I understand that there is a difference between perception and reality. I also get that the kind of people one meets on a tropical vacation in the middle of March are of a certain economic and sociopolitical status.
Nonetheless, I am amazed at how history seems to repeat itself. Year after year, while sitting in the shade and relaxing by the pool, …
Our health system is changing, and it’s a damn shame
I walked into room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a …
A thank you to a mother and son in the ER
American physicians have had it. We are retiring early, cutting back, changing careers, and moping in to work in astounding numbers. The typical pep talks, whether given aloud by medical directors and administrators or consisting of internal dialog occurring in the physician’s mind, are not working anymore. “You have it better than most people.” “You are still making good money.” “Your …
This is why physicians are burning out
Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long.
Surgeon and writer, Atul Gawande, explores the medicalization of aging and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and say enough …
The vexing problem of dying for the medical profession
Health care in the U.S. continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the health care landscape because it has awakened the health care consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41 percent of all firms (32 percent of large employers, 61 percent of small …
Patient experience builds brand equity
Members of Congress and the news media have a bad habit of referring to efforts to stop Medicare from arbitrarily cutting payments to physicians for taking care of their patients as the “doc fix.” Typical is this story from CNN — “Bipartisan Love: Boehner, Pelosi strike deal to kick doc fix” — that reported on the release yesterday of an agreement between the two leaders on a bill to repeal …
Stop calling SGR repeal the doc fix. It’s about fixing Medicare.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman comes to the office for advice regarding maintaining bone health. She has no history of fracture. The patient recently had a lumpectomy and radiation therapy to treat breast cancer, is currently taking tamoxifen, and will begin taking an aromatase inhibitor in 2 months. She underwent menopause at age 52 …
MKSAP: 54-year-old woman asking advice about bone health
Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.”
Thousands of people have …
Heart-wrenching photo of a doctor crying goes viral. Here’s why.
As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some point, sent the patients home. This simple formula was the business model for hospitals, and it worked well.
Same with the doctors. The hospital would pretty much let us do what …
Why you should help your local hospital improve
The mortality from colorectal cancer has decreased substantially in the U.S. during the past decade. While some of the improvement is due to better cancer treatment and reduced risk factors, the largest proportion is thought due to screening. The concept that early detection saves lives has now become well recognized. The harms of screening — particularly among individuals with limited life expectancy — are less well appreciated.
Royce et al. recently published a …
Colorectal cancer screening in the elderly: Can we stop the train?
Right now, there are two patients in every room. One is made with flesh, bones, and blood. One is made with a monitor, a mouse, and a keyboard.
Both demand my time.
Both demand my concentration.
A little over two weeks ago I wrote the short story “Please Choose One.” I posted it online. The response it generated exceeded anything I …
To health IT: You are the ones who can save us
In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 — a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month.
This is such a familiar story by now that it hardly makes …
The ethics and money in medicine
I am a clinician and a clinical trialist. Medical research in some form or another (performing it, consuming it, reviewing it, editing it, etc.) occupies much of my time. Therefore, you can imagine my excitement while watching Apple’s product announcement when they introduced a new open source software platform called ResearchKit. Apple states ResearchKit could “revolutionize medical studies, potentially transforming medicine forever.”
ResearchKit allows clinical researchers to have data about various diseases …
Apple’s ResearchKit has problems. Can they be fixed?
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(with a hat tip to “Who’s On First?”)
A guest column by the American College of Physicians, exclusive to KevinMD.com.
(Scene is the back office of a small primary care clinic. Lou is sitting at his workstation, looking at a computer screen. Bud walks by and Lou stops him …)
LOU: Hey, Abbott! I just saw …
What if Abbott and Costello were primary care physicians?
Thanks to the measles outbreak, the news is full of stories on vaccines and anti-vaxxers. The blogosphere and Twitterverse and all the other social media dimensions are buzzing with invective against ignorant unvaccinated savages and their backward science denial. For the record, I’m a pro-vaccine physician. My children have been and are vaccinated, despite being unsocialized homeschoolers.
I’ve had my own share of needles; Physicians are mandated to have hepatitis B, …
The sense of superiority by those who are pro-vaccine
They say that the path to hell is paved with good intentions. Few things in medicine illustrate that as well as how we’ve approached chronic pain management in the past 10 to 20 years.
The advances that we have made in medicine in the past few decades have been truly remarkable. But, unfortunately, pain is one of the ailments we still do not treat well. One of the difficult aspects of …
Will the pendulum of pain management swing too far?
It happens every once in a while in my practice: Parents ask if we can delay or skip certain vaccines, or spread them out.
According to a study just published in the journal Pediatrics, I’m not alone — in fact, 93 percent of pediatricians get asked the same thing.
Now, it’s important to point out that most families don’t ask for this. Most families are fine with the current vaccine schedule — …
To the parents who want an alternative vaccine schedule: Here’s what I say
The world of health care will likely look very different in a decade, owing to a variety of diverse factors including; medical breakthroughs, political reform and not least of all the tremendous advances in technology that are occurring at breathtaking pace. The traditional model of the doctor-patient interaction will also continue to change dramatically (as it already has over the last several years). The days of an unchecked paternalistic relationship …
Why we need less virtual medicine
Termites are endemic in southern California, and we’ve had spot treatments several times over the years at various sites in our house where little piles of sawdust have appeared as evidence of termite activity. Finally, it became clear that the termites were winning, and more aggressive treatment was in order: tenting. This is the process of hoisting a big, brightly-colored tent over the whole house and putting an end to …
How an eleven-pound cat precipitated domestic chaos and delayed surgery
The “age of the giants” has passed. The idea of larger-than-life doctors devoting themselves completely to patient care and sacrificing their personal lives in the process is giving way to an era of recognizing the limits to a physician’s work life.
This change in attitude has been advanced, in part, by Read more…
We must recognize the limits of doctors’ work lives
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