Time for a new health care dress code?

Does what your doctor wear endanger your health?


There's a debate brewing over whether attire is leading to cross contamination from patient to patient and raising the infection levels in hospitals and physician offices. The idea of ditching flagrant garb — like neckties and the iconic white coats — was floated in an article titled "Healthcare Personnel Attire in Non-Operating-Room Settings" in the journal Infection Control and Hospital Epidemiology (no, I didn't read the article, but I did read about it in the New York Times!).

So what to do about the biggest culprits — the neckties and white coats?

We can dispense with neckties (they should go anyway — and many clinicians have favored bow ties instead to lessen the risk of cross contamination!). But the white coats play a helpful role in identifying who does what in the health care setting.

In fact, who is in the room with you, the patient, is a big issue. These days, more and more health care workers are wearing scrubs, the pajama-like uniforms that were once reserved just for the Operating Room. In some places, even cleaning staff wear scrubs.

Uniforms are important, but proper identification and introduction of staff is the real critical element. When every staff member walks into a patient's room, they should introduce themselves and clearly state why they are there and what they will be doing — in terms the patient can understand!

If we expect patients to be partners in their care, they need to know who they are partnering with — and why!


Health care under Glass

Rhode Island Hospital ER docs will soon have a new instrument: Google Glass.

Physicians at the Providence-based teaching hospital will use Google Glass for real-time consults with consenting patients who need a dermatology consultation. 

"We live in a world of instant gratification, and in many ways, we’re testing that mindset by using Google Glass to enhance telemedicine in the emergency department,” said principal investigator Paul Porter, MD, a physician in the emergency departments of Rhode Island, Hasbro Children’s and The Miriam hospitals. 

Using the video-enabled goggles, the attending ER physician can live stream video of the patient's skin to a consulting dermatologist, who will view the video in real time on a tablet.

The hospital is working with a third party to modify the stock Google Glass so it is HIPAA compliant.

Rhode Island Hospital is the first in the nation to study the efficacy of using Glass in the ER setting.


Your doctor's latest sidekick: A scribe

Dr. Marian Bednar, an emergency room physician in Dallas, left, with Amanda Nieto, 27, her scribe and constant shadow.   Image Source:  NY Times.  

Dr. Marian Bednar, an emergency room physician in Dallas, left, with Amanda Nieto, 27, her scribe and constant shadow.

Image Source: NY Times. 

Holmes had Watson. Batman had Robin. SpongeBob SquarePants had Patrick Starfish.

These are famous sidekicks. Now doctors have warmed to the idea.

At Texas Health Presbyterian Hospital Dallas, ER physician Marian Bednar, MD, has a scribe assigned to her so she can pay attention — full attention — to her patients.

Dr. Bednar told the New York Times ("A Busy Doctor’s Right Hand, Ever Ready to Type," January 12, 2014):

"With a scribe, I can think medically instead of clerically."

In fact, there may be as many as 10,000 scribes working in hospitals and medical practices in the U.S., the Times reported.

In our age of technology, it's not the tech that is making a difference in health care — it's the human interaction. And the proliferation of scribes, albeit slowly, is bringing about the return of uninterrupted attention between doctor and patient.  

It shows that good ideas can be as old as, well, ancient Egypt!


When caring for patients, being there doesn't mean just being there

Is your doctor really there?

Suzanne Koven, MD

Suzanne Koven, MD

Suzanne Koven, MD, gave this question some thought after seeing a "Doctor present" sign at a pharmacy while traveling in Dublin. 

Am I “present” in my practice, even when I am in? Though we all like to think of ourselves as exceptions when it comes to unflattering statistics, the likelihood is that I am not as present as I think I am or would want to be. If we define “presence” for a doctor as maintaining eye contact, paying close attention to what a patient is saying and not interrupting the statistics aren’t pretty.

One reason is time. Another is volume.

In 2010, there were 1 billion physician office visits, with 55.5 percent visits with primary care doctors. The top reason for the visit was a cough. And the top diagnosis was hypertension. More than 51 percent of those visits lasted 15 minutes or less.

But those 15 minutes need to count.

Patient engagement is the buzz of the health care industry. Everyone from marketers to quality directors are embracing and exploiting it.

Here are three ideas for better patient engagement — and it starts with "being there."

  1. Be ready: Patients must do their part to clearly articulate their ailment. If patients spend a little time to prepare before their appointment, they will better understand their treatment plans and their satisfaction will skyrocket.
  2. Be in the moment: Caregivers must listen first. And listen well. You are face-to-face with another human being — make a connection and understand the obstacles that stand in the way of compliance with your care plan. Look beyond the individual in front of you and absorb the totality of the person and his or her environment. That will help you develop a care plan that will actually be effective and successful.
  3. Be encouraging: Nobody likes to go see the doctor, even if it's for a "well checkup." Your caregivers poke, prod, ask personal and sometimes seemingly embarrassing questions and, of course, weigh you. And when the advice is "lose weight" or "just take these," caregivers need to try to be a little more encouraging to patients who see these encounters as their Sisyphus moments. A little communication goes a long way — and makes for a happier and healthier patient.

This post originally appeared on EngagingPatients.org, a blog dedicated to advancing patient and family-centered care. I am a member of the Engaging Patients Advisory Board and write for the blog. 


Should you trust your doctor?

Yes. Maybe. But do a little asking around first.

An opinion piece on CNN.com from Anthony Youn, MD, a Detroit-based plastic surgeon, has some good, common-sense advice for everyone seeking a physician.

Start by poking around online. Online health care rating services like Healthgrades have long had information about quality and malpractice experience (usually taken from state databases). They are now being joined by the likes of Angie's List, where patients rate doctors on the experience they had.

One of Dr. Youn's specific pieces of advice: 

Be cautious of doctors who advertise too much. The quality of a doctor is often inversely proportional to the size of his or her ad.

This may be less true as physicians and large practices join even larger health systems where advertising will become an increasingly important part of practice building and practice management. The irony is when I accessed the page on CNN.com, the right column included sponsored links from physicians!

Dr. Youn's final advice:  

So should you trust your doctor?
After you do your research.

Just what the doctor ordered.