I knew that friendly Mr. S on our hospice unit had been a decorated World War II hero, having fought for the United States on the Italian front lines in 1944. I knew that a grenade had exploded right next to him four weeks into combat, sending him to the hospital for months with terrible shrapnel injuries. I also knew that he wished …
Being an American patriot means promoting tolerance even in the face of crisis
Readmissions to hospital, especially within 30 days of discharge, are on the radar of all health care organizations in the United States. This is due in no small part to stiff financial penalties that are now imposed on the worst performers by the federal government.
On the surface, it may seem like a reasonable thing to penalize hospitals that don’t successfully “get their patients better enough” to avoid readmission. However, the …
Reducing hospital readmissions: The burden shouldn’t be all on the doctors
I thoroughly enjoy my 65-year-old male with his horrendous diabetic foot ulcer. But there’s not enough insulin in the state of Tennessee to cover the two bacon, egg, and cheese biscuits he eats every morning.
And I adore my 57-year-old female with COPD. But the inhalers won’t work until she stops smoking two packs of cigarettes per day. I laugh every time I see that hilarious 32-year-old with hypertension. But the …
Society’s health should not be doctors’ responsibilities
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Through Dec. 15, federal regulators will accept public comments on the next set of rules that will shape the future of medicine in the transition to a super information highway for electronic health records (EHRs). For health providers, this is a time to speak out.
One idea: Why not suggest options to give leniency to older doctors struggling with the shift to technology late in their careers?
By the government’s own estimate, …
Tell Uncle Sam to go easy on older doctors
UnitedHealthcare (UHC), the nation’s largest health insurer, will likely pull out of Obamacare in 2017. Citing high costs and huge potential losses, they warned that 2016 will probably be their last year offering health insurance through the Obamacare exchanges.
Is this another example of greedy insurance companies with fat cat CEOs gouging the system? Or are economic realities interfering with the “hope and change” of Obamacare?
UHC isn’t really selling insurance. Instead …
Why is UnitedHealthcare thinking of bailing on Obamacare?
An observation that I and many of my emergency medicine colleagues have made about vacations: We need them. We need them for wellness, to recharge, to recover. Great saves, terrible tragedies, we witness it all and it can wear on you. Unfortunately, when vacation plans are made, it is not uncommon to find oneself working even more shifts before the break to offset our absence on the schedule, making the …
Survival of the fittest in the ER
The optimism of a Rwandan in 2015 will strike you. Take a population that has seen or been raised in the wake of more horror than the average Westerner can imagine, and bring up a problem or something negative. Too short to reach the top shelf? It’s OK, you’ll fit under doors better. Hair stands out when bright red? Easier to pick out in a crowd. Mother has had 3 …
A physician reflects on her experience in Rwanda
The other day, the mother of a nine-week-old baby girl called my office in a panic. Her daughter was having terrible breathing trouble, with coughing and wheezing. She asked to been seen that day, and of course I said yes. I asked mom how the baby had been doing overall, and she said that she’d had some noisy breathing as a newborn, but all was well until the past few …
Others can be harmed when patients lie
Here’s the most distressing piece of unsolicited advice I’ve received to date. It showed up in my Inbox two days after I’d completed a course of radiation for breast cancer. The email was in response to an article I’d written about this new, unexpected turn my life had taken; the article included the fact that, at the time, I was in the middle of a course of radiation treatment. Here’s …
4 ways to handle unsolicited health advice
The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”
The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …
There is no oversight for prior authorizations. There should be.
The “necessity-burden monster” are words of my own choosing, and does not reflect any authoritatively-stated or generally-accepted health care paradigm. It is, for me, an apt summation for how the progressive stages of the administrative side of health care have become a degeneration to the original intention of keeping medical records: to assist in patient care.
What it has undergone, particularly in the last twenty years or so, and when compared to the …
The administrative monstrosity of medical documentation is out of control
The holy grail of clinical reasoning is, in a word, assessment. Ought we to measure clinical reasoning as a function of experience, knowledge base, or as a process measure? In medical parlance, there is no “gold standard.”
In 2015, to tell whether your doctor is a great diagnostician is based more on reputation than hard evidence. This gap in evidence is all the more interesting given recent press about the inattention …
Searching for the holy grail of clinical reasoning
The amount of hostility among health care professionals seems to be at an all-time high. Are “scope of practice” and “turf” battles really escalating, or is it just more palpable in the modern era of anonymous comments and viral online posts? I don’t know for sure, but lately, the conversation seems louder and uglier to me.
In medical school, I heard derogatory comments (“jokes”?) from physicians and nurses alike about pretty …
Stop the hostility among health care professionals
It was recently World Antibiotic Awareness Week and Get Smart About Antibiotics Week. According to the CDC, 2 million people in the United States become infected with antibiotic-resistant bacteria and 23,000 people die from such infections each year. What’s worse is that antibiotic resistance continues to increase.
“To give you an idea of how high the pressure is to prescribe antibiotics, I didn’t get a job once because during …
Reducing antibiotic use requires a commitment from both patients and doctors
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea and periodic vomiting …
MKSAP: 60-year-old woman with gastroparesis
Every time I walk through the automatic sliding doors, that strong smell of ammonia stings my nose. The lobby is clean — too clean — with a vast amount of open space leading to the front desk. The just-below-comfortable air brushes against my skin, raising the hair on my arms and legs. Almost cold enough to be a morgue — but that’s later. The room is silent, except for the …
What it’s like to talk to patients, then cut them open
In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value — above and beyond anything else — the general radiologist.
Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the …
The general radiologist is still valued. Here’s why.
In a recent post Rocky Bilhartz outlined some of the challenges health care providers face when working with software. Health care providers are spending more time in the digital world and less time interacting with patients. The problem of less patient contact, in part, accounts for their complaints leading to the desire to streamline repetitive tasks so they can get back to why they really choose to be …
Why EMRs require cloud-based solutions
Receiving medical school interview offers simultaneously provides relief, justifies the incredibly hard work you’ve put into your primary and secondary applications, and confirms that you are indeed cut out for medicine.
In other words, you’ve convinced them — at least on paper — that you will succeed in their program and make an excellent doctor.
So why do they even want to interview you?
Consider what schools can only learn about you in …
Use the power of psychology to ace your medical school interview
One of my best friends from high school is battling with leukemia. I remember days hanging out in my room, listening to music (we were both huge REO Speedwagon fans), shooting Nerf hoops and talking about life (mainly girls at that time). We were not sure of what life would bring, but we knew we were destined for big things.
Denny was always more confident than I was at the time …
Physicians need to recognize the power of vulnerability
