The Atlantic publishes a model of minimally disruptive medicine that works efficiently!
Posted: October 28, 2011 Filed under: Uncategorized Leave a comment »The Atlantic magazine published an article entitled The Quite Health-care Revolution that essentially reports on a successful implementation of minimally disruptive medicine, with a twist: it lowered costs! Read and comment.
Farmacia minimamente impertinente
Posted: October 28, 2011 Filed under: Uncategorized Leave a comment »Desde La Sala de Lectura, el muy recomendable blog del Rincón de Sísifo, viene un primer eco a la presentación sobre Medicina Minimamente Impertinente que dimos en el congreso nacional de farmacéuticos de atención primaria en Bilbao. Fue un gran placer presentar en esta ocasión y disfrutar luego de los comentarios en twitter y en este blog sobre lo que podría ser. Gracias por soñar con nosotros.
Medicina minimamente impertinente
Posted: October 28, 2011 Filed under: Uncategorized Leave a comment »Here is the video of my presentation in Spanish about MDM at the National Meeting of Primary Care Pharmacists in Bilbao, Spain in October 2011.
Aqui esta el video de mi presentación en español sobre Medicina Minimamente Impertinente en el Congreso Nacional de Farmacéuticos de Atención Primaria en Bilbao, España en octubre 2011.
http://www.irekia.euskadi.net/video/flowplayer-3.2.4.swf
Fuente: Irekia – Gobierno Vasco
Minimally disruptive medicine at Evidence2010
Posted: October 5, 2011 Filed under: Papers and presentations, Reflections on MDM 1 Comment »Now the whole talk has been posted at the Evidence-live website.
Here it is for those who have not yet seen it.
The role of guidelines in Goldilocks medicine
Posted: August 15, 2011 Filed under: Reflections on MDM, Views from the frontline of care 2 Comments »We have been concerned about the role that guidelines could play in overwhelming patients. This leads to practitioners considering guidelines as mandates for quality, often overriding patient context and patient values and preferences. In the case of diabetes, there is a big concern that many guidelines reflect the interests of for profit interests on professional organizations that formulate these guidelines.
Last year, the VA, led by Pogach, Aron, McConnell and others, produced guidelines that take a different approach – a patient-centered one! To learn more about these guidelines, there is a very interesting discussion in this podcast.
In this podcast, Mark McConnell from the VA in LaCrosse, WI discusses with the Therapeutics Education Collaboration hosts about the evidence in support of diabetes control and how this should be translated in care that fits the life of patients with diabetes. A valiant effort indeed to reduce the way this care can disrupt people’s lives!
Transferring complexity – how healthcare interrupts life
Posted: July 26, 2011 Filed under: Reflections on MDM 1 Comment »In working through minimally disruptive medicine, we are uncovering how the healthcare system has been developing habits — I think this is the right term — that essentially transfer complex work from the healthcare system to the patient.
Take appointment scheduling – some back offices have different schedulers for different types of appointments resulting in uncoordinated visits. A patient with whom we are currently working made more than 30 trips to the clinic, often times for one or two visits each time. This was particularly problematic because she could not drive. A family member ended up moving to town to help with this task…her life being disrupted by this “need”.
Take prescription refilling – some insurers do not enable pharmacies to refill prescriptions before a particular date even if this was the day that worked for this patient to ask for the refill. Some specialists will write their own prescriptions and these will get renewed at different times than those of others. Thus, the patient is left with multiple prescriptions refilled and renewed by different providers. One of our patients went to the pharmacy 43 times in a year to refill prescriptions!
Take e-health interventions. Many of the new technologies require patients to interact with machines and devices, often times in quite extensive ways. The designers of these technologies have not clearly acknowledged that the purpose of healthcare is to enable patients to pursue their life’s goals and dreams unhindered by health concerns (or by healthcare itself). Healthcare should get out of the way, not be “the way”.
More to come as we get deeper into ‘Goldilocks’ care.
Tailoring treatments to patient capacity
Posted: July 21, 2011 Filed under: Uncategorized Leave a comment »In a provocative piece, Slate magazine’s Darshak Sanghavi writes about “tiered medicine” and proposes that clinical protocols be titrated to patient capacity. This again approaches the notion of “Goldilocks” medicine we spouse in Minimally Disruptive Medicine. We have also discussed the need to have guidelines that appreciate this issue and that perhaps efficacy may need to have a secondary priority, particularly among patients who are overwhelmed with multiple chronic conditions.
Administrative disruption as a component of treatment burden and as opportunity for minimally disruptive medicine
Posted: July 15, 2011 Filed under: MDM in practice, Reflections on MDM Leave a comment »I had a patient who told me that she was not experiencing any significant burden of treatment from caring for her type 1 diabetes. A minutes later she went on to tell of a tragicomic experience trying to get an Omnipod insulin pump: calls to diabetes clinician, educator, insurance company, Omnipod rep, plus their administrative assistants, voicemails, faxed forms requests, etc. This story made me think of this brilliant video by The Altons:
This video of Air Healthcare is based on an article by Jonathan Rauch in The National Journal Magazine here.
Clinicians need to be aware of what happens in their own front offices, back offices, and the administrative challenges patients face with access to them, their medicines, devices, and other components of their care. These disruptions may lead to poor treatment fidelity and outcomes. A minimally disruptive medicine approach would apply lean methods from a patient centered perspective to correct this situation. Thoughts?
Who benefits the most from minimally disruptive medicine?
Posted: July 15, 2011 Filed under: MDM in practice, Reference material, Research on MDM Leave a comment »We are actively working to make MDM a reality in our primary care practice. A key step involves identifying patients who may benefit the most from MDM, or the most intensive form of MDM at least.
After some discussion we came out with this list (order does not necessarily implies importance)
- Patient has a complicated treatment regimen and is overwhelmed by it (as judged by self report, nonadherence or other strong clue)
- The current form of care does not meet the patient’s needs
- The patient’s health is at risk of a health catastrophe if we do not take action
- The patient is willing to invest in MDM work with the goal of achieving the patient’s goals for life and healthcare while reducing the burden of treatment (the imbalance in patient workload to patient capacity)
The patient voice – the need for a minimally disruptive medicine service
Posted: July 12, 2011 Filed under: MDM in practice, Reflections on MDM, Views from the frontline of care Leave a comment »We are working as a multidisciplinary team to develop a service offering for patients with multiple chronic conditions that will reduce the burden of treatment while pursuing patient goals in primary care. We are trying to learn as much as we can from other models such as PACE and Graded care. We are also learning as much as we can from our colleagues in multiple disciplines and in public health. And, of course, from our patients.
During an in-depth interview, one of our patients commented to the notion of a MDM service the following
I wouldn’t mind having like the whole team of doctors that I work with being able to sit down with them and look at the whole picture and decide a plan that would work out for all of my illnesses and how maybe I could avoid certain things or certain costs or just help me live better, period.
…I just think the biggest, most important thing in illness is having all the doctors be on the same page and know what is going on with you individually so that they can help you meet your best expectations and your best health.
Hi expectations we will have to satisfy if we are to make a difference to the workload/capacity balance of these patients. Onwards!!
