Healthcare’s Quality Revolution

1 00:00:00,701 --> 00:00:02,406 Speaker 1: Welcome to the Healthy, Wealthy and Wise 2 00:00:02,446 --> 00:00:06,043 podcast with Dr William Chowk-Taw. In this episode, Dr 3 00:00:06,083 --> 00:00:09,518 Chowk-Taw will continue his Leadership Masterclass series by 4 00:00:09,518 --> 00:00:13,585 covering healthcare's quality revolution. He'll explore a 5 00:00:13,705 --> 00:00:17,478 number of factors that are driving this revolution, factors 6 00:00:17,478 --> 00:00:19,966 that include the latest developments in healthcare 7 00:00:20,007 --> 00:00:24,000 quality and how it has changed the landscape of healthcare 8 00:00:24,079 --> 00:00:29,053 delivery, the Affordable Care Act, patient-centered care, high 9 00:00:29,053 --> 00:00:33,476 reliability organizations, lean Six Sigma and medical 10 00:00:33,517 --> 00:00:38,112 malpractice. Dr Chowk-Taw will also explore data and analytics 11 00:00:38,512 --> 00:00:42,043 and how they are used and applied to help improve 12 00:00:42,103 --> 00:00:46,109 healthcare. So, whether you are a healthcare practitioner, a 13 00:00:46,151 --> 00:00:50,021 healthcare professional, a patient or just a consumer of 14 00:00:50,101 --> 00:00:55,823 good information, this podcast episode is for you. Join us now 15 00:00:56,003 --> 00:00:59,816 as we explore healthcare's quality revolution and discover 16 00:00:59,875 --> 00:01:03,405 how we can work together to help improve the quality of 17 00:01:03,466 --> 00:01:08,361 healthcare delivery for everyone . So let's get started. Here's 18 00:01:08,421 --> 00:01:09,548 Dr William Chowk-Taw. 19 00:01:09,989 --> 00:01:13,501 Speaker 2: Good morning. Good morning. I'm absolutely 20 00:01:13,563 --> 00:01:18,631 delighted to be here and I welcome you to the Masterclass 21 00:01:19,111 --> 00:01:24,102 Number Five. Masterclass Number Five Today we're going to talk 22 00:01:24,143 --> 00:01:30,000 about leadership in terms of healthcare's quality revolution 23 00:01:30,281 --> 00:01:34,688 quality revolution. I believe that life is about being of 24 00:01:34,787 --> 00:01:38,822 service to others. I believe knowledge is power. I believe 25 00:01:38,903 --> 00:01:42,203 leaders can change the world. You notice, i always start off 26 00:01:42,242 --> 00:01:45,581 with the same beliefs and these are my beliefs. And you may say 27 00:01:45,602 --> 00:01:49,542 with Dr Chowk-Taw why don't you talk about what you believe? I 28 00:01:49,581 --> 00:01:54,867 do this for two reasons. One is to emphasize the important point 29 00:01:54,867 --> 00:01:59,763 that we started with the very first Masterclass about talking 30 00:01:59,802 --> 00:02:03,486 about the brain. That is what you believe that affects how you 31 00:02:03,486 --> 00:02:08,401 think, and it is how you think that affects how you act, and so 32 00:02:08,401 --> 00:02:12,530 it's always important for us to go back individually to our 33 00:02:12,650 --> 00:02:16,506 individual belief and make sure that they're in sync with where 34 00:02:16,545 --> 00:02:20,848 we want to be and where we think life is going for us. If they 35 00:02:20,908 --> 00:02:26,144 are not, then change them, but to always be aware of them. For 36 00:02:26,183 --> 00:02:29,435 the last five weeks, i've asked you to think like doctors as we 37 00:02:29,474 --> 00:02:33,844 talk about this Masterclass And, as Jesse mentioned earlier, 38 00:02:34,284 --> 00:02:38,352 we're going to deal with both medicine and law as we talk 39 00:02:38,391 --> 00:02:43,066 about healthcare. One of the things that I learned. Let me 40 00:02:43,105 --> 00:02:47,322 back up. I graduated from medical school in 1973. I 41 00:02:47,361 --> 00:02:54,822 graduated from law school in 1998. 25 years different. And 42 00:02:54,882 --> 00:02:58,628 one of the things that I learned is the difference between 43 00:02:58,669 --> 00:03:03,241 doctors and lawyers. I did not know this before. We doctors 44 00:03:03,260 --> 00:03:06,901 think in terms of black and white. Either my patient has 45 00:03:06,921 --> 00:03:09,048 acute appendicitis or my patient does not have acute 46 00:03:09,068 --> 00:03:12,625 appendicitis. Either my patients had a heart attack or my 47 00:03:12,685 --> 00:03:17,717 patient did not have a heart attack. Doctors like to have 48 00:03:17,758 --> 00:03:22,604 exactness. They like to be specific, but when we are not 49 00:03:22,665 --> 00:03:26,888 able to be specific To lawyers, there is no black and white. 50 00:03:27,068 --> 00:03:29,979 Think about this. Doctors think in terms of black and white. 51 00:03:30,681 --> 00:03:34,503 Lawyers there is no black and white. Lawyers think in terms of 52 00:03:34,503 --> 00:03:39,044 grayness. Everything is gray. It's how you use the facts to 53 00:03:39,104 --> 00:03:42,943 make it a little dark or a little light. So it's one of the 54 00:03:42,943 --> 00:03:46,276 reasons why, when a doctor is talking to a lawyer, they many 55 00:03:46,296 --> 00:03:49,366 times there's a conflict, because the doctor is saying but 56 00:03:49,366 --> 00:03:52,966 I saved his life, so why in the world is he suing me for 57 00:03:53,007 --> 00:03:56,275 malpractice? The lawyer is saying I don't care that you 58 00:03:56,314 --> 00:04:00,735 saved his life, you violated section one of XYZ, blah, blah, 59 00:04:00,754 --> 00:04:03,563 blah, blah, blah, blah, blah. Therefore, you're going to be 60 00:04:03,645 --> 00:04:08,645 liable for malpractice. So it's a different welcome. So it's a 61 00:04:08,687 --> 00:04:12,288 difference in the way we think. Doctors think in terms of black 62 00:04:12,328 --> 00:04:16,963 and white, lawyers think in terms of grayness, and I'm 63 00:04:17,043 --> 00:04:19,574 definitely a black and white guy in terms of how I think and 64 00:04:19,634 --> 00:04:22,843 what an exactness of this and that. But what I have learned, 65 00:04:23,444 --> 00:04:27,391 what I have learned as I've gotten older, is that the world 66 00:04:27,451 --> 00:04:30,824 is probably gray. Most people probably do think in terms of 67 00:04:30,845 --> 00:04:34,564 black and in terms of grayness, but we'll go over that a little 68 00:04:34,605 --> 00:04:38,382 bit more as we move along. If you remember, this is your 69 00:04:38,723 --> 00:04:44,007 computer. Some people call it a cell phone, some people call it 70 00:04:44,026 --> 00:04:48,348 a smartphone. I call it an academic hand computer because 71 00:04:48,387 --> 00:04:52,278 you're in the master class and you're exceptional compared to 72 00:04:52,418 --> 00:04:55,891 other students. You're expected to use your academic hand 73 00:04:55,932 --> 00:04:59,382 computer and look up stuff all the time. Anytime you have a 74 00:04:59,442 --> 00:05:03,271 question about anything maybe a couple of times a day you should 75 00:05:03,271 --> 00:05:06,718 go to your academic hand computer and put into the 76 00:05:06,778 --> 00:05:10,723 browser What is the meaning of artificial intelligence? Blah, 77 00:05:10,742 --> 00:05:13,425 blah, blah, blah, blah, blah. I always want to make sure to 78 00:05:13,464 --> 00:05:16,838 remind you about that. As always , i always like to include an 79 00:05:16,858 --> 00:05:19,545 outline, and the purpose of the outline is to let you know what 80 00:05:19,586 --> 00:05:22,480 we're going to talk about. That's one purpose. Second 81 00:05:22,500 --> 00:05:25,108 purpose of the outline is to let you know where we're just about 82 00:05:25,108 --> 00:05:28,980 done. So I know you want to visit people and, god bless you, 83 00:05:28,980 --> 00:05:33,331 you're taking time out of your Saturday to be here with us for 84 00:05:33,370 --> 00:05:37,187 an hour. So we're going to talk about change, and we always talk 85 00:05:37,187 --> 00:05:39,961 about change to some extent. We're going to talk about the 86 00:05:39,982 --> 00:05:43,271 Affordable Care Act, or Obamacare, as you probably heard 87 00:05:43,271 --> 00:05:46,598 it, because that has been fundamental to the change in 88 00:05:46,639 --> 00:05:49,930 health care. We're going to talk about something called HCAPS. 89 00:05:50,680 --> 00:05:54,226 This is a survey that the government started doing, 90 00:05:54,708 --> 00:05:59,875 probably about 20 years ago 15, 20 years ago of patients to help 91 00:05:59,875 --> 00:06:03,413 to evaluate doctors and hospitals, and we'll go into 92 00:06:03,434 --> 00:06:05,716 detail about that. We'll mention about high reliable 93 00:06:05,737 --> 00:06:09,201 organizations. This is where hospitals want to be High 94 00:06:09,221 --> 00:06:12,048 reliable organizations, those organizations that are trying to 95 00:06:12,048 --> 00:06:20,307 get to zero patient harm, zero patient harm. One of the codes 96 00:06:20,326 --> 00:06:24,894 that we take as positions in essence is to first do no harm. 97 00:06:25,482 --> 00:06:28,685 You may not help, but you don't want to harm anybody, so the 98 00:06:28,745 --> 00:06:31,461 first thing you want to do is not to harm anybody. We'll 99 00:06:31,500 --> 00:06:35,127 mention briefly about the Lean Six Sigma just as a process of 100 00:06:35,228 --> 00:06:39,220 excellence, and then we'll end with medical malpractice. So 101 00:06:39,261 --> 00:06:41,245 when we get to medical malpractice, you know what I'm 102 00:06:41,264 --> 00:06:46,959 just about done. Okay, all right , here we go Quality revolution. 103 00:06:46,959 --> 00:06:49,526 One of the things you hear people talk about a lot in 104 00:06:49,565 --> 00:06:55,427 health care is quality, the essence of what you do to a 105 00:06:55,487 --> 00:06:59,595 person, or are you giving them the best type of care as 106 00:06:59,634 --> 00:07:04,043 compared to less? best type of care? And one of the truisms 107 00:07:04,084 --> 00:07:06,749 that I've learned that I want to share with you, and I heard 108 00:07:06,790 --> 00:07:10,165 somebody say this to me a long time ago if you can control the 109 00:07:10,206 --> 00:07:14,266 dictionary, you can rule the world. Think about that If you 110 00:07:14,307 --> 00:07:18,564 can control the dictionary, you can rule the world. See, if I 111 00:07:18,603 --> 00:07:21,672 control the dictionary, things mean whatever I say. They mean 112 00:07:22,139 --> 00:07:25,793 Black, means white, up, means down and means out, because I 113 00:07:25,853 --> 00:07:29,704 control the dictionary Right? So you want to be very, very 114 00:07:29,745 --> 00:07:32,072 careful when you hear people talk about whatever they're 115 00:07:32,091 --> 00:07:35,100 talking about and ask yourself who controls the dictionary? Who 116 00:07:35,100 --> 00:07:39,596 decides what's good? Who decides what's high quality, 117 00:07:39,617 --> 00:07:43,646 what's poor quality? Who makes that decision? And how did they 118 00:07:43,706 --> 00:07:48,665 get that ability to be able to do that? Another fundamental 119 00:07:48,706 --> 00:07:52,718 principle that we'll address multiple times today is health 120 00:07:52,759 --> 00:07:58,362 care. Is health care a privilege or is it a right? Do you have a 121 00:07:58,362 --> 00:08:03,095 right to quality health care, or is it a privilege that you've 122 00:08:03,095 --> 00:08:07,024 been blessed with being able to experience More and more? now, 123 00:08:07,204 --> 00:08:11,012 and I'm in the category that believes that health care is a 124 00:08:11,091 --> 00:08:14,737 fundamental right. I do not care where you are, i do not care 125 00:08:14,757 --> 00:08:18,333 what you do, i do not care what you look like, i do not care 126 00:08:18,353 --> 00:08:21,545 what your politics are, i do not care whether you're a follower 127 00:08:21,565 --> 00:08:24,192 of Martin Luther King or you're the imperial wizard of the Ku 128 00:08:24,211 --> 00:08:28,494 Klux Klan. If I am your surgeon, i'm going to give you the very 129 00:08:28,533 --> 00:08:31,648 best care and it does not matter to me. I'm not even going to 130 00:08:31,829 --> 00:08:35,225 ask you about your policy. Does that make sense? Because, as a 131 00:08:35,245 --> 00:08:40,822 physician, my job is not to judge you, so I don't judge. I 132 00:08:40,863 --> 00:08:44,009 don't judge. Now, that's a little different from the way I 133 00:08:44,049 --> 00:08:48,167 grew up, where you do judge. I look at him and I judge this and 134 00:08:48,167 --> 00:08:51,392 I judge that. But as a physician, my job is not to say 135 00:08:51,754 --> 00:08:56,068 well, he's wearing a black watch , therefore ABC, or he's wearing 136 00:08:56,068 --> 00:08:59,990 a blue jacket, therefore I am a physician. My job is to give 137 00:09:00,009 --> 00:09:04,708 you the best care possible, and that is irrespective of what you 138 00:09:04,708 --> 00:09:07,866 believe in, who you are. Now, everybody does not believe that, 139 00:09:07,866 --> 00:09:11,746 but I think it's fair to say that most in society are moving 140 00:09:11,768 --> 00:09:15,822 toward the fact that health care is a right. It is not a 141 00:09:15,884 --> 00:09:19,621 privilege. I don't care what your citizenship is, i don't 142 00:09:19,682 --> 00:09:23,644 care where you were born. If you landed my hospital, on my 143 00:09:23,826 --> 00:09:26,871 operating room table, i'm going to give you the very best care 144 00:09:26,932 --> 00:09:30,461 possible, and all that other stuff does not matter to me. It 145 00:09:30,520 --> 00:09:34,767 is not relevant to the quality of care that I give you, and 146 00:09:34,787 --> 00:09:37,057 this is where we're trying to get doctors and nurses and 147 00:09:37,119 --> 00:09:40,727 hospitals to get to today. One of the other basic principles 148 00:09:40,847 --> 00:09:44,734 that the federal government figured out some years ago is it 149 00:09:44,734 --> 00:09:49,504 pays most of the money in this country for health care. The 150 00:09:49,625 --> 00:09:54,559 federal government, washington DC, pays most of the money for 151 00:09:54,620 --> 00:09:58,769 health care in this country. So the government said if I pay 152 00:09:58,809 --> 00:10:02,057 most of the money, i think I should control that dictionary 153 00:10:03,768 --> 00:10:06,873 Right. If you can't do it without me paying you and you 154 00:10:06,913 --> 00:10:11,106 rely on me to pay you, then I can decide what's what. And so 155 00:10:11,126 --> 00:10:15,316 then the government said I will decide, or help to decide, what 156 00:10:15,395 --> 00:10:18,731 quality is. No, dr Choctaw, we're going to go by your 157 00:10:18,772 --> 00:10:23,572 definition because I'm paying you Right, so you can have your 158 00:10:23,631 --> 00:10:26,645 thoughts. That's good. I'll listen to your opinion, but at 159 00:10:26,686 --> 00:10:30,091 the end of the day, it is my responsibility. So I'm going to 160 00:10:30,131 --> 00:10:34,828 tell you what my expectations of you are. Hospital X I'm going 161 00:10:34,849 --> 00:10:40,469 to tell you what my expectations of you are. Okay, one of the 162 00:10:40,548 --> 00:10:44,115 big ways this occurred in this country admittedly, you've heard 163 00:10:44,115 --> 00:10:47,067 about this and you sort of know about it, but it may not have 164 00:10:47,106 --> 00:10:51,986 been obvious to you at the time is the Affordable Care Act. And 165 00:10:52,006 --> 00:10:54,196 you hear one party in this country saying they're going to 166 00:10:54,235 --> 00:10:55,903 repeal it and they promise they're going to repeal, they're 167 00:10:55,903 --> 00:10:58,528 going to get rid of it. And the other party in this country 168 00:10:58,568 --> 00:11:02,197 said it's the best thing that's ever happened to health care in 169 00:11:02,216 --> 00:11:05,610 the last 20 years. And some even call it Obamacare because it 170 00:11:05,650 --> 00:11:09,748 was President Obama who actually pushed it through. It's similar 171 00:11:09,748 --> 00:11:15,240 to the 1950s, where Medicare was first adopted. Medicare did 172 00:11:15,279 --> 00:11:19,830 not exist until the 1950s. What does Medicare do? Medicare helps 173 00:11:19,830 --> 00:11:24,219 to ensure quality care for elderly patients in this country 174 00:11:24,219 --> 00:11:29,168 , because when you're elderly, you probably no longer work, and 175 00:11:29,168 --> 00:11:32,375 the older you get, the more and more and more medical 176 00:11:32,434 --> 00:11:36,187 conditions you're going to develop. Just the way it is Okay 177 00:11:36,187 --> 00:11:40,355 . So the government decides. Well, if you've worked hard all 178 00:11:40,394 --> 00:11:45,634 your life or you've lived a long time, you should not be denied 179 00:11:46,416 --> 00:11:50,528 health care just because you're over 65 years of age. So 180 00:11:50,589 --> 00:11:53,499 Medicare says we're going to help pay for your health care 181 00:11:54,019 --> 00:11:57,289 And that's why we have Medicare. And I might add that some 182 00:11:57,331 --> 00:12:00,860 people who objected to that in the 1950s no, no, no, no, no, no 183 00:12:00,860 --> 00:12:04,760 . That's socialized medicine. People ought to work for the 184 00:12:04,841 --> 00:12:07,909 health care. For instance, i've been working for the last 50 185 00:12:07,970 --> 00:12:12,645 years. I'm 75 years old, i'm not going to work anymore, but 186 00:12:12,745 --> 00:12:16,874 still it depends on whether you believe that health care is a 187 00:12:17,014 --> 00:12:21,831 right or a privilege. Should it only be for certain people who 188 00:12:21,910 --> 00:12:25,326 have a certain amount of income we have a certain amount of blah 189 00:12:25,326 --> 00:12:28,094 , blah, blah, or live in a certain zip code or should it be 190 00:12:28,094 --> 00:12:31,850 for everybody, because it's a God-given right to human beings 191 00:12:31,910 --> 00:12:35,445 and it should not matter who you are, what you look like. But 192 00:12:35,485 --> 00:12:38,335 that's the fundamental argument. That's the fundamental argument 193 00:12:38,335 --> 00:12:42,147 . You hear it play out all the time, every day. Three things, 194 00:12:42,668 --> 00:12:45,894 very briefly, that the Affordable Care Act did or does, 195 00:12:45,894 --> 00:12:49,549 because it's still with us. The other part was not able to 196 00:12:49,591 --> 00:12:53,606 repeal it. They keep trying but they keep failing. One it 197 00:12:53,746 --> 00:12:58,315 covered more people and it paid for care for more people. A 198 00:12:58,394 --> 00:13:02,648 single parent, three to four children, may not have a job, 199 00:13:03,028 --> 00:13:09,009 stays on welfare or something like that. How do you pay for? 200 00:13:09,229 --> 00:13:13,504 if you have a sick child, how do you pay for those expenses? The 201 00:13:13,504 --> 00:13:17,414 Affordable Care Act helps to pay for that. It controls costs. 202 00:13:17,414 --> 00:13:21,693 Does somebody believe? well, you know you pay whatever I 203 00:13:21,714 --> 00:13:26,054 charge. Well not really. If I don't control the dictionary 204 00:13:26,745 --> 00:13:29,514 Okay, because the first control is the dictionary that's in the 205 00:13:29,533 --> 00:13:33,711 chalkbook You can't charge $1,000 for cutting a toenail. 206 00:13:33,913 --> 00:13:37,366 That just doesn't work. You can't do that. I know you may 207 00:13:37,386 --> 00:13:41,876 have house payments. Get a smaller house. Get a smaller 208 00:13:41,937 --> 00:13:46,874 house, Okay. The other thing, and probably one of the most 209 00:13:47,014 --> 00:13:50,186 subtle and I think one of the most profound things that 210 00:13:50,245 --> 00:13:55,794 Obamacare did back in 2010, is that if forced hospitals and 211 00:13:55,894 --> 00:14:02,253 doctors help go all electronic, force us to use the computers, 212 00:14:02,673 --> 00:14:07,648 put down that pen and pencil and it drove the industry crazy. I 213 00:14:07,687 --> 00:14:10,735 know nurses they quit at hospitals because they had to 214 00:14:10,794 --> 00:14:13,267 learn how to use the computer. And the nurses I want to be at 215 00:14:13,307 --> 00:14:17,509 the bedside Doctors who said well, i'm a doctor, i operate on 216 00:14:17,509 --> 00:14:19,946 people, i don't want to do all that paperwork. And the 217 00:14:19,985 --> 00:14:23,033 government said you know what. I control the dictionary. I'm 218 00:14:23,073 --> 00:14:27,553 paying your salary. Quality is what I say. It is What I say it 219 00:14:27,653 --> 00:14:31,232 is And right, honestly, my personal opinion the government 220 00:14:31,273 --> 00:14:34,892 was correct Because if you're doing the right thing, why is it 221 00:14:34,892 --> 00:14:39,009 a big deal for you? Okay, what are the other fundamental things 222 00:14:39,009 --> 00:14:43,937 about this cold change? and the idea about quality healthcare 223 00:14:44,378 --> 00:14:48,894 is let me do it with a hypothetical, and I'm sure I've 224 00:14:48,913 --> 00:14:53,070 said this before. When I graduated from medical school in 225 00:14:53,070 --> 00:14:57,938 the early 70s as a physician, we were told that we're in 226 00:14:57,979 --> 00:15:01,572 charge. We doctors, i mean, are in charge. People just do what 227 00:15:01,592 --> 00:15:06,190 we say in a hospital. And I think I've mentioned, you know, 228 00:15:06,210 --> 00:15:09,576 about how nurses used to stand when the doctor used to walk on 229 00:15:09,596 --> 00:15:12,667 to the ward and all that sort of stuff. But basically the 230 00:15:12,706 --> 00:15:17,696 response to the thing was yes, doctor. I say do X, yes, doctor, 231 00:15:17,696 --> 00:15:22,244 do Y, yes, doctor, no question, no, blah, blah, blah, none of 232 00:15:22,283 --> 00:15:27,115 that. And the government said you know what, if you go and 233 00:15:27,216 --> 00:15:31,024 stay a couple nights at the Ritz-Caulter, before you even 234 00:15:31,063 --> 00:15:33,952 get home, they will send you something and say how was our 235 00:15:33,974 --> 00:15:37,144 service? Did you like it? Were you okay? Were there any 236 00:15:37,183 --> 00:15:41,437 problems? Would you come back again? Would you recommend us to 237 00:15:41,437 --> 00:15:44,528 your friends? Blah, blah, blah. What's my point? My point is 238 00:15:44,548 --> 00:15:48,783 that quality organizations are always interested in the opinion 239 00:15:48,783 --> 00:15:51,971 of the customer. Who is the customer in health care? 240 00:15:52,211 --> 00:15:56,355 Doctor's not the customer, nurse is not the customer, patient is 241 00:15:56,355 --> 00:16:00,614 the customer. And so one of the things that might last seven or 242 00:16:00,614 --> 00:16:04,004 eight years in full-time employment run around the 243 00:16:04,063 --> 00:16:06,990 country trying to help, along with the joint commission, 244 00:16:07,110 --> 00:16:10,505 educate physicians at hospitals about quality care, a 245 00:16:10,605 --> 00:16:14,384 fundamental thing, i would say it is no longer doctor about you 246 00:16:14,384 --> 00:16:19,355 . Used to be about you. Seven is an eight. This is now 2023. 247 00:16:19,375 --> 00:16:23,711 It's about the patient. It's what the patient thinks, it's 248 00:16:23,770 --> 00:16:26,885 what the patient believes, it's what the patient feels And so, 249 00:16:26,985 --> 00:16:30,192 in effect, this is what the government who controls the 250 00:16:30,231 --> 00:16:34,870 dictionary, who pays the money has adopted and said it's 251 00:16:35,212 --> 00:16:39,216 patient-centered care. So what do you do with something that's 252 00:16:39,255 --> 00:16:42,788 patient-centered or customer-centered? The patient 253 00:16:42,889 --> 00:16:46,807 is your customer. You ask their opinion. So the government, many 254 00:16:46,807 --> 00:16:50,453 years, came up with something called HCAPS and that stands for 255 00:16:50,453 --> 00:16:55,730 Hospital Consumer Assessment of Healthcare Provider and Systems 256 00:16:55,730 --> 00:17:00,341 . What that means is hospital consumer assessment, patient of 257 00:17:00,523 --> 00:17:04,853 healthcare providers, doctors and nurses, and hospitals and 258 00:17:04,932 --> 00:17:09,387 systems, healthcare delivery systems. So two weeks after the 259 00:17:09,448 --> 00:17:13,913 Medicare patient is discharged from hospital, a hospital will 260 00:17:13,953 --> 00:17:21,090 send a correspondence, a letter with a survey, and it will have 261 00:17:21,230 --> 00:17:25,607 27 questions, only 27 questions, and the questions are in 262 00:17:25,647 --> 00:17:28,976 different areas, and I'll just deal with the question about 263 00:17:29,017 --> 00:17:30,969 doctor And the only three questions. They ask the patient 264 00:17:30,989 --> 00:17:34,484 about doctor and the concern here is zero patient harm And 265 00:17:34,505 --> 00:17:38,913 the answers to the questions are either always, usually, 266 00:17:39,755 --> 00:17:44,189 sometimes or never. Okay, all the patients do is fill in the 267 00:17:44,209 --> 00:17:49,565 circle that says always, usually , sometimes or never. The three 268 00:17:49,585 --> 00:17:55,415 questions that they ask about doctors is how often does your 269 00:17:55,455 --> 00:17:58,529 doctor treat you with courtesy and respect? Real basic question 270 00:17:58,529 --> 00:18:02,209 How often did your doctor, when you were in the hospital 271 00:18:02,650 --> 00:18:07,416 hospital ABC for two weeks how often did your doctor treat you 272 00:18:07,877 --> 00:18:14,656 with courtesy and respect? Always, usually, sometimes or 273 00:18:14,737 --> 00:18:18,630 never? And here's the deal If the patient's answer is not 274 00:18:19,491 --> 00:18:24,240 always or usually, medicare ignores the other two scores. 275 00:18:24,865 --> 00:18:30,661 They don't care about never and sometimes It is zero. You get a 276 00:18:30,721 --> 00:18:34,412 zero for that. The only thing they score are four for always, 277 00:18:34,873 --> 00:18:39,628 three for usually, that's all Okay. Second question they ask 278 00:18:39,648 --> 00:18:42,875 the patient about the doctor. How often does your doctor 279 00:18:43,016 --> 00:18:47,070 listen to you? Real basic stuff. Doctor comes in making rounds. 280 00:18:47,111 --> 00:18:51,027 Good morning, mr Smith. How are you this morning? Mr Smith says 281 00:18:51,227 --> 00:18:54,676 oh, you know, doctor, i had this horrible headache and my eyes 282 00:18:54,757 --> 00:18:58,667 have sort of been watering and my neck is sore. He says okay, 283 00:18:58,688 --> 00:19:07,346 you have a nice day, mr Smith. God bless Anybody in the next 284 00:19:07,366 --> 00:19:12,086 section. How often does your doctor listen to you? Real basic 285 00:19:12,086 --> 00:19:15,613 stuff, right? Third and final question They ask the patient, 286 00:19:15,653 --> 00:19:20,346 medicare patient in this survey they send out. How often does 287 00:19:20,386 --> 00:19:26,126 your doctor explain in ways that you can understand? How often 288 00:19:26,166 --> 00:19:31,505 does your doctor explain in ways that you can understand? One of 289 00:19:31,505 --> 00:19:34,068 my responsibilities that I won't mention the name, but a 290 00:19:34,108 --> 00:19:36,833 small hospital in West convenient California is that I 291 00:19:36,853 --> 00:19:41,779 would try to educate the doctors about sitting when you make 292 00:19:41,839 --> 00:19:44,608 rounds. You know, doctor comes in morning, mr Jones, blah, blah 293 00:19:44,608 --> 00:19:46,491 , blah, blah, blah, blah, blah, blah, blah, blah. Have a great 294 00:19:46,512 --> 00:19:51,267 day. Any questions? And you know , leave in the room. And usually 295 00:19:51,267 --> 00:19:53,751 when the doctor says are there any questions, his hand is on 296 00:19:53,771 --> 00:19:58,246 the doorknob right Because he's going out the door. And do you 297 00:19:58,306 --> 00:20:00,529 know and this is what I would explain to the doctor, because I 298 00:20:00,529 --> 00:20:05,597 learned this, most patients believe very strongly that 299 00:20:05,698 --> 00:20:10,250 doctors are extremely busy. Number one, number two most 300 00:20:10,309 --> 00:20:15,077 patients are extremely, extremely, extremely respectful 301 00:20:15,157 --> 00:20:20,373 of physicians. They will not ask you a question if they think 302 00:20:20,413 --> 00:20:24,006 you're too busy to answer. They will not. And they can have a 303 00:20:24,026 --> 00:20:27,011 question. Oh my God, i've been waiting all night and I, you 304 00:20:27,051 --> 00:20:30,097 know, i want to make sure that I grab Dr Chalker this morning. 305 00:20:30,545 --> 00:20:32,989 And so what? I tell the doctor, you've got to give them 306 00:20:33,048 --> 00:20:36,753 permission to ask you a question . And how do you do that? You 307 00:20:36,814 --> 00:20:43,670 say thank you, mr Jones, do you have any questions? And you 308 00:20:43,789 --> 00:20:50,510 follow it up with one simple sentence I have the time. So 309 00:20:50,691 --> 00:20:57,048 take your hand off the doorknob And say do you have any 310 00:20:57,087 --> 00:21:02,040 questions? Mr Smith, i have the time. When you say I have the 311 00:21:02,080 --> 00:21:06,422 time now, you're saying okay, he's given me permission to ask 312 00:21:06,481 --> 00:21:11,722 him a question. They will not ordinarily, they will 98 percent 313 00:21:11,722 --> 00:21:15,260 , 99 percent of the patients said I do have this pain, that I 314 00:21:15,260 --> 00:21:20,161 want to answer Dr Bob, but Dr Choctaw is so busy. He's so busy 315 00:21:20,161 --> 00:21:24,617 . I see him running up and down the place and this and that I'll 316 00:21:24,617 --> 00:21:29,364 be okay. I'll be okay, but it is our responsibility to go to 317 00:21:29,384 --> 00:21:32,182 the patient. Patient should have tried to figure out what to ask 318 00:21:32,182 --> 00:21:37,098 us. Our responsibility is do you have any questions? That's 319 00:21:37,138 --> 00:21:40,661 the huge change in health care where it's basically top down 320 00:21:40,721 --> 00:21:44,278 and you do what we say and you do the way I say it. I remember 321 00:21:45,080 --> 00:21:47,497 when I would go on rounds and I'm wearing my little white 322 00:21:47,537 --> 00:21:51,209 pants as an intern and then there's the middle resident and 323 00:21:51,229 --> 00:21:53,842 the senior resident, then there's the professor in surgery 324 00:21:53,842 --> 00:21:56,663 at Yale. The professor would walk into the patient is going 325 00:21:56,682 --> 00:21:59,212 to have surgery and he would look at her and he would say 326 00:21:59,252 --> 00:22:01,318 something like this tomorrow morning I'm going to take you to 327 00:22:01,318 --> 00:22:03,617 surgery at 730 in the morning and I'm going to do a 328 00:22:03,657 --> 00:22:06,643 colisostectomy. The operation will last approximately two 329 00:22:06,722 --> 00:22:09,714 hours and four to five minutes. You will have some discomfort, i 330 00:22:09,714 --> 00:22:12,578 will give you pain medication, you will be in the hospital 331 00:22:12,598 --> 00:22:16,137 maybe about two weeks and then he walk out of the room. I had 332 00:22:16,157 --> 00:22:20,537 to answer the same What. What did he say? And what would 333 00:22:20,576 --> 00:22:25,780 happen was the resident would stop and say Mrs Smith, do you 334 00:22:25,801 --> 00:22:31,025 have any questions? Professor Choctaw is so busy, but I'll ask 335 00:22:31,025 --> 00:22:35,181 you a question And that's how we used to do it. So hopefully, 336 00:22:35,480 --> 00:22:40,157 most of that chain where we stopped and we even tell the doc 337 00:22:40,157 --> 00:22:45,141 sit in a chair by the bed. So if you feel comfortable, sit on 338 00:22:45,161 --> 00:22:48,202 the bedside. Some do that and say do you have any questions? 339 00:22:48,434 --> 00:22:51,878 Why? Because most communication is non-verbal, it is not what I 340 00:22:51,999 --> 00:22:56,654 say, it is what I do. So if I don't say I have the time, but 341 00:22:56,675 --> 00:23:00,663 if I sit on your bed or if I pull up a chair beside your bed, 342 00:23:00,663 --> 00:23:05,976 i'm telling you yeah, i got some minutes. Talk to me Very 343 00:23:06,057 --> 00:23:09,583 important. And so this is what's happening in healthcare. Then 344 00:23:10,055 --> 00:23:15,198 Some hate this. Some vicious hate this. Some in healthcare 345 00:23:15,218 --> 00:23:19,483 hate this, but I think it's fair to say that the majority of us 346 00:23:20,115 --> 00:23:22,980 are moving in this direction And this is one of my jobs, which I 347 00:23:22,980 --> 00:23:26,419 loved, among other things, one of the things that I have 348 00:23:26,479 --> 00:23:30,219 learned, like a lot of times, doctors say well, you know, i 349 00:23:30,278 --> 00:23:34,395 practice in San Gabriel Valley and it is so diverse, you've got 350 00:23:34,395 --> 00:23:37,019 so many different ethnic groups and so many different, so many 351 00:23:37,039 --> 00:23:41,777 of that. I can't be responsible for making sure that everybody 352 00:23:41,877 --> 00:23:45,617 understands everything. It understands me and whatever, and 353 00:23:45,617 --> 00:23:48,580 what I would do, what I would give, like my little 354 00:23:51,056 --> 00:23:55,281 quick-to-minute lecture to the doc I said respect transcends 355 00:23:55,342 --> 00:23:59,015 all culture. You don't have to be an expert in Mandarin or 356 00:23:59,036 --> 00:24:05,415 Chinese or Tagalog or Filipino or on and on and on. Just be 357 00:24:05,455 --> 00:24:09,635 respectful, be respectful. And how do you be respectful? Most 358 00:24:09,655 --> 00:24:13,698 communication is non-verbal. Read the room. You walk into a 359 00:24:13,758 --> 00:24:19,954 room and father is the patient, mother is sitting beside him and 360 00:24:19,954 --> 00:24:22,522 the kids the adult kids are standing in the room. What do 361 00:24:22,564 --> 00:24:26,817 you do? One of the things you wanna do is you speak to father, 362 00:24:26,817 --> 00:24:30,159 but you wanna speak to mother. I used to shake hands with the 363 00:24:30,219 --> 00:24:32,357 little kids. They'd all grin and laugh cause they thought I was 364 00:24:32,377 --> 00:24:36,942 silly. But what's my purpose? My purpose is I am respecting you, 365 00:24:36,942 --> 00:24:41,141 i see you. I see you, you're not just a chair up against the 366 00:24:41,182 --> 00:24:44,999 wall. We'll come back to that. Let me say a real quick word 367 00:24:45,038 --> 00:24:47,380 about Ling Six Sigma and I won't spend a lot of time on this. 368 00:24:47,914 --> 00:24:53,557 But those of you who are very process-oriented and much of 369 00:24:53,617 --> 00:24:59,502 this has come from institutions like airlines, industry and 370 00:24:59,663 --> 00:25:03,438 others that have to get everything right And if they 371 00:25:03,458 --> 00:25:06,079 don't get everything right, if they make mistakes, so things 372 00:25:06,099 --> 00:25:09,803 don't go right, they all die many times along with the 373 00:25:09,843 --> 00:25:12,996 patient. Big incentive, big incentive, right, different from 374 00:25:12,996 --> 00:25:15,957 healthcare. Different from healthcare where you say, well, 375 00:25:16,057 --> 00:25:19,051 he was 900 years old and blah, blah, blah, blah, blah, blah. 376 00:25:19,375 --> 00:25:23,998 But if you're on that same plane , right, you're on that same 377 00:25:24,038 --> 00:25:27,596 plane, you don't need a bigger incentive. One of the most 378 00:25:27,678 --> 00:25:32,037 important I think one of the most excellent systems is Ling 379 00:25:32,057 --> 00:25:36,144 Six Sigma. Ling, real quickly, just means eliminating waste. 380 00:25:37,035 --> 00:25:41,202 Eliminating waste which you guessed is one of the biggest 381 00:25:41,403 --> 00:25:44,903 waste when you go to the hospital or go to see the doctor 382 00:25:44,903 --> 00:25:47,857 , what's one of the biggest waste, something that should not 383 00:25:47,857 --> 00:25:53,405 happen. You think, what are those rooms that you fit in? 384 00:25:53,875 --> 00:25:58,938 waiting room waiting. Why do you have to wait? What dictionary 385 00:25:58,959 --> 00:26:02,076 is that in? Who says that you gotta wait two hours before your 386 00:26:02,076 --> 00:26:05,935 doctor sees you when you go to her office? Where is that 387 00:26:05,996 --> 00:26:10,636 written that you have to wait two hours? But one of the things 388 00:26:10,636 --> 00:26:17,646 that I used to do in my office, in my office manager is sitting 389 00:26:17,646 --> 00:26:21,816 right in front of me. She ran not only me but my office. We 390 00:26:21,836 --> 00:26:26,576 had a policy. Who started? We had a policy in my office If you 391 00:26:26,576 --> 00:26:30,078 had a one o'clock appointment to see me but you arrived at 392 00:26:30,098 --> 00:26:34,981 1230, we would see you at 1230. Because we were already there 30 393 00:26:34,981 --> 00:26:37,957 or an hour before your appointment time. Right, Because 394 00:26:37,957 --> 00:26:40,058 we scheduled appointments. We know what time you're supposed 395 00:26:40,078 --> 00:26:44,244 to come in And we would see you because, the idea being number 396 00:26:44,345 --> 00:26:48,895 one, to show respect, my time is valuable. Who is your turn? But 397 00:26:48,895 --> 00:26:51,999 why should you have to wait for me? Why should I have to wait 398 00:26:52,038 --> 00:26:57,757 for you? Mutual respect okay, so lean eliminates waste. What Six 399 00:26:57,757 --> 00:27:03,236 Sigma does is Six Sigma the one that eliminates variation. If 400 00:27:03,296 --> 00:27:08,118 there are six of us, seven of us in this room, and we all wanna 401 00:27:08,138 --> 00:27:12,075 get out that door, but we all wanna get out of this room, but 402 00:27:12,115 --> 00:27:14,817 we come up with seven different ways to do it. Some go out the 403 00:27:14,857 --> 00:27:17,339 door, some go out this door, some go out the window, some go 404 00:27:17,400 --> 00:27:20,141 out this other way. That's really pretty inefficient, 405 00:27:20,221 --> 00:27:23,782 wouldn't you say? Now, multiply that in a huge hospital delivery 406 00:27:23,782 --> 00:27:29,195 system, a thousand beds with a thousand plus patients. So to 407 00:27:29,277 --> 00:27:34,720 have efficiency, to not make mistakes, you need to have a 408 00:27:34,961 --> 00:27:38,740 simple but effective process, and that's what Six Sigma does, 409 00:27:39,001 --> 00:27:44,375 right. Six Sigma says I would be on rounds in a hospital, c and 410 00:27:44,856 --> 00:27:47,797 Chicago, and they would be presenting to me about something 411 00:27:47,797 --> 00:27:51,843 they're very proud of and they say you know, we decreased our 412 00:27:51,923 --> 00:28:00,132 infection rate from 80%, we improved our efficiency up to 413 00:28:00,251 --> 00:28:07,699 80%, 85%, and nobody in the area has hit 80%. And I was saying 414 00:28:08,541 --> 00:28:15,061 you're good. I said but why not 90? I said, well, nobody does 90 415 00:28:15,061 --> 00:28:18,278 . I said I'm not talking about all those other people, you're 416 00:28:18,298 --> 00:28:25,356 the superstar. I said well, why not 95? Why not 100? When did we 417 00:28:25,356 --> 00:28:30,615 decide that 80% was excellent? Who wrote that dictionary? And 418 00:28:30,655 --> 00:28:33,559 then I would tell them true story. I said because if I'm a 419 00:28:33,619 --> 00:28:37,401 patient in your hospital, or my wife or my children or my 420 00:28:37,461 --> 00:28:42,455 grandchildren, i want 100%. I'm not impressed with the 85%. Good 421 00:28:42,455 --> 00:28:47,219 job, good job, but I expect you to do more. I expect you. Six 422 00:28:47,259 --> 00:28:55,028 Sigma to break it down mathematically says 99.999666, 423 00:28:55,429 --> 00:29:00,684 that that distance between 99% and 100, you can do better. That 424 00:29:00,684 --> 00:29:04,336 makes sense. Six Sigma says you need to be not at 85%, it needs 425 00:29:04,336 --> 00:29:08,921 to be at 99, but even at 99, you can do better before you get 426 00:29:08,921 --> 00:29:13,457 to 100. It asks us you never stop improving. There's always 427 00:29:13,518 --> 00:29:17,682 something better that you can do . And that's actually been 428 00:29:17,823 --> 00:29:20,140 articulated. And I would encourage you to take that 429 00:29:20,560 --> 00:29:25,276 handheld computer that you have in Lookup Lean Six Sigma Real 430 00:29:25,296 --> 00:29:28,317 quickly. This is just the roadmap for it define, measure, 431 00:29:28,417 --> 00:29:31,460 analyze, improve, control. I'll just say a quick word about 432 00:29:31,500 --> 00:29:37,816 define, whenever there's a problem, a system. Let's say Dr 433 00:29:37,855 --> 00:29:44,076 McClure is the owner of a small hospital, 250 beds. In his 434 00:29:44,135 --> 00:29:48,855 hospital he has OBGYN department for delivering babies. He has 435 00:29:48,895 --> 00:29:51,696 an emergency department where patients come in if they have 436 00:29:51,737 --> 00:29:56,236 emergencies. One of his managers comes to him and he says Dr 437 00:29:56,256 --> 00:29:59,060 McClure, we have a problem. And he said but what's your problem? 438 00:29:59,060 --> 00:30:02,178 And she says well, we have a lot of people who come to our 439 00:30:02,238 --> 00:30:06,316 emergency room but they leave before they see the doctor. They 440 00:30:06,316 --> 00:30:09,259 leave before they see the doctor. We call it left without 441 00:30:09,338 --> 00:30:13,936 being seen. Okay, leave before they see the doctor. But he says 442 00:30:13,936 --> 00:30:16,936 why are they leaving before they see the doctor? She says I 443 00:30:16,957 --> 00:30:21,217 don't know. She said what is the problem? She said because we 444 00:30:21,257 --> 00:30:25,182 have all these people tired of and, more importantly, we aren't 445 00:30:25,182 --> 00:30:27,582 doing anything for the community. So what are some of 446 00:30:27,602 --> 00:30:29,895 the reasons they can be leaving without seeing the doctor? Well, 447 00:30:29,895 --> 00:30:32,816 maybe they have to wait too long See the doctor. If they 448 00:30:32,836 --> 00:30:37,301 have to wait six hours, 10 hours , would you leave your mother? 449 00:30:37,835 --> 00:30:41,256 You bring your kid in because he had an ear infection. You got 450 00:30:41,276 --> 00:30:43,739 to go to work the next morning. You bring the kid in at two 451 00:30:43,759 --> 00:30:47,482 o'clock at night and you wait eight hours in an emergency room 452 00:30:47,482 --> 00:30:51,739 before taking him, before having him seen. So is it 453 00:30:51,759 --> 00:30:55,201 waiting too long? Is it they feel uncomfortable in your 454 00:30:55,241 --> 00:30:58,538 emergency room? Maybe it's not clean, maybe there's a lot of 455 00:30:58,617 --> 00:31:02,359 activity and they don't feel safe in their emergency room. 456 00:31:03,214 --> 00:31:06,778 Maybe they've seen your doctors walk around in the emergency 457 00:31:06,798 --> 00:31:12,180 room and they wear flip flops in shorts And you said whoa, whoa, 458 00:31:12,180 --> 00:31:18,997 am I in the right place? So what's my point? My point is, 459 00:31:19,818 --> 00:31:24,018 for those of you who are math enthusiasts, there's a formula 460 00:31:24,058 --> 00:31:29,037 for lane sixing. It says y equals a function of x. Y is 461 00:31:29,057 --> 00:31:33,557 your problem, y is what you're trying to solve. Y is what 462 00:31:33,597 --> 00:31:37,422 you've got to fix. X are the number of reasons that are 463 00:31:37,461 --> 00:31:40,401 causing your problems, but you don't know which one it is. 464 00:31:41,015 --> 00:31:44,476 Let's say you have five x's. One you have to wait too long. Two 465 00:31:44,516 --> 00:31:46,759 your emergency room is dirty. Three they don't like to wear 466 00:31:46,778 --> 00:31:49,875 your doctor's. Look on, and on, and on and on and on. Lane 467 00:31:49,895 --> 00:31:52,763 sixing may help you identify which x you need to fix 468 00:31:53,429 --> 00:31:57,382 basically. And one final thing about defined. Whenever there's 469 00:31:57,422 --> 00:32:01,739 a problem in any organization or something has happened and see, 470 00:32:01,739 --> 00:32:04,338 we got to fix that, first thing that happens when you have a 471 00:32:04,398 --> 00:32:07,118 meeting. Everybody comes up with a solution Well, i think we 472 00:32:07,138 --> 00:32:08,999 should do this and this. And somebody says, well, i think you 473 00:32:08,999 --> 00:32:11,961 should do EFG. Somebody said, well, i think you should A and B 474 00:32:11,961 --> 00:32:16,262 . Albert Einstein once said and I always remember this when I 475 00:32:16,303 --> 00:32:19,259 have a problem and I've said this before when I have a 476 00:32:19,318 --> 00:32:26,038 problem, i spend and I have an hour fixing it. I spend 55 477 00:32:26,098 --> 00:32:29,866 minutes defining the problem and five minutes solving the 478 00:32:29,887 --> 00:32:33,417 problem. What's my point? Most of the things that will help you 479 00:32:33,417 --> 00:32:38,538 solve a problem is sitting down and talking about defining. 480 00:32:38,578 --> 00:32:41,484 What do you mean when you say enough without B and C? What do 481 00:32:41,525 --> 00:32:45,067 you mean? Blah, blah, blah. You would be amazed at how much 482 00:32:45,133 --> 00:32:48,069 miscommunication occurs because we say things but everybody has 483 00:32:48,089 --> 00:32:51,935 a different meaning. But we never asked. I think that's what 484 00:32:51,935 --> 00:32:56,877 the roadmap looks like with Lean Six Sigma. Again, use your 485 00:32:57,378 --> 00:33:02,099 hand computer to look up Lean Six Sigma. Okay, medical 486 00:33:02,181 --> 00:33:05,922 malpractice. So I'm just about done, right, right, right, 487 00:33:05,942 --> 00:33:10,859 you've been following me, right? I'm just about done. So what is 488 00:33:10,859 --> 00:33:14,961 medical malpractice Now I have been asking you for the last 489 00:33:15,101 --> 00:33:18,655 five weeks, five months, to think like doctors. I'm not 490 00:33:18,675 --> 00:33:21,298 going to ask you to think like lawyers. What about being a 491 00:33:21,337 --> 00:33:25,894 doctor? You're now an attorney. You're now attorneys. We're 492 00:33:25,914 --> 00:33:35,667 dealing with the Andrew Collins, hammons, jesse Hammons law 493 00:33:35,708 --> 00:33:41,824 practice. They are famous around the area, particularly medical 494 00:33:41,864 --> 00:33:51,319 malpractice, So they're the top of the line. And one of the 495 00:33:51,339 --> 00:33:54,788 things I learned is that people tend to like doctors in general. 496 00:33:54,788 --> 00:33:59,119 People don't tend to like lawyers in general. I'm just 497 00:33:59,160 --> 00:34:02,161 generalizing them, but somebody once said people tend to hate 498 00:34:02,221 --> 00:34:06,256 lawyers until you need one, Until you need one. When you 499 00:34:06,276 --> 00:34:09,498 need one, you need a good one. And one of the things that I 500 00:34:09,557 --> 00:34:13,155 learned when I went to law school was how little I knew 501 00:34:13,275 --> 00:34:17,340 about the law, and the reason for that is the law is 502 00:34:17,400 --> 00:34:24,144 deceptively complex. You read a line that says you for God, go 503 00:34:24,164 --> 00:34:27,856 to prison. And you say well, i understand that. I know what a 504 00:34:27,896 --> 00:34:30,969 God is. I know what a prison is. I know what you for God, god, 505 00:34:30,989 --> 00:34:32,980 go to prison. I know what that means. But that's not 506 00:34:33,061 --> 00:34:36,615 necessarily true. That's not necessarily true, and I can tell 507 00:34:36,615 --> 00:34:42,751 you when I went to law school, I was older than the other 508 00:34:42,791 --> 00:34:46,740 students. They were 20 something , i was 40 something, whatever, 509 00:34:47,061 --> 00:34:51,240 40 or 50 something. And one of my favorite classes was TORT, 510 00:34:51,641 --> 00:34:56,940 p-o-r-t, and TORT means injury And that's connected to our 511 00:34:56,960 --> 00:35:00,981 subject. And I was sitting. You got to say I'm one of those 512 00:35:01,021 --> 00:35:06,039 students who gets a class an hour, 30 minutes ahead of time. 513 00:35:06,394 --> 00:35:10,576 I sit in the front row. I mean, you know the type, i got my 514 00:35:10,635 --> 00:35:15,619 pencils in my bag. You say them, come on, i'm that type of 515 00:35:15,639 --> 00:35:18,956 student, all right, so you get the picture. So I'm sitting in 516 00:35:18,976 --> 00:35:23,898 the front row, you know, ready, ready. And instructor gets up 517 00:35:23,958 --> 00:35:28,155 and says man walks up to another man, takes a gun, puts it to 518 00:35:28,335 --> 00:35:32,103 his head, pulls the trigger, puts him in the head, man drops 519 00:35:32,164 --> 00:35:35,701 and he's dead. Is that murder? And I jump up and I'm throwing 520 00:35:35,721 --> 00:35:38,831 my hand up. I'm on the front row throwing my hand up and he's 521 00:35:38,851 --> 00:35:43,342 still there. And he said, dr Chalkton, i said yes, it's 522 00:35:43,402 --> 00:35:46,552 murder. And the instructor looked at me and he says it 523 00:35:46,572 --> 00:35:50,737 depends. And I said well, even it depends. You just told me 524 00:35:51,077 --> 00:35:53,503 that the guy walked up, put the gun to his head, pulled the 525 00:35:53,523 --> 00:35:57,914 trigger. The guy was there. He said was it his house? I don't 526 00:35:57,934 --> 00:36:02,775 know. He said what was the man doing when the guy shot him? I 527 00:36:02,795 --> 00:36:06,076 said I don't know. He said was the man coming at him? Did he 528 00:36:06,115 --> 00:36:10,862 have a gun? also, i said I don't know what the instructor was 529 00:36:10,942 --> 00:36:15,398 telling me is it does depend. You've got to know the fact 530 00:36:15,559 --> 00:36:19,942 before you come to a conclusion. Braininess, it is not black and 531 00:36:19,942 --> 00:36:24,161 white. I'm a doctor, not only I'm a surgeon. We really are 532 00:36:24,202 --> 00:36:27,458 black and white. Give me a knife , i'll find out what the problem 533 00:36:27,458 --> 00:36:35,119 is. Right, no Longest, don't get nice. And so whenever you 534 00:36:35,278 --> 00:36:39,894 ask an attorney and I encourage you to take me up on this, any 535 00:36:40,014 --> 00:36:44,097 attorney ask him or her a question And I guarantee you the 536 00:36:44,097 --> 00:36:47,224 first thing she will say to you . But he will say to you it 537 00:36:47,264 --> 00:36:50,322 depends. First thing they will say they'll say two words, it 538 00:36:50,362 --> 00:36:52,961 depends, because what they're saying is you got to give me 539 00:36:53,001 --> 00:36:55,956 more information, you got to give me more. You can't just 540 00:36:55,996 --> 00:36:59,143 tell me somebody got shot and expect me to come to a 541 00:36:59,164 --> 00:37:03,076 conclusion and not give me anything to work with. So that's 542 00:37:03,076 --> 00:37:07,782 the fundamental difference between medicine and law. Right, 543 00:37:07,782 --> 00:37:14,652 i would tell members of my hospital when I was people's bad 544 00:37:14,652 --> 00:37:18,280 and they would bring to me a situation, let's say harassment 545 00:37:18,882 --> 00:37:22,335 of some type And they would say, oh, it's terrible, this this, 546 00:37:22,376 --> 00:37:24,777 this, this this, this, this, this, this. We need to do A, b 547 00:37:24,836 --> 00:37:30,375 and C And I would say have you talked to the other party? Do 548 00:37:30,416 --> 00:37:32,619 you have the other side of it? One of the things I learned in 549 00:37:32,659 --> 00:37:35,815 law school if I did not move before, there are always two 550 00:37:35,876 --> 00:37:41,378 sides, always, always, always. I don't care if the guy put the 551 00:37:41,418 --> 00:37:43,844 handgun to the guy's head and shot, just like I was saying. 552 00:37:44,954 --> 00:37:47,737 What were the circumstances around that? But what was the 553 00:37:47,757 --> 00:37:51,635 guy holding the guy's family hostage? I don't know, i don't 554 00:37:51,655 --> 00:37:56,063 know. So my point is and I really believe this is where the 555 00:37:56,063 --> 00:37:59,759 law helped me personally, i have, for the most part, always 556 00:37:59,798 --> 00:38:02,815 met a black and white type of guy. You know, blah blah, blah, 557 00:38:02,856 --> 00:38:04,331 blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, 558 00:38:04,351 --> 00:38:07,842 blah. What I have learned? what I have learned is to take a step 559 00:38:07,842 --> 00:38:12,586 back, ask a few more questions, don't be so quick to judge, 560 00:38:13,554 --> 00:38:16,880 don't be so quick to think I have the answer, because many 561 00:38:16,920 --> 00:38:20,568 times are wrong and I don't want to be wrong. That makes sense. 562 00:38:21,175 --> 00:38:25,786 So. So my point is that, regards to what you think about lawyers 563 00:38:25,786 --> 00:38:29,762 , one of the things that the law does is that it makes you slow 564 00:38:29,802 --> 00:38:33,096 down and get all the facts, because you don't want to be 565 00:38:33,155 --> 00:38:37,902 wrong. Whatever conclusion you come to, you want it to be the 566 00:38:37,963 --> 00:38:41,139 right conclusion. You're right, so. So just keep that in mind. 567 00:38:41,239 --> 00:38:45,791 Okay, let's go. So. Chart is a type of law that means injury, 568 00:38:45,992 --> 00:38:50,614 porp. Now there are two main big sections of the law. There's 569 00:38:50,655 --> 00:38:55,918 criminal and there's there's civil right. Criminal and civil 570 00:38:57,355 --> 00:39:02,516 Malpractice is civil law. It is not criminal. Let me explain the 571 00:39:02,516 --> 00:39:07,764 difference. If I am found in violation of a civil statute, 572 00:39:08,324 --> 00:39:12,221 basically I pay money, i have injured somebody or I have 573 00:39:12,260 --> 00:39:16,800 created an injury And to make that person whole, i have to 574 00:39:16,920 --> 00:39:21,958 compensate them for their injury . Okay, if, on the other hand, i 575 00:39:21,958 --> 00:39:26,246 am found guilty of a criminal statute, i go to jail. Think 576 00:39:26,286 --> 00:39:30,119 about that. Civil, you pay money , criminal, you go to jail. 577 00:39:31,335 --> 00:39:36,025 Civil. Somebody will sue me or some entity will sue me and blah 578 00:39:36,025 --> 00:39:40,061 , blah, blah, blah. You defame me, you violated this or 579 00:39:40,101 --> 00:39:44,820 whatever, whatever, whatever. But if it's criminal, the 580 00:39:45,463 --> 00:39:48,472 District Attorney of the State of California will say, 581 00:39:48,873 --> 00:39:52,880 representing the citizens of the State of California, because my 582 00:39:52,880 --> 00:39:59,639 crime is considered a violation of the state, i violated all 583 00:40:00,001 --> 00:40:02,626 the members of the State of California, and that's my other 584 00:40:02,666 --> 00:40:05,918 point Medical malpractice is a state law. It is not a federal 585 00:40:05,978 --> 00:40:10,217 law. That's why it may vary from state to state. Texas may be a 586 00:40:10,257 --> 00:40:12,938 little different from California , but the basic parts of it, 587 00:40:12,978 --> 00:40:19,061 though, is the same. What is the definition? going back to what 588 00:40:19,101 --> 00:40:24,018 was said before about defining What is the definition of 589 00:40:24,099 --> 00:40:28,880 medical malpractice, the definition is acting 590 00:40:29,219 --> 00:40:34,135 unreasonably under the circumstances. Acting 591 00:40:34,235 --> 00:40:38,737 unreasonably under the circumstances. There are three 592 00:40:38,856 --> 00:40:41,960 elements to that definition. Three elements, only three. 593 00:40:43,114 --> 00:40:47,436 Number one acting you got to do something. You got to do 594 00:40:47,516 --> 00:40:53,005 something. Number two unreasonably what you did was 595 00:40:53,065 --> 00:40:58,059 not reasonable. And third element under the circumstances. 596 00:40:58,059 --> 00:41:07,460 Let me give you an idea. The patient comes into the emergency 597 00:41:07,460 --> 00:41:17,735 room as part of a 50 car call up on the freeway. The patient 598 00:41:17,775 --> 00:41:21,614 comes in and the emergency room is just a big scramble. They 599 00:41:21,655 --> 00:41:24,643 call it down with trauma surgeons and we come down and 600 00:41:24,663 --> 00:41:28,119 we're taking different patients and blah, blah, blah, blah, blah 601 00:41:28,119 --> 00:41:35,302 , and, let's say, one of the surgeons, at the end of the 602 00:41:35,403 --> 00:41:40,820 operation the scar of the surgery is longer than it 603 00:41:40,920 --> 00:41:44,994 normally would be. That's just for the sake of argument. And 604 00:41:45,014 --> 00:41:48,021 the patient decides to sue the surgeon because she didn't like 605 00:41:48,043 --> 00:41:52,601 the way her scar looked Surgeon's attorney will say 606 00:41:52,621 --> 00:41:55,958 there were 50 people in that emergency room. Dr McClure was 607 00:41:56,059 --> 00:41:59,940 operating on 25 of them By himself because he's a super 608 00:41:59,960 --> 00:42:07,431 doctor. So if the scar on patient number 10 was a little 609 00:42:07,635 --> 00:42:12,621 longer than patient number 11, under those circumstances that's 610 00:42:12,621 --> 00:42:17,918 really okay. That's not a big deal. So it's important to 611 00:42:18,039 --> 00:42:21,976 understand the definition. You got to do something. Let's say 612 00:42:22,657 --> 00:42:28,853 you are at a meeting, so you're a church, and someone comes up 613 00:42:28,932 --> 00:42:33,344 and says you know, i've got this blah, blah, blah, blah blah and 614 00:42:33,344 --> 00:42:37,427 I've been taking medicine A or medicine B and I'm thinking 615 00:42:37,447 --> 00:42:41,445 about throwing out medicine A and just taking medicine B. Do 616 00:42:41,485 --> 00:42:50,548 you think that's okay, dr X? So what should Dr X do? True true, 617 00:42:51,751 --> 00:42:55,228 never was should not answer the question, but at the very 618 00:42:55,349 --> 00:43:00,351 minimum is to say I don't have enough information, which is 619 00:43:00,391 --> 00:43:04,492 true. I wanna think I should tell the young doctors coming up 620 00:43:04,492 --> 00:43:08,650 don't make telephone diagnoses. People will call you up and say 621 00:43:08,650 --> 00:43:11,365 you know, i just woke up and I got this pain that's on the 622 00:43:11,405 --> 00:43:14,905 right side and it's going around to the disc and to the that. Do 623 00:43:14,905 --> 00:43:17,847 you think I need to go see the doctor? or just wait until 624 00:43:17,887 --> 00:43:22,266 morning And I would say do the safest thing, and that's 625 00:43:22,306 --> 00:43:25,369 probably go into the emergency room. But you don't know, you 626 00:43:25,409 --> 00:43:29,389 don't have a clue. You don't have a clue. Now, this is based 627 00:43:29,628 --> 00:43:32,885 on what's reasonable for the reasonable position. The 628 00:43:32,925 --> 00:43:35,827 standard is not the reasonable person, the standard is the 629 00:43:35,867 --> 00:43:38,510 reasonable position. So what they will do is that they will 630 00:43:38,552 --> 00:43:46,431 call in a expert doctor, dr Rebus, and say Dr Rebus, we want 631 00:43:46,431 --> 00:43:50,150 you to review this record because there's been a concern 632 00:43:50,190 --> 00:43:55,135 about DrX and we want to make sure that you think that he did 633 00:43:55,264 --> 00:43:59,626 or did not operate reasonably under the circumstances. Okay, 634 00:44:00,525 --> 00:44:03,355 so, therefore, elements that plaintiffs counsel has approved 635 00:44:03,505 --> 00:44:08,210 to find reliable for malpractice Did you have a duty to the 636 00:44:08,250 --> 00:44:12,248 patient? Did you have a duty to the patient. Now, if the patient 637 00:44:12,248 --> 00:44:15,130 came into your office and you touched him, then you have a 638 00:44:15,170 --> 00:44:18,126 duty. If you saw the patient in the emergency room, you touched 639 00:44:18,186 --> 00:44:23,626 him, you have a duty. And I say you're at a dinner party and 640 00:44:23,666 --> 00:44:31,931 you're all drinking your sodas. Exploders. Cold, cold, whatever 641 00:44:31,971 --> 00:44:36,925 you like. You're getting the charm. You're getting the charm. 642 00:44:36,925 --> 00:44:41,769 You didn't even miss that event And you're drinking your sodas 643 00:44:42,304 --> 00:44:46,429 and someone asks you for advice. Do you have a duty to that 644 00:44:46,449 --> 00:44:50,326 patient? Probably not. So my point is. My point is you got to 645 00:44:50,326 --> 00:44:54,893 have a duty to the patient. Did you breach your duty for the 646 00:44:54,934 --> 00:44:58,471 patient? Second element breach means did you violate that duty? 647 00:44:58,471 --> 00:45:01,253 That's why you called in the expert witness to review the 648 00:45:01,313 --> 00:45:04,927 record. It was gonna be another doctor to say, yeah, he did. It 649 00:45:04,947 --> 00:45:08,925 did not breach your duty. Did your breach cause damages? And 650 00:45:08,985 --> 00:45:11,887 indeed were there damages. So the four elements that 651 00:45:11,907 --> 00:45:15,389 plaintiffs counsel has to prove before you can be found liable 652 00:45:15,851 --> 00:45:21,594 for medical malpractice. Now, if you are inclined to find out 653 00:45:21,695 --> 00:45:26,896 more about this subject, there's an expert, expert, expert. No, 654 00:45:26,936 --> 00:45:34,849 it's not One of the things that I would give. I talk to doctors 655 00:45:34,889 --> 00:45:39,106 and I would give basically the same talk to the doctor. There 656 00:45:39,126 --> 00:45:41,871 are certain things I would tell them, and I'll summarize it like 657 00:45:41,871 --> 00:45:45,751 this that I would tell them most patients will forgive you, 658 00:45:46,144 --> 00:45:49,786 even if you make a mistake. They will. I'm telling you they will 659 00:45:49,786 --> 00:45:54,188 after 50 years of practice they will. Most people will forgive 660 00:45:54,289 --> 00:45:58,228 you. They'll say, doctor, blah, blah, blah, whatever, whatever. 661 00:45:59,284 --> 00:46:02,585 And they won't even think about malpractice as soon. But there's 662 00:46:02,585 --> 00:46:06,291 one exception And that exception is if you are injured. 663 00:46:06,291 --> 00:46:12,605 If you are injured D-E-R-P, they will not forgive you. If 664 00:46:12,666 --> 00:46:17,586 you walk into the room and wife is the patient, husband standing 665 00:46:17,586 --> 00:46:22,793 in the corner you ignore him. You just talk to her. You ignore 666 00:46:22,793 --> 00:46:25,708 him. Or the family or the grandparents or whatever. I'm 667 00:46:25,728 --> 00:46:28,811 just making this up. You ignore them in the room. You're 668 00:46:28,871 --> 00:46:32,985 disrespectful. One of the hypotheticals I used to use in 669 00:46:33,025 --> 00:46:36,170 my presentation to the doctors patient comes and see the doctor 670 00:46:36,170 --> 00:46:39,186 . Patient said to be Spanish-speaking only. Nurse 671 00:46:39,246 --> 00:46:41,909 gives a chart to the doctor and as the nurse is handing the 672 00:46:41,929 --> 00:46:44,431 chart to the doctor, the nurse says Spanish-speaking only. 673 00:46:44,452 --> 00:46:46,746 Doctor says okay, doctor doesn't speak Spanish. There's a 674 00:46:46,766 --> 00:46:49,590 patient in the room. Doctor goes into the patient's room with 675 00:46:49,610 --> 00:46:54,447 the nurse who interprets for him and does his exam and history 676 00:46:54,487 --> 00:46:57,630 and all that sort of stuff, writes a prescription for the 677 00:46:57,650 --> 00:47:04,347 patient, okay, and before the doctor leaves the room he turns 678 00:47:04,427 --> 00:47:08,666 to the nurse and makes a comment about the patient. Quite common 679 00:47:08,666 --> 00:47:13,094 , real quick comment, but it's sort of a disparaging type of 680 00:47:13,134 --> 00:47:17,144 comment. Not anything, rude, rude, but it's not nice. It's 681 00:47:17,186 --> 00:47:20,628 not a nice comment. I'll put it like that, and one of the things 682 00:47:20,628 --> 00:47:25,893 that I always tell the doctor. I said I don't care what the 683 00:47:25,974 --> 00:47:30,045 language is and I don't care what the nurse tells you. I 684 00:47:30,085 --> 00:47:34,865 don't care what language they say the patient speaks, or the 685 00:47:34,905 --> 00:47:40,173 patient speaks to everybody who is said to be Spanish-speaking, 686 00:47:40,224 --> 00:47:42,746 and you can fill in the blank with Spanish. You can put it 687 00:47:42,766 --> 00:47:48,070 into Gaelic, mandarin, cantonese , on and on and on and on. Speak 688 00:47:48,070 --> 00:47:52,385 from English, so you do not have to speak the language to 689 00:47:52,425 --> 00:47:57,527 communicate. for a kind for the patient, i said so don't make 690 00:47:57,588 --> 00:48:00,931 stupid mistake, right? I mean, in my mind that's a stupid 691 00:48:00,971 --> 00:48:05,166 mistake or whatever, but there's no excuse for that. And it goes 692 00:48:05,166 --> 00:48:09,831 back to respect transcends all culture. Be respectful, just be 693 00:48:09,871 --> 00:48:12,192 respectful. Same thing your mother and father taught you 694 00:48:12,505 --> 00:48:16,027 when you were growing up be respectful. So I would always 695 00:48:16,248 --> 00:48:20,528 end my presentation with the docs by saying don't be a jerk. 696 00:48:21,090 --> 00:48:25,186 Real easy to remember, just don't be a jerk. In summary, 697 00:48:25,206 --> 00:48:29,534 transformation in healthcare is patient-centered. Obama was a 698 00:48:29,594 --> 00:48:33,025 landmark healthcare legislation. Hospitals are achievement high 699 00:48:33,065 --> 00:48:36,907 reliability with link six and similar types of processes. 700 00:48:37,568 --> 00:48:43,452 Respect transcends all culture and avoid medical malpractice by 701 00:48:43,452 --> 00:48:47,192 not being a jerk. My basic principles is I always like to 702 00:48:47,291 --> 00:48:52,027 end up, god is in charge. I don't have bad days, don't sweat 703 00:48:52,027 --> 00:48:55,829 the small stuff, and most stuff is small. Forgiveness really is 704 00:48:55,829 --> 00:48:59,349 therapy and everything, everything, everything is a 705 00:48:59,431 --> 00:49:04,275 relationship, mutual respect, mutual trust, good communication 706 00:49:04,275 --> 00:49:05,409 . Are there any questions? 707 00:49:06,067 --> 00:49:12,471 Speaker 3: Yes, Yes, we were talking about. It was a good 708 00:49:12,510 --> 00:49:13,735 question. Ha, ha, ha ha. 709 00:49:16,764 --> 00:49:20,153 Speaker 4: When you were talking about you doing things black 710 00:49:20,193 --> 00:49:26,545 and white and the way let's say, if I'm your patient, are you 711 00:49:26,626 --> 00:49:33,791 nice with me because of the way you think, or because of the 712 00:49:34,432 --> 00:49:36,958 privilege that I have, or the law? 713 00:49:37,965 --> 00:49:41,170 Speaker 2: Excellent question. I am nice with you because you're 714 00:49:41,170 --> 00:49:46,967 human And that's all you need is just to be human And all that 715 00:49:46,967 --> 00:49:50,235 other stuff. I completely agree . Go ahead. 716 00:49:50,844 --> 00:50:00,400 Speaker 4: So there is no law, in other words, to tell you to 717 00:50:01,061 --> 00:50:01,722 respect the other. 718 00:50:03,088 --> 00:50:05,173 Speaker 2: There is a law, and that's an excellent question. 719 00:50:05,213 --> 00:50:09,425 I'll tell you why, because what we know is there are laws and 720 00:50:09,445 --> 00:50:13,411 then there's how you interpret. There is a law that says I need 721 00:50:13,431 --> 00:50:22,376 to treat you reasonably and responsibly. But a lot of times 722 00:50:22,797 --> 00:50:26,710 individuals can sort of do what they wanna do and sort of get 723 00:50:26,751 --> 00:50:30,427 around the law. But yes, there are rules that say I'm supposed 724 00:50:30,467 --> 00:50:36,034 to treat you a certain way. But a lot of that depends on whether 725 00:50:36,034 --> 00:50:39,027 I think I can get away with it or whether I think you will tell 726 00:50:39,027 --> 00:50:42,490 somebody, et cetera, et cetera. But the right way is it 727 00:50:42,530 --> 00:50:46,313 shouldn't matter that my approach should be the same as 728 00:50:46,355 --> 00:50:49,592 it is with everybody else, and that is with absolute respect. 729 00:50:49,885 --> 00:50:51,891 Speaker 4: And just to finish it up, this is not a question, 730 00:50:52,626 --> 00:50:56,213 that's a question. When I went to the office, the doctor's 731 00:50:56,273 --> 00:51:03,449 office, i saw a sign that said don't tell me, why'd you Google 732 00:51:03,972 --> 00:51:04,853 on your symptoms? 733 00:51:08,146 --> 00:51:09,672 Speaker 2: Oh, my God okay. 734 00:51:09,824 --> 00:51:14,188 Speaker 4: So why is that a problem? Well, why is that? 735 00:51:14,449 --> 00:51:17,672 Speaker 2: Okay, i would consider that rude if I were a 736 00:51:17,692 --> 00:51:21,588 period, because what he or she is saying is I don't wanna 737 00:51:21,648 --> 00:51:24,932 listen to you. But the reality is, and I think this is a good 738 00:51:24,992 --> 00:51:28,407 reality. Yeah, there are bad things about the internet or AI, 739 00:51:28,407 --> 00:51:31,626 whatever it is, but I think the good thing about it is that 740 00:51:31,706 --> 00:51:35,971 it's an harrowing patient. It used to be that we control all 741 00:51:35,990 --> 00:51:40,052 the information, but now you can do a check bot or you can go 742 00:51:40,112 --> 00:51:45,429 online and you can look up anything that I tell you. So 743 00:51:45,469 --> 00:51:48,309 what I would interpret that is that they are interested in 744 00:51:48,369 --> 00:51:51,431 listening to you. They just want to tell me what they want to 745 00:51:51,452 --> 00:51:56,186 tell me, and for me that would be a non-star. I go to another 746 00:51:56,206 --> 00:52:00,269 doctor because I wanna have a discussion. Now, if I'm just a 747 00:52:00,311 --> 00:52:03,110 patient I'm not a doctor I at least want you to be able to 748 00:52:03,130 --> 00:52:07,646 explain to me what it is you're gonna do in plain English. Don't 749 00:52:07,646 --> 00:52:10,809 use all those big words to try to impress me in plain English 750 00:52:11,144 --> 00:52:15,646 And just like that HGAP question that I can understand. So it's 751 00:52:15,786 --> 00:52:19,266 the patient's perspective, not the doctor's perspective. And if 752 00:52:19,266 --> 00:52:26,246 someone was permanently putting stuff on the door said don't 753 00:52:26,327 --> 00:52:30,028 even come in if you want me to ask a question. I'd pass them 754 00:52:31,264 --> 00:52:33,744 Because I would consider them rude. I would consider them And 755 00:52:33,764 --> 00:52:36,664 they already telling me they don't wanna talk to me, they 756 00:52:36,686 --> 00:52:39,570 just wanna tell me what to do And I'm not interested in that 757 00:52:39,610 --> 00:52:43,168 kind of thing. If I have the option, if I have the option, i 758 00:52:43,188 --> 00:52:47,485 pass them. I'm saying yes, sir, please go ahead. Gary, oh, can 759 00:52:47,505 --> 00:52:47,867 you hear me? 760 00:52:48,824 --> 00:52:53,447 Speaker 5: Yes, I had a question about what's the word. So, if 761 00:52:53,467 --> 00:52:57,036 there's a question of mild practice or anything like that, 762 00:52:58,824 --> 00:53:00,967 what is the statute of limitations as far as time 763 00:53:01,007 --> 00:53:01,369 period? 764 00:53:01,824 --> 00:53:04,548 Speaker 2: I think that's a good question. I think it's about 765 00:53:04,889 --> 00:53:08,871 that's a various per state. I wanna say it's like a couple of 766 00:53:08,911 --> 00:53:13,445 years, but that would be a good thing to put into Google and say 767 00:53:13,445 --> 00:53:16,228 it's now practice statute of limitation And they can tell you 768 00:53:16,228 --> 00:53:19,172 exactly. But I think it's at least probably about a couple of 769 00:53:19,172 --> 00:53:19,514 years. 770 00:53:19,885 --> 00:53:23,155 Speaker 5: Okay, and the B part to that is how would you then, 771 00:53:24,465 --> 00:53:27,110 if you do have a suspicion, how would you then acquire the 772 00:53:27,190 --> 00:53:29,592 information as far as what happened or what took place? 773 00:53:29,684 --> 00:53:30,213 Excellent question. 774 00:53:31,266 --> 00:53:33,570 Speaker 2: Excellent question. I think the first thing you would 775 00:53:33,570 --> 00:53:38,516 do is that you wanna talk to an attorney. So then the question 776 00:53:38,556 --> 00:53:41,106 is well, how do you find an attorney? There are a couple of 777 00:53:41,146 --> 00:53:45,414 ways to do that. One is if you know friends who know an 778 00:53:45,454 --> 00:53:49,072 attorney. But the answer is most people don't, quite honestly. 779 00:53:50,125 --> 00:53:53,311 And what I would do is I would get, i would go back to the 780 00:53:53,351 --> 00:53:56,744 search and I would put in a medical malpractice attorney is 781 00:53:56,865 --> 00:54:00,326 near me, medical malpractice attorney is near me. I would 782 00:54:00,346 --> 00:54:04,250 call them up and I would say I need a consultation on a 783 00:54:04,349 --> 00:54:08,230 possible malpractice case. Most of the times they'll give you a 784 00:54:08,269 --> 00:54:11,532 consultation about 30 minutes, 45 minutes and ask what their 785 00:54:11,572 --> 00:54:14,927 fee is And then you can shop around to make sure that fee is 786 00:54:14,967 --> 00:54:17,927 compatible with what you're willing to pay. And go in and 787 00:54:17,967 --> 00:54:21,286 talk to somebody, because what you wanna do is you wanna 788 00:54:21,327 --> 00:54:26,545 present the facts and have them use their legal expertise to let 789 00:54:26,545 --> 00:54:30,067 you know is there anything there or not. And for a lot of 790 00:54:30,128 --> 00:54:32,967 people, just doing that is therapy. You know a lot of 791 00:54:32,987 --> 00:54:35,510 people are not interested in that, but they have a question. 792 00:54:35,644 --> 00:54:39,086 You know they're uncomfortable, they say I'm not sure. And just 793 00:54:39,126 --> 00:54:42,409 getting legal advice sometimes is worth it, but that's the way 794 00:54:42,449 --> 00:54:42,851 I would do it. 795 00:54:44,668 --> 00:54:48,550 Speaker 5: So does the hospital. Do you have a right to 796 00:54:48,751 --> 00:54:51,612 information? as far as that, as far as a release of information 797 00:54:52,485 --> 00:54:53,951 from the hospital or doctor? 798 00:54:55,465 --> 00:54:57,994 Speaker 2: Are you saying information about the hospital 799 00:54:58,726 --> 00:55:00,452 and about the doctor from the hospital? 800 00:55:02,288 --> 00:55:06,528 Speaker 5: Yeah, as far as your possible question, as far as 801 00:55:06,588 --> 00:55:09,166 what happened in a particular situation, does the hospital 802 00:55:09,228 --> 00:55:12,791 have a right to release information to you based on that 803 00:55:12,791 --> 00:55:13,233 situation? 804 00:55:13,565 --> 00:55:16,733 Speaker 2: Okay, the hospital has a right to release your 805 00:55:16,813 --> 00:55:21,067 information. If you say I want my medical records, or let's say 806 00:55:21,067 --> 00:55:23,965 , if it's a child, i want my child's medical records, then 807 00:55:24,005 --> 00:55:26,688 that's within your right. The hospital is not gonna tell you 808 00:55:26,768 --> 00:55:30,268 much else other than that because they have their own 809 00:55:30,309 --> 00:55:34,768 attorneys and the physicians have their own attorneys. Now 810 00:55:34,889 --> 00:55:37,530 you break up a good point that I think is important to emphasize 811 00:55:37,530 --> 00:55:41,469 . Every hospital has a complaint department. If you have a 812 00:55:41,509 --> 00:55:46,458 concern, you can put it in very general terms and say I was in 813 00:55:46,478 --> 00:55:49,661 the hospital blah blah blah, or my chairman blah blah, blah, 814 00:55:49,681 --> 00:55:53,164 blah blah and we didn't understand why blah blah blah 815 00:55:53,204 --> 00:55:56,621 happened. Please explain. You can write a very generic letter 816 00:55:56,681 --> 00:56:00,184 like that. The important thing is that when you do a complaint, 817 00:56:00,184 --> 00:56:03,856 it has to be in writing. Most people don't know that You can't 818 00:56:03,856 --> 00:56:07,518 just call up and talk to somebody. You have to put it in 819 00:56:07,579 --> 00:56:10,755 writing. One of the things that we used to do when we did 820 00:56:10,815 --> 00:56:14,179 evaluate at predational hospitals is how they deal with 821 00:56:14,239 --> 00:56:17,519 complaints in writing. They have a timeframe that they have to 822 00:56:17,719 --> 00:56:21,135 answer you specifically. So put it in writing. It doesn't have 823 00:56:21,155 --> 00:56:25,722 to be very long and say we have some questions about our case. 824 00:56:26,074 --> 00:56:29,768 We want more information. Mard hospitals will be very happy to 825 00:56:29,809 --> 00:56:30,875 talk to you about it. 826 00:56:30,974 --> 00:56:31,255 Speaker 5: Thank you. 827 00:56:32,155 --> 00:56:34,139 Speaker 2: You're welcome Any other questions? 828 00:56:34,755 --> 00:56:41,945 Speaker 6: Yes, Yeah, regarding that, usually if somebody calls 829 00:56:42,106 --> 00:56:48,045 in, they have some symptoms And not to give, what is it? you 830 00:56:48,065 --> 00:56:53,501 tell them Port of America or go see a doctor. And now sometimes, 831 00:56:53,501 --> 00:56:55,338 when you want to make an appointment at the hospital, 832 00:56:56,000 --> 00:57:00,485 they say, well, we can give you online at such a time if you 833 00:57:00,525 --> 00:57:04,039 want to know what's wrong with you. Is that something that is 834 00:57:04,119 --> 00:57:07,702 going to be or is that something that is just that hospital? 835 00:57:08,074 --> 00:57:09,501 Speaker 2: Well, that's something that's happening right 836 00:57:09,501 --> 00:57:13,262 now And that's fine, Because what's happened is that now 837 00:57:15,139 --> 00:57:20,143 doctor of patient hospital in reaction is being virtual or in 838 00:57:20,204 --> 00:57:24,159 person That is perfectly OK, Where you put in your basic 839 00:57:24,199 --> 00:57:27,496 symptoms and then they'll ask you some questions And what 840 00:57:27,516 --> 00:57:30,438 they're doing is they're trying to decide is this something they 841 00:57:30,438 --> 00:57:33,860 need to have them come in for Or is this something that they 842 00:57:33,920 --> 00:57:36,601 can answer for you online? That's the best way to be quite 843 00:57:36,661 --> 00:57:39,402 honest Absolutely, Absolutely. 844 00:57:39,541 --> 00:57:42,422 Speaker 3: Yes, lauren, just mentioning that they can also 845 00:57:42,835 --> 00:57:44,644 risk the very expensive. 846 00:57:45,635 --> 00:57:50,065 Speaker 2: Excellent point. Excellent point If it's sort of 847 00:57:50,106 --> 00:57:53,902 like a relationship that's about to go bad in a way, you see 848 00:57:53,922 --> 00:57:57,016 them saying I'm talking about doctor of patient. There it is 849 00:57:57,197 --> 00:58:02,670 reasonable to say, doctor, we have a lot of questions about 850 00:58:02,974 --> 00:58:08,797 what happened to my uncle that you took care of. It is smarter 851 00:58:09,338 --> 00:58:12,827 to ask to meet with the physician for number of reasons. 852 00:58:12,827 --> 00:58:19,217 If he says no, that you want to make a note on him. But a lot 853 00:58:19,257 --> 00:58:23,621 of times, to Lauren's point, this can be resolved just with a 854 00:58:23,621 --> 00:58:26,795 quick conversation. Most of the times there are questions that 855 00:58:26,835 --> 00:58:30,045 have not been answered or have not been answered completely, 856 00:58:30,735 --> 00:58:34,039 And just by getting those things answered all that stuff can go 857 00:58:34,059 --> 00:58:38,478 away. I would argue more than 50% of the time. It can go away 858 00:58:38,878 --> 00:58:41,980 if that position is willing to talk, Because the position, in 859 00:58:42,019 --> 00:58:45,498 my opinion, is more important than the hospital, unless it's a 860 00:58:45,498 --> 00:58:49,981 possible related employee. Even then I would still start with 861 00:58:50,001 --> 00:58:52,641 the position, Because you want to get that position on your 862 00:58:52,661 --> 00:58:56,257 side. If it's this oh, you're exactly right, There's no way 863 00:58:56,599 --> 00:58:59,740 blah, blah, blah should have done that, Then that's important 864 00:58:59,740 --> 00:59:02,197 for you to know. But excellent point, You want to have that 865 00:59:02,237 --> 00:59:04,902 meeting first, Because a lot of times the hospital will put 866 00:59:04,922 --> 00:59:08,177 together a team to meet with you , But it's always better to have 867 00:59:08,177 --> 00:59:11,385 the meeting first. Have the meeting first, Absolutely Yes, 868 00:59:11,405 --> 00:59:14,737 sir. Do you have a question? I'll let you Any other questions 869 00:59:14,737 --> 00:59:14,737 . 870 00:59:15,157 --> 00:59:18,364 Speaker 5: Yes, sir, Yes Dr, Oh, yeah Well go ahead, go ahead, 871 00:59:18,405 --> 00:59:19,768 william. Go ahead William. 872 00:59:20,114 --> 00:59:20,637 Speaker 2: Runsilkram. 873 00:59:21,414 --> 00:59:25,617 Speaker 5: I'm sorry. I was going to ask. So if you have a 874 00:59:25,677 --> 00:59:31,094 current doctor that you're not exactly gelling with right So 875 00:59:31,115 --> 00:59:35,155 let's say you feel like the office is always in a rush, your 876 00:59:35,155 --> 00:59:38,456 appointment is kind of rushed through and stuff like that How 877 00:59:38,536 --> 00:59:45,478 do you go about getting another doctor as far as OK? so you call 878 00:59:45,478 --> 00:59:48,936 your insurance, you get a list of whatever. Are there certain 879 00:59:48,996 --> 00:59:52,878 questions that you should ask those doctors when choosing a 880 00:59:52,918 --> 00:59:57,061 doctor? What would you say is the best process of doing that? 881 00:59:57,574 --> 01:00:00,023 Speaker 2: I personally think the best process of doing that 882 01:00:01,197 --> 01:00:04,596 is actually being there physically, if you can, because 883 01:00:04,635 --> 01:00:08,257 I think you're going to pick up some things that may not come up 884 01:00:08,257 --> 01:00:11,041 in a normal question. You're going to look around the office 885 01:00:11,195 --> 01:00:14,057 Is it clean? Are there a lot of people? Are there a few people? 886 01:00:15,994 --> 01:00:19,818 You can certainly still ask questions in terms of what their 887 01:00:19,818 --> 01:00:22,842 experience is. Let's say, if it's a procedure or whatever, 888 01:00:22,894 --> 01:00:27,081 you can ask some basic questions . But I think, if possible, make 889 01:00:27,081 --> 01:00:30,780 an eye contact. Doing that person-to-person type of thing 890 01:00:32,264 --> 01:00:36,215 is worth doing, one of the things that my wife and I do. We 891 01:00:36,215 --> 01:00:40,619 tend to do things differently sometimes, so I'd like to always 892 01:00:40,619 --> 01:00:43,639 help her with me, or vice versa , because she's going to pick up 893 01:00:43,639 --> 01:00:46,400 stuff that I'm going to miss. Well, i may pick up stuff that 894 01:00:46,440 --> 01:00:52,259 she missed. So I'm a big believer, if possible now, to 895 01:00:52,318 --> 01:00:55,898 have that in-person type of thing. If not, you can certainly 896 01:00:55,898 --> 01:00:59,762 ask certain basic things about procedures in terms of how that 897 01:00:59,822 --> 01:01:03,541 person explains things to you or if they're even willing to talk 898 01:01:03,541 --> 01:01:06,335 to you. All those things are things that you can sort of 899 01:01:06,737 --> 01:01:10,280 check the boxes in terms of pro or con or others. The other 900 01:01:10,300 --> 01:01:11,210 question. 901 01:01:11,938 --> 01:01:15,460 Speaker 4: I think, yes, i think I'm one of those persons that 902 01:01:15,481 --> 01:01:20,135 you said, that I think the physicians are always busy And 903 01:01:20,257 --> 01:01:24,800 unless I don't see some openness , i won't even ask about what I 904 01:01:24,862 --> 01:01:31,221 went for. I'm just waiting for them to tell me. But you're a 905 01:01:31,260 --> 01:01:37,335 doctor over here And we usually tend well I'm usually tend to 906 01:01:37,356 --> 01:01:40,757 know his doctor and he's not a simple doctor, i mean he's a 907 01:01:40,797 --> 01:01:46,202 surgeon, oh man I have it with me. So when we approach to you, 908 01:01:46,282 --> 01:01:53,576 if we do and we engage in a term of a conversation, do you or 909 01:01:53,635 --> 01:01:58,164 your duty to that person under the regulations, medical 910 01:01:58,204 --> 01:01:59,806 regulations? Oh, I see, OK. 911 01:02:00,268 --> 01:02:07,960 Speaker 2: It depends. I'm putting it on the hand, no, 912 01:02:08,081 --> 01:02:10,378 because it depends on the circumstances. Are you in my 913 01:02:10,538 --> 01:02:15,521 office Or are we in the No, we're here in Park lot. 914 01:02:16,364 --> 01:02:19,019 Speaker 4: Well, in Park lot, ok Yeah, in the field lot then 915 01:02:19,039 --> 01:02:20,945 there are probably no obligations. 916 01:02:21,074 --> 01:02:23,864 Speaker 2: But I'm going to go back to your original comment 917 01:02:23,923 --> 01:02:28,277 also In terms of because a lot of I would say 50% of, not more 918 01:02:28,318 --> 01:02:32,342 people are exactly like you, i would write down the question, 919 01:02:32,574 --> 01:02:35,896 because what that does that helps to slow you down. You can 920 01:02:35,916 --> 01:02:38,538 just say I just have a couple of questions And I wrote them down 921 01:02:38,538 --> 01:02:41,137 , is that OK? And you just go down your list. That way you 922 01:02:41,157 --> 01:02:43,478 don't have to worry about getting flustered and trying to 923 01:02:43,518 --> 01:02:46,722 remember And I'll just write down two or three questions that 924 01:02:46,722 --> 01:02:51,644 you have. Now, if it's at a social event, many times the 925 01:02:51,684 --> 01:02:55,940 doctor is not obligated to say anything, but that's on her what 926 01:02:55,940 --> 01:02:59,420 she says and doesn't say, and what I do. I always reply 927 01:02:59,440 --> 01:03:02,858 because I think it's really not to type. You know what I mean, 928 01:03:04,717 --> 01:03:09,260 but just say well, i'm not sure, or refer I use just refer to 929 01:03:09,280 --> 01:03:10,224 the primary doctor. 930 01:03:10,494 --> 01:03:12,856 Speaker 4: Because there are persons I mean I work for the 931 01:03:13,077 --> 01:03:17,217 medical team management in the hospital There are people who 932 01:03:17,297 --> 01:03:22,483 know who they're looking for. Yes, A girl, a gap, good to get, 933 01:03:22,483 --> 01:03:27,077 Just to get that person or that hospital. Yes, yes. The same. 934 01:03:28,516 --> 01:03:31,063 Speaker 2: There is no question that if one has an addiction, 935 01:03:32,315 --> 01:03:36,481 then a lot of it is intentional, where they're strategizing and 936 01:03:36,501 --> 01:03:40,643 that sort of thing, that I view them as a subset as compared to 937 01:03:40,682 --> 01:03:44,561 just a regular patient. But having said that, one of the 938 01:03:44,601 --> 01:03:49,925 things that we dogs have to be careful of is assuming that one 939 01:03:50,005 --> 01:03:52,817 is acting a certain way to cause addiction, and one of the 940 01:03:52,836 --> 01:03:56,996 things I used to say drug addicts have pain too. They have 941 01:03:56,996 --> 01:04:02,304 real pain too, and just because one is a drug, that doesn't 942 01:04:02,324 --> 01:04:06,521 mean it doesn't hurt. And so we have to make that separation, 943 01:04:06,541 --> 01:04:09,922 because it's very easy And I've seen this in the hospitals a lot 944 01:04:09,922 --> 01:04:12,974 , oh so, and so is the blah, blah, blah, blah, blah It 945 01:04:12,994 --> 01:04:15,463 doesn't really hurt, it doesn't really hurt. Of course it hurts, 946 01:04:15,463 --> 01:04:19,757 of course it hurts. And I'll end on this The whole thing 947 01:04:19,797 --> 01:04:23,240 about health care disparities is where we look at people a 948 01:04:23,280 --> 01:04:27,097 certain way and then come to conclusions about them based on 949 01:04:27,137 --> 01:04:30,300 how they look And nothing to do with science just based on how 950 01:04:30,320 --> 01:04:33,860 they look, and that's like the worst form of health care 951 01:04:33,880 --> 01:04:37,556 disparities. But there's no question, there are people who 952 01:04:37,617 --> 01:04:41,117 are manipulative, usually addicts. People who know the 953 01:04:41,137 --> 01:04:45,442 system know it very well. I've been doing it for years and know 954 01:04:45,442 --> 01:04:47,960 how to work the system. Most of them are going to be in the 955 01:04:48,000 --> 01:04:52,836 minority, except it might be a drug addiction clinic where 956 01:04:52,856 --> 01:04:55,003 addiction is the primary issue. 957 01:04:55,644 --> 01:04:58,356 Speaker 3: Yes, do you think there's a span on the way about 958 01:04:58,717 --> 01:05:02,717 how a person can deal with their natural physician, how they can 959 01:05:02,717 --> 01:05:07,824 go through their insurance from the end post-imperial to the 960 01:05:07,844 --> 01:05:12,070 end of the session, and it's really fine? 961 01:05:12,090 --> 01:05:15,297 Speaker 2: That's an excellent point, thank you. One of the 962 01:05:15,317 --> 01:05:20,376 things that we all know is that it doesn't always work. Nobody's 963 01:05:20,376 --> 01:05:23,436 fault, not the doctor's fault, not the patient's fault. Your 964 01:05:23,476 --> 01:05:25,777 insurance company can certainly help you with that. Just say 965 01:05:26,097 --> 01:05:28,699 well, i went to see Dr Chalktop and I think I want to go see Dr 966 01:05:28,719 --> 01:05:34,097 Collins. He seems to be a nicer guy, he has a pretty watch, and 967 01:05:34,157 --> 01:05:37,259 I just think I want to go sit here And then it's your 968 01:05:37,278 --> 01:05:39,476 insurance company that will accommodate you Because, 969 01:05:39,556 --> 01:05:44,195 remember, it's patient-centered. Now the Lorrainez point 50 970 01:05:44,235 --> 01:05:50,057 years ago they'd say puff, chalktop's, all you have. But 971 01:05:50,117 --> 01:05:54,141 now you do have that leverage. And I would clearly encourage 972 01:05:54,181 --> 01:05:59,097 you to say it's just us or whatever. We just want to get a 973 01:05:59,157 --> 01:06:02,956 second opinion. But you want to explore that. You don't want to 974 01:06:02,996 --> 01:06:08,362 be uncomfortable all the way through. When you go into health 975 01:06:08,362 --> 01:06:12,797 care And you know from day one it's not working And you're not 976 01:06:12,836 --> 01:06:17,195 communicating, you don't trust the trust, whatever, you don't 977 01:06:17,237 --> 01:06:20,217 have the feeling, whatever that is, then you want to get out of 978 01:06:20,237 --> 01:06:22,998 that before they even start, because it's not going to get 979 01:06:23,038 --> 01:06:23,298 better. 980 01:06:24,302 --> 01:06:27,117 Speaker 6: Yes, I would say, we should do that OK. 981 01:06:28,356 --> 01:06:29,097 Speaker 2: How did you do it? 982 01:06:29,639 --> 01:06:33,777 Speaker 6: Online. Online is a product doctor And when I needed 983 01:06:33,777 --> 01:06:43,215 a disease. I was able to change it. I had to get a first But, 984 01:06:43,255 --> 01:06:47,186 jamie, if it was not, i would have aligned and looked for 985 01:06:47,226 --> 01:06:49,679 someone else, and this thing I could do. 986 01:06:50,101 --> 01:06:52,838 Speaker 2: There you go. Yeah, and that's an excellent point 987 01:06:53,554 --> 01:06:57,458 That you have power, which is a whole bunch, and part of your 988 01:06:57,498 --> 01:07:00,938 power is that you can say no, that's like we talked about in 989 01:07:01,079 --> 01:07:05,177 other lectures. And part of your power is you will say I want 990 01:07:05,217 --> 01:07:09,280 another opinion or whatever. But I would encourage you to do 991 01:07:09,320 --> 01:07:11,737 that, and it doesn't mean you're a bad person, it doesn't mean 992 01:07:11,757 --> 01:07:15,001 the doctor is a bad person, it just means it's not working. 993 01:07:15,715 --> 01:07:19,219 Nobody has to be at fault, but you have the authority to change 994 01:07:19,219 --> 01:07:22,920 that. Ok, all right, thank you. Thank you very much. Have a 995 01:07:22,960 --> 01:07:25,202 great week And happy Mother's Day to all the mothers. 996 01:07:25,715 --> 01:07:27,643 Speaker 1: Thanks for listening to the Healthy, wealthy and Wise 997 01:07:27,643 --> 01:07:31,797 Podcast with Dr William Chokdough. We hope you enjoyed 998 01:07:31,838 --> 01:07:35,996 this episode on health care's quality revolution, and if you 999 01:07:36,036 --> 01:07:39,920 found this episode helpful, please subscribe to the podcast 1000 01:07:39,981 --> 01:07:43,157 on your favorite podcast platform. This will help ensure 1001 01:07:43,197 --> 01:07:46,878 that you don't miss any future episodes And then share it with 1002 01:07:46,938 --> 01:07:50,858 your family, friends and or your coworkers. Well, thank you for 1003 01:07:50,878 --> 01:07:55,286 it, and we thank you once again for listening to the Healthy, 1004 01:07:55,375 --> 01:07:59,755 wealthy and Wise Podcast with Dr William Chokdough. Live your 1005 01:07:59,795 --> 01:08:01,442 best life the best way.