Grand Rounds 2.19

Grand Rounds 2.19, this week’s best of the medical blogosphere, is up at Barbados Butterfly.  ‘Dr. Butterfly’ is a surgical registrar in Australia, and has recently been sharing posts about how much she’s enjoying the Australian summer. I would say we’ll get her back come July, but it appears that it doesn’t drop much below 40 degrees F ( 4 celsius) in the winter months there. 

So put on some surfing tunes and settle in for a summer read.

Find out more about Barbados Butterfly at MedScape’s Pre-Rounds Index.

Make Verification Between Hospitals Meaningful

What do you feel passionate about in your work as a medical staff service professional? I recently asked a colleague that question. I do believe I hit a nerve…

What am I passionate about?

I am absolutely wild about this verification business that we do between hospitals. Make it meaningful – or we are just wasting our time!

I was darn well pleased about the Kadlec case. (A recent case that hinges on the responsiblity of individuals and organizations to respond to hospital inquiries about physicians in a truthful and complete manner.)

I firmly believe there should be a national list of questions that we ask each other. We are all trying to get at the same thing.

If you are going to send me questions – don’t waste my time. If you are doing a verification at reappointment, and want us to complete your form – don’t expect us to waste time putting down the dates of appointment. We have probably told you this half a dozen times, and if you aren’t going to do anything with the appointment date, don’t require us to take our time to look it up in our system and write it down for you again.


And if you are not going to look at the staff status – don’t ask me – or keep track of it yourself, and we will tell you if it changes.

If we all agreed to a standard verification letter, we could all put it into our systems, with appropriate boxes checked, and then change the ones that need it. Then you’d have the appointment dates, staff status and specialty if you really want it.

Medical Staff offices should be able to give us the straight scoop. Organizations should be put on notice that the MSO is expected to be able to respond to these inquiries. I am appalled by MSOs that say they can’t complete our form because they don’t know the answers. And we get so much flack trying to get our form completed, even though we have a big sheet of paper saying we must have our questions answered – no form letters.

DON’T EVEN GET ME STARTED ON THIS ISSUE! (Ah, it seems we already did…)

So, do you agree? If not, why not?

Is there something else you feel passionate about in the world of medical staff services? Feel free to leave a comment.

Go Red for Women – February 3rd

Don’t forget, February 3rd is Go Red For Women’s Heart Health Day!

I lost my mother to heart disease when she wasn’t much older than I am now.  Go red for heart health is a reminder – take good care of  your heart for yourself, and for those who love you.

 Too few people realize that heart disease is the No. 1 killer of women—and of men—but the good news is that heart disease can largely be prevented. Spreading the Go Red For Women message—Love your heart—raises awareness of heart disease and empowers women to reduce their risk. And as you encourage everyone in your organization to wear red on Wear Red Day, you’ll be sharing with them the tools and information they need to protect themselves and their loved ones.

Webinar – 2006 JCAHO Medical Staff Standards Update

John Herringer, Associate Director in the Department of Standards Interpretation at the Joint Commission on Accreditation of Healthcare Organizations will be participating in an online Edge-U-Cate Webinar on the topic of 2006 JCAHO Medical Staff Standards Update

Program Date/Time:  Friday February 24th at 1:00 P.M. Eastern Time.

More information on this program is available through the Edge-U-Cate Web Site.



On a related note:
JCAHO has released the 2007 Draft Hospital Standards

WebMD Joins Grand Rounds

WebMD welcomes Grand Rounds Readers.

Good doctors share what they know and this applies to medical blogs as well. A consortium of medical bloggers hosts a weekly collection of contributed posts that are appropriately labeled Grand Rounds. This week Kevin, MD hosts Grand Rounds and WebMD was included. Thank you for the warm welcome!

Organization Leadership – Staying in the Loop

Choices, choices… You decided on a medical school, an internship, a residency and maybe a fellowship, and then more choices. Solo or group practice? Large group or small? What hospital staffs should you join, and at which facilities will you actively practice? How involved will you become in the politics of organization leadership?

I’ve spent the past twenty years working closely with hospital and medical staff leaders.  In most hospitals the Chief-of-Staff, Vice-Chief-of-Staff, Credentials Chair, and other physician leadership positions are short term, usually two or three years, and are essentially unpaid.  The trend is to offer a small stipend, but it is rarely enough to offset the time and energy the job demands. 

So why do it?

Aside from all the noble causes, and there are many, consider serving because it can be a personally satisfying role, and it can help you further develop your leadership skills.  Many organizations offer training for volunteer leaders which can enable you to see the complex maze of healthcare administration from a broader perspective. Not only that, but the courses are usually offered in pretty nice places…   

Consider the advice of Richard L. Reece, M.D., author of Voices of Health Reform in Thoughts on Being a Doctor – Part I and Part II

I’ve excerpted one of Dr. Reece’s key points here:


Cultivate hospital executives.

As a general rule, the most influential and powerful healthcare organization in any given community is the local hospital. My advice is that business-minded doctors prepare themselves educationally to negotiate with hospitals, develop a strategic vision for collaboration, set economic goals and objectives, plan for implementing doctor-driven centers, and become clinical and economic partners of the hospitals.

Hospitals are anticipating a usage spike by baby boomers, who will want a new kind of hospital–more patient-friendly, more specialist-oriented, more convenient. There will be a demand for business-savvy physicians who are closely attuned to consumer demands for prospective pricing, evidence of quality and outcome information, and creature comforts for patients.


Even if you never choose to become Chief of Staff, or Vice-President of Medical Affairs, don’t allow yourself to become an outsider to the process. Work with hospital leadership, get to know the people in the Medical/Professional Staff Office, keep in touch with the direction and goals of the organization.

Staying “in the loop” will enhance your ability to practice medicine effectively, and to steer the direction of your own career.

Thoughts on Being a Doctor – From Healthleaders

Interview – Kim Pakney, CPCS, CPMSM

Welcome to the third in my interview series with interesting people in healthcare.  This interview is with Kim Pakney, CPCS, CPMSM, a co-founder of the Alaska Association Medical Staff Professionals and a current member of the NAMSS Certification Board.

MSSPNexus: How long have you been working in the field of medical staff services, and what drew you to the profession?

I’ve been working in medical staff services for nine years, and like many people got into the field by working as a temp. I helped an overworked, understaffed hospital Medical Staff Coordinator catch up on reappointments that had expired over a year’s time. I got hooked. The job can be fairly repetitive, but I find it interesting because our customers keep it different and keep me coming back for more. I love a challenge!

Prior to working in medical staff services I worked in the travel industry. My last job was for a firm that hired airline pilots and contracted them out to air carriers. (That’s where I met my awesome husband). My job was to help determine a pilot’s eligibility for the contract, and bring them into the company (contracts, HR paperwork, etc.). Sound familiar? The only difference between pilots and doctors is what they do, one group saves lives, the other carries lives.  The issues and attitudes we deal with in credentialing both are very similar.

MSSPNexus: What made you decide to co-found the Alaska Association of Medical Staff Professionals?

In Alaska most of our hospitals and/or healthcare entities only have one Medical Staff Professional. In addition, many of those MSP’s work in very remote areas. Most of our cities in Alaska cannot be accessed by road, only by air. So most of us here had no connection to each other; we often didn’t even know about each other. When I went to my first NAMSS conference in Orlando Florida in 1997 I quickly realized the benefit of networking with others who do what you do.

Barb Kuper, who became our first president and who was a Medical Staff Coordinator at Providence Alaska Medical Center at the time, and I co-founded the Alaska Association Medical Staff Services in February 1998.

Many of our small facilities were going through MSP’s like water because there was very little training or education available to them without traveling to the lower 48, which was cost prohibitive for many of them. So I figured if we got a state organization together and had an annual education conference, it would allow networking and education for those who might not otherwise get the help they need. I hoped it could help us maintain MSP’s in the state for a longer period of time. I’d say it’s working for the most part. Are we responsible for that? I’d like to think so, but we don’t really know.

MSSPNexus: How has AKAMSP benefited you?

The camaraderie in our state is amazing. We are working on a mentoring program, and people new to the medical staff profession are contacted about our group and learn quickly that they have access to help. I love coming together annually with all my colleagues around the state, enjoying their company and learning about things that effect our profession. Also we have some unique challenges here, so it’s nice to be able to get input from the group as a whole.

MSSPNexus: Keeping a state associaton active and growing is a challenge. Do you have recommendations based on your state’s experience?

What has worked best for us is that we communicate regularly by e-mail with all our members. Our meetings are held via conference call, only annually do we all meet in person. That detail keeps us active in light of growth, because new members are simply added to our e-mails and quickly become involved. We also have MSP’s in the state who are not members of the state association and we still keep in touch with them as well. Some messages are sent only to members, but some are sent to all MSP’s in the state, especially the annual education session, we invite EVERYONE!

MSSPNexus: You’re a member of the NAMSS Certification Board. Why do you feel that certification is important?

I think certification helps an MSP prove that they have a high level of knowledge about our profession. They stand out because they worked for a higher level of education in the field. It offers employers a certain confidence, knowing that an employee has passed a national exam that verifies a high level of knowledge. I personally love certification, and strived to attain dual certification for my personal satisfaction, to prove to myself that I have obtained that level of knowledge. An awesome side benefit of that is getting to serve on the Certification Board of NAMSS.

MSSPNexus: Any closing comments?

I wish more people could see the medical staff field as a profession and not just a job. I make it my personal mission to help with this. I love my chosen career and will stick with it for as long as I am still working. It’s fun, challenging and worthwhile.

Dear Doctor – You Could Be Better

The Patient’s Doctor suggests that if you think a physician could really make some practice improvements, tell him/her by writing a respectful letter like the one below. 

He asks “How will doctors improve unless patients tell them what they are doing wrong?”

We’ve probably all interacted with physicians who we felt were capable but cold, disorganized, or just plain unpleasant.  It happened to me once and I confess, I was a chicken and just never went back.

Professionally I have no problem standing my ground with the most intimidating of physicians; however, when I’m the patient I am far more prone to feeling vulnerable and uncertain. (You guys can be pretty scary…)

As a patient, if I wrote a letter like the one below, I’d have to wonder how awkward I would feel at my next visit.  Makes me wonder whether a face to face conversation might be better. 

So docs – would you try to improve if you got this letter, or would it make you uncomfortable enough that you’d hope the patient wouldn’t return? 

And, what about patients who are cold, disorganized and unpleasant to you?  Would you send them a letter, and what would it say?


Dear Doctor:

This is a note to help you improve your healthcare practice.

I find you to be a talented, capable and intelligent clinician. You provide good healthcare. However, your bedside manner needs development. The quality of the technical care you provide is sometimes lost because you do not show that you care about me, and my life.

I respectfully request that you take time to look at your behaviors. When you do, you will see that your patients need your compassion, with respect and humility, as much as they need your expertise.

Walking Alone

I left work quite late recently, and was struck by the oddity of seeing this usually busy skywalk completely deserted. 

One thing about working in a medical center large enough to employ the equivalent population of a small city, you’re rarely alone.  That; and everyone walks fast.  We’re always in a hurry to get somewhere we’re not. 

I like listening to snippets of conversation as I hurry along.  Many of them are carried on in languages I can’t identify, let alone understand.  I find myself wondering how the speakers feel about their lives here in the US. What do they enjoy and admire?  What do they find disconcerting and uncomfortable?  Do they miss their homelands, or is this now home? 

Walking these hallways gives me a sense of connectedness to the world community, especially the medical community.  For those visitors who spend a little time here and then leave, I hope the memories they take with them of these hallways and the people who walk them are good ones.