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Morning rituals
“How we spend our days is, of course, how we spend our lives.” – Annie Dillard
It’s 4:40 a.m. and I’ve got two items checked off my list. As I stir my coffee, made the same way each day, I’m engaged in my morning ritual. It begins at 4:30 a.m. and ends with me ready for whatever comes that day.
In our life-hacking world, morning rituals are hotter than my mug of Italian roast. Blog posts, magazine articles, podcasts, and books, such as the New York Times best-selling “Make Your Bed,” (New York: Hachette Book Group, 2017) written by a former Navy SEAL, all argue that the secret to a successful day, and life, lies in the start. But do morning rituals apply to us doctors?
Dr. William Osler, the father of modern medicine, had the answer a century ago: “The day [can] be predicted from the first waking hour. The start is everything,” he advised Yale medical students in his “Way of Life” address. “Live with day-tight compartments,” and focus on “what lies clearly at hand.” He encouraged them to develop focus so they might avoid “indecision and worry,” and fluster and flurry. Today, we call it “mindfulness,” so we might avoid “burnout.”
Dr. Osler, who read Ben Franklin, no doubt would have been familiar with Franklin’s recommendations: 5 a.m.: “Rise, wash, and address Powerful Goodness [prayer]! Contrive day’s business and take the resolution of the day; prosecute the present study, and breakfast.” Tested by over 200 years of self-help seekers, this is a good start. Through years of research and experimentation, I’ve refined this to the five morning activities that matter most:
2. Reflect on yesterday. Your brain is coming online in the few minutes after waking; while booting, review what happened yesterday. According to an article on-line in the Harvard Business Review (hbr.org), top CEOs make a habit of reviewing their actions and decisions to deconstruct both successes and failures. Replaying your day, like reviewing game film, is key to getting better.
3. Exercise. Physical activity improves memory, and cognition and aerobics are particularly effective. I vary both my activities and length of time in the gym. Ten minutes, if done all-out, might be all you need.
4. Preview and plan. In the excellent “How to Have a Good Day,” (New York: Penguin Random House, 2016) author Caroline Webb recommends an approach from three angles: “Aim, Attitude, and Attention.” Aim: What are the most important activities today? Who will you meet? What might you say to be successful? Attitude is key and often overlooked. Perhaps you have a patient you’d prefer not to see or a colleague with whom you need to have a difficult conversation. Reflect on how your attitude will impact the outcome. Lastly, attention must be paid. It’s as relevant today as when Dr. Osler recommended it. What must you focus on today to be successful?
5. Breathe deeply. Developing the habit of mindful breathing can help you become more resilient and focused. Spend 10-30 minutes breathing deeply and mindfully. You can take this time to pray as Franklin did or for priming as self-help guru Tony Robbins recommends today. Whichever you choose, be deliberate and consistent.
I’m invariably energized when I finish my morning routine. Even on my worst procrastination days, I have the satisfaction of getting at least five things done. Much of today will be out of my control: Patients will arrive late and surgeries might run over. But this morning was all mine. By faithfully carrying out this ritual I’m not only ready each day, I’m better each day.
What’s your morning ritual?
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
“How we spend our days is, of course, how we spend our lives.” – Annie Dillard
It’s 4:40 a.m. and I’ve got two items checked off my list. As I stir my coffee, made the same way each day, I’m engaged in my morning ritual. It begins at 4:30 a.m. and ends with me ready for whatever comes that day.
In our life-hacking world, morning rituals are hotter than my mug of Italian roast. Blog posts, magazine articles, podcasts, and books, such as the New York Times best-selling “Make Your Bed,” (New York: Hachette Book Group, 2017) written by a former Navy SEAL, all argue that the secret to a successful day, and life, lies in the start. But do morning rituals apply to us doctors?
Dr. William Osler, the father of modern medicine, had the answer a century ago: “The day [can] be predicted from the first waking hour. The start is everything,” he advised Yale medical students in his “Way of Life” address. “Live with day-tight compartments,” and focus on “what lies clearly at hand.” He encouraged them to develop focus so they might avoid “indecision and worry,” and fluster and flurry. Today, we call it “mindfulness,” so we might avoid “burnout.”
Dr. Osler, who read Ben Franklin, no doubt would have been familiar with Franklin’s recommendations: 5 a.m.: “Rise, wash, and address Powerful Goodness [prayer]! Contrive day’s business and take the resolution of the day; prosecute the present study, and breakfast.” Tested by over 200 years of self-help seekers, this is a good start. Through years of research and experimentation, I’ve refined this to the five morning activities that matter most:
2. Reflect on yesterday. Your brain is coming online in the few minutes after waking; while booting, review what happened yesterday. According to an article on-line in the Harvard Business Review (hbr.org), top CEOs make a habit of reviewing their actions and decisions to deconstruct both successes and failures. Replaying your day, like reviewing game film, is key to getting better.
3. Exercise. Physical activity improves memory, and cognition and aerobics are particularly effective. I vary both my activities and length of time in the gym. Ten minutes, if done all-out, might be all you need.
4. Preview and plan. In the excellent “How to Have a Good Day,” (New York: Penguin Random House, 2016) author Caroline Webb recommends an approach from three angles: “Aim, Attitude, and Attention.” Aim: What are the most important activities today? Who will you meet? What might you say to be successful? Attitude is key and often overlooked. Perhaps you have a patient you’d prefer not to see or a colleague with whom you need to have a difficult conversation. Reflect on how your attitude will impact the outcome. Lastly, attention must be paid. It’s as relevant today as when Dr. Osler recommended it. What must you focus on today to be successful?
5. Breathe deeply. Developing the habit of mindful breathing can help you become more resilient and focused. Spend 10-30 minutes breathing deeply and mindfully. You can take this time to pray as Franklin did or for priming as self-help guru Tony Robbins recommends today. Whichever you choose, be deliberate and consistent.
I’m invariably energized when I finish my morning routine. Even on my worst procrastination days, I have the satisfaction of getting at least five things done. Much of today will be out of my control: Patients will arrive late and surgeries might run over. But this morning was all mine. By faithfully carrying out this ritual I’m not only ready each day, I’m better each day.
What’s your morning ritual?
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
“How we spend our days is, of course, how we spend our lives.” – Annie Dillard
It’s 4:40 a.m. and I’ve got two items checked off my list. As I stir my coffee, made the same way each day, I’m engaged in my morning ritual. It begins at 4:30 a.m. and ends with me ready for whatever comes that day.
In our life-hacking world, morning rituals are hotter than my mug of Italian roast. Blog posts, magazine articles, podcasts, and books, such as the New York Times best-selling “Make Your Bed,” (New York: Hachette Book Group, 2017) written by a former Navy SEAL, all argue that the secret to a successful day, and life, lies in the start. But do morning rituals apply to us doctors?
Dr. William Osler, the father of modern medicine, had the answer a century ago: “The day [can] be predicted from the first waking hour. The start is everything,” he advised Yale medical students in his “Way of Life” address. “Live with day-tight compartments,” and focus on “what lies clearly at hand.” He encouraged them to develop focus so they might avoid “indecision and worry,” and fluster and flurry. Today, we call it “mindfulness,” so we might avoid “burnout.”
Dr. Osler, who read Ben Franklin, no doubt would have been familiar with Franklin’s recommendations: 5 a.m.: “Rise, wash, and address Powerful Goodness [prayer]! Contrive day’s business and take the resolution of the day; prosecute the present study, and breakfast.” Tested by over 200 years of self-help seekers, this is a good start. Through years of research and experimentation, I’ve refined this to the five morning activities that matter most:
2. Reflect on yesterday. Your brain is coming online in the few minutes after waking; while booting, review what happened yesterday. According to an article on-line in the Harvard Business Review (hbr.org), top CEOs make a habit of reviewing their actions and decisions to deconstruct both successes and failures. Replaying your day, like reviewing game film, is key to getting better.
3. Exercise. Physical activity improves memory, and cognition and aerobics are particularly effective. I vary both my activities and length of time in the gym. Ten minutes, if done all-out, might be all you need.
4. Preview and plan. In the excellent “How to Have a Good Day,” (New York: Penguin Random House, 2016) author Caroline Webb recommends an approach from three angles: “Aim, Attitude, and Attention.” Aim: What are the most important activities today? Who will you meet? What might you say to be successful? Attitude is key and often overlooked. Perhaps you have a patient you’d prefer not to see or a colleague with whom you need to have a difficult conversation. Reflect on how your attitude will impact the outcome. Lastly, attention must be paid. It’s as relevant today as when Dr. Osler recommended it. What must you focus on today to be successful?
5. Breathe deeply. Developing the habit of mindful breathing can help you become more resilient and focused. Spend 10-30 minutes breathing deeply and mindfully. You can take this time to pray as Franklin did or for priming as self-help guru Tony Robbins recommends today. Whichever you choose, be deliberate and consistent.
I’m invariably energized when I finish my morning routine. Even on my worst procrastination days, I have the satisfaction of getting at least five things done. Much of today will be out of my control: Patients will arrive late and surgeries might run over. But this morning was all mine. By faithfully carrying out this ritual I’m not only ready each day, I’m better each day.
What’s your morning ritual?
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
Reflecting on my first 10 years
Ten years ago, I was flying back from my last job interview – I did nearly 20 – and my wife and I were stuck: Should I take a lucrative private practice gig, an academic position, or join a group? We listed the pros and cons on several condensation-soaked Southwest Air napkins and agreed to make a decision before landing. (Fortunately, it was a cross country, BWI to SAN, flight).
I don’t know if I made the right decision. I’m sure I’d have enjoyed either a cosmetic practice or walking the halls with medical students in tow. I chose to join a medical group at Kaiser Permanente, and I’ve loved it. Working here has helped me become a better dermatologist, teammate, friend, and husband. It has also allowed me to embrace digital medicine a bit earlier and with less difficulty than most. You wouldn’t be reading my “Digital Doctor” column if I hadn’t.
Digital made medicine more accessible than ever. It also made medicine more of a commodity than ever. It turned us into the highest paid data entry clerks in the world. It changed the sacrosanct doctor-patient relationship. It has also presented us with the greatest opportunity in a thousand years. An opportunity to create a new medicine, one that is patient-centric, smart, affordable, efficient, and human. I started this column to explore the digital devices we doctors have and to find ways they might improve the care we give.
I’ve been in practice for 10 years, and I’m now the chief of service for a large dermatology group, as well as physician director for Healthcare Transformation for Kaiser Permanente, San Diego. My job is to help our physicians perform at their best both at work and in life. Through research, interviews, and my own practice, I’ve learned a lot and would like to share it with you.
Starting in September, I’ll broaden the scope of this column. No longer will it be just digital. Rather, it will be about you and how you can be the best you can be. We’ll explore tools, techniques, diet, exercise, and Jedi mind tricks to make you the fastest, smartest, happiest, healthiest, funniest (results may vary) doctor you can be. It’s time to take this column, and you, to the next level – the Optimized Doctor. I can hardly wait.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente, San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
Ten years ago, I was flying back from my last job interview – I did nearly 20 – and my wife and I were stuck: Should I take a lucrative private practice gig, an academic position, or join a group? We listed the pros and cons on several condensation-soaked Southwest Air napkins and agreed to make a decision before landing. (Fortunately, it was a cross country, BWI to SAN, flight).
I don’t know if I made the right decision. I’m sure I’d have enjoyed either a cosmetic practice or walking the halls with medical students in tow. I chose to join a medical group at Kaiser Permanente, and I’ve loved it. Working here has helped me become a better dermatologist, teammate, friend, and husband. It has also allowed me to embrace digital medicine a bit earlier and with less difficulty than most. You wouldn’t be reading my “Digital Doctor” column if I hadn’t.
Digital made medicine more accessible than ever. It also made medicine more of a commodity than ever. It turned us into the highest paid data entry clerks in the world. It changed the sacrosanct doctor-patient relationship. It has also presented us with the greatest opportunity in a thousand years. An opportunity to create a new medicine, one that is patient-centric, smart, affordable, efficient, and human. I started this column to explore the digital devices we doctors have and to find ways they might improve the care we give.
I’ve been in practice for 10 years, and I’m now the chief of service for a large dermatology group, as well as physician director for Healthcare Transformation for Kaiser Permanente, San Diego. My job is to help our physicians perform at their best both at work and in life. Through research, interviews, and my own practice, I’ve learned a lot and would like to share it with you.
Starting in September, I’ll broaden the scope of this column. No longer will it be just digital. Rather, it will be about you and how you can be the best you can be. We’ll explore tools, techniques, diet, exercise, and Jedi mind tricks to make you the fastest, smartest, happiest, healthiest, funniest (results may vary) doctor you can be. It’s time to take this column, and you, to the next level – the Optimized Doctor. I can hardly wait.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente, San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
Ten years ago, I was flying back from my last job interview – I did nearly 20 – and my wife and I were stuck: Should I take a lucrative private practice gig, an academic position, or join a group? We listed the pros and cons on several condensation-soaked Southwest Air napkins and agreed to make a decision before landing. (Fortunately, it was a cross country, BWI to SAN, flight).
I don’t know if I made the right decision. I’m sure I’d have enjoyed either a cosmetic practice or walking the halls with medical students in tow. I chose to join a medical group at Kaiser Permanente, and I’ve loved it. Working here has helped me become a better dermatologist, teammate, friend, and husband. It has also allowed me to embrace digital medicine a bit earlier and with less difficulty than most. You wouldn’t be reading my “Digital Doctor” column if I hadn’t.
Digital made medicine more accessible than ever. It also made medicine more of a commodity than ever. It turned us into the highest paid data entry clerks in the world. It changed the sacrosanct doctor-patient relationship. It has also presented us with the greatest opportunity in a thousand years. An opportunity to create a new medicine, one that is patient-centric, smart, affordable, efficient, and human. I started this column to explore the digital devices we doctors have and to find ways they might improve the care we give.
I’ve been in practice for 10 years, and I’m now the chief of service for a large dermatology group, as well as physician director for Healthcare Transformation for Kaiser Permanente, San Diego. My job is to help our physicians perform at their best both at work and in life. Through research, interviews, and my own practice, I’ve learned a lot and would like to share it with you.
Starting in September, I’ll broaden the scope of this column. No longer will it be just digital. Rather, it will be about you and how you can be the best you can be. We’ll explore tools, techniques, diet, exercise, and Jedi mind tricks to make you the fastest, smartest, happiest, healthiest, funniest (results may vary) doctor you can be. It’s time to take this column, and you, to the next level – the Optimized Doctor. I can hardly wait.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente, San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
How patients want their biopsy results
I had just done an ED&C, scraping the friable tumor gently from her tissue paper–thin skin. “Yes,” I replied more loudly than our close proximity would warrant. “This is probably another basal cell carcinoma. When I get the pathology back, I’ll call you.” As my medical assistant was putting on the Band-Aid, my patient exclaimed, “Oh, no! “Don’t call me! Just send me an email, honey.”
At the time of the biopsy, she was 84 years old. My 84-year-old patient just chastised me for not using her preferred method of communication. She didn’t want a follow-up visit or a phone call. She wanted an email.
A certain trend is that patients want speed and convenience. Patients, like all humans, hate to wait. They hate to wait for an appointment. They hate to wait in waiting rooms. They hate to wait for answers. They also hate phone tag and long lines at the TSA (the latter will not be covered in this column).
For most of my biopsy results, I send a secure message – essentially an email – to my patients. I do this for benign results, as well as for treated cancerous growths. For serious diagnoses such as melanoma, I call them and sometimes arrange for a follow-up appointment.
Securely emailing results saves my patients, and me, bags of time. In fact, I not only send them the diagnosis, I include the pathology report. This might seem risky: What will patients make of “atypical melanocytic hyperplasia” or “cannot rule out invasive carcinoma” in their result? I can tell you, not much. After thousands of such emails, I’ve learned that follow-up replies are rare. And I cannot recall any follow-up question that was unhelpful. I’ve even had one correct our report (“Doc, it was on the left arm, not the right”) and at least one that led to a great discussion of different treatments based on my patient’s research.
If nothing else, I hope sending path reports directly to patients will eradicate the unhelpful past medical history of “skin cancer of unknown type or stage.” One biopsy result at a time, thousands of results later, each of my patients has his or her own copy to print and share with their next dermatologist, who might just be you.
“Yes, ma’am, I’ll email the result as soon as it’s back,” I replied, trying to save face. “Great!” she said, showing me her new iPhone, which was one generation advanced from my own. “I’ll get it right here!”
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
I had just done an ED&C, scraping the friable tumor gently from her tissue paper–thin skin. “Yes,” I replied more loudly than our close proximity would warrant. “This is probably another basal cell carcinoma. When I get the pathology back, I’ll call you.” As my medical assistant was putting on the Band-Aid, my patient exclaimed, “Oh, no! “Don’t call me! Just send me an email, honey.”
At the time of the biopsy, she was 84 years old. My 84-year-old patient just chastised me for not using her preferred method of communication. She didn’t want a follow-up visit or a phone call. She wanted an email.
A certain trend is that patients want speed and convenience. Patients, like all humans, hate to wait. They hate to wait for an appointment. They hate to wait in waiting rooms. They hate to wait for answers. They also hate phone tag and long lines at the TSA (the latter will not be covered in this column).
For most of my biopsy results, I send a secure message – essentially an email – to my patients. I do this for benign results, as well as for treated cancerous growths. For serious diagnoses such as melanoma, I call them and sometimes arrange for a follow-up appointment.
Securely emailing results saves my patients, and me, bags of time. In fact, I not only send them the diagnosis, I include the pathology report. This might seem risky: What will patients make of “atypical melanocytic hyperplasia” or “cannot rule out invasive carcinoma” in their result? I can tell you, not much. After thousands of such emails, I’ve learned that follow-up replies are rare. And I cannot recall any follow-up question that was unhelpful. I’ve even had one correct our report (“Doc, it was on the left arm, not the right”) and at least one that led to a great discussion of different treatments based on my patient’s research.
If nothing else, I hope sending path reports directly to patients will eradicate the unhelpful past medical history of “skin cancer of unknown type or stage.” One biopsy result at a time, thousands of results later, each of my patients has his or her own copy to print and share with their next dermatologist, who might just be you.
“Yes, ma’am, I’ll email the result as soon as it’s back,” I replied, trying to save face. “Great!” she said, showing me her new iPhone, which was one generation advanced from my own. “I’ll get it right here!”
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
I had just done an ED&C, scraping the friable tumor gently from her tissue paper–thin skin. “Yes,” I replied more loudly than our close proximity would warrant. “This is probably another basal cell carcinoma. When I get the pathology back, I’ll call you.” As my medical assistant was putting on the Band-Aid, my patient exclaimed, “Oh, no! “Don’t call me! Just send me an email, honey.”
At the time of the biopsy, she was 84 years old. My 84-year-old patient just chastised me for not using her preferred method of communication. She didn’t want a follow-up visit or a phone call. She wanted an email.
A certain trend is that patients want speed and convenience. Patients, like all humans, hate to wait. They hate to wait for an appointment. They hate to wait in waiting rooms. They hate to wait for answers. They also hate phone tag and long lines at the TSA (the latter will not be covered in this column).
For most of my biopsy results, I send a secure message – essentially an email – to my patients. I do this for benign results, as well as for treated cancerous growths. For serious diagnoses such as melanoma, I call them and sometimes arrange for a follow-up appointment.
Securely emailing results saves my patients, and me, bags of time. In fact, I not only send them the diagnosis, I include the pathology report. This might seem risky: What will patients make of “atypical melanocytic hyperplasia” or “cannot rule out invasive carcinoma” in their result? I can tell you, not much. After thousands of such emails, I’ve learned that follow-up replies are rare. And I cannot recall any follow-up question that was unhelpful. I’ve even had one correct our report (“Doc, it was on the left arm, not the right”) and at least one that led to a great discussion of different treatments based on my patient’s research.
If nothing else, I hope sending path reports directly to patients will eradicate the unhelpful past medical history of “skin cancer of unknown type or stage.” One biopsy result at a time, thousands of results later, each of my patients has his or her own copy to print and share with their next dermatologist, who might just be you.
“Yes, ma’am, I’ll email the result as soon as it’s back,” I replied, trying to save face. “Great!” she said, showing me her new iPhone, which was one generation advanced from my own. “I’ll get it right here!”
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
A note about OpenNotes
“He is a frequent flyer.” This is a term we reserve for patients who consume a lot of services. In the outpatient clinic, it’s the type of patient who comes for frequent visits, perhaps more often than medically necessary. Oftentimes, more than we’d like. They can be demanding. They can also be an invaluable resource: None of your patients will likely be more forthright with you than those who are so motivated.
I saw one of my frequent flyer patients recently. He, like all patients, has medical problems, but, unlike most, he never misses an opportunity to schedule an appointment to solve them. A once red-, now gray-haired engineer, he has quite a record of skin issues and has meticulously documented all of them himself.
I felt myself stiffening. I added him on to my schedule today because I’m a good guy, yet he wants a piece of me? Bring it.
“So, you can read my notes online?” I asked. “Yes,” he replied, “for some reason I can read all of my charts for dermatology visits.”
“Well, that’s because I volunteered for our OpenNotes program,” I said. As a participant, all of my patients are able to read all of my notes, if they choose to do so. They can access them but cannot make any changes.
Yeah, great idea, Jeff.
“I just want to know, why would you put that if you didn’t do it?” he asked.
“Well, it’s not a lie. We did discuss the risks and benefits of my freezing your AKs previously, right?” “Yes, we did,” he replied. “Did you not want me to freeze them?” I asked. “No, I did,” he answered. “I just wanted you to know that I can see what you write about me, and I don’t want you to say anything you don’t want me to read because I really trust you.”
“I won’t,” I said.
That’s because I understand that you are my patient, and all patients deserve my unmitigated care. It’s what makes me a doctor.
I’ve since added to my EMR template: “Previously discussed risks and benefits.” Not because it really matters. But because it matters to him. And that matters to me.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
“He is a frequent flyer.” This is a term we reserve for patients who consume a lot of services. In the outpatient clinic, it’s the type of patient who comes for frequent visits, perhaps more often than medically necessary. Oftentimes, more than we’d like. They can be demanding. They can also be an invaluable resource: None of your patients will likely be more forthright with you than those who are so motivated.
I saw one of my frequent flyer patients recently. He, like all patients, has medical problems, but, unlike most, he never misses an opportunity to schedule an appointment to solve them. A once red-, now gray-haired engineer, he has quite a record of skin issues and has meticulously documented all of them himself.
I felt myself stiffening. I added him on to my schedule today because I’m a good guy, yet he wants a piece of me? Bring it.
“So, you can read my notes online?” I asked. “Yes,” he replied, “for some reason I can read all of my charts for dermatology visits.”
“Well, that’s because I volunteered for our OpenNotes program,” I said. As a participant, all of my patients are able to read all of my notes, if they choose to do so. They can access them but cannot make any changes.
Yeah, great idea, Jeff.
“I just want to know, why would you put that if you didn’t do it?” he asked.
“Well, it’s not a lie. We did discuss the risks and benefits of my freezing your AKs previously, right?” “Yes, we did,” he replied. “Did you not want me to freeze them?” I asked. “No, I did,” he answered. “I just wanted you to know that I can see what you write about me, and I don’t want you to say anything you don’t want me to read because I really trust you.”
“I won’t,” I said.
That’s because I understand that you are my patient, and all patients deserve my unmitigated care. It’s what makes me a doctor.
I’ve since added to my EMR template: “Previously discussed risks and benefits.” Not because it really matters. But because it matters to him. And that matters to me.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
“He is a frequent flyer.” This is a term we reserve for patients who consume a lot of services. In the outpatient clinic, it’s the type of patient who comes for frequent visits, perhaps more often than medically necessary. Oftentimes, more than we’d like. They can be demanding. They can also be an invaluable resource: None of your patients will likely be more forthright with you than those who are so motivated.
I saw one of my frequent flyer patients recently. He, like all patients, has medical problems, but, unlike most, he never misses an opportunity to schedule an appointment to solve them. A once red-, now gray-haired engineer, he has quite a record of skin issues and has meticulously documented all of them himself.
I felt myself stiffening. I added him on to my schedule today because I’m a good guy, yet he wants a piece of me? Bring it.
“So, you can read my notes online?” I asked. “Yes,” he replied, “for some reason I can read all of my charts for dermatology visits.”
“Well, that’s because I volunteered for our OpenNotes program,” I said. As a participant, all of my patients are able to read all of my notes, if they choose to do so. They can access them but cannot make any changes.
Yeah, great idea, Jeff.
“I just want to know, why would you put that if you didn’t do it?” he asked.
“Well, it’s not a lie. We did discuss the risks and benefits of my freezing your AKs previously, right?” “Yes, we did,” he replied. “Did you not want me to freeze them?” I asked. “No, I did,” he answered. “I just wanted you to know that I can see what you write about me, and I don’t want you to say anything you don’t want me to read because I really trust you.”
“I won’t,” I said.
That’s because I understand that you are my patient, and all patients deserve my unmitigated care. It’s what makes me a doctor.
I’ve since added to my EMR template: “Previously discussed risks and benefits.” Not because it really matters. But because it matters to him. And that matters to me.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
Combining teamwork and technology when tragedy strikes
I’m the new chief of service for the department of dermatology at Kaiser Permanente San Diego. We are hiring, so I’ve been working on my answers to astute questions about how we at Kaiser Permanente differ from other health systems and why I love our medical group. Many points of differentiation involve how we work as an integrated system and how we are compensated for effective care instead of simply volume of care.
There are more than 70 dermatologists and staff in our department, and we all play a role in meeting the access needs of our patients. When one of our docs emailed me at 4 a.m. to tell me of a terrible catastrophe that struck her family, it set off a somber day for our team. In addition to offering our sympathy to her, we got right to work to help her. She needed time off to be with her family, and like all of us, she had full schedules booked for weeks ahead.
By 6 a.m., our administrative team was aware and working to recover. We canceled her clinic, and, using scheduling software, identified dermatologists in our department who might be able to help. With a few clicks, we reassigned patients from her to me and others who immediately volunteered. This was seamless as far as the patients would be concerned. Patients coming in within hours that morning were picked up by other doctors; one by one, they added them to their schedules.
Every doctor in San Diego has a Kaiser Permanente–issued smartphone. These allowed us to quickly email, text, and message to coordinate our efforts. Each of us dermatologists connected to her in-basket in our electronic medical record and set to work sending out her biopsy results, answering her secure email messages, and calling her patients. Others volunteered to cover her call, and we reassigned her teledermatology shifts with just a click. By noon, all her responsibilities as a dermatologist had been accounted for, allowing her to focus on her family. Teamwork was enabled by our digital system of care.
This story isn’t a sales pitch. We wish it had never happened. But it might be the best answer to the question of why we love working here. When we combine team plus technology to care for our patients and to care for each other, there’s no medical group we’d rather be.
I hope this is the last tragedy to befall us as a department. And if it is not, I hope to have just this same team around me to cope.
I’m sure others have similar stories of how technology helped them work as a team. Please send them to me at dermnews@frontlinemedcom.com; I’d like to write a follow-up piece.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
I’m the new chief of service for the department of dermatology at Kaiser Permanente San Diego. We are hiring, so I’ve been working on my answers to astute questions about how we at Kaiser Permanente differ from other health systems and why I love our medical group. Many points of differentiation involve how we work as an integrated system and how we are compensated for effective care instead of simply volume of care.
There are more than 70 dermatologists and staff in our department, and we all play a role in meeting the access needs of our patients. When one of our docs emailed me at 4 a.m. to tell me of a terrible catastrophe that struck her family, it set off a somber day for our team. In addition to offering our sympathy to her, we got right to work to help her. She needed time off to be with her family, and like all of us, she had full schedules booked for weeks ahead.
By 6 a.m., our administrative team was aware and working to recover. We canceled her clinic, and, using scheduling software, identified dermatologists in our department who might be able to help. With a few clicks, we reassigned patients from her to me and others who immediately volunteered. This was seamless as far as the patients would be concerned. Patients coming in within hours that morning were picked up by other doctors; one by one, they added them to their schedules.
Every doctor in San Diego has a Kaiser Permanente–issued smartphone. These allowed us to quickly email, text, and message to coordinate our efforts. Each of us dermatologists connected to her in-basket in our electronic medical record and set to work sending out her biopsy results, answering her secure email messages, and calling her patients. Others volunteered to cover her call, and we reassigned her teledermatology shifts with just a click. By noon, all her responsibilities as a dermatologist had been accounted for, allowing her to focus on her family. Teamwork was enabled by our digital system of care.
This story isn’t a sales pitch. We wish it had never happened. But it might be the best answer to the question of why we love working here. When we combine team plus technology to care for our patients and to care for each other, there’s no medical group we’d rather be.
I hope this is the last tragedy to befall us as a department. And if it is not, I hope to have just this same team around me to cope.
I’m sure others have similar stories of how technology helped them work as a team. Please send them to me at dermnews@frontlinemedcom.com; I’d like to write a follow-up piece.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
I’m the new chief of service for the department of dermatology at Kaiser Permanente San Diego. We are hiring, so I’ve been working on my answers to astute questions about how we at Kaiser Permanente differ from other health systems and why I love our medical group. Many points of differentiation involve how we work as an integrated system and how we are compensated for effective care instead of simply volume of care.
There are more than 70 dermatologists and staff in our department, and we all play a role in meeting the access needs of our patients. When one of our docs emailed me at 4 a.m. to tell me of a terrible catastrophe that struck her family, it set off a somber day for our team. In addition to offering our sympathy to her, we got right to work to help her. She needed time off to be with her family, and like all of us, she had full schedules booked for weeks ahead.
By 6 a.m., our administrative team was aware and working to recover. We canceled her clinic, and, using scheduling software, identified dermatologists in our department who might be able to help. With a few clicks, we reassigned patients from her to me and others who immediately volunteered. This was seamless as far as the patients would be concerned. Patients coming in within hours that morning were picked up by other doctors; one by one, they added them to their schedules.
Every doctor in San Diego has a Kaiser Permanente–issued smartphone. These allowed us to quickly email, text, and message to coordinate our efforts. Each of us dermatologists connected to her in-basket in our electronic medical record and set to work sending out her biopsy results, answering her secure email messages, and calling her patients. Others volunteered to cover her call, and we reassigned her teledermatology shifts with just a click. By noon, all her responsibilities as a dermatologist had been accounted for, allowing her to focus on her family. Teamwork was enabled by our digital system of care.
This story isn’t a sales pitch. We wish it had never happened. But it might be the best answer to the question of why we love working here. When we combine team plus technology to care for our patients and to care for each other, there’s no medical group we’d rather be.
I hope this is the last tragedy to befall us as a department. And if it is not, I hope to have just this same team around me to cope.
I’m sure others have similar stories of how technology helped them work as a team. Please send them to me at dermnews@frontlinemedcom.com; I’d like to write a follow-up piece.
Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
Artificial intelligence, CNN, and diagnosing melanomas
I have a breakthrough article to share with you. It’s about a technology that detects skin cancer. Before I tell you about that, however, I need to teach you a few things. For example, do you know what AI is? How about machine learning? What about CNN? (This column is a nonpolitical arena, so, no, not that CNN).
AI stands for artificial intelligence. We are surrounded by it everywhere – computers, cars, and cell phones all use AI. AI describes a machine with the ability to problem solve, to create, to understand, to learn. These are characteristics we call “intelligence,” hence, artificial intelligence.
You and I intuitively know that a picture of a chair is a chair. This is true of an folding chair, a Barcelona chair, or a Ghost chair. This ability – to intuit – is a hallmark of humans. Computers don’t intuit, they learn. We don’t need to study 3 million chairs to identify chairs. (Nor could we study 3 million pictures of chairs, a feat that would take years.) Computers, in contrast, can review 3 million pictures of chairs. And learn. In minutes.
Not only do computers learn from millions of examples, they also layer learning. For example, one set of programs will look only for lines that appear to be legs of chairs. This information is then passed on to another layer of programming that can look for seats, then another for backs, then another and another until a final layer puts it together. Do these layers remind you of something we all learned in medical school? It is analogous to the mammalian visual cortex! In the brain, one layer of neurons talks with another. In machines, one layer of programs pushes information to another. We call these machine layers “neural networks.” A convoluted neural network or CNN, therefore, describes a complex network that is analogous to brain cortex. The implications are astounding.
Things get interesting when a CNN is given a complex task to learn and a massive observational data set to learn on. With recent advances in chips called GPUs, deeply nested program layers can accomplish difficult tasks like recognizing faces, understanding voices, and avoiding a bicyclist on a foggy day. Self-driving cars, airport security, and voice-activated assistants all rely on this “deep learning.” And they are getting smarter everyday.
So, now when I say a team at Stanford University has used a CNN and deep learning to diagnose melanoma from pictures, you’ll understand what I mean. And you’ll realize computers can do something heretofore unthinkable – make diagnoses as accurately as a doctor. That story should make you both a little giddy and afraid. But wait, there’s more! Read all about it next time.
Dr. Benabio is a partner physician and chief of service for the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com . He has no disclosures related to this column.
I have a breakthrough article to share with you. It’s about a technology that detects skin cancer. Before I tell you about that, however, I need to teach you a few things. For example, do you know what AI is? How about machine learning? What about CNN? (This column is a nonpolitical arena, so, no, not that CNN).
AI stands for artificial intelligence. We are surrounded by it everywhere – computers, cars, and cell phones all use AI. AI describes a machine with the ability to problem solve, to create, to understand, to learn. These are characteristics we call “intelligence,” hence, artificial intelligence.
You and I intuitively know that a picture of a chair is a chair. This is true of an folding chair, a Barcelona chair, or a Ghost chair. This ability – to intuit – is a hallmark of humans. Computers don’t intuit, they learn. We don’t need to study 3 million chairs to identify chairs. (Nor could we study 3 million pictures of chairs, a feat that would take years.) Computers, in contrast, can review 3 million pictures of chairs. And learn. In minutes.
Not only do computers learn from millions of examples, they also layer learning. For example, one set of programs will look only for lines that appear to be legs of chairs. This information is then passed on to another layer of programming that can look for seats, then another for backs, then another and another until a final layer puts it together. Do these layers remind you of something we all learned in medical school? It is analogous to the mammalian visual cortex! In the brain, one layer of neurons talks with another. In machines, one layer of programs pushes information to another. We call these machine layers “neural networks.” A convoluted neural network or CNN, therefore, describes a complex network that is analogous to brain cortex. The implications are astounding.
Things get interesting when a CNN is given a complex task to learn and a massive observational data set to learn on. With recent advances in chips called GPUs, deeply nested program layers can accomplish difficult tasks like recognizing faces, understanding voices, and avoiding a bicyclist on a foggy day. Self-driving cars, airport security, and voice-activated assistants all rely on this “deep learning.” And they are getting smarter everyday.
So, now when I say a team at Stanford University has used a CNN and deep learning to diagnose melanoma from pictures, you’ll understand what I mean. And you’ll realize computers can do something heretofore unthinkable – make diagnoses as accurately as a doctor. That story should make you both a little giddy and afraid. But wait, there’s more! Read all about it next time.
Dr. Benabio is a partner physician and chief of service for the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com . He has no disclosures related to this column.
I have a breakthrough article to share with you. It’s about a technology that detects skin cancer. Before I tell you about that, however, I need to teach you a few things. For example, do you know what AI is? How about machine learning? What about CNN? (This column is a nonpolitical arena, so, no, not that CNN).
AI stands for artificial intelligence. We are surrounded by it everywhere – computers, cars, and cell phones all use AI. AI describes a machine with the ability to problem solve, to create, to understand, to learn. These are characteristics we call “intelligence,” hence, artificial intelligence.
You and I intuitively know that a picture of a chair is a chair. This is true of an folding chair, a Barcelona chair, or a Ghost chair. This ability – to intuit – is a hallmark of humans. Computers don’t intuit, they learn. We don’t need to study 3 million chairs to identify chairs. (Nor could we study 3 million pictures of chairs, a feat that would take years.) Computers, in contrast, can review 3 million pictures of chairs. And learn. In minutes.
Not only do computers learn from millions of examples, they also layer learning. For example, one set of programs will look only for lines that appear to be legs of chairs. This information is then passed on to another layer of programming that can look for seats, then another for backs, then another and another until a final layer puts it together. Do these layers remind you of something we all learned in medical school? It is analogous to the mammalian visual cortex! In the brain, one layer of neurons talks with another. In machines, one layer of programs pushes information to another. We call these machine layers “neural networks.” A convoluted neural network or CNN, therefore, describes a complex network that is analogous to brain cortex. The implications are astounding.
Things get interesting when a CNN is given a complex task to learn and a massive observational data set to learn on. With recent advances in chips called GPUs, deeply nested program layers can accomplish difficult tasks like recognizing faces, understanding voices, and avoiding a bicyclist on a foggy day. Self-driving cars, airport security, and voice-activated assistants all rely on this “deep learning.” And they are getting smarter everyday.
So, now when I say a team at Stanford University has used a CNN and deep learning to diagnose melanoma from pictures, you’ll understand what I mean. And you’ll realize computers can do something heretofore unthinkable – make diagnoses as accurately as a doctor. That story should make you both a little giddy and afraid. But wait, there’s more! Read all about it next time.
Dr. Benabio is a partner physician and chief of service for the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com . He has no disclosures related to this column.
Alexa
How many calories are there in a cheeseburger? (Yes, I too am looking forward to a svelter 2017). The answer, according to my new assistant, is 300 calories. She knows the dose of acetaminophen for a 10-year-old, 65-pound child is 325 mg every 4-6 hours. She also plays George Michael, reorders my Dentyne Ice gum, and turns off the lights. She is Alexa of Amazon’s Echo, the intelligent personal assistant.
Echo and Google Home are popular voice-assisted home appliances. Amazon has built a natural language processing system, so to use it, you simply say, “Alexa,” pause, then ask your question (What’s the weather in New York?) or deliver your command (Play Spotify). It’s hands free, so you can interface while typing, reading, or cooking dinner.
Some medical centers, such as the Boston Children’s Hospital, are leading the way to make voice-assisted technology useful in health care. Their KidsMD app, for example, gives Alexa the “skill” to offer simple health advice regarding their children’s fever and medication dosing. I found this Alexa skill interesting but rudimentary. Most of the advice was reasonable; however, the scope is small and the responses glitchy. For example, when I asked Alexa what to do for a feverish 2-month-old, it advised me to contact my doctor then immediately followed this with recommended antipyretic medication dosing. Although we physicians understand the child must see a doctor, some parents might be confused and choose only to administer the medication. As with any new digital health technology, the team at Boston Children’s are continually iterating and improving based upon feedback.
I found Alexa currently has a few other skills for health care. For example, a skill called Marvee functions as a “care companion” to help aging family members and their caregivers. Another skill, Health Care Genius, helps patients decipher healthcare terminology by asking questions such as, “What is a deductible?”
The potential of voice-assisted technology in clinical and home health care settings is limitless, and I expect this segment to grow dramatically. Here are a few examples:
1. Physicians can ask for real-time help such as: What are treatment options for juvenile dermatomyositis? Order doxycycline 100 mg by mouth, twice daily, quantity sufficient 10 days.
2. Physicians might also use it to dictate notes intelligently, and even extract patient instructions directly from the notes to be emailed to the patient.
3. Surgeons could command an MRI to be viewed without having to scrub out.
4. Bedridden or chronically ill patients could use it to refill medications, make doctor appointments, or contact a caregiver in an emergency.
5. Patients could receive customized instructions, such as the answer to “How often do I change my surgical bandage?”
For all its potential, voice-assisted personal assistants have a long way to go. It would be a mistake to think these won’t be integrated into the entire health care chain from care to wellness, but it will be awhile before we get there.
Interestingly, when I asked my Apple Siri how many calories are in a cheeseburger, she reported 500, which is much more than Alexa’s 300. Which is why, for now, devices like Alexa are ideal for ordering a pizza hands free from your recliner. Just don’t ask how many calories are in it.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.
How many calories are there in a cheeseburger? (Yes, I too am looking forward to a svelter 2017). The answer, according to my new assistant, is 300 calories. She knows the dose of acetaminophen for a 10-year-old, 65-pound child is 325 mg every 4-6 hours. She also plays George Michael, reorders my Dentyne Ice gum, and turns off the lights. She is Alexa of Amazon’s Echo, the intelligent personal assistant.
Echo and Google Home are popular voice-assisted home appliances. Amazon has built a natural language processing system, so to use it, you simply say, “Alexa,” pause, then ask your question (What’s the weather in New York?) or deliver your command (Play Spotify). It’s hands free, so you can interface while typing, reading, or cooking dinner.
Some medical centers, such as the Boston Children’s Hospital, are leading the way to make voice-assisted technology useful in health care. Their KidsMD app, for example, gives Alexa the “skill” to offer simple health advice regarding their children’s fever and medication dosing. I found this Alexa skill interesting but rudimentary. Most of the advice was reasonable; however, the scope is small and the responses glitchy. For example, when I asked Alexa what to do for a feverish 2-month-old, it advised me to contact my doctor then immediately followed this with recommended antipyretic medication dosing. Although we physicians understand the child must see a doctor, some parents might be confused and choose only to administer the medication. As with any new digital health technology, the team at Boston Children’s are continually iterating and improving based upon feedback.
I found Alexa currently has a few other skills for health care. For example, a skill called Marvee functions as a “care companion” to help aging family members and their caregivers. Another skill, Health Care Genius, helps patients decipher healthcare terminology by asking questions such as, “What is a deductible?”
The potential of voice-assisted technology in clinical and home health care settings is limitless, and I expect this segment to grow dramatically. Here are a few examples:
1. Physicians can ask for real-time help such as: What are treatment options for juvenile dermatomyositis? Order doxycycline 100 mg by mouth, twice daily, quantity sufficient 10 days.
2. Physicians might also use it to dictate notes intelligently, and even extract patient instructions directly from the notes to be emailed to the patient.
3. Surgeons could command an MRI to be viewed without having to scrub out.
4. Bedridden or chronically ill patients could use it to refill medications, make doctor appointments, or contact a caregiver in an emergency.
5. Patients could receive customized instructions, such as the answer to “How often do I change my surgical bandage?”
For all its potential, voice-assisted personal assistants have a long way to go. It would be a mistake to think these won’t be integrated into the entire health care chain from care to wellness, but it will be awhile before we get there.
Interestingly, when I asked my Apple Siri how many calories are in a cheeseburger, she reported 500, which is much more than Alexa’s 300. Which is why, for now, devices like Alexa are ideal for ordering a pizza hands free from your recliner. Just don’t ask how many calories are in it.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.
How many calories are there in a cheeseburger? (Yes, I too am looking forward to a svelter 2017). The answer, according to my new assistant, is 300 calories. She knows the dose of acetaminophen for a 10-year-old, 65-pound child is 325 mg every 4-6 hours. She also plays George Michael, reorders my Dentyne Ice gum, and turns off the lights. She is Alexa of Amazon’s Echo, the intelligent personal assistant.
Echo and Google Home are popular voice-assisted home appliances. Amazon has built a natural language processing system, so to use it, you simply say, “Alexa,” pause, then ask your question (What’s the weather in New York?) or deliver your command (Play Spotify). It’s hands free, so you can interface while typing, reading, or cooking dinner.
Some medical centers, such as the Boston Children’s Hospital, are leading the way to make voice-assisted technology useful in health care. Their KidsMD app, for example, gives Alexa the “skill” to offer simple health advice regarding their children’s fever and medication dosing. I found this Alexa skill interesting but rudimentary. Most of the advice was reasonable; however, the scope is small and the responses glitchy. For example, when I asked Alexa what to do for a feverish 2-month-old, it advised me to contact my doctor then immediately followed this with recommended antipyretic medication dosing. Although we physicians understand the child must see a doctor, some parents might be confused and choose only to administer the medication. As with any new digital health technology, the team at Boston Children’s are continually iterating and improving based upon feedback.
I found Alexa currently has a few other skills for health care. For example, a skill called Marvee functions as a “care companion” to help aging family members and their caregivers. Another skill, Health Care Genius, helps patients decipher healthcare terminology by asking questions such as, “What is a deductible?”
The potential of voice-assisted technology in clinical and home health care settings is limitless, and I expect this segment to grow dramatically. Here are a few examples:
1. Physicians can ask for real-time help such as: What are treatment options for juvenile dermatomyositis? Order doxycycline 100 mg by mouth, twice daily, quantity sufficient 10 days.
2. Physicians might also use it to dictate notes intelligently, and even extract patient instructions directly from the notes to be emailed to the patient.
3. Surgeons could command an MRI to be viewed without having to scrub out.
4. Bedridden or chronically ill patients could use it to refill medications, make doctor appointments, or contact a caregiver in an emergency.
5. Patients could receive customized instructions, such as the answer to “How often do I change my surgical bandage?”
For all its potential, voice-assisted personal assistants have a long way to go. It would be a mistake to think these won’t be integrated into the entire health care chain from care to wellness, but it will be awhile before we get there.
Interestingly, when I asked my Apple Siri how many calories are in a cheeseburger, she reported 500, which is much more than Alexa’s 300. Which is why, for now, devices like Alexa are ideal for ordering a pizza hands free from your recliner. Just don’t ask how many calories are in it.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.
Digital Doctor
There were many books I read in 2016 that I found relevant and helpful for the practice of medicine as modern physicians. Here were some of my favorites:
”How to Have a Good Day” by Caroline Webb (Crown Business, 2016).
With media headlines screaming about the surge in physician burnout, now is a good time to read “How to Have a Good Day.” The author, Caroline Webb, an Oxford- and Cambridge-trained economist, management consultant, and executive coach, shows how little tweaks in behavior can garner big results in both your workday productivity and your overall well-being. Her science-based techniques are wonderfully practical. She teaches you how to be more effective at work by establishing smart habits, setting appropriate priorities, and pumping up your workplace enthusiasm. She also shows you a path to stronger workplace relationships by learning how to better manage conflict, build rapport, and get the most out of others. My copy is dog-eared. I hope yours will be too.
In this expansively researched book, Nancy Tomes, Ph.D., professor of history at the State University of New York, Stony Brook, documents the formation and consequences of the consumer economy in American medicine. Unlike other medical historians, who claim that patient consumerism emerged in the 1970s, Dr. Tomes argues that it developed “a full century earlier.” She dismantles the American ideal of the “golden age” of Norman Rockwell doctors and “deferential patients.” In eminently readable prose, Dr. Tomes analyzes numerous developments that have disrupted the doctor-patient relationship, including the growth of drug stores, the ever-changing medical insurance industry, and direct-to-consumer advertising. A skilled historian and writer, she doesn’t provide tidy answers to messy questions. She acknowledges that, despite many technological and social advances, particularly patient empowerment, there is no “magic bullet” to cure what ails our current medical system. This is a good choice for those looking to put digital medicine into historical context.
”Visual Intelligence: Sharpen Your Perception, Change Your Life” by Amy E. Herman (Eamon Dolan/Houghton Mifflin Harcourt, 2016).
How do we see? Not terribly well, according to Amy E. Herman. A lawyer and art historian, Ms. Herman has developed a course called “The Art of Perception” that has helped professionals from physicians to police officers hone their observation and communication skills. The course happens to be based on the class for students and residents of dermatology given by the eminent dermatologist Irwin Braverman, MD. A basic tenet of the book is that even highly intelligent professionals often experience “blindness.” She writes: “For no physiological reason, sometimes we fail to see something that’s in our direct line of sight. We overlook things when they are unexpected or too familiar, when they blend in, and when they are too aberrant or abhorrent to imagine.” Fortunately, correcting such “inattentional blindness” isn’t a gift, it’s a skill that improves with practice. The key is to acknowledge the “blind spots” in our perception and to become more detail oriented. Enter the art. Through analyzing dozens of works of art, Ms. Herman shows you how to “see what matters,” encouraging you to notice every detail and, equally important, every missing detail. The result: Over time, attention to detail becomes second nature, helping you to become more observant and fully present both in clinic and at home.
”When Breath Becomes Air” by Paul Kalanithi, MD (Penguin Random House, 2016).
This posthumously published memoir by Paul Kalanithi, MD, is tormentingly beautiful. In May 2013, the 36-year-old neurosurgeon was diagnosed with stage IV lung cancer; he was a nonsmoker. In a blink, Dr. Kalanithi would don the patient’s gown and relinquish his role as healer. “Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering,” he writes. Dr. Kalanithi battles the cancer valiantly for 2 years, during which time he writes this book and has a child with his wife, Lucy, also a doctor. As someone with a BA and MA in literature from Stanford and a MPhil from Cambridge, his writing is eloquent and compelling, in the vein of Atul Gawande, MD, and Jerome Groopman, MD. He voices his readers’ thoughts perfectly when he writes, “My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close.” We ache for him, for his unrealized contributions to the worlds of medicine and literature, and for his loved ones. Yet, as Lucy writes in the epilogue, “this book is a new way for him to help others, a contribution only he could make.” When Breath Becomes Air will leave you both deeply saddened and deeply inspired.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.
There were many books I read in 2016 that I found relevant and helpful for the practice of medicine as modern physicians. Here were some of my favorites:
”How to Have a Good Day” by Caroline Webb (Crown Business, 2016).
With media headlines screaming about the surge in physician burnout, now is a good time to read “How to Have a Good Day.” The author, Caroline Webb, an Oxford- and Cambridge-trained economist, management consultant, and executive coach, shows how little tweaks in behavior can garner big results in both your workday productivity and your overall well-being. Her science-based techniques are wonderfully practical. She teaches you how to be more effective at work by establishing smart habits, setting appropriate priorities, and pumping up your workplace enthusiasm. She also shows you a path to stronger workplace relationships by learning how to better manage conflict, build rapport, and get the most out of others. My copy is dog-eared. I hope yours will be too.
In this expansively researched book, Nancy Tomes, Ph.D., professor of history at the State University of New York, Stony Brook, documents the formation and consequences of the consumer economy in American medicine. Unlike other medical historians, who claim that patient consumerism emerged in the 1970s, Dr. Tomes argues that it developed “a full century earlier.” She dismantles the American ideal of the “golden age” of Norman Rockwell doctors and “deferential patients.” In eminently readable prose, Dr. Tomes analyzes numerous developments that have disrupted the doctor-patient relationship, including the growth of drug stores, the ever-changing medical insurance industry, and direct-to-consumer advertising. A skilled historian and writer, she doesn’t provide tidy answers to messy questions. She acknowledges that, despite many technological and social advances, particularly patient empowerment, there is no “magic bullet” to cure what ails our current medical system. This is a good choice for those looking to put digital medicine into historical context.
”Visual Intelligence: Sharpen Your Perception, Change Your Life” by Amy E. Herman (Eamon Dolan/Houghton Mifflin Harcourt, 2016).
How do we see? Not terribly well, according to Amy E. Herman. A lawyer and art historian, Ms. Herman has developed a course called “The Art of Perception” that has helped professionals from physicians to police officers hone their observation and communication skills. The course happens to be based on the class for students and residents of dermatology given by the eminent dermatologist Irwin Braverman, MD. A basic tenet of the book is that even highly intelligent professionals often experience “blindness.” She writes: “For no physiological reason, sometimes we fail to see something that’s in our direct line of sight. We overlook things when they are unexpected or too familiar, when they blend in, and when they are too aberrant or abhorrent to imagine.” Fortunately, correcting such “inattentional blindness” isn’t a gift, it’s a skill that improves with practice. The key is to acknowledge the “blind spots” in our perception and to become more detail oriented. Enter the art. Through analyzing dozens of works of art, Ms. Herman shows you how to “see what matters,” encouraging you to notice every detail and, equally important, every missing detail. The result: Over time, attention to detail becomes second nature, helping you to become more observant and fully present both in clinic and at home.
”When Breath Becomes Air” by Paul Kalanithi, MD (Penguin Random House, 2016).
This posthumously published memoir by Paul Kalanithi, MD, is tormentingly beautiful. In May 2013, the 36-year-old neurosurgeon was diagnosed with stage IV lung cancer; he was a nonsmoker. In a blink, Dr. Kalanithi would don the patient’s gown and relinquish his role as healer. “Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering,” he writes. Dr. Kalanithi battles the cancer valiantly for 2 years, during which time he writes this book and has a child with his wife, Lucy, also a doctor. As someone with a BA and MA in literature from Stanford and a MPhil from Cambridge, his writing is eloquent and compelling, in the vein of Atul Gawande, MD, and Jerome Groopman, MD. He voices his readers’ thoughts perfectly when he writes, “My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close.” We ache for him, for his unrealized contributions to the worlds of medicine and literature, and for his loved ones. Yet, as Lucy writes in the epilogue, “this book is a new way for him to help others, a contribution only he could make.” When Breath Becomes Air will leave you both deeply saddened and deeply inspired.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.
There were many books I read in 2016 that I found relevant and helpful for the practice of medicine as modern physicians. Here were some of my favorites:
”How to Have a Good Day” by Caroline Webb (Crown Business, 2016).
With media headlines screaming about the surge in physician burnout, now is a good time to read “How to Have a Good Day.” The author, Caroline Webb, an Oxford- and Cambridge-trained economist, management consultant, and executive coach, shows how little tweaks in behavior can garner big results in both your workday productivity and your overall well-being. Her science-based techniques are wonderfully practical. She teaches you how to be more effective at work by establishing smart habits, setting appropriate priorities, and pumping up your workplace enthusiasm. She also shows you a path to stronger workplace relationships by learning how to better manage conflict, build rapport, and get the most out of others. My copy is dog-eared. I hope yours will be too.
In this expansively researched book, Nancy Tomes, Ph.D., professor of history at the State University of New York, Stony Brook, documents the formation and consequences of the consumer economy in American medicine. Unlike other medical historians, who claim that patient consumerism emerged in the 1970s, Dr. Tomes argues that it developed “a full century earlier.” She dismantles the American ideal of the “golden age” of Norman Rockwell doctors and “deferential patients.” In eminently readable prose, Dr. Tomes analyzes numerous developments that have disrupted the doctor-patient relationship, including the growth of drug stores, the ever-changing medical insurance industry, and direct-to-consumer advertising. A skilled historian and writer, she doesn’t provide tidy answers to messy questions. She acknowledges that, despite many technological and social advances, particularly patient empowerment, there is no “magic bullet” to cure what ails our current medical system. This is a good choice for those looking to put digital medicine into historical context.
”Visual Intelligence: Sharpen Your Perception, Change Your Life” by Amy E. Herman (Eamon Dolan/Houghton Mifflin Harcourt, 2016).
How do we see? Not terribly well, according to Amy E. Herman. A lawyer and art historian, Ms. Herman has developed a course called “The Art of Perception” that has helped professionals from physicians to police officers hone their observation and communication skills. The course happens to be based on the class for students and residents of dermatology given by the eminent dermatologist Irwin Braverman, MD. A basic tenet of the book is that even highly intelligent professionals often experience “blindness.” She writes: “For no physiological reason, sometimes we fail to see something that’s in our direct line of sight. We overlook things when they are unexpected or too familiar, when they blend in, and when they are too aberrant or abhorrent to imagine.” Fortunately, correcting such “inattentional blindness” isn’t a gift, it’s a skill that improves with practice. The key is to acknowledge the “blind spots” in our perception and to become more detail oriented. Enter the art. Through analyzing dozens of works of art, Ms. Herman shows you how to “see what matters,” encouraging you to notice every detail and, equally important, every missing detail. The result: Over time, attention to detail becomes second nature, helping you to become more observant and fully present both in clinic and at home.
”When Breath Becomes Air” by Paul Kalanithi, MD (Penguin Random House, 2016).
This posthumously published memoir by Paul Kalanithi, MD, is tormentingly beautiful. In May 2013, the 36-year-old neurosurgeon was diagnosed with stage IV lung cancer; he was a nonsmoker. In a blink, Dr. Kalanithi would don the patient’s gown and relinquish his role as healer. “Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering,” he writes. Dr. Kalanithi battles the cancer valiantly for 2 years, during which time he writes this book and has a child with his wife, Lucy, also a doctor. As someone with a BA and MA in literature from Stanford and a MPhil from Cambridge, his writing is eloquent and compelling, in the vein of Atul Gawande, MD, and Jerome Groopman, MD. He voices his readers’ thoughts perfectly when he writes, “My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close.” We ache for him, for his unrealized contributions to the worlds of medicine and literature, and for his loved ones. Yet, as Lucy writes in the epilogue, “this book is a new way for him to help others, a contribution only he could make.” When Breath Becomes Air will leave you both deeply saddened and deeply inspired.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com. He has no disclosures related to this column.
Mindfulness
How might mindfulness contribute to your mental collapse? Let’s say your work has become tedious. Tottering toward burnout, you decide to try mindfulness meditation to reverse your downward trend. However, you habitually fail to do your daily meditation. Now, “Meditate today” just piles on to your to-do list, a daily reminder of just how weak and disorganized you have become. Voila! Mindfulness is making you more crazy. There are things you can do to avoid this.
There are plenty of things to tip us doctors into burnout. We are not alone in the burnout epidemic, but we are overrepresented. More than 50% of physicians have burnout symptoms according to a recent Mayo Clinic study. Mindfulness training can help.
According to an interview with the program’s director, Douglas Zeidonis, MD, professor and chair of the department of psychiatry at the University of Massachusetts, most of the physicians reported that mindfulness training significantly benefited their work and personal lives. Mindfulness helped them feel more present and engaged with colleagues and patients and made them better clinicians – they reported showing more compassion toward patients.
Like any desirable habit, the key is to do it again and again and again. Here are a few recommendations to help you become more mindful during your workday.
1. Set random alarms (vibrate mode) on your smartphone to remind yourself to take a moment. When it goes off, do this: Breathe (4 seconds in, hold, then 8 seconds out) and be totally present for one minute.
2. Remove deliciously distracting apps from your phone’s home screen. Instead, tuck them away in a folder to reduce the likelihood you’ll click on them when you’re stressed.
3. Put meditation apps where you easily see them. You might try:
• The Mindfulness App: This app offers guided meditations in varying lengths from 3 to 30 minutes, so you can choose the one that’s right for you at any time of the day. Cool features include tracking your progress and setting reminders.
• Headspace: Headspace is known for helping people learn to meditate in just 10 easy minutes a day. Cool features include the ability to track your progress and to buddy up with a friend to help keep you motivated.
• Omvana: This app offers over 500 “transformative” audios to improve all areas of your life from work to personal relationships. Cool features include tracks to improve sleep, something more than a few of us might appreciate.
• Stop, Breathe, & Think: Quicker than Headspace, this app teaches you to meditate in 5 minutes a day and is easy to use at your workplace. Cool features include customizing meditations based upon your mood.
• Take a Break!: Ideal for the workplace, this app will help you carve out time each day to breathe, relax, and focus. Cool features include the ability to choose meditations with voice, music, or nature sounds.
4. Block a 10-minute mindfulness appointment on your schedule in the afternoon. Becoming more resilient will more than offset the short term lost revenue if you avoid retiring too soon due to burnout!
5. If you have an Apple watch, then try the new Breathe app. It reminds you to stop, breathe, and relax and even reports your heart rate afterward.
So unless you are expecting 2017 to be uneventful, I suggest you start building your mindfulness habit today.
Serenity now, serenity now.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com . He has no disclosures related to this column.
How might mindfulness contribute to your mental collapse? Let’s say your work has become tedious. Tottering toward burnout, you decide to try mindfulness meditation to reverse your downward trend. However, you habitually fail to do your daily meditation. Now, “Meditate today” just piles on to your to-do list, a daily reminder of just how weak and disorganized you have become. Voila! Mindfulness is making you more crazy. There are things you can do to avoid this.
There are plenty of things to tip us doctors into burnout. We are not alone in the burnout epidemic, but we are overrepresented. More than 50% of physicians have burnout symptoms according to a recent Mayo Clinic study. Mindfulness training can help.
According to an interview with the program’s director, Douglas Zeidonis, MD, professor and chair of the department of psychiatry at the University of Massachusetts, most of the physicians reported that mindfulness training significantly benefited their work and personal lives. Mindfulness helped them feel more present and engaged with colleagues and patients and made them better clinicians – they reported showing more compassion toward patients.
Like any desirable habit, the key is to do it again and again and again. Here are a few recommendations to help you become more mindful during your workday.
1. Set random alarms (vibrate mode) on your smartphone to remind yourself to take a moment. When it goes off, do this: Breathe (4 seconds in, hold, then 8 seconds out) and be totally present for one minute.
2. Remove deliciously distracting apps from your phone’s home screen. Instead, tuck them away in a folder to reduce the likelihood you’ll click on them when you’re stressed.
3. Put meditation apps where you easily see them. You might try:
• The Mindfulness App: This app offers guided meditations in varying lengths from 3 to 30 minutes, so you can choose the one that’s right for you at any time of the day. Cool features include tracking your progress and setting reminders.
• Headspace: Headspace is known for helping people learn to meditate in just 10 easy minutes a day. Cool features include the ability to track your progress and to buddy up with a friend to help keep you motivated.
• Omvana: This app offers over 500 “transformative” audios to improve all areas of your life from work to personal relationships. Cool features include tracks to improve sleep, something more than a few of us might appreciate.
• Stop, Breathe, & Think: Quicker than Headspace, this app teaches you to meditate in 5 minutes a day and is easy to use at your workplace. Cool features include customizing meditations based upon your mood.
• Take a Break!: Ideal for the workplace, this app will help you carve out time each day to breathe, relax, and focus. Cool features include the ability to choose meditations with voice, music, or nature sounds.
4. Block a 10-minute mindfulness appointment on your schedule in the afternoon. Becoming more resilient will more than offset the short term lost revenue if you avoid retiring too soon due to burnout!
5. If you have an Apple watch, then try the new Breathe app. It reminds you to stop, breathe, and relax and even reports your heart rate afterward.
So unless you are expecting 2017 to be uneventful, I suggest you start building your mindfulness habit today.
Serenity now, serenity now.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com . He has no disclosures related to this column.
How might mindfulness contribute to your mental collapse? Let’s say your work has become tedious. Tottering toward burnout, you decide to try mindfulness meditation to reverse your downward trend. However, you habitually fail to do your daily meditation. Now, “Meditate today” just piles on to your to-do list, a daily reminder of just how weak and disorganized you have become. Voila! Mindfulness is making you more crazy. There are things you can do to avoid this.
There are plenty of things to tip us doctors into burnout. We are not alone in the burnout epidemic, but we are overrepresented. More than 50% of physicians have burnout symptoms according to a recent Mayo Clinic study. Mindfulness training can help.
According to an interview with the program’s director, Douglas Zeidonis, MD, professor and chair of the department of psychiatry at the University of Massachusetts, most of the physicians reported that mindfulness training significantly benefited their work and personal lives. Mindfulness helped them feel more present and engaged with colleagues and patients and made them better clinicians – they reported showing more compassion toward patients.
Like any desirable habit, the key is to do it again and again and again. Here are a few recommendations to help you become more mindful during your workday.
1. Set random alarms (vibrate mode) on your smartphone to remind yourself to take a moment. When it goes off, do this: Breathe (4 seconds in, hold, then 8 seconds out) and be totally present for one minute.
2. Remove deliciously distracting apps from your phone’s home screen. Instead, tuck them away in a folder to reduce the likelihood you’ll click on them when you’re stressed.
3. Put meditation apps where you easily see them. You might try:
• The Mindfulness App: This app offers guided meditations in varying lengths from 3 to 30 minutes, so you can choose the one that’s right for you at any time of the day. Cool features include tracking your progress and setting reminders.
• Headspace: Headspace is known for helping people learn to meditate in just 10 easy minutes a day. Cool features include the ability to track your progress and to buddy up with a friend to help keep you motivated.
• Omvana: This app offers over 500 “transformative” audios to improve all areas of your life from work to personal relationships. Cool features include tracks to improve sleep, something more than a few of us might appreciate.
• Stop, Breathe, & Think: Quicker than Headspace, this app teaches you to meditate in 5 minutes a day and is easy to use at your workplace. Cool features include customizing meditations based upon your mood.
• Take a Break!: Ideal for the workplace, this app will help you carve out time each day to breathe, relax, and focus. Cool features include the ability to choose meditations with voice, music, or nature sounds.
4. Block a 10-minute mindfulness appointment on your schedule in the afternoon. Becoming more resilient will more than offset the short term lost revenue if you avoid retiring too soon due to burnout!
5. If you have an Apple watch, then try the new Breathe app. It reminds you to stop, breathe, and relax and even reports your heart rate afterward.
So unless you are expecting 2017 to be uneventful, I suggest you start building your mindfulness habit today.
Serenity now, serenity now.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. Dr. Benabio is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com . He has no disclosures related to this column.
‘Thank you, EMR!’
“Thank you, EMR!” Said no doctor. Ever.
At least up until now.
For years, we have had to put up with these machines in our exam rooms, distracting data entry devices that offer insignificant contributions to the work we do. That’s starting to change.
Recently, I led a workshop at the annual Kaiser Permanente internal medicine conference in Southern California. I gave one of my more popular sessions on the art of diagnosis and therapy (inspired and borrowed from Dr. Irwin M. Braverman’s marvelous lectures on learning dermatology through art).
What’s more, the listed steroids change automatically based on the current formulary. This ensures the lowest cost to the patient and minimizes rework of having to go back and pick another when the patient balks at unjustifiably high prices. The clinician has only to click and sign to place the order. Now a primary care physician – or even a dermatologist! – needs only to estimate the potency of the therapy, pick a vehicle (cream, ointment, gel, solution), and the EMR guides him or her to prescribe the right medication. It is easy to use, active at the point of care, and helpful to both clinician and patient.
This SRX program was developed by our local physicians in conjunction with pharmacists and the informatics team. It has enormous potential, providing more point of care clinical decision support based on best practice, formulary, and even personalized information automatically gleaned from that patient’s chart. As of now, we can customize our order entry such that if I want to order labs to look for connective tissue disease, I have to type only .CTD, and my personal picks for a lupus workup come up. It saves me time. Yes, I did just say that in reference to my EMR. And it helps ensure high-quality care. Whenever new diagnostics or new treatments become best practice, I can put them on my preference list, thereby making the best thing to do the easy thing to do.
The internal medicine physicians were appreciative for my lecture and loved learning through art. However, the big hit was the SRX DERM. “This will make it so much easier,” said one hospitalist, “thanks for doing this!”
I had nothing to do with it though. Thank you, EMR.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
“Thank you, EMR!” Said no doctor. Ever.
At least up until now.
For years, we have had to put up with these machines in our exam rooms, distracting data entry devices that offer insignificant contributions to the work we do. That’s starting to change.
Recently, I led a workshop at the annual Kaiser Permanente internal medicine conference in Southern California. I gave one of my more popular sessions on the art of diagnosis and therapy (inspired and borrowed from Dr. Irwin M. Braverman’s marvelous lectures on learning dermatology through art).
What’s more, the listed steroids change automatically based on the current formulary. This ensures the lowest cost to the patient and minimizes rework of having to go back and pick another when the patient balks at unjustifiably high prices. The clinician has only to click and sign to place the order. Now a primary care physician – or even a dermatologist! – needs only to estimate the potency of the therapy, pick a vehicle (cream, ointment, gel, solution), and the EMR guides him or her to prescribe the right medication. It is easy to use, active at the point of care, and helpful to both clinician and patient.
This SRX program was developed by our local physicians in conjunction with pharmacists and the informatics team. It has enormous potential, providing more point of care clinical decision support based on best practice, formulary, and even personalized information automatically gleaned from that patient’s chart. As of now, we can customize our order entry such that if I want to order labs to look for connective tissue disease, I have to type only .CTD, and my personal picks for a lupus workup come up. It saves me time. Yes, I did just say that in reference to my EMR. And it helps ensure high-quality care. Whenever new diagnostics or new treatments become best practice, I can put them on my preference list, thereby making the best thing to do the easy thing to do.
The internal medicine physicians were appreciative for my lecture and loved learning through art. However, the big hit was the SRX DERM. “This will make it so much easier,” said one hospitalist, “thanks for doing this!”
I had nothing to do with it though. Thank you, EMR.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.
“Thank you, EMR!” Said no doctor. Ever.
At least up until now.
For years, we have had to put up with these machines in our exam rooms, distracting data entry devices that offer insignificant contributions to the work we do. That’s starting to change.
Recently, I led a workshop at the annual Kaiser Permanente internal medicine conference in Southern California. I gave one of my more popular sessions on the art of diagnosis and therapy (inspired and borrowed from Dr. Irwin M. Braverman’s marvelous lectures on learning dermatology through art).
What’s more, the listed steroids change automatically based on the current formulary. This ensures the lowest cost to the patient and minimizes rework of having to go back and pick another when the patient balks at unjustifiably high prices. The clinician has only to click and sign to place the order. Now a primary care physician – or even a dermatologist! – needs only to estimate the potency of the therapy, pick a vehicle (cream, ointment, gel, solution), and the EMR guides him or her to prescribe the right medication. It is easy to use, active at the point of care, and helpful to both clinician and patient.
This SRX program was developed by our local physicians in conjunction with pharmacists and the informatics team. It has enormous potential, providing more point of care clinical decision support based on best practice, formulary, and even personalized information automatically gleaned from that patient’s chart. As of now, we can customize our order entry such that if I want to order labs to look for connective tissue disease, I have to type only .CTD, and my personal picks for a lupus workup come up. It saves me time. Yes, I did just say that in reference to my EMR. And it helps ensure high-quality care. Whenever new diagnostics or new treatments become best practice, I can put them on my preference list, thereby making the best thing to do the easy thing to do.
The internal medicine physicians were appreciative for my lecture and loved learning through art. However, the big hit was the SRX DERM. “This will make it so much easier,” said one hospitalist, “thanks for doing this!”
I had nothing to do with it though. Thank you, EMR.
Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego. He is @Dermdoc on Twitter. Write to him at dermnews@frontlinemedcom.com.