This is one of those columns that will risk the respect and friendship of some of my closest colleagues in the health care world. In addition to disagreeing with me, they may argue that I am giving aid and ammunition to “the enemy,” where the enemy might be viewed as those forces in the health care world who really don’t want …
The triple aim has been hijacked by powerful political forces
Note: This case is meant to illustrate the potential negative effects of inappropriate imaging. It is not intended as a diatribe towards any member of the health care team. Really the only “mistake” made here was the ordering of the CT scan in the first place.
A 37-year-old woman presents to her local emergency department (ED) with a 4-hour history of heartburn …
How heartburn caused a patient to lose her left leg
In a recent Forbes editorial, conservative commentator John Goodman argues that the Texas Medical Board is sending the state back to “the middle ages” because they are trying to limit the practice of medicine in the absence of a face-to-face, doctor-patient relationship. He believes that telemedicine should have an unfettered role in health care — diagnosis and treatment should be available to anyone who wishes to share their …
Can we expand physicians’ reach without eroding the patient relationship?
Facebook is a remarkable thing. I use it for private matters — to keep in touch with family and friends from long ago. Because of it, I’ve reconnected with people from every stage of my life, as far back as third grade to high school to college and beyond. One of the …
A poignant Facebook birthday for this physician
Out-of-context quote of the day: “We have no malls and no Walmart. Recruitment is nearly impossible.”
These astonishing statements were made by Elizabeth Nelson, a nurse practitioner in Nebraska. She was not talking about teenage summer jobs. She was not talking about professional Walmart greeters, addicts of cheap stuff made in China who want an employee discount, or people who really like Cinnabon. …
Go fund a physician rather than fight nurse practitioners
Did you know that you are a “telemedicine provider”? No? I can’t blame you for not knowing, but you are, and always have been. Well, maybe not always, but certainly since Alexander Graham Bell invented the telephone. Better yet, you provide free telemedicine services. Here is an idea: on the home page of your practice website, you should add a big …
You’re already a telemedicine provider. You just don’t know it yet.
When I began the practice of medicine, I used to think of the entranceway to the exam room in mystical terms. How else could I explain my patient’s willingness to suspend all social rules and norms upon passing through those magical doors? They would sit down in front of their baby faced-doctor and talk about things. Private things. Scary things.
Conversations occurred that would be unthinkable if two strangers were to …
The sanctity of the exam room doesn’t define this physician
“I want to tell you my story now,” a patient recently told me, a woman who suffers from many physical and emotional ailments. She had the diagnosis of PTSD on her problem list, along with hospitalizations for “stress,” but I never asked beyond that.
“OK,” I answered, not knowing what to expect. “Tell me your story.”
She paused for about 30 seconds, but I …
If my patients know I am human, they don’t ask for me to be superhuman
Who can argue against evidence-based medicine? Who can argue with using evidence to develop guidelines? The key to practicing great medicine must involve using the best evidence to guide our protocols.
My son, while in college, was an English major. I remember reading his papers. He often used the phrase “on further reflection.” I often recall that phrase when considering these complex issues.
Frederick Nietzsche wrote, “There are not data, only interpretations.” …
Why guidelines should only be a framework. They should not be rules.
With my white coat still on, I put my hands together behind my back and heard the police officer ratchet the handcuffs shut. The last place I’d expect this to happen is in the hospital while taking care of patients. But there I was, getting handcuffed along with my attending while standing in the middle of the psychiatry inpatient unit.
Ashley (name …
Breaking the cycle of human trafficking: What can physicians do?
Recently a neighbor of mine was in our local hospital for several weeks undergoing treatment for MRSA and dehydration. Polly is a woman in her late seventies who is completely alert and oriented. She lives an active and independent lifestyle and is fully capable of understanding and communicating clearly with others.
I asked her adult daughter how her mother’s experience had been so far. Given that this is a hospital that …
Improve patient satisfaction with these common sense tips
You’ve probably heard that we remember negative things we’re told ten times longer than positive things. What’s the implication for those of us in the medical field?
Does all that negativity create more burned out doctors?
If you’re at all like me, those negative things started in your training. Did you feel tortured during grand rounds or oral board exams? Yeah. Me, too.
And …
The baggage of burnt out doctors
An excerpt from Burning the Short White Coat: A Story of Becoming a Woman Doctor.
Chief’s pager went off and he looked at me.
“It’s time to go down to the OR,” he said. “Just because you dated Dr. Lawson doesn’t mean we are going to give you special treatment or anything.”
“I wasn’t asking for any,” I said. The gossip session was over.
We dumped our breakfast trays into …
Operating with the Boss: The story of the drill
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Readers know that I am a conservative practitioner. I rail against overdiagnosis and overtreatment. Less medicine results in more healing and protection. In an example, I have explained previously why I advise patients not to undergo total body scans, despite the lure that they offer a cancerophobic public.
I’ve never undergone a CXR in my life. I’ve never entered medicine’s tunnel of …
Don’t make waiting for the doctor a stress test
The New England Journal of Medicine (NEJM) called the question: Has criticism of the pharmaceutical industry, and of physician relationships with that industry, gone too far? Are self-righteous “pharmascolds” blocking the kind of essential collaboration that brought streptomycin and other lifesaving treatments to market? The editorial by Dr. Jeffrey Drazen and the lengthy three–part Read more…
Has criticism of the pharmaceutical industry gone too far?
“Dr. Vashist, I’m sorry to bother but you really need to look at this medication being taken by our patient.”
My hospital pharmacist gently prodded me as he handed over the patient’s medication list along with cost information and side-effects of the offending medication. The issue with the list was a subcutaneous injectable form of calcitonin, Miacalcin, costing approximately $11,300 per day of treatment.
The patient had been admitted about 11 days back …
Hospitalists need to care about costs too
My oldest son is almost a second grader.
He attends a public elementary school in town, and very soon, he will start preparing for an exam known as the STAAR test.
The STAAR test is an “assessment of academic readiness.” In my state, it gets administered to publicly-funded school children. Students must pass the exam to continue progressing in school, and ultimately, students must master the exit level test to graduate high school.
There’s good …
Applying pay for performance in medicine to public schools
I am presenting my startup costs here, to give some ideas for those providers who are considering starting their own family practice, or for those who say it can’t be done anymore.
To become a business, I spent $50 for the state LLC filing, and $12 for business cards. I already had my medical license and DEA from residency, so the only certificate …
I started a family medicine practice for $11,000. You can, too.
I have this life. It’s not a cubicle life — there’s a lot of everything in it, and I never really know what the next hour will hold. Whenever I talk to people about what I do, it’s surprising to me that almost no one has any real clue what my life is really about.
Here are the impressions that they tell …
A country surgeon with kids: A day in the life
I recently found something I had lost. Or rather, I found someone I had lost. He was a dear friend from my childhood. We spent days and nights roaming the woods near our homes, catching crawdads and minnows in the creek and turning rocks over to look for banded water snakes. We shot bows and arrows and rode bikes. Standard Appalachian stuff, that.
In the winter, we would sled until we …
This doctor transcends the differences he has with others
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