Learning about Locations of Care

In this episode, Dianne and Dr. Crossnoe discuss hospitals, and how patients should think about them.

In this episode, Dianne and Dr. Crossnoe discuss various strategies and insights for you to use when dealing with doctor's offices, including appointments and communication.

In this episode, Dianne and Dr. Crossnoe interview Dr. Kristen Patterson about the specialty of OB/Gyn.

In this episode Dianne and Dr. Crossnoe talk to Dr. Jarred Riley about the process of training doctors.  They discuss the experience of medical school and residency, as well as beginning a medical practice.

In this episode, Dianne and Dr. Crossnoe discuss what locations of care might be appropriate for what types of problems.  They discuss the emergency department, walk-in clinics, and doctor's offices, as well as virtual visits!  After reviewing each of these places, they play a game in which Dr. Crossnoe gives several different examples, and Dianne guesses which location of care is most appropriate for that problem.Email address:  [email protected]

In Episode 5, Dianne and Dr. Crossnoe discuss the phenomenon of healthcare failure, when the healthcare system doesn't work as well as it should.  Dr. Crossnoe discusses the analogy of organ failure as a way to understand problems with the delivery of healthcare.In order to illustrate some of these problems, they use the case of Pauline, an elderly woman who is having some negative symptoms but has difficulty getting answers.  They discuss how things might go wrong in many locations of care, including ERs, walk-in clinics, and doctor's offices.  They consider how poor communication can be a major problem in healthcare. Among other things, Dr. Crossnoe emphasizes the importance of bringing medications or a list to every office visit.  They also discuss trying to improve communication through patient portals.

In episode 4, Dr. Brinker again joins Dianne and Dr. Crossnoe to discuss evidence-based medicine, and why patients should care about this.  Dr. Crossnoe suggests that it is important to understand the evidence in order to evaluate who a patient should listen to and how doctors make clinical decisions.  In order to have a context to discuss this, Dr. Crossnoe presents the case of a patient named Paul, who presents as a new patient who wants screening for prostate cancer.  Dr. Crossnoe and Dr. Brinker use this example as a way to discuss the evidence around screening for various medical conditions.  They also discuss other situations in which evidence has changed the standard of care in medicine, including tonsillectomies and peanut allergy.  Dr. Crossnoe and Dr. Brinker introduce the listeners to the United States Preventive Services Task Force (USPSTF), which gives evidence-based recommendations about screening for medical conditions.  They also discuss the importance of shared decision making and patient autonomy in medicine.  The group then discusses situations in which patients might want certain tests done, but evidence does not support doing the tests.  They discuss what makes good research, and that there are organizations and systems who screen and monitor these studies and make appropriate recommendations.  Dr. Crossnoe suggests that one major benefit of evidence-based medicine is to avoid clinical bias.They then return to the case of Paul, and discuss what other screening and health monitoring might be appropriate.  Dianne asks about what to think about recommended guidelines, particularly from the CDC, in the wake of COVID and the controversies during that time.  They discuss some of the lessons learned during the pandemic.The group then returns to the process of research, from initial studies through recommendations and guidelines.   As examples, they discuss cholesterol medications including statins and fish oil.  They also discuss what happens when new evidence overturns previous practice, such as in the case of the Women's Health Initiative and hormone replacement therapy and new recommendations on Pap smears.Dr. Crossnoe admits to initial skepticism about evidence based medicine while he was in medical school, and addresses the fact that not all decisions can be made directly on the evidence.  They again return to Paul and talk about some of the risks of screening for prostate cancer.  They also address screening for colon cancer.  They discuss appropriate skepticism in medicine, by patients and by physicians.Email address:  [email protected] Links:  Home page | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

In this episode, Dianne and Dr. Crossnoe talk with their first guest, Dr. Jared Brinker, about the specialty of Family Medicine.  Dianne is excited to interview Dr. Brinker, as he is her own personal physician.  Dr. Crossnoe does a brief erratum from the first two episodes.  Dr. Brinker summarizes his residency at John Peter Smith Hospital in Fort Worth, including additional training in Maternal Fetal Medicine.  He discusses how his practice has become more comfortable in the last few years compared to the first few.  He discusses rounding on patients at the hospital.  Dianne reveals that Dr. Brinker delivered her second child and her experience with that.  Dianne asks how patients contact Dr. Brinker.  Dr. Crossnoe uses this opportunity to discuss how call works for physicians.  Dr. Brinker demonstrates how call works in his OB call group.  Dianne asks Dr. Brinker about his nurse practitioners, and he talks about how much his two NPs help him in the clinic.   She asks him about why people need a family medicine physician, and Dr. Brinker talks about the advantages of family-based care.  Dr. Crossnoe discusses why people need primary care doctors in the first place.Dr. Crossnoe and Dr. Brinker talk about the size of their practices, giving an idea of how many patients they see per day.  They discuss how much work they have to do outside of the exam room for each visit, and mention two journal articles (linked above) which have studied this.  They discuss the difficulty of balancing this clerical work with the needs of patients.  Dr. Brinker discusses what he wishes patients knew about medicine, and how he has experienced the system from the other side when his wife had a surgery.  They then discuss the difficulties that doctors also face in dealing with the system, often due to insurance requirements.  He discusses how his staff helps with this.Dr. Crossnoe asks Dr. Brinker his favorite and his least favorite things about his practice of medicine.  Spurred by Dianne's story, they discuss the importance but also the difficulty in giving patients the attention they deserve.  Dianne asks Dr. Brinker about "Dr. Google".  He discusses the pros and cons of the massive amount of information available on the internet.To end the episode, Dianne asks Dr. Brinker some "fun" questions, including what TV doctor he relates to and what he would like to do if he was not a physician.Email address:  [email protected] Links:Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations | Annals of Family Medicine (annfammed.org)Revisiting the Time Needed to Provide Adult Primary Care | SpringerLink

In episode two, we discuss the many specializations of medicine.  Dr. Crossnoe uses the example of a tree, with many branches coming off representing the specializations.   Dr. Crossnoe and Dianne first discuss what specialties are considered to be primary care.  Dr. Crossnoe suggests that modern medicine could be considered as a tree with two major branches coming off of the trunk, representing the medical and surgical subspecialties.  Several other branches representing specialties that don't quite fit in one of these groups also come off of the trunk.  Dr. Crossnoe points out that if we consider it this way, we should also consider a smaller tree next to the main tree which represents the pediatric specialties.Dr. Crossnoe first discusses Family Medicine, which is his own specialty.  It is actually one of the newest specialties, effectively replacing General Practice by providing further training for primary care physicians.Dr. Crossnoe then discusses the first big branch, the medical specialties.  He starts with the foundational medical specialty, Internal Medicine.  He defines the role of a hospitalist, which is a physician who only sees hospitalized patients.  He then quickly summarizes many of the most important of the medical specialties, including Endocrinology, Cardiology, Gastroenterology (GI), Nephrology, Pulmonology, Infectious Disease, Hematology/Oncology, and Rheumatology.Dr. Crossnoe then reviews the second major branch, the surgical subspecialties.  Beginning with General Surgery, he then also summarizes Orthopedic Surgery, Otorhinolaryngology (ENT), Cardiothoracic Surgery, Urology, Plastic Surgery, and Neurosurgery.Dr. Crossnoe then points out that this organization of specialties is really just a way to think about it, there is nothing official about it.  The real authority on the specialties is the American Board of Medical Specialties (link above).Dr. Crossnoe then summarizes the remaining specialties, including OB/Gyn, Anesthesiology, Allergy/Immunology, Neurology, Psychiatry, Dermatology, Ophthalmology, Emergency Medicine, Pathology, Radiology, and Hospice Medicine.  Dianne asks about what the initials D.O. stand for, and how that distinguishes from M.D.  Dr. crossnoe explains the difference between osteopathic and allopathic medicine. The hosts then discuss again the pediatric specialty tree and how it is similar and how it differs from the adult medicine specialties.Dianne then asks the listeners for questions for specialists, or suggestions on what specialties they might want to hear from, to be sent to their email at [email protected] address:  [email protected] Links:  ABMS | American Board of Medical Specialties

In episode one, Dianne and Dr. Crossnoe introduce themselves and discuss their motivation for starting the Dealing with Doctors podcast.  Dr. Crossnoe discusses his background, family, and education.  He explains that the primary motivation behind Dealing with Doctors is to provide a resource to patients in dealing with healthcare to understand how modern medicine works.  Dianne introduces herself as an administrator in the same healthcare system that Dr. Crossnoe works, and explains that her role in this series will be to ask the questions that regular, non-medical patients might want to know.  Dr. Crossnoe suggests that he probably won't know many of the questions that people may have, and so the format for this series for many shows will be to have guests on in various fields, both physician specialists as well as other roles in healthcare.  Other shows will be done with Dianne and Dr. Crossnoe alone.The hosts identify patients as the primary audience for Dealing with Doctors.  They set the goal that this series will help patients understand the perspective of healthcare workers and how they can best communicate with physicians and other healthcare workers.Dr. Crossnoe points out that a major problem in modern medicine is access to healthcare.  He suggests that one significant cause of this is the lack of manpower in medicine, both for physicians and other workers.  He points out that his practice, which is probably on the smaller side for primary care, consists of about 3800 patients for two providers, Dr. Crossnoe and his nurse practitioner Karen.  He says that he thinks that the national average is around 2000 patients per provider in primary care.Dr. Crossnoe suggests that a major way we are going to have to manage this problem will be through the better use of technology, including the internet and patient portals.  Dianne asks about "Dr. Google", and Dr. Crossnoe suggests this can be a good and powerful tool, although it does come with some disadvantages.  He says that the two major online resources he uses are UpToDate and the American Family Physician magazine (links below). Dianne asks Dr. Crossnoe about crazy stories he has as a physician.  Dr. Crossnoe points out the difficulty in sharing many of these things due to privacy concerns.  All stories told on this podcast will either be completely fictitious (although realistic) or will have major changes in demographics and other protected information to make the patient unidentifiable.  Dr. Crossnoe shares the difficulty that being a provider sometimes brings due to concern about patient's well-being.  Dianne confirms that she has seen many providers in her job dealing with difficult situations.The hosts then invite listeners to send their questions to their email at [email protected] address:  [email protected] Links:Evidence-Based Clinical Decision Support System| UpToDate | Wolters KluwerAFP | AAFP