned. The insurer ended up paying me nothing for it, except to apply the amount to what I owed. So much for trying to give them some PR and saving them from possible litigation. 

Downcoding, pharma freebies, vaccine costs

Author | Erich Burnett

Articles

Viewpoint: Help your patients make a difference in their own lives

Viewpoint: What do patients think about doctors' use of technology?

Viewpoint: A little more conversation

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