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Jennifer Frank, MD: Vulnerable to stress?

I recently took an online quiz to assess my vulnerability to stress. I was anxious to identify those areas that I needed to improve in order to lower my cortisol-induced stress haze.

I scored a perfect score of invulnerability. Seriously – I didn’t even fudge any of the answers. The questions were things like “Do you get regular dental care?” and “Do you get seven to eight hours of sleep at least four nights per week?” It didn’t even ask if I have kids! Needless to say, I don’t believe that quiz. I am vulnerable to stress, and I feel it on a fairly frequent basis.

These are my stress triggers:

1) Over-commitment. It is my modus operandi to say “yes” too frequently. As a result, I get stressed by competing appointments and demands.

2) No breaks. In medical school, you were better and tougher if you didn’t need to sleep, eat, or use the bathroom during a call shift. This has translated into marathon workdays in which I down a Power Bar on my way to the bathroom in a twisted unhealthy multi-tasking spree. Don’t even get me started on how the mother of four small kids is supposed to take a shower.

3) Perfectionism. Doctors are expected to know everything, do everything, be everything. Actually I think this is just what we expect of ourselves. During those (too frequent) times I have had to confess an error or mistake to a patient, they are much more forgiving of me than I am of myself.
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In looking at my quiz results, I realized there are a number of stress insulators – things that protect me from stress. Probably would be a good idea to maximize these areas. According to the authoritative stress vulnerability profile, this is what I have going for me to keep my stress to a minimum:

1) Healthy lifestyle habits. Okay, I admit to eating half of an apple streudel dessert and a handful of barbeque flavor rice chips for breakfast occasionally, but in general, I eat healthy, exercise, and get as much sleep as my children allow.

2) Friends and family. I do have a “four o’clock in the morning” friend (you know, the person you can call at 4 a.m. with any concern minor or serious) and am fortunate to have family close by.

3) Comfortable lifestyle. Physicians (even primary-care physicians) make a great salary. This enables me to afford all kinds of stress minimizers like dental care, babysitters for date night, and even a cleaning service for our house.

4) A strong marriage. A poem that hangs on the wall of our bedroom describes it perfectly: “You are the strong embrace in my challenge.”

5) Finally, spiritual grounding to give it all meaning.

You probably have your own list of stress inducers and stress deflectors. It is crucial to avoid those things that cause stress while soaking in the wonderful parts of life that reduce stress.

Melissa Young, MD: I need 36 hours in a day and two pairs of hands

I shouldn’t complain. Venturing out on my own has not been the financial disaster my former senior partner predicted despite the often miserable reimbursements. I have a steady stream of patients and the schedule is reasonably busy. After six months of practice, the current wait for a new patient is six weeks. For the coveted late afternoon slots, it’s about two months.

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So, yes, life is good. For me, anyway. For the most part. But for the patients who call and want to be seen ASAP, and for my poor office staff who get yelled at on a daily basis by these same patients, not so much. Not a day goes by that a patient doesn’t pour out her sob story, or name-drop, or just get plain nasty with my staff. Like doing any of those things will miraculously make a new appointment slot appear. Some of them hang up threatening (?) to find another doctor, only call back two hours later because at ever other practice the wait is six months.

I understand their frustration — their fear even. If your primary care doc says “You need to get in to see her right away,” you want an appointment right away. And yet, what am I to do? I can only see one patient at a time. I refuse to double book. I refuse to make patients wait for two hours because I am behind schedule. I get patients all the time who say they left another practice because they had to wait for two, three, or even 10 — oh, yes, 10! — hours to be seen. So while they may wait six weeks to come in and see me, once they are here, they are seen promptly and have my undivided attention. I’m not looking at the clock thinking, “Oh my God, I have eight more patients to see in the next 45 minutes”.

So what do I do? Do I accept the way things are, and say “sorry, such is life”? I will gladly take suggestions … or a time machine.

Randall Wong, MD: Tools for SEO

Last week, I introduced the concept of SEO (search engine optimization) and how it can be used for marketing. Good SEO is matching the content of your web page with the keywords used for an organic search (i.e., the words you type into "Google" or another search engine).

My Web site has become more visible on the Internet due to improved rankings on search pages. This is a result of my own SEO efforts.

While most blog software seems interchangeable, there are a few "themes" that are better at SEO than others. I recently bought "Thesis” for WordPress. Not only can I change the design of any element of the page (graphics, number of columns, font, background colors, etc.), but I can do it without knowing how to code.
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While most of the "themes" available for WordPress are free, Thesis (which is inexpensive) is designed to maximize the SEO of a Web site. It is written, or coded, so that search engines are able to easily find what they are looking for and rank your page.

Search engine optimization is the only way a page gets ranked, and stays ranked.

I also recently started using "Scribe." Scribe is a program that analyzes your article to maximize the SEO of your content.

After writing an article or post, I'll analyze it with "Scribe." Scribe will check for keyword usage (making sure I don't use a word too often) and review my excerpt, title, etc., to increase the SEO of my content. It makes my content more relevant for the search engines.

Scribe is a subscription service. It has a monthly fee and allows me up to 300 analyses per month.

Why bother?

I started using both of these tools about 6 weeks ago. Since then, my traffic has started to increase, I no longer write daily, and I don't have to "Tweet" to get traffic to my blog. It has saved me a tremendous amount of time.

My biggest source of traffic is now Google, and 70% of my traffic (an increase even from last week) is from search engines.

SEO can be done without these tools, but having software help you reduces the amount of work and time required to maximize your efforts. These tools allow me to spend more time writing and less time worrying about SEO.

Gerald O'Malley, DO: Sadao

My father-in-law passed away on Saturday.

Sadao Nagakuni was born in 1942 in Katsurahama, Kochi Prefecture on Shikoku, the smallest and least populated island in Japan. He lived through the occupation of Japan following World War II but he was too young to remember much of it. He loved to swim in the ocean when he was a child, even though it was prohibited because of the rough surf. He put himself through school as a guitar player in a “Hawaiian band” that would play in beer halls. He loved classical guitar and his favorite artist was the Spanish guitarist Andres Segovia. Nagakuni-san developed a method of playing traditional Japanese melodies with a flamenco/Spanish styling that was exquisitely beautiful and quite unlike anything I had ever heard.
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As a young man, Nagakuni-san was forced to work in his father’s factory making water tanks to hold fresh seafood. My father-in-law didn’t get along with his father and moved away from Shikoku to Tokyo where he met his wife. They settled in Osaka, the second largest city in Japan and started a company that designed, built and serviced water tanks to hold live seafood, mostly for restaurants and seafood suppliers.

In the early days of their marriage they had no money to rent a house so they lived in the workshop where they built the water tanks and slept on a futon in the corner of the building.

In Japan, you can judge the quality of a restaurant by the way they display their fish and seafood, Nagakuni-san created elaborate and beautiful and functional water tank/display systems for clients all over Japan. When Rika introduced us, her father treated me to many wonderful meals all over Osaka. He knew all the owners because they were his clients and we received VIP treatment wherever we ate.

Japan remains a very culturally closed and homogenous society. At the time that Rika and I became engaged I was stationed at the US Naval Hospital in Okinawa and relations between the Japanese and the US military were very strained because of some heinous and criminal behavior by one or two members of the more than 40,000 active duty members stationed in Japan. US military members were spit on and harassed by the Japanese in the streets of Okinawa.

None of that seemed to bother Sadao. I remember sitting at a lunch counter with him eating teriyaki and beef bowls surrounded by muttering construction workers and clucking housewives while we tried to communicate through his limited English and my nonexistent Japanese. We must have made a strange duo. I’m left to wonder if he ever wished that his daughter had fallen in love with a Japanese guy because he only ever treated me as his son-in-law.

Sadao suffered a cerebral aneurysm bleed in 2002 which robbed him of many of his cognitive faculties. Physically he appeared fine and he was even able to still play the guitar although not as easily or fluently as before and he would often play the same song over and over again for hours. It still sounded beautiful to me.

For the past several years, Nagakuni-san required around-the-clock supervision for his own safety. We saw him last March and visited with him several times and he remembered me and our daughter and surprisingly our son, whom he had only met once before. He reportedly woke up Saturday morning, walked out to the lounge area, sat down in front of the TV to watch the morning news show and didn’t respond when they called him for breakfast.

Sadao Nagakuni was a quiet man with an easy smile and a deep laugh. He worked hard, helped neighbors and strangers alike, was honest and generous to a fault and raised my wife and her brother in a loving and disciplined home. He was one of the millions of men that live their lives honorably and productively with a quiet nobility that are the soul of the family and the engine of the world. I will miss him.

Sayonara Nagakuni-san.

Physicians Practice LIVE is live!

Physicians Practice LIVE, our first ever virtual practice management conference opens this morning.

It's just like a physician conference, complete with an exhibit hall stocked with booths, an auditorium with presentations from the experts on everything from HITECH dollars to work flow fixes, and a networking lounge to chat with other attendees. Well, except that it all is happening online.

So, as people are interacting with colleagues, vendors, and experts today at Physicians Practice LIVE, we'll use the blog as an extension of the communications. We'll post updates here throughout the day. We welcome your comments and insights!

Trendspotter: Computer-Assisted Coding Is Coming

By Ken Terry


Are you ready for computer-assisted coding (CAC)? So far, it’s being used mainly in hospital outpatient departments, emergency rooms, imaging centers, and ambulatory surgery centers. But it’s starting to move into inpatient settings and ambulatory-care clinics, as well. So you might soon be receiving solicitations from CAC vendors such as CodeRyte, A-Life Medical, AMI and 3M Healthcare Solutions. Whether or not your practice can benefit may depend on such factors as EHR adoption, the types of work you and your colleagues do, and whether you employ professional coders.

There are at least two different forms of CAC. One is similar to the E&M code checkers found in many EHRs. Products from companies like IMO are integrated with EHRs and map the medical terms used in those records to diagnosis and procedure codes. So if you use drop-downs and pick lists for most of your documentation, the program can identify many of the codes you should be using, based on the discrete data in the EHR.
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A more common approach to CAC uses what is known as “natural language processing” to identify relevant terms in electronic text and analyze them in the context of coding logic. By using this kind of software, some radiology departments have been able to code up to 60 percent of their claims automatically and send them directly to the billing system. Radiology and a few other specialties are especially suited to CAC because they have so many repetitive cases. Because these are easy to code, CAC is fairly accurate in these areas.

In more complex care settings, CAC helps increase productivity by doing some of the basic coding work, while allowing human coders to make the final decisions. These programs reduce the amount of time that coders have to spend searching through documents to find relevant information. CAC software does not work with paper or scanned documents; it’s designed for electronic text, such as transcribed notes or reports. But since that’s all that the majority of practices have online right now, CAC might be useful to some groups in which physicians don’t code their own claims.CodeRyte, which has been around for a decade, claims that it “automates medical coding for leading multi-specialty clinics around the country.” It also automates coding for about 70 single-specialty, hospital-based practices. Most of them are radiology, pathology and ER groups, but their customers also include some cardiology practices. CodeRyte avers that its product can increase coder productivity by up to 200-300 percent.

A-Life Medical, another CAC leader, also says that it improves coder productivity and integrates with hundreds of billing, hospital and document management systems. According to the company, it assists coding operations for more than 40,000 physicians.

There are a few reasons why CAC is likely to become more prevalent. First, experienced coders are in short supply, which means that practices need to maximize the productivity of those who are available. Second, hospitals are using these products, and more and more physicians are working for hospitals. And third, the industry is on the verge of moving to ICD-10 diagnostic coding. When that happens, there will be a big expansion of codes, with an accompanying rise in the complexity of coding. Some observers believe that computer-assisted coding can help physicians and hospitals cope with this challenge.

One thing is for certain: physicians and their staffs spend far too much time on administrative tasks that take time away from patient care. If CAC can remove some of that burden, while helping practices code more appropriately, it will be welcomed in physician groups of all kinds.