Shadowing a doctor

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Case Study: The Crowded Clinic Authors: Kate Ellis, M.D., Family Physician, Charles River Medical Associates Morana Lasic, M.D., Clinical Instructor in Anesthesia, Harvard Medical School and Brigham and Women’s Hospital You are one of the health care practitioners in a community health center that provides primary care to a multi-ethnic, multi-lingual urban community. Many, but not all, of the patients live below the poverty line. Physicians and nurses see a large volume of patients with challenging medical and psychosocial issues. Lately you have realized that the scheduling of patient visits has become something of a nightmare. Because of the high volume of patients, the wait for an appointment for routine care can be anywhere from six to eight months or more. Even acutely ill patients often wait for two to three days to see a health care provider. Out of frustration, many patients are walking in without appointments, often during lunch hour or late in the afternoon when everyone is getting ready to leave. What makes the problem so challenging is that 20 to 40 percent of patients fail to show up for appointments on a given day. Because of this high no-show rate, every other appointment on physicians’ schedules is double-booked with the expectation that, out of the 30 to 35 scheduled patients, only 20 to 25 will actually show up. Occasionally, however, most of the patients do show up – and when a significant number of acutely ill patients also arrive, the work environment becomes unbearably chaotic for everyone. Providers become harried and more likely to make mistakes, patients wait for long periods of time in crowded waiting rooms, and the atmosphere becomes increasingly hostile as the stress level mounts. It is clear that the quality and experience of health care for many of these patients is suffering partly because of a simple lack of access to care. And it is becoming increasingly clear also that the better-insured and English-speaking patients may be getting better access: they are more likely to get a timely appointment because they are more demanding of the system, and they are more likely to keep and show up for their appointments because of better communication. You are interested in finding a way to promote more equitable access to health care. Case Analysis The main problem that everyone is experiencing in this clinic is the high rate of no- shows. It would be very easy to simply label the clinic’s patients “non-compliant.” But is it so? As health care providers, the burden is on us to find the most effective ways to serve our patient population. One possible approach to the problem at hand is to conduct a survey in an attempt to identify some specific reasons that may be contributing to such a high percentage of no-shows. When patients are surveyed about their reasons for not coming to appointments, a few common reasons may emerge: • A sick pa ...

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Ethical Decision-Making Model Ethical decision-making at an individual level and one's ethical behavior can be viewed in three primary steps using an ethical decision-making model. First is one's moral awareness, recognizing the existence of an ethical dilemma. This is the pathway to establishing the need for an ethical decision. This awareness is an individual sensitivity to one's values and personal morals. Once a personal awareness is evident, we can make a judgment in deciding what is right or wrong. This sounds simple, yet there are a number of variables driving this personal judgment. One variable is the individual differences and cognitive bias we all have based on our personal history and experiences. A second variable is the organization. This variable may be influenced from a group, organizational or cultural perspective. A code of conduct or standards of behavior may also influence our judgment. This model, operating in a dynamic fashion, leads us to our ethical behavior; taking action to do the right thing. Is the right thing the same decision for everyone? Obviously not. We are all influenced my multiple factors in our decision-making. This decision-making model can help us understand the pathway to our ethical decisions. References · Trevino, L. K., Nelson, K. A. (2007). Business ethics: Straight talk about how to do it right. Wiley. Credits Subject Matter Expert: John Herr Interactive Design: Tara Schiller Instructional Designer: Lee Scholder Project Manager: Daniela Green Ethical Case Studies Consider the ethical dilemma the health care professional faces in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior). Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make. Reducing Hospital Readmissions Caleb Powell was preparing the agenda for the upcoming executive leadership meeting and he shook his head ruefully. As chief executive officer for Virginia County Regional Hospital (VCRH), Caleb believes that a key piece of VCRH's future success lies in reducing readmission rates, not only in the areas identified by federal guidelines, but across the board. A few weeks ago, he read a piece from the National Institutes of Health discussing strategies associated with reduction in readmission rates. He decided that he wanted to discuss the issue in detail with his leadership team. Caleb's goal is to align the hospital's strategic planning with the goal of reducing readmissions. The stakes are high; under provisions of the Affordable Care Act, hospitals with higher than expected 30 day readmission rates for heart failure, heart attack and pneumonia are penalized with re ...

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Read through the Tree Trimming Project case in chapter 13 of the textbook. This case refers to the earned value (EV) of the owner, Will Fence’s Tree Trimming business. Will briefly describes his techniques for EV. Based on the description provided in the case, is Will using EV? Answer the corresponding question provided at the end of the case (300-500 words). Use references from the reading materials to support your response. ⏐ PUBLIC HEALTH THEN AND NOW ⏐ Joffe | Peer Reviewed | Public Health Then and Now | 57January 2013, Vol 103, No. 1 | American Journal of Public Health | Carole Joffe, PhD WHAT SHOULD STAFF IN abortion-providing facilities say to abortion patients prior to the procedure? This seemingly simple question is of course not simple at all, in light of the deep social and political divide over abortion that continues to char- acterize the contemporary United States, some 40 years after legalization. This conflict has inevita- bly had consequences for how abortion is organized as a service. Beyond their efforts to over- turn Roe v Wade,2 opponents have sought in numerous ways to regulate the delivery of abortion, The field of abortion counseling originated in the abortion rights movement of the 1970s. During its evolution to the present day, it has faced significant challenges, primarily arising from the increasing politicization and stigmatization of abortion since legalization. Abortion counseling has been affected not only by the imposition of antiabortion statutes, but also by the changing needs of patients who have come of age in a very different era than when this occupation was first developed. One major innovation—head and heart counseling—departs in significant ways from previous conventions of the field and illustrates the complex and changing political meanings of abortion and therefore the challenges to abortion providers in the years following Roe v Wade. (Am J Public Health. 2013;103:57–65. doi:10.2105/AJPH.2012.301063) including staff interactions with patients. State legislatures, for example, have passed laws that mandate that patients be forced to view their ultrasounds and hear detailed descriptions of their fetus’s development; numerous states have also dictated scripts—often containing untrue statements—that clinic staff must deliver to patients.3 Abortion rights supporters, and particularly those who work in abortion-providing facilities, vehe- mently reject opponents’ argu- ments that such regulations are in abortion patients’ interest; rather, they argue, these requirements exist to make access to abortion more difficult and the experience more upsetting. Although they reject what they see as politically driven restrictions, however, those involved in abortion provi- sion are not in complete agree- ment about what precisely the abortion experience should be for patients. In particular, opinions differ about what the nonmedical com.

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