Healthcare’s Quality Revolution

100:00:00,701 --> 00:00:02,406Speaker 1: Welcome to the Healthy, Wealthy and Wise 200:00:02,446 --> 00:00:06,043podcast with Dr William Chowk-Taw. In this episode, Dr 300:00:06,083 --> 00:00:09,518Chowk-Taw will continue his Leadership Masterclass series by400:00:09,518 --> 00:00:13,585covering healthcare's quality revolution. He'll explore a 500:00:13,705 --> 00:00:17,478number of factors that are driving this revolution, factors600:00:17,478 --> 00:00:19,966that include the latest developments in healthcare 700:00:20,007 --> 00:00:24,000quality and how it has changed the landscape of healthcare 800:00:24,079 --> 00:00:29,053delivery, the Affordable Care Act, patient-centered care, high900:00:29,053 --> 00:00:33,476reliability organizations, leanSix Sigma and medical 1000:00:33,517 --> 00:00:38,112malpractice. Dr Chowk-Taw will also explore data and analytics 1100:00:38,512 --> 00:00:42,043and how they are used and applied to help improve 1200:00:42,103 --> 00:00:46,109healthcare. So, whether you are a healthcare practitioner, a 1300:00:46,151 --> 00:00:50,021healthcare professional, a patient or just a consumer of 1400:00:50,101 --> 00:00:55,823good information, this podcast episode is for you. Join us now 1500:00:56,003 --> 00:00:59,816as we explore healthcare's quality revolution and discover 1600:00:59,875 --> 00:01:03,405how we can work together to helpimprove the quality of 1700:01:03,466 --> 00:01:08,361healthcare delivery for everyone. So let's get started. Here's 1800:01:08,421 --> 00:01:09,548Dr William Chowk-Taw. 1900:01:09,989 --> 00:01:13,501Speaker 2: Good morning. Good morning. I'm absolutely 2000:01:13,563 --> 00:01:18,631delighted to be here and I welcome you to the Masterclass 2100:01:19,111 --> 00:01:24,102Number Five. Masterclass Number Five Today we're going to talk 2200:01:24,143 --> 00:01:30,000about leadership in terms of healthcare's quality revolution 2300:01:30,281 --> 00:01:34,688quality revolution. I believe that life is about being of 2400:01:34,787 --> 00:01:38,822service to others. I believe knowledge is power. I believe 2500:01:38,903 --> 00:01:42,203leaders can change the world. You notice, i always start off 2600:01:42,242 --> 00:01:45,581with the same beliefs and these are my beliefs. And you may say 2700:01:45,602 --> 00:01:49,542with Dr Chowk-Taw why don't you talk about what you believe? I 2800:01:49,581 --> 00:01:54,867do this for two reasons. One is to emphasize the important point2900:01:54,867 --> 00:01:59,763that we started with the very first Masterclass about talking 3000:01:59,802 --> 00:02:03,486about the brain. That is what you believe that affects how you3100:02:03,486 --> 00:02:08,401think, and it is how you think that affects how you act, and so3200:02:08,401 --> 00:02:12,530it's always important for us togo back individually to our 3300:02:12,650 --> 00:02:16,506individual belief and make sure that they're in sync with where 3400:02:16,545 --> 00:02:20,848we want to be and where we thinklife is going for us. If they 3500:02:20,908 --> 00:02:26,144are not, then change them, but to always be aware of them. For 3600:02:26,183 --> 00:02:29,435the last five weeks, i've asked you to think like doctors as we 3700:02:29,474 --> 00:02:33,844talk about this Masterclass And,as Jesse mentioned earlier, 3800:02:34,284 --> 00:02:38,352we're going to deal with both medicine and law as we talk 3900:02:38,391 --> 00:02:43,066about healthcare. One of the things that I learned. Let me 4000:02:43,105 --> 00:02:47,322back up. I graduated from medical school in 1973. I 4100:02:47,361 --> 00:02:54,822graduated from law school in 1998. 25 years different. And 4200:02:54,882 --> 00:02:58,628one of the things that I learnedis the difference between 4300:02:58,669 --> 00:03:03,241doctors and lawyers. I did not know this before. We doctors 4400:03:03,260 --> 00:03:06,901think in terms of black and white. Either my patient has 4500:03:06,921 --> 00:03:09,048acute appendicitis or my patientdoes not have acute 4600:03:09,068 --> 00:03:12,625appendicitis. Either my patientshad a heart attack or my 4700:03:12,685 --> 00:03:17,717patient did not have a heart attack. Doctors like to have 4800:03:17,758 --> 00:03:22,604exactness. They like to be specific, but when we are not 4900:03:22,665 --> 00:03:26,888able to be specific To lawyers, there is no black and white. 5000:03:27,068 --> 00:03:29,979Think about this. Doctors think in terms of black and white. 5100:03:30,681 --> 00:03:34,503Lawyers there is no black and white. Lawyers think in terms of5200:03:34,503 --> 00:03:39,044grayness. Everything is gray. It's how you use the facts to 5300:03:39,104 --> 00:03:42,943make it a little dark or a little light. So it's one of the5400:03:42,943 --> 00:03:46,276reasons why, when a doctor is talking to a lawyer, they many 5500:03:46,296 --> 00:03:49,366times there's a conflict, because the doctor is saying but5600:03:49,366 --> 00:03:52,966I saved his life, so why in theworld is he suing me for 5700:03:53,007 --> 00:03:56,275malpractice? The lawyer is saying I don't care that you 5800:03:56,314 --> 00:04:00,735saved his life, you violated section one of XYZ, blah, blah, 5900:04:00,754 --> 00:04:03,563blah, blah, blah, blah, blah. Therefore, you're going to be 6000:04:03,645 --> 00:04:08,645liable for malpractice. So it's a different welcome. So it's a 6100:04:08,687 --> 00:04:12,288difference in the way we think. Doctors think in terms of black 6200:04:12,328 --> 00:04:16,963and white, lawyers think in terms of grayness, and I'm 6300:04:17,043 --> 00:04:19,574definitely a black and white guyin terms of how I think and 6400:04:19,634 --> 00:04:22,843what an exactness of this and that. But what I have learned, 6500:04:23,444 --> 00:04:27,391what I have learned as I've gotten older, is that the world 6600:04:27,451 --> 00:04:30,824is probably gray. Most people probably do think in terms of 6700:04:30,845 --> 00:04:34,564black and in terms of grayness, but we'll go over that a little 6800:04:34,605 --> 00:04:38,382bit more as we move along. If you remember, this is your 6900:04:38,723 --> 00:04:44,007computer. Some people call it a cell phone, some people call it 7000:04:44,026 --> 00:04:48,348a smartphone. I call it an academic hand computer because 7100:04:48,387 --> 00:04:52,278you're in the master class and you're exceptional compared to 7200:04:52,418 --> 00:04:55,891other students. You're expected to use your academic hand 7300:04:55,932 --> 00:04:59,382computer and look up stuff all the time. Anytime you have a 7400:04:59,442 --> 00:05:03,271question about anything maybe a couple of times a day you should7500:05:03,271 --> 00:05:06,718go to your academic hand computer and put into the 7600:05:06,778 --> 00:05:10,723browser What is the meaning of artificial intelligence? Blah, 7700:05:10,742 --> 00:05:13,425blah, blah, blah, blah, blah. I always want to make sure to 7800:05:13,464 --> 00:05:16,838remind you about that. As always, i always like to include an 7900:05:16,858 --> 00:05:19,545outline, and the purpose of the outline is to let you know what 8000:05:19,586 --> 00:05:22,480we're going to talk about. That's one purpose. Second 8100:05:22,500 --> 00:05:25,108purpose of the outline is to letyou know where we're just about8200:05:25,108 --> 00:05:28,980done. So I know you want to visit people and, god bless you,8300:05:28,980 --> 00:05:33,331you're taking time out of your Saturday to be here with us for 8400:05:33,370 --> 00:05:37,187an hour. So we're going to talk about change, and we always talk8500:05:37,187 --> 00:05:39,961about change to some extent. We're going to talk about the 8600:05:39,982 --> 00:05:43,271Affordable Care Act, or Obamacare, as you probably heard8700:05:43,271 --> 00:05:46,598it, because that has been fundamental to the change in 8800:05:46,639 --> 00:05:49,930health care. We're going to talkabout something called HCAPS. 8900:05:50,680 --> 00:05:54,226This is a survey that the government started doing, 9000:05:54,708 --> 00:05:59,875probably about 20 years ago 15, 20 years ago of patients to help9100:05:59,875 --> 00:06:03,413to evaluate doctors and hospitals, and we'll go into 9200:06:03,434 --> 00:06:05,716detail about that. We'll mentionabout high reliable 9300:06:05,737 --> 00:06:09,201organizations. This is where hospitals want to be High 9400:06:09,221 --> 00:06:12,048reliable organizations, those organizations that are trying to9500:06:12,048 --> 00:06:20,307get to zero patient harm, zero patient harm. One of the codes 9600:06:20,326 --> 00:06:24,894that we take as positions in essence is to first do no harm. 9700:06:25,482 --> 00:06:28,685You may not help, but you don't want to harm anybody, so the 9800:06:28,745 --> 00:06:31,461first thing you want to do is not to harm anybody. We'll 9900:06:31,500 --> 00:06:35,127mention briefly about the Lean Six Sigma just as a process of 10000:06:35,228 --> 00:06:39,220excellence, and then we'll end with medical malpractice. So 10100:06:39,261 --> 00:06:41,245when we get to medical malpractice, you know what I'm 10200:06:41,264 --> 00:06:46,959just about done. Okay, all right, here we go Quality revolution.10300:06:46,959 --> 00:06:49,526One of the things you hear people talk about a lot in 10400:06:49,565 --> 00:06:55,427health care is quality, the essence of what you do to a 10500:06:55,487 --> 00:06:59,595person, or are you giving them the best type of care as 10600:06:59,634 --> 00:07:04,043compared to less? best type of care? And one of the truisms 10700:07:04,084 --> 00:07:06,749that I've learned that I want toshare with you, and I heard 10800:07:06,790 --> 00:07:10,165somebody say this to me a long time ago if you can control the 10900:07:10,206 --> 00:07:14,266dictionary, you can rule the world. Think about that If you 11000:07:14,307 --> 00:07:18,564can control the dictionary, you can rule the world. See, if I 11100:07:18,603 --> 00:07:21,672control the dictionary, things mean whatever I say. They mean 11200:07:22,139 --> 00:07:25,793Black, means white, up, means down and means out, because I 11300:07:25,853 --> 00:07:29,704control the dictionary Right? Soyou want to be very, very 11400:07:29,745 --> 00:07:32,072careful when you hear people talk about whatever they're 11500:07:32,091 --> 00:07:35,100talking about and ask yourself who controls the dictionary? Who11600:07:35,100 --> 00:07:39,596decides what's good? Who decides what's high quality, 11700:07:39,617 --> 00:07:43,646what's poor quality? Who makes that decision? And how did they 11800:07:43,706 --> 00:07:48,665get that ability to be able to do that? Another fundamental 11900:07:48,706 --> 00:07:52,718principle that we'll address multiple times today is health 12000:07:52,759 --> 00:07:58,362care. Is health care a privilegeor is it a right? Do you have a12100:07:58,362 --> 00:08:03,095right to quality health care, or is it a privilege that you've12200:08:03,095 --> 00:08:07,024been blessed with being able toexperience More and more? now, 12300:08:07,204 --> 00:08:11,012and I'm in the category that believes that health care is a 12400:08:11,091 --> 00:08:14,737fundamental right. I do not carewhere you are, i do not care 12500:08:14,757 --> 00:08:18,333what you do, i do not care what you look like, i do not care 12600:08:18,353 --> 00:08:21,545what your politics are, i do notcare whether you're a follower 12700:08:21,565 --> 00:08:24,192of Martin Luther King or you're the imperial wizard of the Ku 12800:08:24,211 --> 00:08:28,494Klux Klan. If I am your surgeon,i'm going to give you the very 12900:08:28,533 --> 00:08:31,648best care and it does not matterto me. I'm not even going to 13000:08:31,829 --> 00:08:35,225ask you about your policy. Does that make sense? Because, as a 13100:08:35,245 --> 00:08:40,822physician, my job is not to judge you, so I don't judge. I 13200:08:40,863 --> 00:08:44,009don't judge. Now, that's a little different from the way I 13300:08:44,049 --> 00:08:48,167grew up, where you do judge. I look at him and I judge this and13400:08:48,167 --> 00:08:51,392I judge that. But as a physician, my job is not to say 13500:08:51,754 --> 00:08:56,068well, he's wearing a black watch, therefore ABC, or he's wearing13600:08:56,068 --> 00:08:59,990a blue jacket, therefore I am aphysician. My job is to give 13700:09:00,009 --> 00:09:04,708you the best care possible, and that is irrespective of what you13800:09:04,708 --> 00:09:07,866believe in, who you are. Now, everybody does not believe that,13900:09:07,866 --> 00:09:11,746but I think it's fair to say that most in society are moving 14000:09:11,768 --> 00:09:15,822toward the fact that health careis a right. It is not a 14100:09:15,884 --> 00:09:19,621privilege. I don't care what your citizenship is, i don't 14200:09:19,682 --> 00:09:23,644care where you were born. If youlanded my hospital, on my 14300:09:23,826 --> 00:09:26,871operating room table, i'm going to give you the very best care 14400:09:26,932 --> 00:09:30,461possible, and all that other stuff does not matter to me. It 14500:09:30,520 --> 00:09:34,767is not relevant to the quality of care that I give you, and 14600:09:34,787 --> 00:09:37,057this is where we're trying to get doctors and nurses and 14700:09:37,119 --> 00:09:40,727hospitals to get to today. One of the other basic principles 14800:09:40,847 --> 00:09:44,734that the federal government figured out some years ago is it14900:09:44,734 --> 00:09:49,504pays most of the money in this country for health care. The 15000:09:49,625 --> 00:09:54,559federal government, washington DC, pays most of the money for 15100:09:54,620 --> 00:09:58,769health care in this country. So the government said if I pay 15200:09:58,809 --> 00:10:02,057most of the money, i think I should control that dictionary 15300:10:03,768 --> 00:10:06,873Right. If you can't do it without me paying you and you 15400:10:06,913 --> 00:10:11,106rely on me to pay you, then I can decide what's what. And so 15500:10:11,126 --> 00:10:15,316then the government said I will decide, or help to decide, what 15600:10:15,395 --> 00:10:18,731quality is. No, dr Choctaw, we're going to go by your 15700:10:18,772 --> 00:10:23,572definition because I'm paying you Right, so you can have your 15800:10:23,631 --> 00:10:26,645thoughts. That's good. I'll listen to your opinion, but at 15900:10:26,686 --> 00:10:30,091the end of the day, it is my responsibility. So I'm going to 16000:10:30,131 --> 00:10:34,828tell you what my expectations ofyou are. Hospital X I'm going 16100:10:34,849 --> 00:10:40,469to tell you what my expectationsof you are. Okay, one of the 16200:10:40,548 --> 00:10:44,115big ways this occurred in this country admittedly, you've heard16300:10:44,115 --> 00:10:47,067about this and you sort of knowabout it, but it may not have 16400:10:47,106 --> 00:10:51,986been obvious to you at the time is the Affordable Care Act. And 16500:10:52,006 --> 00:10:54,196you hear one party in this country saying they're going to 16600:10:54,235 --> 00:10:55,903repeal it and they promise they're going to repeal, they're16700:10:55,903 --> 00:10:58,528going to get rid of it. And theother party in this country 16800:10:58,568 --> 00:11:02,197said it's the best thing that's ever happened to health care in 16900:11:02,216 --> 00:11:05,610the last 20 years. And some evencall it Obamacare because it 17000:11:05,650 --> 00:11:09,748was President Obama who actuallypushed it through. It's similar17100:11:09,748 --> 00:11:15,240to the 1950s, where Medicare was first adopted. Medicare did 17200:11:15,279 --> 00:11:19,830not exist until the 1950s. What does Medicare do? Medicare helps17300:11:19,830 --> 00:11:24,219to ensure quality care for elderly patients in this country17400:11:24,219 --> 00:11:29,168, because when you're elderly, you probably no longer work, and17500:11:29,168 --> 00:11:32,375the older you get, the more andmore and more medical 17600:11:32,434 --> 00:11:36,187conditions you're going to develop. Just the way it is Okay17700:11:36,187 --> 00:11:40,355. So the government decides. Well, if you've worked hard all 17800:11:40,394 --> 00:11:45,634your life or you've lived a longtime, you should not be denied 17900:11:46,416 --> 00:11:50,528health care just because you're over 65 years of age. So 18000:11:50,589 --> 00:11:53,499Medicare says we're going to help pay for your health care 18100:11:54,019 --> 00:11:57,289And that's why we have Medicare.And I might add that some 18200:11:57,331 --> 00:12:00,860people who objected to that in the 1950s no, no, no, no, no, no18300:12:00,860 --> 00:12:04,760. That's socialized medicine. People ought to work for the 18400:12:04,841 --> 00:12:07,909health care. For instance, i've been working for the last 50 18500:12:07,970 --> 00:12:12,645years. I'm 75 years old, i'm notgoing to work anymore, but 18600:12:12,745 --> 00:12:16,874still it depends on whether you believe that health care is a 18700:12:17,014 --> 00:12:21,831right or a privilege. Should it only be for certain people who 18800:12:21,910 --> 00:12:25,326have a certain amount of income we have a certain amount of blah18900:12:25,326 --> 00:12:28,094, blah, blah, or live in a certain zip code or should it be19000:12:28,094 --> 00:12:31,850for everybody, because it's a God-given right to human beings 19100:12:31,910 --> 00:12:35,445and it should not matter who youare, what you look like. But 19200:12:35,485 --> 00:12:38,335that's the fundamental argument.That's the fundamental argument19300:12:38,335 --> 00:12:42,147. You hear it play out all the time, every day. Three things, 19400:12:42,668 --> 00:12:45,894very briefly, that the Affordable Care Act did or does,19500:12:45,894 --> 00:12:49,549because it's still with us. Theother part was not able to 19600:12:49,591 --> 00:12:53,606repeal it. They keep trying but they keep failing. One it 19700:12:53,746 --> 00:12:58,315covered more people and it paid for care for more people. A 19800:12:58,394 --> 00:13:02,648single parent, three to four children, may not have a job, 19900:13:03,028 --> 00:13:09,009stays on welfare or something like that. How do you pay for? 20000:13:09,229 --> 00:13:13,504if you have a sick child, how doyou pay for those expenses? The20100:13:13,504 --> 00:13:17,414Affordable Care Act helps to pay for that. It controls costs.20200:13:17,414 --> 00:13:21,693Does somebody believe? well, you know you pay whatever I 20300:13:21,714 --> 00:13:26,054charge. Well not really. If I don't control the dictionary 20400:13:26,745 --> 00:13:29,514Okay, because the first control is the dictionary that's in the 20500:13:29,533 --> 00:13:33,711chalkbook You can't charge $1,000 for cutting a toenail. 20600:13:33,913 --> 00:13:37,366That just doesn't work. You can't do that. I know you may 20700:13:37,386 --> 00:13:41,876have house payments. Get a smaller house. Get a smaller 20800:13:41,937 --> 00:13:46,874house, Okay. The other thing, and probably one of the most 20900:13:47,014 --> 00:13:50,186subtle and I think one of the most profound things that 21000:13:50,245 --> 00:13:55,794Obamacare did back in 2010, is that if forced hospitals and 21100:13:55,894 --> 00:14:02,253doctors help go all electronic, force us to use the computers, 21200:14:02,673 --> 00:14:07,648put down that pen and pencil andit drove the industry crazy. I 21300:14:07,687 --> 00:14:10,735know nurses they quit at hospitals because they had to 21400:14:10,794 --> 00:14:13,267learn how to use the computer. And the nurses I want to be at 21500:14:13,307 --> 00:14:17,509the bedside Doctors who said well, i'm a doctor, i operate on21600:14:17,509 --> 00:14:19,946people, i don't want to do all that paperwork. And the 21700:14:19,985 --> 00:14:23,033government said you know what. Icontrol the dictionary. I'm 21800:14:23,073 --> 00:14:27,553paying your salary. Quality is what I say. It is What I say it 21900:14:27,653 --> 00:14:31,232is And right, honestly, my personal opinion the government 22000:14:31,273 --> 00:14:34,892was correct Because if you're doing the right thing, why is it22100:14:34,892 --> 00:14:39,009a big deal for you? Okay, what are the other fundamental things22200:14:39,009 --> 00:14:43,937about this cold change? and theidea about quality healthcare 22300:14:44,378 --> 00:14:48,894is let me do it with a hypothetical, and I'm sure I've 22400:14:48,913 --> 00:14:53,070said this before. When I graduated from medical school in22500:14:53,070 --> 00:14:57,938the early 70s as a physician, we were told that we're in 22600:14:57,979 --> 00:15:01,572charge. We doctors, i mean, are in charge. People just do what 22700:15:01,592 --> 00:15:06,190we say in a hospital. And I think I've mentioned, you know, 22800:15:06,210 --> 00:15:09,576about how nurses used to stand when the doctor used to walk on 22900:15:09,596 --> 00:15:12,667to the ward and all that sort ofstuff. But basically the 23000:15:12,706 --> 00:15:17,696response to the thing was yes, doctor. I say do X, yes, doctor,23100:15:17,696 --> 00:15:22,244do Y, yes, doctor, no question,no, blah, blah, blah, none of 23200:15:22,283 --> 00:15:27,115that. And the government said you know what, if you go and 23300:15:27,216 --> 00:15:31,024stay a couple nights at the Ritz-Caulter, before you even 23400:15:31,063 --> 00:15:33,952get home, they will send you something and say how was our 23500:15:33,974 --> 00:15:37,144service? Did you like it? Were you okay? Were there any 23600:15:37,183 --> 00:15:41,437problems? Would you come back again? Would you recommend us to23700:15:41,437 --> 00:15:44,528your friends? Blah, blah, blah.What's my point? My point is 23800:15:44,548 --> 00:15:48,783that quality organizations are always interested in the opinion23900:15:48,783 --> 00:15:51,971of the customer. Who is the customer in health care? 24000:15:52,211 --> 00:15:56,355Doctor's not the customer, nurseis not the customer, patient is24100:15:56,355 --> 00:16:00,614the customer. And so one of thethings that might last seven or24200:16:00,614 --> 00:16:04,004eight years in full-time employment run around the 24300:16:04,063 --> 00:16:06,990country trying to help, along with the joint commission, 24400:16:07,110 --> 00:16:10,505educate physicians at hospitals about quality care, a 24500:16:10,605 --> 00:16:14,384fundamental thing, i would say it is no longer doctor about you24600:16:14,384 --> 00:16:19,355. Used to be about you. Seven isan eight. This is now 2023. 24700:16:19,375 --> 00:16:23,711It's about the patient. It's what the patient thinks, it's 24800:16:23,770 --> 00:16:26,885what the patient believes, it's what the patient feels And so, 24900:16:26,985 --> 00:16:30,192in effect, this is what the government who controls the 25000:16:30,231 --> 00:16:34,870dictionary, who pays the money has adopted and said it's 25100:16:35,212 --> 00:16:39,216patient-centered care. So what do you do with something that's 25200:16:39,255 --> 00:16:42,788patient-centered or customer-centered? The patient 25300:16:42,889 --> 00:16:46,807is your customer. You ask their opinion. So the government, many25400:16:46,807 --> 00:16:50,453years, came up with something called HCAPS and that stands for25500:16:50,453 --> 00:16:55,730Hospital Consumer Assessment ofHealthcare Provider and Systems25600:16:55,730 --> 00:17:00,341. What that means is hospital consumer assessment, patient of 25700:17:00,523 --> 00:17:04,853healthcare providers, doctors and nurses, and hospitals and 25800:17:04,932 --> 00:17:09,387systems, healthcare delivery systems. So two weeks after the 25900:17:09,448 --> 00:17:13,913Medicare patient is discharged from hospital, a hospital will 26000:17:13,953 --> 00:17:21,090send a correspondence, a letter with a survey, and it will have 26100:17:21,230 --> 00:17:25,60727 questions, only 27 questions,and the questions are in 26200:17:25,647 --> 00:17:28,976different areas, and I'll just deal with the question about 26300:17:29,017 --> 00:17:30,969doctor And the only three questions. They ask the patient 26400:17:30,989 --> 00:17:34,484about doctor and the concern here is zero patient harm And 26500:17:34,505 --> 00:17:38,913the answers to the questions areeither always, usually, 26600:17:39,755 --> 00:17:44,189sometimes or never. Okay, all the patients do is fill in the 26700:17:44,209 --> 00:17:49,565circle that says always, usually, sometimes or never. The three 26800:17:49,585 --> 00:17:55,415questions that they ask about doctors is how often does your 26900:17:55,455 --> 00:17:58,529doctor treat you with courtesy and respect? Real basic question27000:17:58,529 --> 00:18:02,209How often did your doctor, whenyou were in the hospital 27100:18:02,650 --> 00:18:07,416hospital ABC for two weeks how often did your doctor treat you 27200:18:07,877 --> 00:18:14,656with courtesy and respect? Always, usually, sometimes or 27300:18:14,737 --> 00:18:18,630never? And here's the deal If the patient's answer is not 27400:18:19,491 --> 00:18:24,240always or usually, medicare ignores the other two scores. 27500:18:24,865 --> 00:18:30,661They don't care about never and sometimes It is zero. You get a 27600:18:30,721 --> 00:18:34,412zero for that. The only thing they score are four for always, 27700:18:34,873 --> 00:18:39,628three for usually, that's all Okay. Second question they ask 27800:18:39,648 --> 00:18:42,875the patient about the doctor. How often does your doctor 27900:18:43,016 --> 00:18:47,070listen to you? Real basic stuff.Doctor comes in making rounds. 28000:18:47,111 --> 00:18:51,027Good morning, mr Smith. How are you this morning? Mr Smith says 28100:18:51,227 --> 00:18:54,676oh, you know, doctor, i had thishorrible headache and my eyes 28200:18:54,757 --> 00:18:58,667have sort of been watering and my neck is sore. He says okay, 28300:18:58,688 --> 00:19:07,346you have a nice day, mr Smith. God bless Anybody in the next 28400:19:07,366 --> 00:19:12,086section. How often does your doctor listen to you? Real basic28500:19:12,086 --> 00:19:15,613stuff, right? Third and final question They ask the patient, 28600:19:15,653 --> 00:19:20,346medicare patient in this survey they send out. How often does 28700:19:20,386 --> 00:19:26,126your doctor explain in ways thatyou can understand? How often 28800:19:26,166 --> 00:19:31,505does your doctor explain in waysthat you can understand? One of28900:19:31,505 --> 00:19:34,068my responsibilities that I won't mention the name, but a 29000:19:34,108 --> 00:19:36,833small hospital in West convenient California is that I 29100:19:36,853 --> 00:19:41,779would try to educate the doctorsabout sitting when you make 29200:19:41,839 --> 00:19:44,608rounds. You know, doctor comes in morning, mr Jones, blah, blah29300:19:44,608 --> 00:19:46,491, blah, blah, blah, blah, blah, blah, blah, blah. Have a great 29400:19:46,512 --> 00:19:51,267day. Any questions? And you know, leave in the room. And usually29500:19:51,267 --> 00:19:53,751when the doctor says are there any questions, his hand is on 29600:19:53,771 --> 00:19:58,246the doorknob right Because he's going out the door. And do you 29700:19:58,306 --> 00:20:00,529know and this is what I would explain to the doctor, because I29800:20:00,529 --> 00:20:05,597learned this, most patients believe very strongly that 29900:20:05,698 --> 00:20:10,250doctors are extremely busy. Number one, number two most 30000:20:10,309 --> 00:20:15,077patients are extremely, extremely, extremely respectful 30100:20:15,157 --> 00:20:20,373of physicians. They will not askyou a question if they think 30200:20:20,413 --> 00:20:24,006you're too busy to answer. They will not. And they can have a 30300:20:24,026 --> 00:20:27,011question. Oh my God, i've been waiting all night and I, you 30400:20:27,051 --> 00:20:30,097know, i want to make sure that Igrab Dr Chalker this morning. 30500:20:30,545 --> 00:20:32,989And so what? I tell the doctor, you've got to give them 30600:20:33,048 --> 00:20:36,753permission to ask you a question. And how do you do that? You 30700:20:36,814 --> 00:20:43,670say thank you, mr Jones, do you have any questions? And you 30800:20:43,789 --> 00:20:50,510follow it up with one simple sentence I have the time. So 30900:20:50,691 --> 00:20:57,048take your hand off the doorknob And say do you have any 31000:20:57,087 --> 00:21:02,040questions? Mr Smith, i have the time. When you say I have the 31100:21:02,080 --> 00:21:06,422time now, you're saying okay, he's given me permission to ask 31200:21:06,481 --> 00:21:11,722him a question. They will not ordinarily, they will 98 percent31300:21:11,722 --> 00:21:15,260, 99 percent of the patients said I do have this pain, that I31400:21:15,260 --> 00:21:20,161want to answer Dr Bob, but Dr Choctaw is so busy. He's so busy31500:21:20,161 --> 00:21:24,617. I see him running up and down the place and this and that I'll31600:21:24,617 --> 00:21:29,364be okay. I'll be okay, but it is our responsibility to go to 31700:21:29,384 --> 00:21:32,182the patient. Patient should havetried to figure out what to ask31800:21:32,182 --> 00:21:37,098us. Our responsibility is do you have any questions? That's 31900:21:37,138 --> 00:21:40,661the huge change in health care where it's basically top down 32000:21:40,721 --> 00:21:44,278and you do what we say and you do the way I say it. I remember 32100:21:45,080 --> 00:21:47,497when I would go on rounds and I'm wearing my little white 32200:21:47,537 --> 00:21:51,209pants as an intern and then there's the middle resident and 32300:21:51,229 --> 00:21:53,842the senior resident, then there's the professor in surgery32400:21:53,842 --> 00:21:56,663at Yale. The professor would walk into the patient is going 32500:21:56,682 --> 00:21:59,212to have surgery and he would look at her and he would say 32600:21:59,252 --> 00:22:01,318something like this tomorrow morning I'm going to take you to32700:22:01,318 --> 00:22:03,617surgery at 730 in the morning and I'm going to do a 32800:22:03,657 --> 00:22:06,643colisostectomy. The operation will last approximately two 32900:22:06,722 --> 00:22:09,714hours and four to five minutes. You will have some discomfort, i33000:22:09,714 --> 00:22:12,578will give you pain medication, you will be in the hospital 33100:22:12,598 --> 00:22:16,137maybe about two weeks and then he walk out of the room. I had 33200:22:16,157 --> 00:22:20,537to answer the same What. What did he say? And what would 33300:22:20,576 --> 00:22:25,780happen was the resident would stop and say Mrs Smith, do you 33400:22:25,801 --> 00:22:31,025have any questions? Professor Choctaw is so busy, but I'll ask33500:22:31,025 --> 00:22:35,181you a question And that's how we used to do it. So hopefully, 33600:22:35,480 --> 00:22:40,157most of that chain where we stopped and we even tell the doc33700:22:40,157 --> 00:22:45,141sit in a chair by the bed. So if you feel comfortable, sit on 33800:22:45,161 --> 00:22:48,202the bedside. Some do that and say do you have any questions? 33900:22:48,434 --> 00:22:51,878Why? Because most communication is non-verbal, it is not what I 34000:22:51,999 --> 00:22:56,654say, it is what I do. So if I don't say I have the time, but 34100:22:56,675 --> 00:23:00,663if I sit on your bed or if I pull up a chair beside your bed,34200:23:00,663 --> 00:23:05,976i'm telling you yeah, i got some minutes. Talk to me Very 34300:23:06,057 --> 00:23:09,583important. And so this is what'shappening in healthcare. Then 34400:23:10,055 --> 00:23:15,198Some hate this. Some vicious hate this. Some in healthcare 34500:23:15,218 --> 00:23:19,483hate this, but I think it's fairto say that the majority of us 34600:23:20,115 --> 00:23:22,980are moving in this direction Andthis is one of my jobs, which I34700:23:22,980 --> 00:23:26,419loved, among other things, one of the things that I have 34800:23:26,479 --> 00:23:30,219learned, like a lot of times, doctors say well, you know, i 34900:23:30,278 --> 00:23:34,395practice in San Gabriel Valley and it is so diverse, you've got35000:23:34,395 --> 00:23:37,019so many different ethnic groupsand so many different, so many 35100:23:37,039 --> 00:23:41,777of that. I can't be responsible for making sure that everybody 35200:23:41,877 --> 00:23:45,617understands everything. It understands me and whatever, and35300:23:45,617 --> 00:23:48,580what I would do, what I would give, like my little 35400:23:51,056 --> 00:23:55,281quick-to-minute lecture to the doc I said respect transcends 35500:23:55,342 --> 00:23:59,015all culture. You don't have to be an expert in Mandarin or 35600:23:59,036 --> 00:24:05,415Chinese or Tagalog or Filipino or on and on and on. Just be 35700:24:05,455 --> 00:24:09,635respectful, be respectful. And how do you be respectful? Most 35800:24:09,655 --> 00:24:13,698communication is non-verbal. Read the room. You walk into a 35900:24:13,758 --> 00:24:19,954room and father is the patient, mother is sitting beside him and36000:24:19,954 --> 00:24:22,522the kids the adult kids are standing in the room. What do 36100:24:22,564 --> 00:24:26,817you do? One of the things you wanna do is you speak to father,36200:24:26,817 --> 00:24:30,159but you wanna speak to mother. I used to shake hands with the 36300:24:30,219 --> 00:24:32,357little kids. They'd all grin andlaugh cause they thought I was 36400:24:32,377 --> 00:24:36,942silly. But what's my purpose? Mypurpose is I am respecting you,36500:24:36,942 --> 00:24:41,141i see you. I see you, you're not just a chair up against the 36600:24:41,182 --> 00:24:44,999wall. We'll come back to that. Let me say a real quick word 36700:24:45,038 --> 00:24:47,380about Ling Six Sigma and I won'tspend a lot of time on this. 36800:24:47,914 --> 00:24:53,557But those of you who are very process-oriented and much of 36900:24:53,617 --> 00:24:59,502this has come from institutions like airlines, industry and 37000:24:59,663 --> 00:25:03,438others that have to get everything right And if they 37100:25:03,458 --> 00:25:06,079don't get everything right, if they make mistakes, so things 37200:25:06,099 --> 00:25:09,803don't go right, they all die many times along with the 37300:25:09,843 --> 00:25:12,996patient. Big incentive, big incentive, right, different from37400:25:12,996 --> 00:25:15,957healthcare. Different from healthcare where you say, well, 37500:25:16,057 --> 00:25:19,051he was 900 years old and blah, blah, blah, blah, blah, blah. 37600:25:19,375 --> 00:25:23,998But if you're on that same plane, right, you're on that same 37700:25:24,038 --> 00:25:27,596plane, you don't need a bigger incentive. One of the most 37800:25:27,678 --> 00:25:32,037important I think one of the most excellent systems is Ling 37900:25:32,057 --> 00:25:36,144Six Sigma. Ling, real quickly, just means eliminating waste. 38000:25:37,035 --> 00:25:41,202Eliminating waste which you guessed is one of the biggest 38100:25:41,403 --> 00:25:44,903waste when you go to the hospital or go to see the doctor38200:25:44,903 --> 00:25:47,857, what's one of the biggest waste, something that should not38300:25:47,857 --> 00:25:53,405happen. You think, what are those rooms that you fit in? 38400:25:53,875 --> 00:25:58,938waiting room waiting. Why do youhave to wait? What dictionary 38500:25:58,959 --> 00:26:02,076is that in? Who says that you gotta wait two hours before your38600:26:02,076 --> 00:26:05,935doctor sees you when you go to her office? Where is that 38700:26:05,996 --> 00:26:10,636written that you have to wait two hours? But one of the things38800:26:10,636 --> 00:26:17,646that I used to do in my office,in my office manager is sitting38900:26:17,646 --> 00:26:21,816right in front of me. She ran not only me but my office. We 39000:26:21,836 --> 00:26:26,576had a policy. Who started? We had a policy in my office If you39100:26:26,576 --> 00:26:30,078had a one o'clock appointment to see me but you arrived at 39200:26:30,098 --> 00:26:34,9811230, we would see you at 1230. Because we were already there 3039300:26:34,981 --> 00:26:37,957or an hour before your appointment time. Right, Because39400:26:37,957 --> 00:26:40,058we scheduled appointments. We know what time you're supposed 39500:26:40,078 --> 00:26:44,244to come in And we would see you because, the idea being number 39600:26:44,345 --> 00:26:48,895one, to show respect, my time isvaluable. Who is your turn? But39700:26:48,895 --> 00:26:51,999why should you have to wait forme? Why should I have to wait 39800:26:52,038 --> 00:26:57,757for you? Mutual respect okay, solean eliminates waste. What Six39900:26:57,757 --> 00:27:03,236Sigma does is Six Sigma the onethat eliminates variation. If 40000:27:03,296 --> 00:27:08,118there are six of us, seven of usin this room, and we all wanna 40100:27:08,138 --> 00:27:12,075get out that door, but we all wanna get out of this room, but 40200:27:12,115 --> 00:27:14,817we come up with seven different ways to do it. Some go out the 40300:27:14,857 --> 00:27:17,339door, some go out this door, some go out the window, some go 40400:27:17,400 --> 00:27:20,141out this other way. That's really pretty inefficient, 40500:27:20,221 --> 00:27:23,782wouldn't you say? Now, multiply that in a huge hospital delivery40600:27:23,782 --> 00:27:29,195system, a thousand beds with a thousand plus patients. So to 40700:27:29,277 --> 00:27:34,720have efficiency, to not make mistakes, you need to have a 40800:27:34,961 --> 00:27:38,740simple but effective process, and that's what Six Sigma does, 40900:27:39,001 --> 00:27:44,375right. Six Sigma says I would beon rounds in a hospital, c and 41000:27:44,856 --> 00:27:47,797Chicago, and they would be presenting to me about something41100:27:47,797 --> 00:27:51,843they're very proud of and they say you know, we decreased our 41200:27:51,923 --> 00:28:00,132infection rate from 80%, we improved our efficiency up to 41300:28:00,251 --> 00:28:07,69980%, 85%, and nobody in the areahas hit 80%. And I was saying 41400:28:08,541 --> 00:28:15,061you're good. I said but why not 90? I said, well, nobody does 9041500:28:15,061 --> 00:28:18,278. I said I'm not talking about all those other people, you're 41600:28:18,298 --> 00:28:25,356the superstar. I said well, why not 95? Why not 100? When did we41700:28:25,356 --> 00:28:30,615decide that 80% was excellent? Who wrote that dictionary? And 41800:28:30,655 --> 00:28:33,559then I would tell them true story. I said because if I'm a 41900:28:33,619 --> 00:28:37,401patient in your hospital, or my wife or my children or my 42000:28:37,461 --> 00:28:42,455grandchildren, i want 100%. I'm not impressed with the 85%. Good42100:28:42,455 --> 00:28:47,219job, good job, but I expect youto do more. I expect you. Six 42200:28:47,259 --> 00:28:55,028Sigma to break it down mathematically says 99.999666, 42300:28:55,429 --> 00:29:00,684that that distance between 99% and 100, you can do better. That42400:29:00,684 --> 00:29:04,336makes sense. Six Sigma says youneed to be not at 85%, it needs42500:29:04,336 --> 00:29:08,921to be at 99, but even at 99, you can do better before you get42600:29:08,921 --> 00:29:13,457to 100. It asks us you never stop improving. There's always 42700:29:13,518 --> 00:29:17,682something better that you can do. And that's actually been 42800:29:17,823 --> 00:29:20,140articulated. And I would encourage you to take that 42900:29:20,560 --> 00:29:25,276handheld computer that you have in Lookup Lean Six Sigma Real 43000:29:25,296 --> 00:29:28,317quickly. This is just the roadmap for it define, measure, 43100:29:28,417 --> 00:29:31,460analyze, improve, control. I'll just say a quick word about 43200:29:31,500 --> 00:29:37,816define, whenever there's a problem, a system. Let's say Dr 43300:29:37,855 --> 00:29:44,076McClure is the owner of a small hospital, 250 beds. In his 43400:29:44,135 --> 00:29:48,855hospital he has OBGYN departmentfor delivering babies. He has 43500:29:48,895 --> 00:29:51,696an emergency department where patients come in if they have 43600:29:51,737 --> 00:29:56,236emergencies. One of his managerscomes to him and he says Dr 43700:29:56,256 --> 00:29:59,060McClure, we have a problem. And he said but what's your problem?43800:29:59,060 --> 00:30:02,178And she says well, we have a lot of people who come to our 43900:30:02,238 --> 00:30:06,316emergency room but they leave before they see the doctor. They44000:30:06,316 --> 00:30:09,259leave before they see the doctor. We call it left without 44100:30:09,338 --> 00:30:13,936being seen. Okay, leave before they see the doctor. But he says44200:30:13,936 --> 00:30:16,936why are they leaving before they see the doctor? She says I 44300:30:16,957 --> 00:30:21,217don't know. She said what is theproblem? She said because we 44400:30:21,257 --> 00:30:25,182have all these people tired of and, more importantly, we aren't44500:30:25,182 --> 00:30:27,582doing anything for the community. So what are some of 44600:30:27,602 --> 00:30:29,895the reasons they can be leaving without seeing the doctor? Well,44700:30:29,895 --> 00:30:32,816maybe they have to wait too long See the doctor. If they 44800:30:32,836 --> 00:30:37,301have to wait six hours, 10 hours, would you leave your mother? 44900:30:37,835 --> 00:30:41,256You bring your kid in because hehad an ear infection. You got 45000:30:41,276 --> 00:30:43,739to go to work the next morning. You bring the kid in at two 45100:30:43,759 --> 00:30:47,482o'clock at night and you wait eight hours in an emergency room45200:30:47,482 --> 00:30:51,739before taking him, before having him seen. So is it 45300:30:51,759 --> 00:30:55,201waiting too long? Is it they feel uncomfortable in your 45400:30:55,241 --> 00:30:58,538emergency room? Maybe it's not clean, maybe there's a lot of 45500:30:58,617 --> 00:31:02,359activity and they don't feel safe in their emergency room. 45600:31:03,214 --> 00:31:06,778Maybe they've seen your doctors walk around in the emergency 45700:31:06,798 --> 00:31:12,180room and they wear flip flops inshorts And you said whoa, whoa,45800:31:12,180 --> 00:31:18,997am I in the right place? So what's my point? My point is, 45900:31:19,818 --> 00:31:24,018for those of you who are math enthusiasts, there's a formula 46000:31:24,058 --> 00:31:29,037for lane sixing. It says y equals a function of x. Y is 46100:31:29,057 --> 00:31:33,557your problem, y is what you're trying to solve. Y is what 46200:31:33,597 --> 00:31:37,422you've got to fix. X are the number of reasons that are 46300:31:37,461 --> 00:31:40,401causing your problems, but you don't know which one it is. 46400:31:41,015 --> 00:31:44,476Let's say you have five x's. Oneyou have to wait too long. Two 46500:31:44,516 --> 00:31:46,759your emergency room is dirty. Three they don't like to wear 46600:31:46,778 --> 00:31:49,875your doctor's. Look on, and on, and on and on and on. Lane 46700:31:49,895 --> 00:31:52,763sixing may help you identify which x you need to fix 46800:31:53,429 --> 00:31:57,382basically. And one final thing about defined. Whenever there's 46900:31:57,422 --> 00:32:01,739a problem in any organization orsomething has happened and see,47000:32:01,739 --> 00:32:04,338we got to fix that, first thingthat happens when you have a 47100:32:04,398 --> 00:32:07,118meeting. Everybody comes up witha solution Well, i think we 47200:32:07,138 --> 00:32:08,999should do this and this. And somebody says, well, i think you47300:32:08,999 --> 00:32:11,961should do EFG. Somebody said, well, i think you should A and B47400:32:11,961 --> 00:32:16,262. Albert Einstein once said and I always remember this when I 47500:32:16,303 --> 00:32:19,259have a problem and I've said this before when I have a 47600:32:19,318 --> 00:32:26,038problem, i spend and I have an hour fixing it. I spend 55 47700:32:26,098 --> 00:32:29,866minutes defining the problem andfive minutes solving the 47800:32:29,887 --> 00:32:33,417problem. What's my point? Most of the things that will help you47900:32:33,417 --> 00:32:38,538solve a problem is sitting downand talking about defining. 48000:32:38,578 --> 00:32:41,484What do you mean when you say enough without B and C? What do 48100:32:41,525 --> 00:32:45,067you mean? Blah, blah, blah. You would be amazed at how much 48200:32:45,133 --> 00:32:48,069miscommunication occurs because we say things but everybody has 48300:32:48,089 --> 00:32:51,935a different meaning. But we never asked. I think that's what48400:32:51,935 --> 00:32:56,877the roadmap looks like with Lean Six Sigma. Again, use your 48500:32:57,378 --> 00:33:02,099hand computer to look up Lean Six Sigma. Okay, medical 48600:33:02,181 --> 00:33:05,922malpractice. So I'm just about done, right, right, right, 48700:33:05,942 --> 00:33:10,859you've been following me, right?I'm just about done. So what is48800:33:10,859 --> 00:33:14,961medical malpractice Now I have been asking you for the last 48900:33:15,101 --> 00:33:18,655five weeks, five months, to think like doctors. I'm not 49000:33:18,675 --> 00:33:21,298going to ask you to think like lawyers. What about being a 49100:33:21,337 --> 00:33:25,894doctor? You're now an attorney. You're now attorneys. We're 49200:33:25,914 --> 00:33:35,667dealing with the Andrew Collins,hammons, jesse Hammons law 49300:33:35,708 --> 00:33:41,824practice. They are famous aroundthe area, particularly medical 49400:33:41,864 --> 00:33:51,319malpractice, So they're the top of the line. And one of the 49500:33:51,339 --> 00:33:54,788things I learned is that people tend to like doctors in general.49600:33:54,788 --> 00:33:59,119People don't tend to like lawyers in general. I'm just 49700:33:59,160 --> 00:34:02,161generalizing them, but somebody once said people tend to hate 49800:34:02,221 --> 00:34:06,256lawyers until you need one, Until you need one. When you 49900:34:06,276 --> 00:34:09,498need one, you need a good one. And one of the things that I 50000:34:09,557 --> 00:34:13,155learned when I went to law school was how little I knew 50100:34:13,275 --> 00:34:17,340about the law, and the reason for that is the law is 50200:34:17,400 --> 00:34:24,144deceptively complex. You read a line that says you for God, go 50300:34:24,164 --> 00:34:27,856to prison. And you say well, i understand that. I know what a 50400:34:27,896 --> 00:34:30,969God is. I know what a prison is.I know what you for God, god, 50500:34:30,989 --> 00:34:32,980go to prison. I know what that means. But that's not 50600:34:33,061 --> 00:34:36,615necessarily true. That's not necessarily true, and I can tell50700:34:36,615 --> 00:34:42,751you when I went to law school, I was older than the other 50800:34:42,791 --> 00:34:46,740students. They were 20 something, i was 40 something, whatever, 50900:34:47,061 --> 00:34:51,24040 or 50 something. And one of my favorite classes was TORT, 51000:34:51,641 --> 00:34:56,940p-o-r-t, and TORT means injury And that's connected to our 51100:34:56,960 --> 00:35:00,981subject. And I was sitting. You got to say I'm one of those 51200:35:01,021 --> 00:35:06,039students who gets a class an hour, 30 minutes ahead of time. 51300:35:06,394 --> 00:35:10,576I sit in the front row. I mean, you know the type, i got my 51400:35:10,635 --> 00:35:15,619pencils in my bag. You say them,come on, i'm that type of 51500:35:15,639 --> 00:35:18,956student, all right, so you get the picture. So I'm sitting in 51600:35:18,976 --> 00:35:23,898the front row, you know, ready, ready. And instructor gets up 51700:35:23,958 --> 00:35:28,155and says man walks up to anotherman, takes a gun, puts it to 51800:35:28,335 --> 00:35:32,103his head, pulls the trigger, puts him in the head, man drops 51900:35:32,164 --> 00:35:35,701and he's dead. Is that murder? And I jump up and I'm throwing 52000:35:35,721 --> 00:35:38,831my hand up. I'm on the front rowthrowing my hand up and he's 52100:35:38,851 --> 00:35:43,342still there. And he said, dr Chalkton, i said yes, it's 52200:35:43,402 --> 00:35:46,552murder. And the instructor looked at me and he says it 52300:35:46,572 --> 00:35:50,737depends. And I said well, even it depends. You just told me 52400:35:51,077 --> 00:35:53,503that the guy walked up, put the gun to his head, pulled the 52500:35:53,523 --> 00:35:57,914trigger. The guy was there. He said was it his house? I don't 52600:35:57,934 --> 00:36:02,775know. He said what was the man doing when the guy shot him? I 52700:36:02,795 --> 00:36:06,076said I don't know. He said was the man coming at him? Did he 52800:36:06,115 --> 00:36:10,862have a gun? also, i said I don'tknow what the instructor was 52900:36:10,942 --> 00:36:15,398telling me is it does depend. You've got to know the fact 53000:36:15,559 --> 00:36:19,942before you come to a conclusion.Braininess, it is not black and53100:36:19,942 --> 00:36:24,161white. I'm a doctor, not only I'm a surgeon. We really are 53200:36:24,202 --> 00:36:27,458black and white. Give me a knife, i'll find out what the problem53300:36:27,458 --> 00:36:35,119is. Right, no Longest, don't get nice. And so whenever you 53400:36:35,278 --> 00:36:39,894ask an attorney and I encourage you to take me up on this, any 53500:36:40,014 --> 00:36:44,097attorney ask him or her a question And I guarantee you the53600:36:44,097 --> 00:36:47,224first thing she will say to you. But he will say to you it 53700:36:47,264 --> 00:36:50,322depends. First thing they will say they'll say two words, it 53800:36:50,362 --> 00:36:52,961depends, because what they're saying is you got to give me 53900:36:53,001 --> 00:36:55,956more information, you got to give me more. You can't just 54000:36:55,996 --> 00:36:59,143tell me somebody got shot and expect me to come to a 54100:36:59,164 --> 00:37:03,076conclusion and not give me anything to work with. So that's54200:37:03,076 --> 00:37:07,782the fundamental difference between medicine and law. Right,54300:37:07,782 --> 00:37:14,652i would tell members of my hospital when I was people's bad54400:37:14,652 --> 00:37:18,280and they would bring to me a situation, let's say harassment 54500:37:18,882 --> 00:37:22,335of some type And they would say,oh, it's terrible, this this, 54600:37:22,376 --> 00:37:24,777this, this this, this, this, this, this. We need to do A, b 54700:37:24,836 --> 00:37:30,375and C And I would say have you talked to the other party? Do 54800:37:30,416 --> 00:37:32,619you have the other side of it? One of the things I learned in 54900:37:32,659 --> 00:37:35,815law school if I did not move before, there are always two 55000:37:35,876 --> 00:37:41,378sides, always, always, always. Idon't care if the guy put the 55100:37:41,418 --> 00:37:43,844handgun to the guy's head and shot, just like I was saying. 55200:37:44,954 --> 00:37:47,737What were the circumstances around that? But what was the 55300:37:47,757 --> 00:37:51,635guy holding the guy's family hostage? I don't know, i don't 55400:37:51,655 --> 00:37:56,063know. So my point is and I really believe this is where the55500:37:56,063 --> 00:37:59,759law helped me personally, i have, for the most part, always 55600:37:59,798 --> 00:38:02,815met a black and white type of guy. You know, blah blah, blah, 55700:38:02,856 --> 00:38:04,331blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, 55800:38:04,351 --> 00:38:07,842blah. What I have learned? what I have learned is to take a step55900:38:07,842 --> 00:38:12,586back, ask a few more questions,don't be so quick to judge, 56000:38:13,554 --> 00:38:16,880don't be so quick to think I have the answer, because many 56100:38:16,920 --> 00:38:20,568times are wrong and I don't wantto be wrong. That makes sense. 56200:38:21,175 --> 00:38:25,786So. So my point is that, regardsto what you think about lawyers56300:38:25,786 --> 00:38:29,762, one of the things that the lawdoes is that it makes you slow 56400:38:29,802 --> 00:38:33,096down and get all the facts, because you don't want to be 56500:38:33,155 --> 00:38:37,902wrong. Whatever conclusion you come to, you want it to be the 56600:38:37,963 --> 00:38:41,139right conclusion. You're right, so. So just keep that in mind. 56700:38:41,239 --> 00:38:45,791Okay, let's go. So. Chart is a type of law that means injury, 56800:38:45,992 --> 00:38:50,614porp. Now there are two main bigsections of the law. There's 56900:38:50,655 --> 00:38:55,918criminal and there's there's civil right. Criminal and civil 57000:38:57,355 --> 00:39:02,516Malpractice is civil law. It is not criminal. Let me explain the57100:39:02,516 --> 00:39:07,764difference. If I am found in violation of a civil statute, 57200:39:08,324 --> 00:39:12,221basically I pay money, i have injured somebody or I have 57300:39:12,260 --> 00:39:16,800created an injury And to make that person whole, i have to 57400:39:16,920 --> 00:39:21,958compensate them for their injury. Okay, if, on the other hand, i57500:39:21,958 --> 00:39:26,246am found guilty of a criminal statute, i go to jail. Think 57600:39:26,286 --> 00:39:30,119about that. Civil, you pay money, criminal, you go to jail. 57700:39:31,335 --> 00:39:36,025Civil. Somebody will sue me or some entity will sue me and blah57800:39:36,025 --> 00:39:40,061, blah, blah, blah. You defame me, you violated this or 57900:39:40,101 --> 00:39:44,820whatever, whatever, whatever. But if it's criminal, the 58000:39:45,463 --> 00:39:48,472District Attorney of the State of California will say, 58100:39:48,873 --> 00:39:52,880representing the citizens of theState of California, because my58200:39:52,880 --> 00:39:59,639crime is considered a violationof the state, i violated all 58300:40:00,001 --> 00:40:02,626the members of the State of California, and that's my other 58400:40:02,666 --> 00:40:05,918point Medical malpractice is a state law. It is not a federal 58500:40:05,978 --> 00:40:10,217law. That's why it may vary fromstate to state. Texas may be a 58600:40:10,257 --> 00:40:12,938little different from California, but the basic parts of it, 58700:40:12,978 --> 00:40:19,061though, is the same. What is thedefinition? going back to what 58800:40:19,101 --> 00:40:24,018was said before about defining What is the definition of 58900:40:24,099 --> 00:40:28,880medical malpractice, the definition is acting 59000:40:29,219 --> 00:40:34,135unreasonably under the circumstances. Acting 59100:40:34,235 --> 00:40:38,737unreasonably under the circumstances. There are three 59200:40:38,856 --> 00:40:41,960elements to that definition. Three elements, only three. 59300:40:43,114 --> 00:40:47,436Number one acting you got to do something. You got to do 59400:40:47,516 --> 00:40:53,005something. Number two unreasonably what you did was 59500:40:53,065 --> 00:40:58,059not reasonable. And third element under the circumstances.59600:40:58,059 --> 00:41:07,460Let me give you an idea. The patient comes into the emergency59700:41:07,460 --> 00:41:17,735room as part of a 50 car call up on the freeway. The patient 59800:41:17,775 --> 00:41:21,614comes in and the emergency room is just a big scramble. They 59900:41:21,655 --> 00:41:24,643call it down with trauma surgeons and we come down and 60000:41:24,663 --> 00:41:28,119we're taking different patients and blah, blah, blah, blah, blah60100:41:28,119 --> 00:41:35,302, and, let's say, one of the surgeons, at the end of the 60200:41:35,403 --> 00:41:40,820operation the scar of the surgery is longer than it 60300:41:40,920 --> 00:41:44,994normally would be. That's just for the sake of argument. And 60400:41:45,014 --> 00:41:48,021the patient decides to sue the surgeon because she didn't like 60500:41:48,043 --> 00:41:52,601the way her scar looked Surgeon's attorney will say 60600:41:52,621 --> 00:41:55,958there were 50 people in that emergency room. Dr McClure was 60700:41:56,059 --> 00:41:59,940operating on 25 of them By himself because he's a super 60800:41:59,960 --> 00:42:07,431doctor. So if the scar on patient number 10 was a little 60900:42:07,635 --> 00:42:12,621longer than patient number 11, under those circumstances that's61000:42:12,621 --> 00:42:17,918really okay. That's not a big deal. So it's important to 61100:42:18,039 --> 00:42:21,976understand the definition. You got to do something. Let's say 61200:42:22,657 --> 00:42:28,853you are at a meeting, so you're a church, and someone comes up 61300:42:28,932 --> 00:42:33,344and says you know, i've got thisblah, blah, blah, blah blah and61400:42:33,344 --> 00:42:37,427I've been taking medicine A or medicine B and I'm thinking 61500:42:37,447 --> 00:42:41,445about throwing out medicine A and just taking medicine B. Do 61600:42:41,485 --> 00:42:50,548you think that's okay, dr X? So what should Dr X do? True true, 61700:42:51,751 --> 00:42:55,228never was should not answer the question, but at the very 61800:42:55,349 --> 00:43:00,351minimum is to say I don't have enough information, which is 61900:43:00,391 --> 00:43:04,492true. I wanna think I should tell the young doctors coming up62000:43:04,492 --> 00:43:08,650don't make telephone diagnoses.People will call you up and say62100:43:08,650 --> 00:43:11,365you know, i just woke up and I got this pain that's on the 62200:43:11,405 --> 00:43:14,905right side and it's going aroundto the disc and to the that. Do62300:43:14,905 --> 00:43:17,847you think I need to go see the doctor? or just wait until 62400:43:17,887 --> 00:43:22,266morning And I would say do the safest thing, and that's 62500:43:22,306 --> 00:43:25,369probably go into the emergency room. But you don't know, you 62600:43:25,409 --> 00:43:29,389don't have a clue. You don't have a clue. Now, this is based 62700:43:29,628 --> 00:43:32,885on what's reasonable for the reasonable position. The 62800:43:32,925 --> 00:43:35,827standard is not the reasonable person, the standard is the 62900:43:35,867 --> 00:43:38,510reasonable position. So what they will do is that they will 63000:43:38,552 --> 00:43:46,431call in a expert doctor, dr Rebus, and say Dr Rebus, we want63100:43:46,431 --> 00:43:50,150you to review this record because there's been a concern 63200:43:50,190 --> 00:43:55,135about DrX and we want to make sure that you think that he did 63300:43:55,264 --> 00:43:59,626or did not operate reasonably under the circumstances. Okay, 63400:44:00,525 --> 00:44:03,355so, therefore, elements that plaintiffs counsel has approved 63500:44:03,505 --> 00:44:08,210to find reliable for malpracticeDid you have a duty to the 63600:44:08,250 --> 00:44:12,248patient? Did you have a duty to the patient. Now, if the patient63700:44:12,248 --> 00:44:15,130came into your office and you touched him, then you have a 63800:44:15,170 --> 00:44:18,126duty. If you saw the patient in the emergency room, you touched 63900:44:18,186 --> 00:44:23,626him, you have a duty. And I say you're at a dinner party and 64000:44:23,666 --> 00:44:31,931you're all drinking your sodas. Exploders. Cold, cold, whatever 64100:44:31,971 --> 00:44:36,925you like. You're getting the charm. You're getting the charm.64200:44:36,925 --> 00:44:41,769You didn't even miss that eventAnd you're drinking your sodas 64300:44:42,304 --> 00:44:46,429and someone asks you for advice.Do you have a duty to that 64400:44:46,449 --> 00:44:50,326patient? Probably not. So my point is. My point is you got to64500:44:50,326 --> 00:44:54,893have a duty to the patient. Didyou breach your duty for the 64600:44:54,934 --> 00:44:58,471patient? Second element breach means did you violate that duty?64700:44:58,471 --> 00:45:01,253That's why you called in the expert witness to review the 64800:45:01,313 --> 00:45:04,927record. It was gonna be another doctor to say, yeah, he did. It 64900:45:04,947 --> 00:45:08,925did not breach your duty. Did your breach cause damages? And 65000:45:08,985 --> 00:45:11,887indeed were there damages. So the four elements that 65100:45:11,907 --> 00:45:15,389plaintiffs counsel has to prove before you can be found liable 65200:45:15,851 --> 00:45:21,594for medical malpractice. Now, ifyou are inclined to find out 65300:45:21,695 --> 00:45:26,896more about this subject, there'san expert, expert, expert. No, 65400:45:26,936 --> 00:45:34,849it's not One of the things that I would give. I talk to doctors 65500:45:34,889 --> 00:45:39,106and I would give basically the same talk to the doctor. There 65600:45:39,126 --> 00:45:41,871are certain things I would tell them, and I'll summarize it like65700:45:41,871 --> 00:45:45,751this that I would tell them most patients will forgive you, 65800:45:46,144 --> 00:45:49,786even if you make a mistake. Theywill. I'm telling you they will65900:45:49,786 --> 00:45:54,188after 50 years of practice theywill. Most people will forgive 66000:45:54,289 --> 00:45:58,228you. They'll say, doctor, blah, blah, blah, whatever, whatever. 66100:45:59,284 --> 00:46:02,585And they won't even think about malpractice as soon. But there's66200:46:02,585 --> 00:46:06,291one exception And that exception is if you are injured.66300:46:06,291 --> 00:46:12,605If you are injured D-E-R-P, they will not forgive you. If 66400:46:12,666 --> 00:46:17,586you walk into the room and wife is the patient, husband standing66500:46:17,586 --> 00:46:22,793in the corner you ignore him. You just talk to her. You ignore66600:46:22,793 --> 00:46:25,708him. Or the family or the grandparents or whatever. I'm 66700:46:25,728 --> 00:46:28,811just making this up. You ignore them in the room. You're 66800:46:28,871 --> 00:46:32,985disrespectful. One of the hypotheticals I used to use in 66900:46:33,025 --> 00:46:36,170my presentation to the doctors patient comes and see the doctor67000:46:36,170 --> 00:46:39,186. Patient said to be Spanish-speaking only. Nurse 67100:46:39,246 --> 00:46:41,909gives a chart to the doctor and as the nurse is handing the 67200:46:41,929 --> 00:46:44,431chart to the doctor, the nurse says Spanish-speaking only. 67300:46:44,452 --> 00:46:46,746Doctor says okay, doctor doesn'tspeak Spanish. There's a 67400:46:46,766 --> 00:46:49,590patient in the room. Doctor goesinto the patient's room with 67500:46:49,610 --> 00:46:54,447the nurse who interprets for himand does his exam and history 67600:46:54,487 --> 00:46:57,630and all that sort of stuff, writes a prescription for the 67700:46:57,650 --> 00:47:04,347patient, okay, and before the doctor leaves the room he turns 67800:47:04,427 --> 00:47:08,666to the nurse and makes a commentabout the patient. Quite common67900:47:08,666 --> 00:47:13,094, real quick comment, but it's sort of a disparaging type of 68000:47:13,134 --> 00:47:17,144comment. Not anything, rude, rude, but it's not nice. It's 68100:47:17,186 --> 00:47:20,628not a nice comment. I'll put it like that, and one of the things68200:47:20,628 --> 00:47:25,893that I always tell the doctor. I said I don't care what the 68300:47:25,974 --> 00:47:30,045language is and I don't care what the nurse tells you. I 68400:47:30,085 --> 00:47:34,865don't care what language they say the patient speaks, or the 68500:47:34,905 --> 00:47:40,173patient speaks to everybody who is said to be Spanish-speaking, 68600:47:40,224 --> 00:47:42,746and you can fill in the blank with Spanish. You can put it 68700:47:42,766 --> 00:47:48,070into Gaelic, mandarin, cantonese, on and on and on and on. Speak68800:47:48,070 --> 00:47:52,385from English, so you do not have to speak the language to 68900:47:52,425 --> 00:47:57,527communicate. for a kind for the patient, i said so don't make 69000:47:57,588 --> 00:48:00,931stupid mistake, right? I mean, in my mind that's a stupid 69100:48:00,971 --> 00:48:05,166mistake or whatever, but there'sno excuse for that. And it goes69200:48:05,166 --> 00:48:09,831back to respect transcends all culture. Be respectful, just be 69300:48:09,871 --> 00:48:12,192respectful. Same thing your mother and father taught you 69400:48:12,505 --> 00:48:16,027when you were growing up be respectful. So I would always 69500:48:16,248 --> 00:48:20,528end my presentation with the docs by saying don't be a jerk. 69600:48:21,090 --> 00:48:25,186Real easy to remember, just don't be a jerk. In summary, 69700:48:25,206 --> 00:48:29,534transformation in healthcare is patient-centered. Obama was a 69800:48:29,594 --> 00:48:33,025landmark healthcare legislation.Hospitals are achievement high 69900:48:33,065 --> 00:48:36,907reliability with link six and similar types of processes. 70000:48:37,568 --> 00:48:43,452Respect transcends all culture and avoid medical malpractice by70100:48:43,452 --> 00:48:47,192not being a jerk. My basic principles is I always like to 70200:48:47,291 --> 00:48:52,027end up, god is in charge. I don't have bad days, don't sweat70300:48:52,027 --> 00:48:55,829the small stuff, and most stuffis small. Forgiveness really is70400:48:55,829 --> 00:48:59,349therapy and everything, everything, everything is a 70500:48:59,431 --> 00:49:04,275relationship, mutual respect, mutual trust, good communication70600:49:04,275 --> 00:49:05,409. Are there any questions? 70700:49:06,067 --> 00:49:12,471Speaker 3: Yes, Yes, we were talking about. It was a good 70800:49:12,510 --> 00:49:13,735question. Ha, ha, ha ha. 70900:49:16,764 --> 00:49:20,153Speaker 4: When you were talkingabout you doing things black 71000:49:20,193 --> 00:49:26,545and white and the way let's say,if I'm your patient, are you 71100:49:26,626 --> 00:49:33,791nice with me because of the way you think, or because of the 71200:49:34,432 --> 00:49:36,958privilege that I have, or the law? 71300:49:37,965 --> 00:49:41,170Speaker 2: Excellent question. Iam nice with you because you're71400:49:41,170 --> 00:49:46,967human And that's all you need is just to be human And all that71500:49:46,967 --> 00:49:50,235other stuff. I completely agree. Go ahead. 71600:49:50,844 --> 00:50:00,400Speaker 4: So there is no law, in other words, to tell you to 71700:50:01,061 --> 00:50:01,722respect the other. 71800:50:03,088 --> 00:50:05,173Speaker 2: There is a law, and that's an excellent question. 71900:50:05,213 --> 00:50:09,425I'll tell you why, because what we know is there are laws and 72000:50:09,445 --> 00:50:13,411then there's how you interpret. There is a law that says I need 72100:50:13,431 --> 00:50:22,376to treat you reasonably and responsibly. But a lot of times 72200:50:22,797 --> 00:50:26,710individuals can sort of do what they wanna do and sort of get 72300:50:26,751 --> 00:50:30,427around the law. But yes, there are rules that say I'm supposed 72400:50:30,467 --> 00:50:36,034to treat you a certain way. But a lot of that depends on whether72500:50:36,034 --> 00:50:39,027I think I can get away with it or whether I think you will tell72600:50:39,027 --> 00:50:42,490somebody, et cetera, et cetera.But the right way is it 72700:50:42,530 --> 00:50:46,313shouldn't matter that my approach should be the same as 72800:50:46,355 --> 00:50:49,592it is with everybody else, and that is with absolute respect. 72900:50:49,885 --> 00:50:51,891Speaker 4: And just to finish itup, this is not a question, 73000:50:52,626 --> 00:50:56,213that's a question. When I went to the office, the doctor's 73100:50:56,273 --> 00:51:03,449office, i saw a sign that said don't tell me, why'd you Google 73200:51:03,972 --> 00:51:04,853on your symptoms? 73300:51:08,146 --> 00:51:09,672Speaker 2: Oh, my God okay. 73400:51:09,824 --> 00:51:14,188Speaker 4: So why is that a problem? Well, why is that? 73500:51:14,449 --> 00:51:17,672Speaker 2: Okay, i would consider that rude if I were a 73600:51:17,692 --> 00:51:21,588period, because what he or she is saying is I don't wanna 73700:51:21,648 --> 00:51:24,932listen to you. But the reality is, and I think this is a good 73800:51:24,992 --> 00:51:28,407reality. Yeah, there are bad things about the internet or AI,73900:51:28,407 --> 00:51:31,626whatever it is, but I think thegood thing about it is that 74000:51:31,706 --> 00:51:35,971it's an harrowing patient. It used to be that we control all 74100:51:35,990 --> 00:51:40,052the information, but now you cando a check bot or you can go 74200:51:40,112 --> 00:51:45,429online and you can look up anything that I tell you. So 74300:51:45,469 --> 00:51:48,309what I would interpret that is that they are interested in 74400:51:48,369 --> 00:51:51,431listening to you. They just wantto tell me what they want to 74500:51:51,452 --> 00:51:56,186tell me, and for me that would be a non-star. I go to another 74600:51:56,206 --> 00:52:00,269doctor because I wanna have a discussion. Now, if I'm just a 74700:52:00,311 --> 00:52:03,110patient I'm not a doctor I at least want you to be able to 74800:52:03,130 --> 00:52:07,646explain to me what it is you're gonna do in plain English. Don't74900:52:07,646 --> 00:52:10,809use all those big words to try to impress me in plain English 75000:52:11,144 --> 00:52:15,646And just like that HGAP questionthat I can understand. So it's 75100:52:15,786 --> 00:52:19,266the patient's perspective, not the doctor's perspective. And if75200:52:19,266 --> 00:52:26,246someone was permanently puttingstuff on the door said don't 75300:52:26,327 --> 00:52:30,028even come in if you want me to ask a question. I'd pass them 75400:52:31,264 --> 00:52:33,744Because I would consider them rude. I would consider them And 75500:52:33,764 --> 00:52:36,664they already telling me they don't wanna talk to me, they 75600:52:36,686 --> 00:52:39,570just wanna tell me what to do And I'm not interested in that 75700:52:39,610 --> 00:52:43,168kind of thing. If I have the option, if I have the option, i 75800:52:43,188 --> 00:52:47,485pass them. I'm saying yes, sir, please go ahead. Gary, oh, can 75900:52:47,505 --> 00:52:47,867you hear me? 76000:52:48,824 --> 00:52:53,447Speaker 5: Yes, I had a questionabout what's the word. So, if 76100:52:53,467 --> 00:52:57,036there's a question of mild practice or anything like that, 76200:52:58,824 --> 00:53:00,967what is the statute of limitations as far as time 76300:53:01,007 --> 00:53:01,369period? 76400:53:01,824 --> 00:53:04,548Speaker 2: I think that's a goodquestion. I think it's about 76500:53:04,889 --> 00:53:08,871that's a various per state. I wanna say it's like a couple of 76600:53:08,911 --> 00:53:13,445years, but that would be a good thing to put into Google and say76700:53:13,445 --> 00:53:16,228it's now practice statute of limitation And they can tell you76800:53:16,228 --> 00:53:19,172exactly. But I think it's at least probably about a couple of76900:53:19,172 --> 00:53:19,514years. 77000:53:19,885 --> 00:53:23,155Speaker 5: Okay, and the B part to that is how would you then, 77100:53:24,465 --> 00:53:27,110if you do have a suspicion, how would you then acquire the 77200:53:27,190 --> 00:53:29,592information as far as what happened or what took place? 77300:53:29,684 --> 00:53:30,213Excellent question. 77400:53:31,266 --> 00:53:33,570Speaker 2: Excellent question. Ithink the first thing you would77500:53:33,570 --> 00:53:38,516do is that you wanna talk to anattorney. So then the question 77600:53:38,556 --> 00:53:41,106is well, how do you find an attorney? There are a couple of 77700:53:41,146 --> 00:53:45,414ways to do that. One is if you know friends who know an 77800:53:45,454 --> 00:53:49,072attorney. But the answer is mostpeople don't, quite honestly. 77900:53:50,125 --> 00:53:53,311And what I would do is I would get, i would go back to the 78000:53:53,351 --> 00:53:56,744search and I would put in a medical malpractice attorney is 78100:53:56,865 --> 00:54:00,326near me, medical malpractice attorney is near me. I would 78200:54:00,346 --> 00:54:04,250call them up and I would say I need a consultation on a 78300:54:04,349 --> 00:54:08,230possible malpractice case. Most of the times they'll give you a 78400:54:08,269 --> 00:54:11,532consultation about 30 minutes, 45 minutes and ask what their 78500:54:11,572 --> 00:54:14,927fee is And then you can shop around to make sure that fee is 78600:54:14,967 --> 00:54:17,927compatible with what you're willing to pay. And go in and 78700:54:17,967 --> 00:54:21,286talk to somebody, because what you wanna do is you wanna 78800:54:21,327 --> 00:54:26,545present the facts and have them use their legal expertise to let78900:54:26,545 --> 00:54:30,067you know is there anything there or not. And for a lot of 79000:54:30,128 --> 00:54:32,967people, just doing that is therapy. You know a lot of 79100:54:32,987 --> 00:54:35,510people are not interested in that, but they have a question. 79200:54:35,644 --> 00:54:39,086You know they're uncomfortable, they say I'm not sure. And just 79300:54:39,126 --> 00:54:42,409getting legal advice sometimes is worth it, but that's the way 79400:54:42,449 --> 00:54:42,851I would do it. 79500:54:44,668 --> 00:54:48,550Speaker 5: So does the hospital.Do you have a right to 79600:54:48,751 --> 00:54:51,612information? as far as that, as far as a release of information 79700:54:52,485 --> 00:54:53,951from the hospital or doctor? 79800:54:55,465 --> 00:54:57,994Speaker 2: Are you saying information about the hospital 79900:54:58,726 --> 00:55:00,452and about the doctor from the hospital? 80000:55:02,288 --> 00:55:06,528Speaker 5: Yeah, as far as your possible question, as far as 80100:55:06,588 --> 00:55:09,166what happened in a particular situation, does the hospital 80200:55:09,228 --> 00:55:12,791have a right to release information to you based on that80300:55:12,791 --> 00:55:13,233situation? 80400:55:13,565 --> 00:55:16,733Speaker 2: Okay, the hospital has a right to release your 80500:55:16,813 --> 00:55:21,067information. If you say I want my medical records, or let's say80600:55:21,067 --> 00:55:23,965, if it's a child, i want my child's medical records, then 80700:55:24,005 --> 00:55:26,688that's within your right. The hospital is not gonna tell you 80800:55:26,768 --> 00:55:30,268much else other than that because they have their own 80900:55:30,309 --> 00:55:34,768attorneys and the physicians have their own attorneys. Now 81000:55:34,889 --> 00:55:37,530you break up a good point that Ithink is important to emphasize81100:55:37,530 --> 00:55:41,469. Every hospital has a complaintdepartment. If you have a 81200:55:41,509 --> 00:55:46,458concern, you can put it in very general terms and say I was in 81300:55:46,478 --> 00:55:49,661the hospital blah blah blah, or my chairman blah blah, blah, 81400:55:49,681 --> 00:55:53,164blah blah and we didn't understand why blah blah blah 81500:55:53,204 --> 00:55:56,621happened. Please explain. You can write a very generic letter 81600:55:56,681 --> 00:56:00,184like that. The important thing is that when you do a complaint,81700:56:00,184 --> 00:56:03,856it has to be in writing. Most people don't know that You can't81800:56:03,856 --> 00:56:07,518just call up and talk to somebody. You have to put it in 81900:56:07,579 --> 00:56:10,755writing. One of the things that we used to do when we did 82000:56:10,815 --> 00:56:14,179evaluate at predational hospitals is how they deal with 82100:56:14,239 --> 00:56:17,519complaints in writing. They havea timeframe that they have to 82200:56:17,719 --> 00:56:21,135answer you specifically. So put it in writing. It doesn't have 82300:56:21,155 --> 00:56:25,722to be very long and say we have some questions about our case. 82400:56:26,074 --> 00:56:29,768We want more information. Mard hospitals will be very happy to 82500:56:29,809 --> 00:56:30,875talk to you about it. 82600:56:30,974 --> 00:56:31,255Speaker 5: Thank you. 82700:56:32,155 --> 00:56:34,139Speaker 2: You're welcome Any other questions? 82800:56:34,755 --> 00:56:41,945Speaker 6: Yes, Yeah, regarding that, usually if somebody calls 82900:56:42,106 --> 00:56:48,045in, they have some symptoms And not to give, what is it? you 83000:56:48,065 --> 00:56:53,501tell them Port of America or go see a doctor. And now sometimes,83100:56:53,501 --> 00:56:55,338when you want to make an appointment at the hospital, 83200:56:56,000 --> 00:57:00,485they say, well, we can give you online at such a time if you 83300:57:00,525 --> 00:57:04,039want to know what's wrong with you. Is that something that is 83400:57:04,119 --> 00:57:07,702going to be or is that somethingthat is just that hospital? 83500:57:08,074 --> 00:57:09,501Speaker 2: Well, that's something that's happening right83600:57:09,501 --> 00:57:13,262now And that's fine, Because what's happened is that now 83700:57:15,139 --> 00:57:20,143doctor of patient hospital in reaction is being virtual or in 83800:57:20,204 --> 00:57:24,159person That is perfectly OK, Where you put in your basic 83900:57:24,199 --> 00:57:27,496symptoms and then they'll ask you some questions And what 84000:57:27,516 --> 00:57:30,438they're doing is they're trying to decide is this something they84100:57:30,438 --> 00:57:33,860need to have them come in for Or is this something that they 84200:57:33,920 --> 00:57:36,601can answer for you online? That's the best way to be quite 84300:57:36,661 --> 00:57:39,402honest Absolutely, Absolutely. 84400:57:39,541 --> 00:57:42,422Speaker 3: Yes, lauren, just mentioning that they can also 84500:57:42,835 --> 00:57:44,644risk the very expensive. 84600:57:45,635 --> 00:57:50,065Speaker 2: Excellent point. Excellent point If it's sort of 84700:57:50,106 --> 00:57:53,902like a relationship that's aboutto go bad in a way, you see 84800:57:53,922 --> 00:57:57,016them saying I'm talking about doctor of patient. There it is 84900:57:57,197 --> 00:58:02,670reasonable to say, doctor, we have a lot of questions about 85000:58:02,974 --> 00:58:08,797what happened to my uncle that you took care of. It is smarter 85100:58:09,338 --> 00:58:12,827to ask to meet with the physician for number of reasons.85200:58:12,827 --> 00:58:19,217If he says no, that you want tomake a note on him. But a lot 85300:58:19,257 --> 00:58:23,621of times, to Lauren's point, this can be resolved just with a85400:58:23,621 --> 00:58:26,795quick conversation. Most of thetimes there are questions that 85500:58:26,835 --> 00:58:30,045have not been answered or have not been answered completely, 85600:58:30,735 --> 00:58:34,039And just by getting those thingsanswered all that stuff can go 85700:58:34,059 --> 00:58:38,478away. I would argue more than 50% of the time. It can go away 85800:58:38,878 --> 00:58:41,980if that position is willing to talk, Because the position, in 85900:58:42,019 --> 00:58:45,498my opinion, is more important than the hospital, unless it's a86000:58:45,498 --> 00:58:49,981possible related employee. Eventhen I would still start with 86100:58:50,001 --> 00:58:52,641the position, Because you want to get that position on your 86200:58:52,661 --> 00:58:56,257side. If it's this oh, you're exactly right, There's no way 86300:58:56,599 --> 00:58:59,740blah, blah, blah should have done that, Then that's important86400:58:59,740 --> 00:59:02,197for you to know. But excellent point, You want to have that 86500:59:02,237 --> 00:59:04,902meeting first, Because a lot of times the hospital will put 86600:59:04,922 --> 00:59:08,177together a team to meet with you, But it's always better to have86700:59:08,177 --> 00:59:11,385the meeting first. Have the meeting first, Absolutely Yes, 86800:59:11,405 --> 00:59:14,737sir. Do you have a question? I'll let you Any other questions86900:59:14,737 --> 00:59:14,737. 87000:59:15,157 --> 00:59:18,364Speaker 5: Yes, sir, Yes Dr, Oh,yeah Well go ahead, go ahead, 87100:59:18,405 --> 00:59:19,768william. Go ahead William. 87200:59:20,114 --> 00:59:20,637Speaker 2: Runsilkram. 87300:59:21,414 --> 00:59:25,617Speaker 5: I'm sorry. I was going to ask. So if you have a 87400:59:25,677 --> 00:59:31,094current doctor that you're not exactly gelling with right So 87500:59:31,115 --> 00:59:35,155let's say you feel like the office is always in a rush, your87600:59:35,155 --> 00:59:38,456appointment is kind of rushed through and stuff like that How 87700:59:38,536 --> 00:59:45,478do you go about getting another doctor as far as OK? so you call87800:59:45,478 --> 00:59:48,936your insurance, you get a list of whatever. Are there certain 87900:59:48,996 --> 00:59:52,878questions that you should ask those doctors when choosing a 88000:59:52,918 --> 00:59:57,061doctor? What would you say is the best process of doing that? 88100:59:57,574 --> 01:00:00,023Speaker 2: I personally think the best process of doing that 88201:00:01,197 --> 01:00:04,596is actually being there physically, if you can, because 88301:00:04,635 --> 01:00:08,257I think you're going to pick up some things that may not come up88401:00:08,257 --> 01:00:11,041in a normal question. You're going to look around the office 88501:00:11,195 --> 01:00:14,057Is it clean? Are there a lot of people? Are there a few people? 88601:00:15,994 --> 01:00:19,818You can certainly still ask questions in terms of what their88701:00:19,818 --> 01:00:22,842experience is. Let's say, if it's a procedure or whatever, 88801:00:22,894 --> 01:00:27,081you can ask some basic questions. But I think, if possible, make88901:00:27,081 --> 01:00:30,780an eye contact. Doing that person-to-person type of thing 89001:00:32,264 --> 01:00:36,215is worth doing, one of the things that my wife and I do. We89101:00:36,215 --> 01:00:40,619tend to do things differently sometimes, so I'd like to always89201:00:40,619 --> 01:00:43,639help her with me, or vice versa, because she's going to pick up89301:00:43,639 --> 01:00:46,400stuff that I'm going to miss. Well, i may pick up stuff that 89401:00:46,440 --> 01:00:52,259she missed. So I'm a big believer, if possible now, to 89501:00:52,318 --> 01:00:55,898have that in-person type of thing. If not, you can certainly89601:00:55,898 --> 01:00:59,762ask certain basic things about procedures in terms of how that 89701:00:59,822 --> 01:01:03,541person explains things to you orif they're even willing to talk89801:01:03,541 --> 01:01:06,335to you. All those things are things that you can sort of 89901:01:06,737 --> 01:01:10,280check the boxes in terms of pro or con or others. The other 90001:01:10,300 --> 01:01:11,210question. 90101:01:11,938 --> 01:01:15,460Speaker 4: I think, yes, i thinkI'm one of those persons that 90201:01:15,481 --> 01:01:20,135you said, that I think the physicians are always busy And 90301:01:20,257 --> 01:01:24,800unless I don't see some openness, i won't even ask about what I 90401:01:24,862 --> 01:01:31,221went for. I'm just waiting for them to tell me. But you're a 90501:01:31,260 --> 01:01:37,335doctor over here And we usually tend well I'm usually tend to 90601:01:37,356 --> 01:01:40,757know his doctor and he's not a simple doctor, i mean he's a 90701:01:40,797 --> 01:01:46,202surgeon, oh man I have it with me. So when we approach to you, 90801:01:46,282 --> 01:01:53,576if we do and we engage in a termof a conversation, do you or 90901:01:53,635 --> 01:01:58,164your duty to that person under the regulations, medical 91001:01:58,204 --> 01:01:59,806regulations? Oh, I see, OK. 91101:02:00,268 --> 01:02:07,960Speaker 2: It depends. I'm putting it on the hand, no, 91201:02:08,081 --> 01:02:10,378because it depends on the circumstances. Are you in my 91301:02:10,538 --> 01:02:15,521office Or are we in the No, we're here in Park lot. 91401:02:16,364 --> 01:02:19,019Speaker 4: Well, in Park lot, okYeah, in the field lot then 91501:02:19,039 --> 01:02:20,945there are probably no obligations. 91601:02:21,074 --> 01:02:23,864Speaker 2: But I'm going to go back to your original comment 91701:02:23,923 --> 01:02:28,277also In terms of because a lot of I would say 50% of, not more 91801:02:28,318 --> 01:02:32,342people are exactly like you, i would write down the question, 91901:02:32,574 --> 01:02:35,896because what that does that helps to slow you down. You can 92001:02:35,916 --> 01:02:38,538just say I just have a couple ofquestions And I wrote them down92101:02:38,538 --> 01:02:41,137, is that OK? And you just go down your list. That way you 92201:02:41,157 --> 01:02:43,478don't have to worry about getting flustered and trying to 92301:02:43,518 --> 01:02:46,722remember And I'll just write down two or three questions that92401:02:46,722 --> 01:02:51,644you have. Now, if it's at a social event, many times the 92501:02:51,684 --> 01:02:55,940doctor is not obligated to say anything, but that's on her what92601:02:55,940 --> 01:02:59,420she says and doesn't say, and what I do. I always reply 92701:02:59,440 --> 01:03:02,858because I think it's really not to type. You know what I mean, 92801:03:04,717 --> 01:03:09,260but just say well, i'm not sure,or refer I use just refer to 92901:03:09,280 --> 01:03:10,224the primary doctor. 93001:03:10,494 --> 01:03:12,856Speaker 4: Because there are persons I mean I work for the 93101:03:13,077 --> 01:03:17,217medical team management in the hospital There are people who 93201:03:17,297 --> 01:03:22,483know who they're looking for. Yes, A girl, a gap, good to get,93301:03:22,483 --> 01:03:27,077Just to get that person or thathospital. Yes, yes. The same. 93401:03:28,516 --> 01:03:31,063Speaker 2: There is no question that if one has an addiction, 93501:03:32,315 --> 01:03:36,481then a lot of it is intentional,where they're strategizing and 93601:03:36,501 --> 01:03:40,643that sort of thing, that I view them as a subset as compared to 93701:03:40,682 --> 01:03:44,561just a regular patient. But having said that, one of the 93801:03:44,601 --> 01:03:49,925things that we dogs have to be careful of is assuming that one 93901:03:50,005 --> 01:03:52,817is acting a certain way to causeaddiction, and one of the 94001:03:52,836 --> 01:03:56,996things I used to say drug addicts have pain too. They have94101:03:56,996 --> 01:04:02,304real pain too, and just becauseone is a drug, that doesn't 94201:04:02,324 --> 01:04:06,521mean it doesn't hurt. And so we have to make that separation, 94301:04:06,541 --> 01:04:09,922because it's very easy And I've seen this in the hospitals a lot94401:04:09,922 --> 01:04:12,974, oh so, and so is the blah, blah, blah, blah, blah It 94501:04:12,994 --> 01:04:15,463doesn't really hurt, it doesn't really hurt. Of course it hurts,94601:04:15,463 --> 01:04:19,757of course it hurts. And I'll end on this The whole thing 94701:04:19,797 --> 01:04:23,240about health care disparities iswhere we look at people a 94801:04:23,280 --> 01:04:27,097certain way and then come to conclusions about them based on 94901:04:27,137 --> 01:04:30,300how they look And nothing to do with science just based on how 95001:04:30,320 --> 01:04:33,860they look, and that's like the worst form of health care 95101:04:33,880 --> 01:04:37,556disparities. But there's no question, there are people who 95201:04:37,617 --> 01:04:41,117are manipulative, usually addicts. People who know the 95301:04:41,137 --> 01:04:45,442system know it very well. I've been doing it for years and know95401:04:45,442 --> 01:04:47,960how to work the system. Most ofthem are going to be in the 95501:04:48,000 --> 01:04:52,836minority, except it might be a drug addiction clinic where 95601:04:52,856 --> 01:04:55,003addiction is the primary issue. 95701:04:55,644 --> 01:04:58,356Speaker 3: Yes, do you think there's a span on the way about 95801:04:58,717 --> 01:05:02,717how a person can deal with theirnatural physician, how they can95901:05:02,717 --> 01:05:07,824go through their insurance fromthe end post-imperial to the 96001:05:07,844 --> 01:05:12,070end of the session, and it's really fine? 96101:05:12,090 --> 01:05:15,297Speaker 2: That's an excellent point, thank you. One of the 96201:05:15,317 --> 01:05:20,376things that we all know is that it doesn't always work. Nobody's96301:05:20,376 --> 01:05:23,436fault, not the doctor's fault, not the patient's fault. Your 96401:05:23,476 --> 01:05:25,777insurance company can certainly help you with that. Just say 96501:05:26,097 --> 01:05:28,699well, i went to see Dr Chalktop and I think I want to go see Dr 96601:05:28,719 --> 01:05:34,097Collins. He seems to be a nicer guy, he has a pretty watch, and 96701:05:34,157 --> 01:05:37,259I just think I want to go sit here And then it's your 96801:05:37,278 --> 01:05:39,476insurance company that will accommodate you Because, 96901:05:39,556 --> 01:05:44,195remember, it's patient-centered.Now the Lorrainez point 50 97001:05:44,235 --> 01:05:50,057years ago they'd say puff, chalktop's, all you have. But 97101:05:50,117 --> 01:05:54,141now you do have that leverage. And I would clearly encourage 97201:05:54,181 --> 01:05:59,097you to say it's just us or whatever. We just want to get a 97301:05:59,157 --> 01:06:02,956second opinion. But you want to explore that. You don't want to 97401:06:02,996 --> 01:06:08,362be uncomfortable all the way through. When you go into health97501:06:08,362 --> 01:06:12,797care And you know from day one it's not working And you're not 97601:06:12,836 --> 01:06:17,195communicating, you don't trust the trust, whatever, you don't 97701:06:17,237 --> 01:06:20,217have the feeling, whatever that is, then you want to get out of 97801:06:20,237 --> 01:06:22,998that before they even start, because it's not going to get 97901:06:23,038 --> 01:06:23,298better. 98001:06:24,302 --> 01:06:27,117Speaker 6: Yes, I would say, we should do that OK. 98101:06:28,356 --> 01:06:29,097Speaker 2: How did you do it? 98201:06:29,639 --> 01:06:33,777Speaker 6: Online. Online is a product doctor And when I needed98301:06:33,777 --> 01:06:43,215a disease. I was able to changeit. I had to get a first But, 98401:06:43,255 --> 01:06:47,186jamie, if it was not, i would have aligned and looked for 98501:06:47,226 --> 01:06:49,679someone else, and this thing I could do. 98601:06:50,101 --> 01:06:52,838Speaker 2: There you go. Yeah, and that's an excellent point 98701:06:53,554 --> 01:06:57,458That you have power, which is a whole bunch, and part of your 98801:06:57,498 --> 01:07:00,938power is that you can say no, that's like we talked about in 98901:07:01,079 --> 01:07:05,177other lectures. And part of yourpower is you will say I want 99001:07:05,217 --> 01:07:09,280another opinion or whatever. ButI would encourage you to do 99101:07:09,320 --> 01:07:11,737that, and it doesn't mean you'rea bad person, it doesn't mean 99201:07:11,757 --> 01:07:15,001the doctor is a bad person, it just means it's not working. 99301:07:15,715 --> 01:07:19,219Nobody has to be at fault, but you have the authority to change99401:07:19,219 --> 01:07:22,920that. Ok, all right, thank you.Thank you very much. Have a 99501:07:22,960 --> 01:07:25,202great week And happy Mother's Day to all the mothers. 99601:07:25,715 --> 01:07:27,643Speaker 1: Thanks for listening to the Healthy, wealthy and Wise99701:07:27,643 --> 01:07:31,797Podcast with Dr William Chokdough. We hope you enjoyed 99801:07:31,838 --> 01:07:35,996this episode on health care's quality revolution, and if you 99901:07:36,036 --> 01:07:39,920found this episode helpful, please subscribe to the podcast 100001:07:39,981 --> 01:07:43,157on your favorite podcast platform. This will help ensure 100101:07:43,197 --> 01:07:46,878that you don't miss any future episodes And then share it with 100201:07:46,938 --> 01:07:50,858your family, friends and or yourcoworkers. Well, thank you for 100301:07:50,878 --> 01:07:55,286it, and we thank you once again for listening to the Healthy, 100401:07:55,375 --> 01:07:59,755wealthy and Wise Podcast with DrWilliam Chokdough. Live your 100501:07:59,795 --> 01:08:01,442best life the best way.