Transcript
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Speaker 1: Welcome to the
Healthy, Wealthy and Wise
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podcast with Dr William
Chowk-Taw. In this episode, Dr
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Chowk-Taw will continue his
Leadership Masterclass series by
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covering healthcare's quality
revolution. He'll explore a
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number of factors that are
driving this revolution, factors
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that include the latest
developments in healthcare
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quality and how it has changed
the landscape of healthcare
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delivery, the Affordable Care
Act, patient-centered care, high
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reliability organizations, lean
Six Sigma and medical
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malpractice. Dr Chowk-Taw will
also explore data and analytics
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and how they are used and
applied to help improve
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healthcare. So, whether you are
a healthcare practitioner, a
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healthcare professional, a
patient or just a consumer of
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good information, this podcast
episode is for you. Join us now
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as we explore healthcare's
quality revolution and discover
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how we can work together to help
improve the quality of
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healthcare delivery for everyone
. So let's get started. Here's
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Dr William Chowk-Taw.
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Speaker 2: Good morning. Good
morning. I'm absolutely
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delighted to be here and I
welcome you to the Masterclass
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Number Five. Masterclass Number
Five Today we're going to talk
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about leadership in terms of
healthcare's quality revolution
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quality revolution. I believe
that life is about being of
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service to others. I believe
knowledge is power. I believe
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leaders can change the world.
You notice, i always start off
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with the same beliefs and these
are my beliefs. And you may say
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with Dr Chowk-Taw why don't you
talk about what you believe? I
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do this for two reasons. One is
to emphasize the important point
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that we started with the very
first Masterclass about talking
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about the brain. That is what
you believe that affects how you
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think, and it is how you think
that affects how you act, and so
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it's always important for us to
go back individually to our
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individual belief and make sure
that they're in sync with where
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we want to be and where we think
life is going for us. If they
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are not, then change them, but
to always be aware of them. For
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the last five weeks, i've asked
you to think like doctors as we
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talk about this Masterclass And,
as Jesse mentioned earlier,
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we're going to deal with both
medicine and law as we talk
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about healthcare. One of the
things that I learned. Let me
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back up. I graduated from
medical school in 1973. I
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graduated from law school in
1998. 25 years different. And
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one of the things that I learned
is the difference between
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doctors and lawyers. I did not
know this before. We doctors
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think in terms of black and
white. Either my patient has
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acute appendicitis or my patient
does not have acute
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appendicitis. Either my patients
had a heart attack or my
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patient did not have a heart
attack. Doctors like to have
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exactness. They like to be
specific, but when we are not
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able to be specific To lawyers,
there is no black and white.
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Think about this. Doctors think
in terms of black and white.
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Lawyers there is no black and
white. Lawyers think in terms of
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grayness. Everything is gray.
It's how you use the facts to
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make it a little dark or a
little light. So it's one of the
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reasons why, when a doctor is
talking to a lawyer, they many
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times there's a conflict,
because the doctor is saying but
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I saved his life, so why in the
world is he suing me for
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malpractice? The lawyer is
saying I don't care that you
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saved his life, you violated
section one of XYZ, blah, blah,
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blah, blah, blah, blah, blah.
Therefore, you're going to be
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liable for malpractice. So it's
a different welcome. So it's a
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difference in the way we think.
Doctors think in terms of black
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and white, lawyers think in
terms of grayness, and I'm
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definitely a black and white guy
in terms of how I think and
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what an exactness of this and
that. But what I have learned,
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what I have learned as I've
gotten older, is that the world
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is probably gray. Most people
probably do think in terms of
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black and in terms of grayness,
but we'll go over that a little
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bit more as we move along. If
you remember, this is your
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computer. Some people call it a
cell phone, some people call it
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a smartphone. I call it an
academic hand computer because
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you're in the master class and
you're exceptional compared to
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other students. You're expected
to use your academic hand
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computer and look up stuff all
the time. Anytime you have a
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question about anything maybe a
couple of times a day you should
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go to your academic hand
computer and put into the
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browser What is the meaning of
artificial intelligence? Blah,
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blah, blah, blah, blah, blah. I
always want to make sure to
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remind you about that. As always
, i always like to include an
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outline, and the purpose of the
outline is to let you know what
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we're going to talk about.
That's one purpose. Second
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purpose of the outline is to let
you know where we're just about
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done. So I know you want to
visit people and, god bless you,
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you're taking time out of your
Saturday to be here with us for
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an hour. So we're going to talk
about change, and we always talk
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about change to some extent.
We're going to talk about the
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Affordable Care Act, or
Obamacare, as you probably heard
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it, because that has been
fundamental to the change in
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health care. We're going to talk
about something called HCAPS.
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This is a survey that the
government started doing,
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probably about 20 years ago 15,
20 years ago of patients to help
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to evaluate doctors and
hospitals, and we'll go into
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detail about that. We'll mention
about high reliable
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organizations. This is where
hospitals want to be High
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reliable organizations, those
organizations that are trying to
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get to zero patient harm, zero
patient harm. One of the codes
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that we take as positions in
essence is to first do no harm.
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You may not help, but you don't
want to harm anybody, so the
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first thing you want to do is
not to harm anybody. We'll
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mention briefly about the Lean
Six Sigma just as a process of
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excellence, and then we'll end
with medical malpractice. So
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when we get to medical
malpractice, you know what I'm
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just about done. Okay, all right
, here we go Quality revolution.
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One of the things you hear
people talk about a lot in
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health care is quality, the
essence of what you do to a
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person, or are you giving them
the best type of care as
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compared to less? best type of
care? And one of the truisms
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that I've learned that I want to
share with you, and I heard
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somebody say this to me a long
time ago if you can control the
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dictionary, you can rule the
world. Think about that If you
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can control the dictionary, you
can rule the world. See, if I
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control the dictionary, things
mean whatever I say. They mean
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Black, means white, up, means
down and means out, because I
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control the dictionary Right? So
you want to be very, very
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careful when you hear people
talk about whatever they're
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talking about and ask yourself
who controls the dictionary? Who
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decides what's good? Who
decides what's high quality,
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what's poor quality? Who makes
that decision? And how did they
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get that ability to be able to
do that? Another fundamental
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principle that we'll address
multiple times today is health
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care. Is health care a privilege
or is it a right? Do you have a
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right to quality health care,
or is it a privilege that you've
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been blessed with being able to
experience More and more? now,
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and I'm in the category that
believes that health care is a
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fundamental right. I do not care
where you are, i do not care
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what you do, i do not care what
you look like, i do not care
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what your politics are, i do not
care whether you're a follower
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of Martin Luther King or you're
the imperial wizard of the Ku
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Klux Klan. If I am your surgeon,
i'm going to give you the very
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best care and it does not matter
to me. I'm not even going to
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ask you about your policy. Does
that make sense? Because, as a
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physician, my job is not to
judge you, so I don't judge. I
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don't judge. Now, that's a
little different from the way I
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grew up, where you do judge. I
look at him and I judge this and
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I judge that. But as a
physician, my job is not to say
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well, he's wearing a black watch
, therefore ABC, or he's wearing
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a blue jacket, therefore I am a
physician. My job is to give
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you the best care possible, and
that is irrespective of what you
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believe in, who you are. Now,
everybody does not believe that,
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but I think it's fair to say
that most in society are moving
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toward the fact that health care
is a right. It is not a
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privilege. I don't care what
your citizenship is, i don't
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care where you were born. If you
landed my hospital, on my
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operating room table, i'm going
to give you the very best care
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possible, and all that other
stuff does not matter to me. It
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is not relevant to the quality
of care that I give you, and
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this is where we're trying to
get doctors and nurses and
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hospitals to get to today. One
of the other basic principles
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that the federal government
figured out some years ago is it
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pays most of the money in this
country for health care. The
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federal government, washington
DC, pays most of the money for
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health care in this country. So
the government said if I pay
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most of the money, i think I
should control that dictionary
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Right. If you can't do it
without me paying you and you
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rely on me to pay you, then I
can decide what's what. And so
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then the government said I will
decide, or help to decide, what
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quality is. No, dr Choctaw,
we're going to go by your
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definition because I'm paying
you Right, so you can have your
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thoughts. That's good. I'll
listen to your opinion, but at
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the end of the day, it is my
responsibility. So I'm going to
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tell you what my expectations of
you are. Hospital X I'm going
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to tell you what my expectations
of you are. Okay, one of the
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big ways this occurred in this
country admittedly, you've heard
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about this and you sort of know
about it, but it may not have
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been obvious to you at the time
is the Affordable Care Act. And
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you hear one party in this
country saying they're going to
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repeal it and they promise
they're going to repeal, they're
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going to get rid of it. And the
other party in this country
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said it's the best thing that's
ever happened to health care in
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the last 20 years. And some even
call it Obamacare because it
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was President Obama who actually
pushed it through. It's similar
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to the 1950s, where Medicare
was first adopted. Medicare did
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not exist until the 1950s. What
does Medicare do? Medicare helps
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to ensure quality care for
elderly patients in this country
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, because when you're elderly,
you probably no longer work, and
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the older you get, the more and
more and more medical
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conditions you're going to
develop. Just the way it is Okay
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. So the government decides.
Well, if you've worked hard all
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your life or you've lived a long
time, you should not be denied
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health care just because you're
over 65 years of age. So
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Medicare says we're going to
help pay for your health care
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And that's why we have Medicare.
And I might add that some
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people who objected to that in
the 1950s no, no, no, no, no, no
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. That's socialized medicine.
People ought to work for the
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health care. For instance, i've
been working for the last 50
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years. I'm 75 years old, i'm not
going to work anymore, but
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still it depends on whether you
believe that health care is a
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right or a privilege. Should it
only be for certain people who
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have a certain amount of income
we have a certain amount of blah
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, blah, blah, or live in a
certain zip code or should it be
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for everybody, because it's a
God-given right to human beings
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and it should not matter who you
are, what you look like. But
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that's the fundamental argument.
That's the fundamental argument
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. You hear it play out all the
time, every day. Three things,
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very briefly, that the
Affordable Care Act did or does,
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because it's still with us. The
other part was not able to
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repeal it. They keep trying but
they keep failing. One it
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covered more people and it paid
for care for more people. A
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single parent, three to four
children, may not have a job,
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stays on welfare or something
like that. How do you pay for?
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if you have a sick child, how do
you pay for those expenses? The
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Affordable Care Act helps to
pay for that. It controls costs.
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Does somebody believe? well,
you know you pay whatever I
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charge. Well not really. If I
don't control the dictionary
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Okay, because the first control
is the dictionary that's in the
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chalkbook You can't charge
$1,000 for cutting a toenail.
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That just doesn't work. You
can't do that. I know you may
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have house payments. Get a
smaller house. Get a smaller
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house, Okay. The other thing,
and probably one of the most
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subtle and I think one of the
most profound things that
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Obamacare did back in 2010, is
that if forced hospitals and
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doctors help go all electronic,
force us to use the computers,
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put down that pen and pencil and
it drove the industry crazy. I
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know nurses they quit at
hospitals because they had to
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learn how to use the computer.
And the nurses I want to be at
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the bedside Doctors who said
well, i'm a doctor, i operate on
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people, i don't want to do all
that paperwork. And the
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00:14:19,985 --> 00:14:23,033
government said you know what. I
control the dictionary. I'm
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00:14:23,073 --> 00:14:27,553
paying your salary. Quality is
what I say. It is What I say it
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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
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00:14:39,009 --> 00:14:43,937
about this cold change? and the
idea about quality healthcare
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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
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00:14:57,979 --> 00:15:01,572
charge. We doctors, i mean, are
in charge. People just do what
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we say in a hospital. And I
think I've mentioned, you know,
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00:15:06,210 --> 00:15:09,576
about how nurses used to stand
when the doctor used to walk on
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to the ward and all that sort of
stuff. But basically the
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00:15:12,706 --> 00:15:17,696
response to the thing was yes,
doctor. I say do X, yes, doctor,
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00:15:17,696 --> 00:15:22,244
do Y, yes, doctor, no question,
no, blah, blah, blah, none of
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00:15:22,283 --> 00:15:27,115
that. And the government said
you know what, if you go and
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stay a couple nights at the
Ritz-Caulter, before you even
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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
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your friends? Blah, blah, blah.
What's my point? My point is
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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
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00:15:56,355 --> 00:16:00,614
the customer. And so one of the
things that might last seven or
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00:16:00,614 --> 00:16:04,004
eight years in full-time
employment run around the
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00:16:04,063 --> 00:16:06,990
country trying to help, along
with the joint commission,
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00:16:07,110 --> 00:16:10,505
educate physicians at hospitals
about quality care, a
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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
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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
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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
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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
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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
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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.
