Focus On... Empowering the Patient

Ten strategies to build partnerships with patients

Mary Davis Michaud, MPP; Sarah Davis, JD, MPA; Martha E. Gaines, JD, LLM

Partnerships take many forms. In business, partners share profits as well as losses. In productive therapeutic relationships, counselors exhibit empathy, insight, and acceptance without judgment, and clients are open to constructive feedback. In successful marriages, partners consider each other’s needs, working together to sustain and deepen trust. What makes a successful doctor-patient partnership?


Author Affiliations: The Center for Patient Partnerships at the University of Wisconsin–Madison, (www.patientpartnerships.org), trains graduate and professional students in patient advocacy. Clients seek advocacy to navigate the health care system, make more informed me

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800.

Partnering with our patients

Kathryn K. Leonhardt, MD, MPH

What health care professional doesn’t believe in patient-centered care? The term alone resonates with all of us, whether working in a hospital, clinic, or other health facility, with patients as the foci of our attention. Yet when the various definitions of “patient-centered care” are examined carefully, and our own practice patterns are compared to these standards, many of us come up short.


Author Affiliations: Doctor Leonhardt is the Patient Safety Officer for Aurora Health Care. She is a member of the Milwaukee Patient Safety Collaborative, a committee of the Medical Society of Milwaukee County.


Corresponding Author: Please address correspondence to: Kathryn K. Leonhardt, MD, MPH, Patient Safety Officer, Aurora Health Care, 12500 W. Bluemound Rd, Ste 301, Elm Grove, WI 53122; phone 262.787.2748; fax 262.787.2788; e-mail Kathryn.Leonhardt@aurora.org.

Empowering patients with a written agenda

Sue Gaard, RN, MS; Sarina Schrager, MD, MS

The Empowered Consumer? The future health care consumer is characterized as engaged, activated, adherent, self-managed, vigilant, and empowered; a transformation from the passive role of the traditional patient.


Author Affiliations: Sue Gaard is Founder of Confident Conversations, LLC: Transforming health care interactions one conversation at a time. Sarina Schrager, MD, MS, is Associate Professor (CHS), University of Wisconsin, Department of Family Medicine, 777 S Mills St, Madison

Corresponding Author: Please address correspondence to sue@confidentconversations.com

The power of education

Alan Fleishman, MD; Doris Doherty, RN, BSN

The day of the doctor and the nurse telling the patient what to do is over. Shared decision making is the new model. Patients often come into the health care setting with copious amounts of information related to their suspected or actual diagnosis. Although seen as challenging at times, these patients are the fortunate ones. They believe they have identified their problem, they feel good about what they know, and they are planning to remain as healthy as possible. The health care professional then needs to assess the beliefs held by the patient and together they decide the direction that will send the patient to the road to recovery.


Author Affiliations: Alan Fleishman, MD, and Doris Doherty, RN, BSN are with Franciscan Skemp Healthcare, member of Mayo Health System, La Crosse, Wis.

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Aligning forces for quality: The Wisconsin way

Cynthia Schlough; John A. Weigelt, MD; Dianne Kiehl; Gary W. Kuhnen; Christopher Queram

Wisconsin is a leader in fostering partnerships to improve health care quality. Great strides can be made when physicians, nurses, patients, consumers, community leaders, employers, and insurers work together in collaborative efforts. No single group or profession can improve health care without the support of others. Collaborative approaches help health care professionals deliver better care and patients make better choices.


Author Affiliations: Cynthia Schlough is the director of Member Services and Strategic Partnerships for the Wisconsin Collaborative for Healthcare Quality. John A. Weigelt, MD, is associate dean of Clinical Quality with the Medical College of Wisconsin. Dianne Kiehl is the ex

Corresponding Author: Correspondence may be sent to Cynthia Schlough at cschlough@wchq.org.

The empowered physician

Nileen Verbeten

Economic, demographic, technologic, political, and cultural forces are converging and few in health care are ready. There has never been a time when physician engagement is more important and widespread mobilization is required. Medical societies’ political and legal advocacy remains critically important. However, these efforts, while necessary, are nsufficient. Medicine is confronted by changes of unprecedented magnitude that call every physician to action–but what action?

In evaluating needed action, we can start with a review of systems.


Author Affiliations: Economic, demographic, technologic, political, and cultural forces are converging and few in health care are ready. There has never been a time when physician engagement is more important and widespread mobilization is required. Medical societies’ p

Corresponding Author: Please address correspondence to the Wisconsin Medical Society.

Editorials

Moving our mission forward

Susan L. Turney, MD, MS, FACP, FACMPE

When I became CEO of the Wisconsin Medical Society in 2005, one of our first accomplishments as an organization was the completion and implementation of a strategic plan focused on ensuring access to high quality, cost-efficient care for all patients in Wisconsin. To ensure our success in achieving this mission, we also defined several key initiatives, which include “lead the practice of patient-centered care in Wisconsin” and “protect Wisconsin’s favorable medical liability climate.”


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Susan L. Turney, MD, Wisconsin Medical Society, 330 E Lakeside St, Madison, WI 53715; 866.442.3800.

The privatization of Wisconsin Blue Cross Blue Shield: Public and private goods

Dennis L. Dresang, PhD

Fundamental to sound policy analysis is the distinction between public goods and private goods. This is a distinction that should be made when considering the privatization of Wisconsin Blue Cross Blue Shield.

Author Affiliations: Dennis L. Dresang, PhD, is a Professor of Public Policy and Political Science, University of Wisconsin-Madison.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Helping our patients help themselves

Clarence M. Chou, MD

My focus this year is to consider the role patients can play in taking more responsibility for their own health and health care, a form of patient empowerment.


Author Affiliations: Doctor Chou is a psychiatrist in Milwaukee, Wis. and president of the Wisconsin Medical Society


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Commentaries

In Rememberance

Philip F. Giampietro, MD, PhD; Christina Zaleski, MS;Steve F. Wagner, MD;Noralane M. Lindor, MD;Dusica Babovic-Vuksanovic, MD

In remembrance of Dr. Schowalter

Author Affiliations: Philip F. Giampietro, MD, PhD, Christina Zaleski, MS, are with the Department of Medical Genetic Services, Marshfield Clinic; Steve F. Wagner, MD, Emeritus Physician, is with Marshfield Clinic, and Noralane M. Lindor, MD, and Dusica Babovic-Vuksanovic, MD

Corresponding Author: Please address correspondence to Wisconsin Medical Society at 608.442.3800

As I See It: The Sound of Silence

George W. Kindschi, MD

As I See It

Author Affiliations: Retired physician and member of the Wisconsin Medical Society



Corresponding Author: Please address correspondence to the Wisconsin Medical Society 608.442.3800

Do not discount power of prayer

Mark K Belknap, MD, FACP

Letter to the Editor

Author Affiliations: Past President of the Wisconsin Medical Society



Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Wisconsin Blues’ Conversion: The Privatization of a Health Insurer

Bruce Fetter, PhD

Wisconsin Blue Cross was chartered in 1939 as a “charitable and benevolent corporation” to cover hospitalization costs at a time when most Americans did not have health insurance. In order to promote the protection that insurance afforded, the Wisconsin legislature exempted the company from most state and local taxes. During World War II, the federal government created tax deductions for both employers and employees, which created new demand for health insurance. The company extended its coverage to physicians’ services and, as Blue Cross Blue Shield United of Wisconsin (BCBSUW), became the state’s largest health insurer. In 1965, when Medicare and Medicaid further extended health coverage to the elderly, disabled, and indigent, the company took on the additional activity of administering those benefits on behalf of the government. The surge in demand for health care led to inflation in health costs in the 1970s.
Many in the insurance industry and government felt this inflation could be controlled through the extension of market competition among insurers. They therefore proposed abandoning their tax exemptions in exchange for the right to operate as for-profit corporations. As a condition of this transformation, the state government required that BCBSUW create charitable foundations to benefit medical education and public health. After privatization, however, the for-profit successors of BCBSUW failed to control both medical costs and company administrative expenses. A substantial share of the profits went to their executives.



Author Affiliations: University of Wisconsin-Milwaukee

Corresponding Author: Bruce Fetter, History Department, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201; phone 414.229.5207; fax 414.229.2435; e-mail bruf@uwm.edu

Original Research

Low Vitamin D Status: Time to Recognize and correct a Wisconsin Epidemic

Neil Binkley, MD; Diane Krueger, BS, CCRC, CDT; Marc K. Drezner, MD

As a result of low dietary intake and sun avoidance, low vitamin D status is endemic in Wisconsin. In a convenience sample of postmenopausal Wisconsin residents, 59% had suboptimal D status. Only recently, the medical community has begun to appreciate that low vitamin D status underlies multiple deleterious health consequences including skeletal fragility, muscle weakness, and a potential multitude of non-skeletal morbidities.


Author Affiliations: University of Wisconsin Osteoporosis Clinical Center and Research Program



Corresponding Author: Neil Binkley, MD, University of Wisconsin Osteoporosis Research Program, 2870 University Ave, Ste 100, Madison, WI 53705; phone 608.265.6410; fax 608.265.6409

Elective Percutaneous Coronary Intervention Without On-Site Surgical Backup: A Community Hospital Experience

M. Djelmami-Hani, MD; Mouatou Mouanoutoua, MD; Abdelazim Hashim, MD; Joaquin Solis, MD; Lawrence Bergen, PhD; Neil Oldridge, PhD; Leo C. Egbujiobi, MD; Suhail Allaqaband, MD; Masood Akhtar, MD; Tanvir Bajwa, MD

Our objective was to determine the safety of elective percutaneous coronary intervention (PCI) without on-site surgical backup (OSB).

Author Affiliations: Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wis (Djelmami-Hani, Mouanoutoua, Hashim, Solis, Allaqaband, Akhtar, Bajwa); College of Health Science

Corresponding Author: Tanvir Bajwa, MD, 2801 W Kinnickinnic River Pkwy #777, Milwaukee, WI 53215; phone 414.649.3390; fax 414.649.5769; e-mail bdanek@hrtcare.com

Changes in Themes Over Time from Medical Student Journaling

William Cayley Jr, MD, MDiv; Rae Schilling, PhD, PsyD; Ralph Suechting, MEPD

We evaluated journals kept by primary care medical students to identify prominent themes and
determine change or constancy in themes over time. We looked at third-year medical students participating in a required primary care clerkship in a university-affiliated, community-based family medicine residency program with a rural catchment area.


Author Affiliations: University of Wisconsin Department of Family Medicine at the Eau Claire Family Medicine Residency.

Corresponding Author: William Cayley Jr, MD, MDiv, 617 West Clairemont, Eau Claire, WI 54701; phone 715.839.5175; fax 715.839.5176; e-mail bcayley@yahoo.com.

Proceedings from the 2007 Wisconsin Quality and Safety Forum

Wisconsin Medical Society

The Wisconsin Medical Society, Wisconsin Hospital Association, MetaStar, Wisconsin Collaborative for Healthcare Quality, and the Wisconsin Health Information Organization partnered on the 2007 Wisconsin Quality and Safety Forum held October 22-23 in Waukesha. A highlight of the forum was the showcase of quality and safety projects from health care organizations around the state. We are pleased to publish shortened versions of these projects in this issue of the Wisconsin Medical Journal.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Case Reports

Hypophosphatemia Associated with Paraproteinemia: A Case Report and Review of the Literature

Sarah Kerr, MD; Joshua Kindt, BS; Sumanth R. Daram, MD

The differential diagnosis for hypophosphatemia is long, and involves complex, overlapping physiological systems. Practitioners are often guilty, however, of simply supplementing phosphate without fully investigating the etiology of the problem. The purpose of this case presentation is to illustrate a case of spurious hypophosphatemia that initially led to unnecessary phosphate replacement in a woman with undiagnosed multiple myeloma.

Author Affiliations: Department of Pathology, University of Virginia Health System, Charlottesville, Va (Kerr); Department of Medicine, Medical College of Wisconsin, Milwaukee, Wis (Kindt, Daram); Department of Medicine, Saint Joseph Regional Medical Center, Milwaukee, Wis (D

Corresponding Author: Sumanth R. Daram, MD, Clinical Assistant Professor of Medicine, Saint Joseph Regional Medical Center, 5000 W Chambers St #PIMS, Milwaukee, WI 53210; phone 414.874.4763; fax 414.874.4160; e-mail sumanth.daram@gmail.com.

Your Practice

Index of Articles

Wisconsin Medical Society

Index of all articles from 2007.

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Please address all correspondence to the Wisconsin Medical Society.

ProAssurance and PIC Wisconsin: Prepared for the inevitable

Stan Starnes, JD, CEO, ProAssurance

There’s almost no escaping the fact that you’ll be sued for malpractice.

Author Affiliations: Stan Starnes is the CEO of ProAssurance, the parent company of PIC WISCONSIN. ProAssurance Corporation is the nation’s fourth largest writer of medical professional liability insurance through principal subsidiaries The Medical Assurance Company, In

Corresponding Author: Please address correspondence to Wisconsin Medical Society at 608.442.3800

Patient safety from the patient perspective

Jay Gold, MD, JD, MPH; Greg Simmons, MA; Kay Simmons, MA

Patient safety traditionally has been focused on improving patient safety by focusing on the actions of health care professionals rather than through the empowerment or education of patients. In July 2005, a new organization was formed, choosing as its name “Safe Care Wisconsin: Partners for Advancing Health Care Safety.” The purpose of the group is to help health care consumers to be safer as they engage with health care professionals.

Author Affiliations: Doctor Gold is senior vice president and principal clinical coordinator for MetaStar, Inc. Ms Simmons is vice president of communications. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract w

Corresponding Author: Please address all correspondence to MetaStar, Inc.

Your Profession

Stark Phase III regulations take effect December 4

Michelle Leiker, JD

The Stark Law (often referred to as the Physician Self-Referral Law) prohibits physicians from referring Medicare patients for certain designated health services (DHS) to an entity with which the physician or a member of the physician’s immediate family has a financial relationship (ownership or compensation)—
unless an exception applies and prohibits an entity from filing claims with Medicare for those referred services. Penalties for violating the Stark Law include denial of payment for the service, civil monetary penalties, or even the possibility of being excluded from the Medicare or Medicaid programs.


Author Affiliations: Wisconsin Medical Society



Corresponding Author: Michelle Leiker, JD, Assistant General Counsel, Wisconsin Medical Society, 330 E Lakeside St, Madison, WI 53715; phone 608.442.3800 or 866.442.3800; fax 608.442.3802.

Your Society

Resolutions due February 11, 2008 for Wisconsin Medical Society Annual Meeting

Wisconsin Medical Society

The 2008 Annual Meeting of the Wisconsin Medical Society will convene Friday, April 11, 2008, at the Monona Terrace Convention Center in Madison. The deadline for receipt of resolutions, so they can be included in the House of Delegates handbook, is Monday, February 11, 2008. Resolutions must be submitted, in proper form, to the CEO’s office no later than 2 months prior to the opening session of the House of Delegates.


Author Affiliations: Wisconsin Medical Society



Corresponding Author: For further information, contact Noreen Krueger at 608.442.3904 or email noreenk@wismed.org

2007 Physician Citizen of the Year

Steve Busalacchi

It was 1998 when Patrick Wolf, DO, of Marshfield Clinic, realized his dream of opening a free medical clinic. As an urgent care physician, he knew the health care system was not adequately serving everyone in need. But it wasn’t until after he and his colleagues actually began running the Free Clinic that they realized it was serving more than the uninsured, but the underinsured, as well.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800