I am a foreign born, foreign trained doctor, serving many patients from an ethnic minority, whose native language I never mastered.
So, perhaps I am in a position to reflect a little on the modern notion that health care is a standardized service, which can be equally well provided by anyone, from anywhere, with any kind of medical degree and postgraduate training.
1. …
Bureaucrats think a doctor is a doctor. They’re wrong.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated as a new patient. She is planning to attempt conception with her partner. She has a history of systemic lupus erythematosus complicated by chronic kidney disease that has been inactive for several years off of treatment. She has had borderline blood pressure elevations since the …
MKSAP: 32-year-old woman with systemic lupus erythematosus
Information is everything, communication is the key.
Recently, we were contacted by the medical director of a subspecialist fellow’s practice at one of our affiliated hospitals.
She wanted to discuss ways to improve communication between our practices, and expressed considerable frustration about the information received in consultation requests from the providers in our practice sending patients their way.
She noted that they had “read-only” access to our electronic health record (through an information-sharing …
Information without communication is uninformative
Improving patient engagement is a subject that’s being talked about in hospital boardrooms across the country. It’s become the in-fashion political buzz phrase. Certainly sounds very well and good, but what exactly does it mean?
Likely different things to different people depending on what angle they approach it — all the way from a care assistant up to the hospital CEO. In a nutshell, it’s all about allowing the patient to …
5 ways to improve patient engagement in hospitals
My earliest memories of medicine take me back to dinner table conversations with my mother, who is a physician. She would share with us her daily stories, telling us about patients she took care of in her clinics and in the hospital. As an internist, she often found herself traveling between many locations. I grew up knowing this to be medicine. As I have progressed in my career as a …
Is reactive scheduling for hospitalists a good idea?
There are plenty of good reasons why thoughtful physicians are often unhappy with the current approach to measuring the quality of care they provide. Some, of course, object to the whole notion of quality measurement, but I believe they are in a shrinking minority clinging to an anachronistic mental model in which each physician defines for himself what constitutes high quality care. I have addressed this previously. But even those, …
Can shared accountability improve performance measures?
As part of the second-year clinical skills course, each member of my class is required to complete two 8-hour emergency department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the …
From medical student to patient, in a matter of minutes
So many foods beckoning us from the grocery store shelves — but which ones are healthy for us to consume? We could study nutritional facts labels, but that feels as challenging as the math portion of the SAT, with so much numerical information to process. The label tells us how many calories are in the food in question — how many grams of protein, how many grams of fat, and …
Red light, green light: How nutritional labels can mislead
I once wrote about the communication difficulties caused by electronic medical records systems. The response on Twitter ranged from sentiments including everything from “right on, sister” to “greedy doctors are only complaining about EMRs because of their price tag.” The disconnect between policy wonk’s (and EMR vendor’s) belief in the transformative power of EMRs and exasperated clinician users of these products is jaw-dropping. Physicians are often labeled as obstinate dinosaurs, blocking progress, while policy wonks …
What happens to medical notes today’s EMRs
Chronic pelvic pain (CPP, pain in the pelvis that is present for more than 2 weeks a month and has been there for more than 6 months) affects 15 percent of women and accounts for upwards of $2 billion a year in direct medical costs. To say it is a significant health burden is a gross underestimate at best. My entire practice is devoted to the treatment of pelvic pain …
Hysterectomy for chronic pelvic pain: 7 questions to ask
Young doctors are often progressive thinkers who like to support small businesses, buy locally grown produce from food shares, shop from individual merchants on Etsy, and never be seen in any chain store larger than Trader Joe’s. It seems every industry is recognizing the benefits of the personal service of a small business.
Decades ago, the majority of physicians owned their own …
Hardly anyone is opening their own practice anymore. Why?
Sometimes I tell people I’m learning how to treat cancer, and their first question is ‘why haven’t we cured cancer yet?’
We will. It’s coming.
In medicine, we’re much better at treating infections than cancer, but it wasn’t always that way:
The people who will cure cancer are the patients
I see it all the time at our practice. Parents come with kids who really don’t need to go to the doctor; they are only mildly ill, or already getting better. When I ask them why they came, the answer is simple: daycare.
They need a note saying the child is better in order for the child to go back. They need …
Should sick kids be allowed at daycare?
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Traveling to another country can be daunting. So when a friend of mine hosted a Russian college-aged student named Anna for a year so she could take English classes, I agreed to help out if she ever needed to navigate the American medical system. Anna had insurance provided through her program, and she was in good health, so I wasn’t too …
How many doctors does it take to read a hospital bill?
My lifetime has spanned many of the important developments in the Age of Computers. Back in 1969 when I entered college, I was a frequent visitor to the Kiewit Computing Center, the lair of a GE-635 computer that filled several rooms. Students had access to the computer via noisy teletypes and a multiuser operating system known as Dartmouth Time Sharing. We wrote simple programs in BASIC, a language created by two of …
Competition helped innovate computers: Can it do the same for health care?
Being sick isn’t easy, but neither is being the sibling of someone who’s sick.
We’ve shared many stories about children who are living with a serious illness. We’ve talked about their disease, what life is like for them, how they cope in such dire circumstances. But in all of these conversations, one thing we’ve overlooked is telling the stories of the brothers and sisters who sometimes feel that they live in …
Having a sibling with special needs: A challenge for the whole family
My department had a problem that harmed patients on at least a weekly basis. It was well-known, but it seemed there was no viable solution.
My supervising attending was in his seventies and highly regarded at my hospital, having held powerful administrative positions for decades. About ten or so years ago, he stepped down from running the hospital, and …
An attending threatens patient safety. A resident blows the whistle.
Sovaldi (sofosbuvir), the new hepatitis drug manufactured and marketed by Gilead Sciences, has garnered considerable media attention over the last several months. The drug was approved by the FDA in December after phase III clinical trials showed it was highly effective in the treatment of chronic hepatitis C (HCV) infection. In fact, with an overall SVR (sustained virologic response) of 90 percent for the genotypes studied, Sovaldi may represent a cure for many of the 3.2 million Americans afflicted …
Sovaldi: The drug pricing paradigm has shifted
Dear HMO,
As I prepare to #getcovered or #staycovered, I realize that as a physician, I have an advantage in that I know what specific types of insurance plans would best fit my needs. Unfortunately, this is not the case for many Americans. Most importantly, I know to avoid signing up for certain health maintenance organizations (HMOs). Although I am a strong …
Dear HMO, I don’t want your money
Despite the furious pace of the emergency department, he sat within his private bubble of calm on a hallway cot situated just outside the entrance of room 31. He sat upright, facing the opposite direction from which I approached, with the thinning brown hair of his broad occiput splayed across the upper edge of his pillow. From this approach, I paused for several seconds to appreciate this serene, surreal view …
An ER patient that stirs every emotion
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