Brian Carlson’s Post

This is a wonderful article about PVT application in nursing. I believe PVT brings a crucial perspective to healthcare with wide implications, not just in the healthcare worker-patient dyad, but systemicly. For example: what are the organizational implications? What needs to be in place for nurses, and other healthcare workers, to embrace practices grounded in the neurobiology of safety? What are the implications for workload? Healthcare environments are fast paced, noisy, overloaded, and high demand, which creates chronic SNS activation. This gets so embedded in organizational culture that it becomes normalized and expected. Yet in order to offer care and cues of safety, healthcare providers need to have access to their own social engagement/ventral vagal system. This has potential widespread (and deep) implications at all levels of the organization as well as with the individual’s development and practice. Curious to hear your thoughts: What would prioritizing a PVT lens in healthcare mean for leaders? How can we begin to bring this evidence based perspective into healthcare workpaces and boardrooms?

And the way to clinical excellence is to have the guidance of those who can truely advise…

The value of #debriefing extends beyond the moment. Thoughtful article and valuable practice.

Good morning, everyone. Do you know what a Hospitalist is? I didn't until this morning. Hospitalists are a group of individuals who make up the hospital medicine community and practice hospital medicine. This began with Society of Hospital Medicine which is founded through National Hospitalist Day in 1997. The Society of Hospital Medicine promote quality care by keeping hospitals up-to-date with education and industry-specific information. The National Hospitalist Day's goal is to recognize the contributors of specialist care doctors who make up the members of the Society of Hospital Medicine in the fastest-growing speciality of modern medicine. What's the difference between a primary health care doctor and a hospitalist, you ask? Your hospitalist are doctors who provide care for patients at a hospital and typically have the same training as primary care doctors but specialize in providing in-hospital care. Thank you for all the hospitalists who continue to make hospitals up to date and keeping their staff safe while still providing excellent health-care. BERTOLINO LLP, @national hospitalist day

If you're an emergency physician, you'll want to check out the debate among EM leaders Drs. Bob McNamara, Jesse Pines, & Dominic J. Bagnoli about the importance of financial transparency in emergency medicine practices - @ FB's EM Docs group (PW protected). Direct link: https://lnkd.in/gmvqxw96 The discussion is inspired by Pines & Amer Aldeen, MD's article, "Questions You Should Be Asking About How Your Physician Group Works": https://lnkd.in/gTbj8zTR One conclusion from the sometimes heated debate is that they are on the same side of many EM practice structure issues: a) physicians should own EM practices; b) group leaders should be mission-driven (eg: focus on high quality care delivery within a collegial practice); c) PAs & NPs should be part of physician-led teams and receive structured EM-specific training. What's missing from this & similar discussions are the voices leaders of non-physician owned groups, including TeamHealth, Envision Physician Services, SCP Health, & Sound Physicians. If they believe that their practices represent the right way to organize emergency physician groups, it's time for these practices' leaders to publicly stand up for the value of their practice structures. #emergencymedicine American College of Emergency Physicians American Academy of Emergency Medicine (AAEM) Emergency Medicine Residents' Association (EMRA)

Consider adding concierge medical care as a benefit for your employees.

#DoctorsDay may be over, but we are grateful for our incredible physicians every single day of the year! Today we're spotlighting Benjamin Webster, MD, an emergency medical specialist with Emergency Resources Group at #BaptistJax. Q: When did you begin practicing medicine & how long have you been affiliated with Baptist Health? A: I graduated from the University of Pittsburgh School of Medicine in 2008 & completed my residency at Vanderbilt University Medical Center in 2011. I worked for a year in the Cleveland area before moving to Jacksonville to join Baptist Health & Emergency Resources Group in 2012. Q: How would you describe your specific field of practice? A: I can see a patient of any age, with any problem at any time. We are trained to deal with any emergent or urgent condition, to stabilize your illness/injury & provide definitive treatment or get you into the hands of someone who can. We also provide a great deal of primary care to those who don't otherwise have access to health care. Q: What drove your passion for medicine and led you to become a doctor? A: Growing up, I was always drawn to the life sciences & enjoyed interacting with people. Medicine was the perfect combination. I never really considered anything else. Q: What do you enjoy most about being a physician? A: I enjoy meeting people from every walk of life & the variety that every day in the emergency department brings. I like the fast-paced nature & the ability to see the care I provide make an immediate impact. Q: What is the most significant thing you've learned about caring for patients & the impact you have on their health? A: The biggest thing I've learned is to sit down & be quiet. I've learned that even on my busiest shift, I have 5 minutes to sit down & listen. I find it often leads to less testing because I truly understand the patient's concerns and can allay those fears more efficiently. Q: What does being a physician mean to you and have your feelings about this evolved over the years? A: After being a father and husband, being a physician is the greatest honor in my life. Complete strangers entrust me to care for them or their loved ones, often in their greatest time of need. Q: What would you like others to better understand about your role as a physician? A: My role & efforts extend beyond the bedside. When not directly seeing patients, I & many other physicians work hard to create best-practice guidelines, provide education to other team members, and work to improve the coordination of care between the inpatient and outpatient world. Q: What do you like to do outside of work? A: My wife & I have four wonderful children that keep us running all the time. We spend a lot of our time supporting them at the Apex Theater and the Davis Park baseball/softball fields. I'm currently coaching my son's 6-year-old T-ball team, a true test of patience. I'm a diehard Pittsburgh sports fan, desperate for a winning Pirates team in my lifetime! #BaptistProud

#DoctorsDay may be over, but we are grateful for our incredible physicians every single day of the year! Today we're spotlighting Benjamin Webster, MD, an emergency medical specialist with Emergency Resources Group at #BaptistJax. Q: When did you begin practicing medicine & how long have you been affiliated with Baptist Health? A: I graduated from the University of Pittsburgh School of Medicine in 2008 & completed my residency at Vanderbilt University Medical Center in 2011. I worked for a year in the Cleveland area before moving to Jacksonville to join Baptist Health & Emergency Resources Group in 2012. Q: How would you describe your specific field of practice? A: I can see a patient of any age, with any problem at any time. We are trained to deal with any emergent or urgent condition, to stabilize your illness/injury & provide definitive treatment or get you into the hands of someone who can. We also provide a great deal of primary care to those who don't otherwise have access to health care. Q: What drove your passion for medicine and led you to become a doctor? A: Growing up, I was always drawn to the life sciences & enjoyed interacting with people. Medicine was the perfect combination. I never really considered anything else. Q: What do you enjoy most about being a physician? A: I enjoy meeting people from every walk of life & the variety that every day in the emergency department brings. I like the fast-paced nature & the ability to see the care I provide make an immediate impact. Q: What is the most significant thing you've learned about caring for patients & the impact you have on their health? A: The biggest thing I've learned is to sit down & be quiet. I've learned that even on my busiest shift, I have 5 minutes to sit down & listen. I find it often leads to less testing because I truly understand the patient's concerns and can allay those fears more efficiently. Q: What does being a physician mean to you and have your feelings about this evolved over the years? A: After being a father and husband, being a physician is the greatest honor in my life. Complete strangers entrust me to care for them or their loved ones, often in their greatest time of need. Q: What would you like others to better understand about your role as a physician? A: My role & efforts extend beyond the bedside. When not directly seeing patients, I & many other physicians work hard to create best-practice guidelines, provide education to other team members, and work to improve the coordination of care between the inpatient and outpatient world. Q: What do you like to do outside of work? A: My wife & I have four wonderful children that keep us running all the time. We spend a lot of our time supporting them at the Apex Theater and the Davis Park baseball/softball fields. I'm currently coaching my son's 6-year-old T-ball team, a true test of patience. I'm a diehard Pittsburgh sports fan, desperate for a winning Pirates team in my lifetime! #BaptistProud

On the topic of books by doctors, particularly emergency physicians, I'm pasting in here my Amazon review following a recent read of Dr. Joan Naidorf's book: 5.0 out of 5 stars Overcoming Difficult Healthcare Conversations Reviewed in the United States on March 31, 2024 I heartily endorse Dr. Joan Naidorf’s book Changing How We Think About Difficult Patients. She has overwhelmingly succeeded in her goal of producing a pithy and insightful resource for readers working in all aspects of the healthcare field, especially those just embarking on their careers. I’ve also concluded that additionally even non-medical readers can benefit from her insights into how the often-challenging interactions between suffering patients and those dedicated to relieving that suffering can inadvertently, but readily, go astray. Each side of that interaction can benefit from trying to be more consciously aware of the often subconscious emotional and psychosocial elements influencing our behavior and decision making, as Dr. Naidorf outlines so clearly. As a fellow emergency physician, I can recognize my own shortcomings in much of what she describes. Particularly useful is her guidance on how to recognize and reframe our problematic cognitive shortcuts. This can assist us to avoid our natural reflexive but unhelpful tendency to see our patients as “the problem,” rather than their problems as the problem. As I address in my own recent book, we are all also currently laboring under externally imposed time limitations by a healthcare system motivated by a misplaced dollar-driven focus on “productivity.” This makes Dr. Naidorf’s message even more critically important and relevant in its timeliness; as she envisions it, refocusing medical decision-making to always be based on what is best for the patient. Reading her book will ideally motivate medical and non-medical people alike to recognize and forestall the tendency to categorize each other as not being either “good patients” or “good doctors,” and instead focus our joint attention on “good communication” as the most reliable way to reach excellent results. Drew Remignanti, MD, MPH Joan Naidorf DO

It's Patient Flow Friday ya'll! Yesterday I posted about the unwelcoming lobby window at my new PCP's office. In that same lobby was this sign. My appointment time was 9:00, and I arrived at 8:40. Anybody wanna guess at what time I was roomed? Put your best guess in the comments before proceeding... --------- So, it was 9:30 when I was roomed (30 minutes late). Was your guess close? So clearly this medical practice meant to say that they honor appointment times...when a patient is late, but not when the office is late. Despite having great interpersonal experiences with the MA, PCP, and phlebotomist during my visit, I will not be returning to this PCP for a follow-up visit. Why? Well, because I'm a bit of a stickler when it comes to wait times. I've spent the past year improving patient flow in primary care practices. With a bit of the "Heart, Head, Hands" model, it's reasonable to see a 25% or more reduction in patient wait times, and to see patient satisfaction scores related to wait times go from, say, 55% to 75% in a three-month period. However, if a doctor's office doesn't take patient flow seriously, the wait times can get out of hand even on a typical day. Here is the summary data for my visit yesterday: -Total door-to-door time = 2 hrs 40 minutes -Total caregiver time = 50 minutes -Total delays = 90 minutes -# times I was kept informed of delays = 0 For my fellow flow nerds out there, here are the time-stamps for my visit, which, by the way, I had to schedule two months in advance: -8:40 arrived/paperwork -9:00 appt time -9:30 to 10:00 roomed/vitals/EKG/X-ray -10:00 to 10:20 waiting for doc -10:20 to 10:35 consult w/ doc -10:35 to 11:15 waiting for blood draw, wandering the halls cluelessly -11:15 blood drawn -11:20 visit concluded I report all this not to complain, nor to point out how chronically problematic wait times are in primary care. I'm talking about this because I truly believe MEDICAL PRACTICES SHOULD MAKE IMPROVING PATIENT FLOW A CENTERPIECE OF THEIR IMPROVEMENT EFFORTS. This is not JUST because of the following dynamic: improved patient flow --> reduced wait times --> better patient experience --> more trust-building --> stronger patient/PCP partnerships. This would be reason enough! But also because working on patient flow is perfect for small, daily, incremental, continuous improvement! Because "time is the shadow of waste" and it's hard to ever get to a no delays/zero waste system, working on a time-centric goal such as perfect patient flow gives us an endless runway to practice our continuous improvement skills. Also, improving patient flow is a comprehensive endeavor involving: 1) Making the supply of care more reliable, 2) Smoothing out the demand for care where possible, and 3) Discovering mechanisms by which to dynamically balance supply & demand. Striving for perfect flow is a holistic strategy to build a culture of human-centered continuous improvement. #humancentereddesign #patientflow