by Pepi Granat, MD
Yesterday, and every day, in my office we had one or two patients we call our “Oldie Goldies”.
People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal, I’ve shared, and who share mine. We know their parents, kids and cousins either because they call us in crisis, or they’re our ongoing …
Family doctors cannot be obsolete, for patients’ sake
One of the advantages of marrying an immigrant is having intense exposure to another culture. My wife’s Russian heritage, and her family, have enriched my own life immeasurably. The trip that I took with her and my brother to Russia in 1990, where she served as our personal translator, was unforgettable.
During the early years of our relationship, I heard stories about her family that seemed incredible to an American like …
Physicians should not be used for FDA ad enforcement
There’s an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.
If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.
The patient interviewed in the Boston …
Incentives for switching patients from branded drugs to generic
“An apple a day keeps the doctor away,” or so goes the old adage.
People who believe there’s some truth behind the saying are crunching on a great big Macintosh right now, or at least they will be once they hear about the results of a study from UC-San Diego which showed that every July, there’s a 10% spike in fatal medication errors in hospitals.
The scientists behind the study suggested that …
The July Effect and causes of the spike in medication errors
About a month ago, a 44-year-old insurance executive came to see me with complaints of headaches and muscle cramps. His pain was caused by the typical cluster headache located behind one eye, accompanied by one-sided tearing and nasal congestion, and often triggered by occasional wine or chocolate. The muscle cramps mainly affected the legs and seemed to worsen after exercise.
When I got the results of his lab work, I was …
Creatine causing muscle cramps and how supplements may be dangerous
Recently I had an interesting conversation with a few young doctors regarding the new health care reform that had been passed in the United States. One future specialist asked me why primary care doctors should receive more money than they have in the past.
And this is an important question that I think sheds light on the suboptimal state of our current health care system. It is important to specialists because …
Why primary care is like air traffic control
Can the field of family medicine truly become monotonous?
I never thought I’d ever find myself in a repetitive routine when selecting family medicine as my specialty. I spent eleven years after high school studying what I know. How can eleven years of material really become mundane? In a way, it’s a great thing – it means I am feeling comfortable and confident in my job.
And I am fortunate enough to …
Teaching family practice residents is rewarding
Everyone knows that the heart health of Americans is dismal. Obesity, diabetes, and high blood pressure are all on the rise.
For now, technological advances in cardiac care continue to maintain, or in some cases, lower the death rate from heart disease. Squishing blockages, ablating abnormal heart tissue, and installing cardiac devices have successfully kept the abysmal lifestyle habits of so many at bay. Despite all the fury of modern technology …
Heart health depends on healthy behaviors
by John Trahanas
She was not my patient.
Actually, she was nobody’s patient, she was just a wife; she was “the family.” She was a rough, stern looking woman, and with good reason as she had weathered many difficult times. Her husband had been severely demented for many years; however, it was only in the past few months that he required such intensive inpatient care.
He was not conscious or communicative, but he …
Consider the family’s perspective in the treatment plan
Perhaps the most important principle in practicing medicine, drummed into medical students and junior doctors time and time again, is to do no harm. Our medical interventions and treatments can be given either too early, too late, or inappropriately, with sometimes terrible and tragic results.
Unfortunately, when doctors have harmed patients, the guidelines of what to do thereafter are not as clear, raising the question, “What should doctors do in these …
Doctors need to become whistleblowers after medical error
I’ve been hearing and reading a lot lately about how the doctor-patient relationship is under siege. There are many reasons for this, ranging from care decisions increasingly being made by insurers to the shortage of primary care physicians, to patient empowerment. I didn’t quite understand how patient empowerment could be a threat, until I started thinking about the recent perceptual shift from patients to health-care consumers.
I agree with the consumer …
“I’m a patient, not a consumer”
Great doctors listen to their patients.
They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.
Of course no doctor is likely to be able …
The emotional state of doctors can affect patient care
Recently, the 21 percent cut in Medicare physician reimbursements was replaced with a 2.2 percent pay hike.
Later this year, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on?
Here is the back-story. In 1997, Congress enacted a so-called “sustainable growth …
Congress is actually increasing physician Medicare pay
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As might be expected of reform legislation, the Patient Protection and Affordable Care Act (PPACA) places a lot of emphasis on innovation.
Reasonably enough, most of the potential changes—at least in Medicare—are to be preceded by pilot or demonstration projects designed to test their feasibility. In fact, according to one health care blogger with time on his hands, PPACA includes no less than 312 mentions of demonstrations and 80 mentions of …
Will pilot programs really lead to innovation and save money?
For years, I have been progressively beating a louder and louder drum — one where my colleagues know that I liken radiology to McDonald’s.
Most of the bad press out there, it seems to me, has to do with poor customer service. Our health care system is often inefficient, and delivers limited, incomplete care. The root of the problem, in my opinion, is that there aren’t enough doctors or hours in …
Why radiology should become more like McDonald’s
At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.
Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety. As one speaker highlighted, how can we really start to address this …
Stop calling doctors fleas and teaching professionalism
Since the subtext of the natural childbirth and attachment parenting movements is the notion of the good mother, it’s worth asking what makes a good mother. My whole approach to writing about childbirth and mothering choices is based my rejection of currently popular beliefs about good mothering.
Simply put, I believe that good mothering is about choosing mothering and not about mothering …
Being a good mother is not about specific mothering choices
Raising children in a world full of accessible opinion is a funny thing.
Everyone seems to have an idea about how to do this right. Stay home, work full time, work part time, return to work, cry to sleep, not cry to sleep, pacifier, no pacifier … the recipe for each of us is different, of course. Often we’re all right in what we’re doing from picking out baby food to …
Competitive parenting and raising children in an opinionated world
A couple of months before my son was born 2 1/2 years ago, we were notified that my husband, an active duty member of the Navy, was getting deployed to Iraq.
His date of departure was exactly one week after my due date. To any wife or family member of a service member, this would be difficult news — a loved one going into a war zone. But, to me, 8-months …
Practicing medicine as a single parent requires finding balance
I often find, when I talk with patients and families about hospice care, there is a palpable sense of relief; relief that there is another option when facing a terminal diagnosis or end stage disease process.
Families who have participated in caring for their loved one at the end of life are grateful for the guidance provided in hospice care. Patients in turn are grateful to spend their last days at …
Hospice care and what patients and their families can expect
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