Returning to Health: The Necessity of Certainty

1. Returning to Health: The Necessity of Certainty Lee S. Glass, MD Peter Rothfels, MD

2. Declarations • Lee S. Glass, MD - Conflicts of Interest: None - Biases: Many • Peter Rothfels, MD - No financial or other conflicts of interest - Biases: Many more

3. Course Outline • Introduction • View Daniel Gilbert, PhD: TED Talk: The Synthesis of Happiness • Didactic: Achieving successful health care outcomes • Conversation regarding the above

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

6. Key Practice Points • Must have a treatment plan • Treatment plan needs to be collaborative/ bidirectional 3. Treatment plan is a final and binding agreement upon approach to recovery

7. Treatment Plan • sets expectations, including imaging type and number, consultations, treatment programs, (pain) medication expectations, limits, etc. • documents the care you are about to provide • becomes the basis for measuring ongoing progress, or the lack thereof • facilitates reimbursement of the services you provide • if a dispute arises, it is your most powerful evidence with the patient or licensing authority

8. Treatment Plan Must Be Developed Collaboratively • It memorializes the foundation of the doctor-patient relationship • 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. • It imposes bidirectional responsibilities • you, the physician to provide care • the patient to actively participate in the recovery process

9. Patient’s Buy-In • A patient’s buy-in to a treatment plan cannot be imposed, it must be given/agreed upon by the patient • Especially when times get tough, the patient must be able to realize that this was something to which he/she had agreed

10. 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

11. 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.

12. 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

13. Successful Health Care Outcomes • Health care success is assisted by reinforcement of plan elements at subsequent visits

14. 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

15. “Fortune always leaves one door open in disasters to admit a remedy.” Don Quixote de La Mancha Miguel de Cervantes “They are able because they believe they are able.” Marcus Aurelius ~ Roman Emperor

16. Discussion • Comments or concerns?