The real crisis is a system allowing patients becoming addicts by medicin prescribed by doctors. There should be one doctor responsible for all opiods prescribed beyond e.g. 4 weeks. In some systems that would be the general practitioner og the family doctor. Is may be difficult sanitizing the medicine after a hospital stay, but if hospital doctors let the family doctor take care there would be a sense of temporality of opiod use. The system should detect and report to the authorities about long-term use and the doctor should be asked questions if prescribing opiods to non-malignant diseases beyond 4 weeks.
There should be clinics available for treating chronic pain focusing on non-medical approaches.
What about medical canabis? Is that goind to be the next crisis? The next opium fof the people? It’ll make you passive and forget about other problems in your life and in the society?
We use mostly fixed salaries, but with the option of around 2-4% extra pay for personal properties. There are no bonuses in any way related to productivity in the clinic or research.
If I get rewarded with a bonus this month for doing my job, the next month I would want the same – and a little extra. THereby I change my focus from academics to production.
In stead of bonuses, let people how contribute positively develop their skills. Support them with a little guidance…
I do not have specific recommendations, but some general views. IT platform can be effective, but the integration in daily clinic most often fails. Clinicians only use what helps them with taking care of their patients and in a faster way. The two most important rules are, in my opinion:
1. Involve the clinicians who are supposed to use the software. Not the 1-2 most IT positive, but somebody ‘in the middle’.
2. Develop the software ourself. Avoid companies who own the code – or else it will get very expensive on the long run.
The great advantage is that the leader is new with no history. This makes it possible to define the leader role from day one, where nobody has + or – relations with you. It would be central to interact personally with the doctors who show informal leadership. Make them feel that you are there for them to do their best.
Probably it would be neccesary from day one to say out loud, that there will be changes. And you need input to find the best way to get to the goals.
This is a very complex situation. On the long run:
1. Public education
2. Improved community health care with family doctors. They can handle all non urgent cases and function as gatekeeper to the secondary helath care system.
3. Reforms to allow triage and selection at the door. And to stop the benefits of fast and high-quality of non-urgent cases in the ED setting.
On the short run, it may be possible to introduce some kind of selection by demanding a telehone call before showing up. This may not be feasible in the described setting.