tag:blogger.com,1999:blog-40888796849245411942012-01-24T01:37:18.803-05:00A blog to help health care providers shorten wait times and improve patient flowIan Furst http://www.waittimes.blogspot.comnoreply@blogger.comBlogger2831100tag:blogger.com,1999:blog-4088879684924541194.post-31470017889205128582008-11-03T08:00:00.001-05:002008-11-03T08:00:02.711-05:00

Nothing creates more panic in the eyes of office managers than holes in the schedule. While doctors may complain about too much work and not enough time with a patient, the corollary is a lack of work.I've watched this scenario play out several times now, and in our own practice it's not uncommon in the October/November period after we take on a new surgeon to have openings. An increase in doctor

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com8tag:blogger.com,1999:blog-4088879684924541194.post-68780364264327333782008-10-21T08:51:00.000-04:002008-10-21T08:52:44.692-04:00

Grand Rounds is up with Pallimed. Included is an interview with Tony Clement, Canada's Minister of Health. Not an easy interview to get. Congrads to Sam Soloman.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-76361481499560847582008-10-16T07:00:00.001-04:002008-10-16T07:00:01.044-04:00

FreshMD has posted information given to refugees to Canada. It is as moving as it is simply. For instance,"In Canada, the law lets you practise your religion freely. You will not be asked or forced to change your religion. Freedom of religion is one of Canada’s basic freedoms. There are many Buddhist and Hindu temples, and Christian churches across Canada. In many cities, you can invite Hindu

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-53734345562250095242008-10-15T07:00:00.004-04:002008-10-15T17:59:11.722-04:00

Yesterday I went to the “Gallup World Class Employee Engagement Seminar” to learn about best practices for employee engagement. You can read my previous post about the Gallup Q12 for a more detailed description of the tool.I could wax poetic about how an engaged employee will lead to lower turnover, better business unit performance and more engaged clients. But the entire concept was best summed

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com3tag:blogger.com,1999:blog-4088879684924541194.post-77474553944855784002008-10-14T07:00:00.000-04:002008-10-14T07:00:00.713-04:00

Grand Rounds is up today at Notes of an Anesthesioboist.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-19952691556929643442008-10-13T21:09:00.001-04:002008-10-13T21:10:53.521-04:00

Happy left a wonderfully glib post to a lawyer who visited his site. You know this one is going to end in a comment battle and possibly a lawsuit. I hope Happy knowswhat he's doing. I can hardly wait to see what happens in the comments section.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-11353345525250128762008-10-13T12:52:00.002-04:002008-10-13T13:03:04.264-04:00

I had a link from a new blog this week. Life in the Fast Lane is the writings of an ED physician from Australia. It is an eclectic mix of comedy, clinical cases and policy musings. 'SandnSurf' is a talented writer and has some skills with the technical side of blogging. My guess is this blog will become popular fast. Take a look at Life in the Fast Lane.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-60130151960162510182008-10-13T11:23:00.002-04:002008-10-13T11:34:44.604-04:00

Poka-Yoke is mistake proofing something. Anaesthesia is replete with these handy little tools. For instance the regulator for oxygen will only fit on an oxygen tank due to a pin-index system. On our anaesthesia machines the lowest percent of oxygen you can give is 30% otherwise the machine cuts off and the patient breathes room air.But PokaYoke extends far beyond life-threatening situations. I’ve

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-81623281926487545952008-10-12T16:43:00.004-04:002008-10-12T17:30:37.889-04:00

Few medical bloggers have gained greater access or more popular acceptance among the mainstream media than Dr. Valerie Jones. Under the pseudonym 'Dr. Val' and as a member of the National Press Club Dr. Jones gained access to Washington insiders to provide insight into the politics and policies of US Health Care.Medical Blogging can be a difficult and dangerous business. Most are either

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-54072196818064730002008-10-11T07:00:00.000-04:002008-10-11T07:00:00.631-04:00

The accolades are few and far between in the world of blogging for health care efficiency so I'll take it where I can get it. Check out GruntDoc's caption contest (I placed 4th).

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-63250695049837406402008-10-10T07:00:00.000-04:002008-10-10T07:00:00.588-04:00

In any continuous improvement project I've found one of the major hurdles to be keeping all of the team members on the same page. Grouputer Solutions has come up with an online six sigma tool for everyone to use. Interesting tool -- the link is to the screen shots.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-64613686220227934832008-10-09T07:00:00.000-04:002008-10-09T07:00:01.023-04:00

The CHC published a report this week on the private clinics of Canada. They used anonymous telephone calls to multiple private or semi-private clinics throughout Canada to garner information as well as publicly available information. The study excluded clinics for purely non-necessary medical care (e.g. cosmo clinics) but did include mixed clinics. For instance, some are private but also under

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-18808356980364914832008-10-08T07:00:00.001-04:002008-10-08T07:00:00.699-04:00

I have a soft spot for Parkland Memorial Hospital. It is a county hospital that sees all-comers regardless of their ability to pay or legal status. I also did an externship there and can say from first hand experience that the ER is amazingly busy and they see about as much trauma as any other hospital in the country.On September 19th a 58 year-old man died after waiting 19 hours in the emergency

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-28018932340202486392008-10-07T08:00:00.000-04:002008-10-07T08:01:12.349-04:00

In Part I of this series I discussed what we have done in our clinic to ‘lean’ nursing practices. The last 4 items are smaller but shave minutes every day and decrease the change of having to repeat a task.Standardized Medical HistoryEach incoming patient has their medical history reviewed by the nurses. It is an EMR (electronic medical record) and the questions asked are developed in

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com3tag:blogger.com,1999:blog-4088879684924541194.post-6932345795106332972008-10-06T07:32:00.001-04:002008-10-06T07:34:23.380-04:00

Everdream asked me to blog about Lean nursing practices.DisclaimerOur clinics are the equivalent of a ‘surgi-centre’ with both consultative appointments and procedures under anaesthetics. While I’ve been staff at hospitals for years, I have never supervised a floor lean initiative. I have supervised many clinic lean initiatives with our own 20+ nursing staff. For a framework of lean initiatives

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-87667347432079911862008-10-06T07:00:00.000-04:002008-10-06T07:00:00.149-04:00

Have you ever gotten near the door, on your way out, only to notice that there is still one patient waiting in a room? I admit it. I've done it. On the way out, most lights are off, only to hear "hello?".This patient went to the doctor for a refill on her prescription at 11:20 and got out at 2:30. She figured out she was there over lunch and video taped the whole thing. She has a great sense of

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-33165210771137581952008-10-05T10:29:00.003-04:002008-10-05T10:37:29.324-04:00

I was accepted into the Healthcare Blogger Code of Ethics group this week. Follow the link in the bottom corner of the blog for more information.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-35564268525486358842008-10-05T07:00:00.001-04:002008-10-05T07:00:00.813-04:00

What do carbon taxes and health care user fees have in common? The Liberal Party of Canada has announced the Green Shift. A tax shift program where industry is taxed based on the amount of carbon it produces. The increased cost incentivizes' companies to find production solutions with a lower carbon footprint. The additional costs to the citizen are compensated through lower income taxes and

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-23791290704595028822008-10-04T09:45:00.005-04:002008-10-04T14:09:13.912-04:00

In both the United States and Canada debates were held on Oct 2, 2008. I was torn as to whether to watch the Biden/Pallin debate or the Canadian Leaders debate. With the train wreck of an interview Pallin gave to Katie Couric wetting my appetite I wanted to watch the most public I.Q. test ever given.Alas, my civic duty overshadowed my voyeuristic streak and I watched 5 Canadian Leaders duke it

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-9040511138262340402008-10-03T07:00:00.001-04:002008-10-04T09:42:21.498-04:00

This blog is a technical discussion for people that need to make IT decisions about document management. If you don't care about IT, have never heard of a database or don't need to mange documents I suggest you go have some fun at this web page or this one.If on the other hand, you've ever grappled with the problem of what to do with that electronic report or fax this blog's for you. Here's the

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-19430276017306103202008-10-02T07:00:00.002-04:002008-10-02T07:00:01.815-04:00

Like many other residents I went for interviews at Henry Ford Hospital in Detroit. I have only two memories. One was the border agent giving me the third degree because I was coming over for an interview and the other is the residents telling me about gunfire in the city on Halloween night. What was lost on me is that the hospital was built by Henry Ford with economy of motion in mind. I've

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com4tag:blogger.com,1999:blog-4088879684924541194.post-77075675977046173592008-10-01T07:00:00.000-04:002008-10-01T07:00:00.459-04:00

I found a new blog (for me -- Ben's been blogging a while). Check out Ben Weger. He's an RN, paramedic and second year medical student and has a unique take on Universal Health Care in Massachusetts. My only question is; how much school debt are you carrying now Ben? That's a lot of careers for a 33 year old. For a good laugh check out his marital status under 'About'.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-70830310440988217462008-09-30T09:00:00.000-04:002008-09-30T09:00:02.337-04:00

Grand Rounds is up at Monash Medical Student this week.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-23060068915984935532008-09-30T07:00:00.004-04:002008-09-30T07:00:00.301-04:00

PERT (Project Evaluation and Review Technique) is a method devloped for project management originally intended for the Polaris Submarine design and build. It's a graphical design (flow diagram) that forces the project designers to take into account minimum and maximum time frames and all of the different sub-projects that are required. The major benefits are that PERT joins all the activities in

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-46809403734676600712008-09-29T07:00:00.002-04:002008-09-29T20:01:43.324-04:00

Thanks to Dr. Val for making a guest appearance at Wait Times. Val is a former Candian now living south of the border. When you make it to Waterloo (or Toronto) I'll have some back-bacon on a bun and a pint of Canadian waiting for you. Update: Found Val over at http://other-things-amanzi.blogspot.com/ where she discusses medical errors swept under the rug. I once watch a Discovery channel show

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-76160063306690210272008-09-28T07:00:00.007-04:002008-09-28T07:00:00.624-04:00

I'll have a cartoon of Dr.Val's up later as a guest host but first let's have a little fun with her head :-)Can you find Dr. Val in the picture?From Wait Time & Delayed CarePhoto Courtesy of FreeFoto.com

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-36769195441993199072008-09-27T14:09:00.002-04:002008-09-27T16:19:25.294-04:00

There are two really well known medical bloggers. KevinMD, who is a clearinghouse of med-blogger information, and DrVal who is arguably the most connected med-blogger on the Internet. She has done interviews with everyone from the Surgeon General to NBA All-Stars. I'd recommend you read some of the interviews before the site is sold. Now homeless, Val is roaming the Internet posting blogs in

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-12798880158229875002008-09-27T11:29:00.002-04:002008-09-27T12:00:49.356-04:00

Last year, the average debt of a graduating medical student was $139,517 and 75% carried debts of greater than $100,000. I'm going to make a leap of faith that there are doctors in the US that have also been caught over-extending themselves in order to finance lifestyle choices. Massive graduating debts are pushing newly minted physicians out of primary care and into specialty practices. This

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-36654751357454749182008-09-27T07:00:00.000-04:002008-09-27T07:00:01.224-04:00

Michelle Griever is a family physician in Toronto, Ontario who supports a large family health team. They received funding 2 1/2 years ago from the government to implement an EMR. She's blogged about her journey.After 2 1/2 years only 2/3rd of the physicians have adopted the system. Maintenance does not seem to be sustainable and they are still deciding on whether to keep control of the servers

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-741504719917361042008-09-26T07:00:00.002-04:002008-09-26T07:00:00.901-04:00

The Fraser Institute recently published an investigation on the adoption of Medical Technology in Canada. For example, the report states that the number of CT and MRI machines per 1 million persons is roughly 60% that of comparable countries. Adding insult to injury, roughly 25% of those are beyond their recommended lifecycle.The central theme of the paper is that Canada lags behind other

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-66785378480876018012008-09-25T07:00:00.000-04:002008-09-25T07:00:01.733-04:00

I received my new toy*; a Blue device to link my Blackberry and LCD projector. Impatica makes a Bluetooth enable interface to connect your Blackberry (or Palm or whatever) to your LCD projector. No more laptop.You convert your powerpoint presentation using software sent with the unit then simply link your Blackberry to the Impatica device (our IT manager is going to look at the BES version of

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-69011837522273565412008-09-24T07:00:00.001-04:002008-09-24T09:25:01.156-04:00

J. Gold & Associates, a well known technology analyst firm has just published it's poll of over 400 business' and found that the preferred mobile client is still RIM's Blackberry with 69% of the market. They also expect RIM to retain that margin over the next 3 years.That is good news for me since our doctors are now increasingly dependant on crackberry's.A major difference between RIM and it's

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-36251736275246324602008-09-23T07:00:00.000-04:002008-09-23T07:00:02.758-04:00

I've had enough of politics and policy. Time for a little fun. Microsoft can't win for trying. It turns out the pictures to their new "I'm a PC" advertising campaign (to counter the iconic Apple commercials) were............uh..............well...............made on a Mac.I don't want to suggest that whoever made the photos should have their ass handed to them but someone needs their ass handed

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-77643097222615824922008-09-22T14:20:00.001-04:002008-09-22T14:20:49.446-04:00

In the third part of my series on Canadian Health Care policy I’m discussing the Conservative party platform. Where the Green party’s platform was detailed but unrealistic (I would argue unobtainable), the Liberal party’s was non-existent the Conservative’s have made there health care plan an extension of their current time in power. The platform is relatively straight forward. The

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-47499840781219996872008-09-20T07:00:00.001-04:002008-09-20T07:00:00.743-04:00

This will be a short blog entry.The Liberal party platform appears to based exclusively on the Green Shift (carbon tax shifting) and leadership. They have not posted a health care platform nor their health care accomplishments while the minority party. I've sent emails to the party with no response so I have little to add.In a recent interview, Dion has said that he will accept some private

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-79517843621346003842008-09-16T09:22:00.007-04:002008-09-29T19:33:26.853-04:00

Oct 14th is D-Day for Canadians to go to the polls and elect our next Prime Minister. Like many, I am a swing voter. I tend to be what the political types call a blue-liberal; meaning I'm socially liberal and fiscally conservative. In the last election health care wait times proved to be the most important issue in the minds of Canadians.For the first time in a long time, there are some stark

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-45254205751181041082008-09-16T09:20:00.001-04:002008-09-16T09:21:51.255-04:00

Grand Rounds today is up at Nurse Ratched's Place. Thanks for the round the world tour Mother Jones.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-22465340864742899152008-09-11T14:11:00.004-04:002008-10-02T14:14:50.046-04:00

Few things send a shiver up my spine more than war stories and I just had the honour of hearing a major one. I just met a man who, in 1943, was a rear gunner for the Canadian Air Force. After a mission into Germany he was shot down over the North Sea and had to jump from the airplane. He was rescued and reassigned to another flight crew. One month later, his plane was shot up again over Germany

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-22767580639093393232008-09-09T09:28:00.003-04:002008-09-09T11:45:26.290-04:00

It is now the year 2020 and you have control of your complete health record through an online personal health record (PHR) when you receive an email from your local hospital asking you to update the link for their computer system. Before you know it, your medical insurance is exhausted and someone has posted your complete health record on the web for other would be hackers to use and abuse.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-62683108222076492662008-09-07T05:00:00.000-04:002008-09-07T05:00:01.289-04:00

There are not a lot of dental blogs out there and almost none from India. So I was happy to see that George, an Oral & Maxillofacial Surgeon from Salem, India has started a blog. He's taking on such eclectic topics as his profession, soul food (Indian style) and railway toilets!Check it out at MaxFac

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-92204543072609503142008-09-06T06:00:00.000-04:002008-09-06T08:44:30.603-04:00

"I don't want any yes-men around me. I want everybody to tell me the truth even if it costs them their jobs" Samuel Goldwyn (1882-1974)Dr. John Helliwell, a world-class economist (and fellow Canadian) was recently interviewed for the Gallup Management Journal about the relationship between trust in the work place and life satisfaction. "Dr. Helliwell has discovered a number of factors that affect

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-85413265524752626862008-09-05T06:37:00.003-04:002008-09-05T06:44:37.197-04:00

Measuring the efficiency of the front desk is not always simple. Hang up rates, patient satisfaction and similar metrics are indicators of administrative performance but are not specific nor do they correlate well to clinic efficiency. Global measures of clinic efficiency, on the other hand, are not sensitive to administrator competence. Our clinic has found a metric that appears to measure both

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-44650993504268757152008-09-04T07:30:00.003-04:002008-09-04T07:49:54.797-04:00

I spent the weekend working with some new toys:1. Google Chrome2. Blackberry BoldGoogle Chrome is the new browser (beta version) from Google (you can download it here). It's new, it's cool and I'm using it. When you open a new tab it automatically shows a list of windows that you recently visited. It also has one box for search and addresses with autofill/suggestions. I've had some problems

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-63299857106928992362008-09-02T08:30:00.006-04:002008-09-02T09:26:13.657-04:00

Some bloodwork needs to be done urgently. The system has been reviewed by consultants, the lab has been optimized for six sigma, the nurses have arranged for standing orders yet one bad apple can screw things up. Check out the story at Emergiblog how one dick of a doc arranged with a clerk not to put through any orders without his express approval. With one word, an entire system is ground to

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-41047862518168312752008-08-30T12:15:00.002-04:002008-08-30T12:15:42.584-04:00

Congratulations to Mike and Mona,My brother-in-law got married this weekend.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-37880705837749073962008-08-30T07:37:00.002-04:002008-08-30T07:37:01.024-04:00

The best laid plans..........Despite all my planning to the contrary my afternoon went to hell the other day. Roughly 15 patients in 2.5 hours and I managed to keep almost everyone of them waiting close to an hour. Here's the run down:1 person forgot to take antibiotics prior to a procedure -- had to wait an hour1 person forgot their appointment and showed up in the afternoon2 emergency

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-13017488259476172722008-08-29T08:52:00.003-04:002008-08-29T10:36:33.291-04:00

Two days ago, Mr. John Goodman, a policy advisor to Senator John McCain commented on a recent report of the number of uninsured Americans'. According to the Dallas News;'Mr. Goodman, who helped craft Sen. John McCain's health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort."So I have a solution. And it

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-43808331504683200982008-08-29T07:31:00.000-04:002008-08-29T07:31:00.729-04:00

Here is the most tortured obituary ever written. It is a great reminder to think before you speak when you decide to critique a friend, family member or co-worker. What do you want your obit to say?Thanks to FatDoctor for pointing this one out.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-50829815337470492852008-08-28T18:36:00.004-04:002008-08-29T07:23:34.858-04:00

I have to thank Addicted to Medblogs lack of knowledge for this post. She asked KevinMD what evidence based medicine means? For those of you who haven't heard the term take a quick trip to AMB for a quick read then come back. In short, it is when you apply scientific method to your clinical practice. The better the science, the more credence you give the work and the bigger its' impact on your

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-54521780295265994262008-08-26T11:40:00.000-04:002008-08-26T11:43:22.593-04:00

The Institute for Clinical and Evaluative Studies (ICES) released a study titled "The Impact of Not Having a Primary Care Physician Among People with Chronic Conditions" which found that not having a primary care physician resulted in increased ER usage. This phenomenon is well known and should come as no surprise to readers. The more interesting statistics are that those patients with chronic

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-25337945195410372352008-08-25T13:07:00.003-04:002008-08-25T14:21:45.929-04:00

Check out White Coat Rants for an effective way of clearing (both figuratively and literally) patients that have OD'd from the ER to the floor. There is also a good video at the bottom.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-73224861100229188512008-08-24T07:30:00.001-04:002008-08-24T07:30:00.587-04:00

As a child I was told that honour was made of the virtues prudence, temperance, justice and fortitude. But when I heard the news that 3 Canadian soldiers died in a major road side IED attack in Afghanistan this week I could only question my own honour. How can I sit in the comforts of my home and clinic, while countrymen die abroad and still believe that I hold those same virtues close to my

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-53799823519836286252008-08-23T07:30:00.002-04:002008-08-23T07:30:01.732-04:00

As our IT administrator installs the latest in a long line of anti-SPAM filters (and if you're a SPAM spider here's my gift to you; bite_me@yamail.com) I've had time to reflect on what email has meant to our practice.When we first installed an MS-Exchange server in 2002 I thought it would be a rich-new tool to communicate with colleagues, improve staff communication and generally improve our

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-37631237149048897832008-08-22T07:30:00.000-04:002008-08-22T07:30:00.150-04:00

If you haven't heard the term yet you need get to know it soon. A Health Information Exchange (HIE) is a means for sharing health care information electronically among disparate health care information systems. In layman's terms the clinical and administrative data created when you visit a health care provider are uploaded to a central repository where the patient controls access.Google Health

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-88827767378508738642008-08-21T07:30:00.000-04:002008-08-21T08:33:43.433-04:00

The incoming head of the Canadian Medical Association , Dr. Robert Ouelett gave his inaugural address to 400 of the 67,000 physicians he represents in Canada. Dr. Ouelett envisions a private/public mix of physician services where surgeons, for instance, provide 90% of their services in a public system and 5-10% in the private. Dr. Ouelett's position however is not without bias. He currently runs

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-66034432939405562692008-08-19T20:02:00.002-04:002008-08-19T20:03:00.516-04:00

Back from the cottage and looking foward to reading Grand Rounds. Kerri has posted it atSix Until Me.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-71805927357226616322008-08-18T07:30:00.000-04:002008-08-18T07:30:01.081-04:00

How long would it take for you to learn of a problem on your front desk? I've encountered the situation several times (illness, incompetance) and unfortunately the answer for our clinic is 3 months. I've posted before that wait times could be the yard stick by which health care is measured but as a measure of front desk performance it is too slow and non-specific a metric.In our case, the office

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-85695846967825149062008-08-17T07:30:00.000-04:002008-08-17T07:30:00.983-04:00

The blogger community is abuzz with the latest list of pronouncements of 'never events'. Never events are unintentional injuries or complications that occur while people are under care (usually in a hospital) that are preventable. Something like operating on the wrong body part or a medication error. What is causing the uproar is that Medicare has a) refused to pay for the management of the '

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-21033050937400850712008-08-16T11:10:00.001-04:002008-08-21T20:12:05.813-04:00

I had an interesting conversation while car-pooling with another surgeon and our junior front desk person. The surgeon speculated that we should be adding more blocks of time for one type of surgery. The junior front desk person said “we’ve been adding two ½ hour blocks after lunch for over a month now”. He asked, “Who told you to do that?” and she responded “my supervisor, Joanne”. How does it

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-29101949701044792982008-08-15T07:00:00.000-04:002008-08-15T07:00:00.740-04:00

Infoway Canada (a collaborative of provincial Health Ministers and Federal funding) announced greater funding for electronic health records and the goal of an electronic health record for every Canadian by 2016.I'm conflicted by the report. On the one hand, electronic records can help patient care. The infrastucture is needed (just the other night a radiologist 400km away read an emergency CT

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-56777416384967845942008-08-14T08:28:00.005-04:002008-08-14T09:26:23.738-04:00

I recently went to the optometrist and they refused to submit any claims information electronically for me. I had to do it by snail-mail. As a result (in addition to the fact that they are inconsiderate of my time) I switched providers. While the topic of electronic claims submission may be foreign to public pay systems, submitting claims to insurance companies is common place in private pay.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-35992610582951173462008-08-12T10:03:00.003-04:002008-08-12T10:10:04.282-04:00

The NACHC released it's report on the primary care workforce yesterday. Not surprisingly, they continue to report primary care shortages. What I did find surprising, is that the non-physician workforce is equally short-staffed and may pose as much of a challenge in the coming years. "To reach 30 million patients by 2015, health centers need up to 19,500 primary care providers and up to 14,400

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-55972128673124417002008-08-11T07:56:00.004-04:002008-08-11T18:40:11.312-04:00

Dr. Rob and I had a blog-on-blog post about how to be a good specialist and a good generalist. That is, how should each office conduct themselves when either referring or receiving a patient. After all, the patient should not have to pay the price of the specialist being disorganized, the generalist being vague in their referral or the multitude of other social factors that affect the patient

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-8064842439749684852008-08-08T08:08:00.002-04:002008-08-08T10:24:13.460-04:00

Our clinic has started planning for the 2009 year. To balance where and how the different providers work I balance the days each year. We want to strike a balance between the different offices' to minimize office wait times (for how we find the sweet spot see this post). The more days we work the lower the wait times but there is a plateau where working more does not change the wait. When one

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-48299299677155158892008-08-07T13:00:00.004-04:002008-08-07T13:42:48.754-04:00

I recently wrote a post about the new Blackberry Bold and the latest BES Server (the software that joins corporate computers to the handhelds). John Halamka at Life as a Healthcare CIO took some time to review the iPhone 3G. John is a self professed Apple devotee and his bottom line is that if they can solve some keyboard issues it will be serious competition for the Blackberry. That being

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-17377395539567063782008-08-06T08:16:00.003-04:002008-08-06T13:25:10.654-04:00

As a blogger you don't need to sell me a bill of goods for Web 2.0 but is it the latest fashion or a vital business tool? For business looking to leverage Web 2.0 the pay-back for investment is in collaborative efforts of teams. Certainly, community based multi-disciplinary medical teams could make use of greater collaboration.Here are the statistics according to a recent article in CIO Insight:

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-83334101366721959822008-08-04T16:29:00.004-04:002008-08-05T17:56:25.630-04:00

I'm back again this week with more lessons from Gallup. In my continuing posts on the book Best of the Gallup Management Journal I want to discuss a entire section devoted to branding. In advertising terms branding is "a set of assets (or liabilities) linked to a brand's name and symbol that adds to (or subtracts from) the value provided by a product or service…'" (from David Aaker's book

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-79141051393505492842008-08-02T07:00:00.001-04:002008-08-02T07:00:00.554-04:00

It's summer time so a break is deserved - check out the world longest back yard water slide (coming soon to an ER near you).

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-72785620239035414062008-08-01T06:45:00.001-04:002008-08-01T06:45:00.257-04:00

Each summer my family gathers around the T.V. to watch the Tour de France. Half of the fun is the drama around blood doping and the scandals that rock individual teams. Check out James Young at Pure Pedantry about EPO abuse and how they busted Riccardo Ricco. Smart guy and a good blog. BTW - I had to look up pedantry;"an ostentatious and inappropriate display of learning "Nicely named.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-88016635439675938832008-07-31T06:34:00.000-04:002008-07-31T06:34:00.593-04:00

There is no dismissing the effect of positive feedback on employees both in the performance of a business and happiness of its' workers. Yet, of all the challenges I face in managing a practice, engaging our employees is my single greatest personal challenge. Our office has worked to provide a decent benefit package, cost-of-living increases, yearly reviews and pay raises a pleasant work

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-61388726277643932492008-07-30T07:30:00.000-04:002008-07-30T07:30:00.334-04:00

Dr. Val is publishing interviews with some of the major players in the war on cancer this week. Following on the footsteps of the CONCORD Study (which rated the US at the top of the international list) Dr. Val interviews doctors and policy makers about the direction of cancer care in the next 30 years."The gap between what we know and what we do is lethal."-- Kay Redfield Jamison, Ph.D.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com1tag:blogger.com,1999:blog-4088879684924541194.post-30228059379530602332008-07-30T07:00:00.000-04:002008-07-30T07:00:00.911-04:00

I'll be away this week for summer time fun.I've scheduled several links that I find interesting and some older posts.See you next week.Ian.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-25900983441844772862008-07-29T07:00:00.000-04:002008-07-29T07:00:01.311-04:00

Is up today at Edwin Leap's blog.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-16555452619886746812008-07-28T06:59:00.001-04:002008-11-13T01:36:36.001-05:00

One of the problems with block booking is accurately estimating the time blocks required for all of the “what-ifs”. An example is a patient that is referred to our practice for surgery. Using our EMR we know that 5 +/-3 patients are referred each day and that 80% of them follow-through with surgery. Of the patients who have surgery, 80% have an uneventful recovery. The remaining 20% need either 1

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-10303502642683561802008-07-26T07:00:00.002-04:002008-07-26T07:00:00.337-04:00

Power outages and computer crashes are a real part of an EMR system (unfortunately). See Michelle Greiver's post on back-to-back power outages. We leave the UPS and back-up issues to the IT folks although we do a yearly simulation to ensure the systems actually work and back-ups are intact as we've had bad back-up tapes before.In our clinic, we did an analysis of what we would need to run the

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-16184779080888070212008-07-25T07:00:00.000-04:002008-07-25T07:00:01.059-04:00

I'm going to take a bit of a tangent from my usual posts to comment on a post at Random Acts of Reality (a blog from paramedics of the London Ambulance Service). In their post on what appears to be an abused women;"As it is there is little that we can do - we handed the patient over to the triage nurse and made our concerns known to her, then delegated any decision upwards by noting our

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com3tag:blogger.com,1999:blog-4088879684924541194.post-78834814796555292022008-07-24T07:00:00.000-04:002008-07-24T07:00:00.536-04:00

Each day primary care practices succumb to compromises on many levels. In particular, the expectations of the providers, patients and employees. Compromises are concessions demanded by interested parties by most of the companies in an industry. They are different than trade offs which are value choices such as the difference between a luxury and basic hotel room or a family practice and

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-57599853249441932402008-07-23T12:38:00.002-04:002008-07-23T12:43:48.401-04:00

The Daily Miner news (Kenora, a Northern Ontario city) is reporting that funding for autistic children's rehabilitation is being slashed. As a result children on the waiting list are being dismissed.Having a young son with a speech disorder I can tell readers first hand the the public funding situation for speech pathology is pathetic already. We waited months for assessment and were given

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-76886315235031470372008-07-22T18:30:00.002-04:002008-07-22T18:31:17.668-04:00

Busy day in the OR so I forgot to post that today is the 200th edition of Grand Rounds hosted at one of my favourite blogs GruntDoc.com

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-68610718774340399522008-07-22T07:00:00.000-04:002008-07-22T07:07:07.722-04:00

In the August 2008 issue of Lancet Oncology, Micheal Coleman et al, are reporting that the US and Canada have the best survival rates for Cancer. Canada has a cumulative 5-year survival of 82.5% compared to the US's 91.9%. There is a lot of debate about the merits of various health care systems (public and private) but a 10% difference in survival is nothing to sneeze at. Canada showed less

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-61000839433720783672008-07-21T08:03:00.003-04:002008-07-21T09:20:36.392-04:00

Check out any EMR resource and you'll find tons of data on how quickly the EMR program responds. Unless you're a super-specialist, however, you probably see more than 10 people a day and the amount of time you spend in the EMR software itself is a few minutes per patient. Some of the major causes of headaches come not from the EMR software itself but network issues.That means that the impact of

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-26939992497603343162008-07-20T08:06:00.003-04:002008-07-20T08:08:39.870-04:00

Welcome to those readers from KevinMD. Since I wrote the reader take for Kevin Statscan published additional data. For updated information on access to primary care from Statscan data please see this post.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-75487687787749685092008-07-20T07:41:00.000-04:002008-07-20T07:42:52.237-04:00

Recent cuts to Medicare bring up an interesting practice management problem. If a practice chooses to accept patients on social assistance medical insurance (such as Medicare) is it ethical to leave those patients waiting longer? RealityIt would be easy enough to offer 1 or 2 appointments a day to publicly funded insurance plan patients and leave the rest for private pay (block booking based on

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-72623414912446857282008-07-19T07:00:00.000-04:002008-07-19T07:00:01.152-04:00

Are your patients complaining about waiting too long? Try this joke to lighten things up a little.Waiting Room - The funniest home videos are here

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-24188328374259205832008-07-18T18:30:00.003-04:002008-07-18T18:40:01.930-04:00

A spaghetti map is a graphic showing the movement of patients and providers in a clinic. This article gives an example in an emergency room where spaghetti maps were used to decrease ER wait times. In a clinic one simple step to streamlining patient flow and decrease non-value added time is to standardize each room and ensure that equipment is present at the beginning of each day. My

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-85462280257144484792008-07-17T10:27:00.007-04:002008-11-13T01:36:36.271-05:00

As a business grows the ability to move staff to meet demands becomes critical to keeping staff costs low and customer satisfaction staff. Each year we create a new Excel spreadsheet to schedule staff. Each sheet is a month and one sheet at the end counts the total days for each staff member. Within each month we summarize the number of staff per office per day (number of nurses, doctors,

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-36735800096648662222008-07-17T09:06:00.002-04:002008-07-17T09:10:33.768-04:00

I found a new blog that is pretty entertaining. She gives a hilarious recap of the "dying swan". Someone exaggerating their illness by flopping around on the waiting room floor to get in sooner. I felt guilty laughing given the recent death in a New York waiting room but the story is funny none the less. Check out Albinoblackbear at Asystole is the most stable rhythm.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com3tag:blogger.com,1999:blog-4088879684924541194.post-73469278520449592382008-07-17T06:00:00.001-04:002008-07-17T08:36:40.140-04:00

On my weekly search of wait related news articles I stumbled across an article from the Center for American Progress. The Center is a US based think tank. Included in their article entitled "Six Conservative Myths About Health Care" was the following line about malpractice claims;"Myth: Medical malpractice lawsuits are little more than predatory lawyers destroying honest doctors; caps should be

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-78193748695806807642008-07-15T13:03:00.004-04:002008-07-16T10:03:51.556-04:00

It's time for our semi-annual doctor day balance in the clinic. Twice a year I look at the number of provider-days in each clinic and compare it to growth and efficiency.If a clinic is 10% more efficient and has 10% more referrals we maintain the same number of days. If it is 10% less efficient we add days and so on. To compare efficiency and overall growth I examine the average daily revenue (

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-16056329105113305652008-07-14T20:01:00.003-04:002008-11-13T01:36:36.536-05:00

I've been slow to post these last two weeks due to long weekends. The first in Vegas for my brother-in-laws' bachelor party and the second golfing, Texas holdem' and midnight putt-putt with 26 old friends. “When the character of a man is not clear to you, look at his friends.”Japanese proverb

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-20616019011378379262008-07-12T07:26:00.000-04:002008-07-12T07:26:00.201-04:00

From Slashdot, apparently lawyers in the US are advising their clients to update policy manuals to prevent lawsuits related to employees working 24/7 through mobile devices.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-63882023724409464612008-07-11T07:15:00.004-04:002008-07-11T07:24:19.578-04:00

Here are two stories about doctor shortages. The first from the US for mental health patients in crisis. The hospital board raised money to hire two new psychiatrists which prompted the program manager to say "They really did work hard to make sure that money didn't turn into more bureaucracy,".The second story is from Owen Sound, Ontario (a large but remote city) where the loss of a single ER

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-33280793913820243312008-07-10T06:00:00.001-04:002008-07-10T06:00:01.085-04:00

Right now I have a young man (40ish) with end stage metastatic prostate cancer who had a tooth out while undergoing chemotherapy including bisphosphonate drugs (an anti-osteoporosis medication also used to minimize bone pain and the spread of metastatic disease).One of the side effects is that if you take a tooth out while someone is on a bisphosphonate they can develop persistent dead bone where

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com4tag:blogger.com,1999:blog-4088879684924541194.post-9955769197923544352008-07-09T18:40:00.003-04:002008-07-09T18:59:20.355-04:00

Two weeks ago we instituted a quality assurance program at our clinic for patient/referring office complaints. Normally, when someone complained we had whoever received the call deal with it and if they couldn't the complaint escalated up the ladder. The piece of the puzzle that was missing was how often people complained. For all I knew the front desk was dealing with 5 or 6 major complaints

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-31937082743484279212008-07-08T10:09:00.000-04:002008-07-08T10:11:39.749-04:00

Here is an old clip from ASQ magazine via a Healthcare management workgroup;“Pal's Sudden Service Hot Dog stand uses Baldrige process to gain edge over itscompetition. It's results: customer satisfaction 96% vs 84% of competitors,handout speed is 20 sec vs competitors 76 sec, turnover dropped from 200% to98% vs competitor of 300%.Someone asked its president, "Since you spend 120 hours in new

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-68229673471650008542008-07-08T08:37:00.000-04:002008-07-08T08:38:02.745-04:00

Today at the blog that ate Manhattan

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-27233091026753239612008-07-06T07:00:00.001-04:002008-07-06T07:00:01.814-04:00

Our local think tank the ICES institute released a study proving that lack of primary care access increases emergency department use. So how does our Provincial government spin that into their favour?They repeat that "630,000 more Ontarians have access to primary care physicians" then the president of the provincial medical association goes on a press junket to repeat the same statistic. The

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com2tag:blogger.com,1999:blog-4088879684924541194.post-64292135858230861582008-07-05T20:22:00.003-04:002008-07-05T20:26:47.640-04:00

Need more insight into the workings of the NHS? DrGrumble has some intersting views on the "Choose & Book" policy of the NHS. It's a good blog about the huge disconnect between the providers and administrators in the NHS from a doctors point of view.

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-53599836496348485262008-07-05T10:38:00.004-04:002008-07-05T10:51:24.261-04:00

“Watch your thoughts, for they become words.Watch your words, for they become actions.Watch your actions, for they become habits.Watch your habits, for they become character.Watch your character, for it becomes your destiny.”Every day a single provider can see dozens of patients pass through the door of a clinic. There are two opposing forces. The wait time get an appointment and the wait at the

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0tag:blogger.com,1999:blog-4088879684924541194.post-1164750498148956172008-07-04T12:07:00.000-04:002008-07-04T12:08:18.778-04:00

No good came come of the statement “honey, I was reading your blog”. When creating a blog I think everyone struggles with the decision on whether to do it under a pseudo name. A pseudo name probably makes you more honest but less careful with what you say. Your real name makes you more accountable to your words. Especially to your wife. So even if readers didn’t leave comments I still had to

Ian Furst http://www.waittimes.blogspot.comnoreply@blogger.com0