Returning to Health: The Necessity of Certainty

Lee S. Glass, MDPeter Rothfels, MD

Declarations

• Lee S. Glass, MD- Conflicts of Interest: None- Biases: Many

• Peter Rothfels, MD- No financial or other conflicts of interest- Biases: Many more

Course Outline

• Introduction• View Daniel Gilbert, PhD: TED Talk: The

Synthesis of Happiness• Didactic: Achieving successful health care

outcomes• Conversation regarding the above

https://www.youtube.com/watch?v=4q1dgn_C0AU

Key Practice Points

1. Must have a treatment plan

2. Treatment plan needs to be collaborative/bidirectional

3. Treatment plan is a final and binding agreement upon approach to recovery

Treatment Plan

a) sets expectations, including imaging type and number, consultations, treatment programs, (pain) medication expectations, limits, etc.

b) documents the care you are about to providec) becomes the basis for measuring ongoing

progress, or the lack thereofd) facilitates reimbursement of the services you

providee) if a dispute arises, it is your most powerful

evidence with the patient or licensing authority

Treatment Plan Must Be Developed Collaboratively

a) It memorializes the foundation of the doctor-patient relationship

b) Helps patients understand from the beginning progress, outcome expectations, and what is/is not going to be done, i.e.: number of MRI’s, opioid meds/dosage, etc.

c) It imposes bidirectional responsibilitiesi) you, the physician to provide careii) the patient to actively participate in the recovery process

Patient’s Buy-In

d) A patient’s buy-in to a treatment plan cannot be imposed, it must be given/agreed upon by the patient

e) Especially when times get tough, the patient must be able to realize that this was something to which he/she had agreed

Treatment Plan is Final and Binding

• It was a mutual/bidirectional agreement on the path to recovery

• Cannot make exceptions, absent intervening surgery or other non-related medical event

Successful Health Care Outcomes

• Health care success is facilitated by planning that sets bidirectional expectations– Physician’s commitments: agreed-upon workup,

treatment, meds, etc.– Patient commitment: daily activity log; active

participation in PT, OT, etc.– Joint commitment: After agreed-upon workup, when

treatment fails to produce clinically meaningful improvement in function, further treatment (especially pain treatment) is ended.

Successful Health Care Outcomes

• Health care success is facilitated by collaborative planning:– Honest discussion regarding likelihood of

achieving patient’s sought-after health status– Discussion conducted collaboratively– Principal focal points: workup, treatment, moving

on– Need for agreed-upon certainty

Successful Health Care Outcomes

• Health care success is assisted by reinforcement of plan elements at subsequent visits

Treatment Plan

• Clarity of the outline of the plan

• Clarity of Expectations – you as the physician to provide care and support, the patient to be actively engaged in the recovery process

• Reinforces to the patient that success is achievable, but only by adhering to this structure

“Fortune always leaves one door open in disasters to admit a remedy.”

Don Quixote de La ManchaMiguel de Cervantes

“They are able because they believe they are able.”

Marcus Aurelius ~ Roman Emperor

Discussion

• Comments or concerns?