Remember when we were trying not to panic about Ebola? Seems like that was only yesterday. Oh wait — it was only yesterday. But it already seems as if we are trying to remember that we were trying not to panic.
I listened to my favorite news radio station out of New York City while driving to the office recently. They address all of the major news stories in the first eight …
Ebola is yesterday’s news, but should the media move on?
Information technology clearly has a long way to go before it delivers on the immense promise of technology to truly improve health care. Most of the current solutions — quickly rolled out in response to meaningful use requirements — are slow, inefficient and cumbersome.
Physicians (and nurses) spend far too much time staring at their screen and navigating the system, often to the detriment of patient care time. A study published last …
5 new rules for how doctors interact with health care IT
We sit, we listen, we attempt to focus and absorb what we are required to know. We learn how to give bad news, even using one another as makeshift “standardized” patients. How does one “standardize” a patient anyway? Who knows, who cares, time to cram for the endocrine exam.
But what happens when you stop pretending? When you wake up one morning …
Walk in the shoes of a cancer patient
Training doctors is no easy task. After medical school, newly minted doctors enroll in residency programs at various hospitals throughout the country for a length of 3 to 8 years, depending on their specialty. Some specialties, like family medicine, are even considering adding another year to the process. Resident physicians spend this time working long, arduous hours under their attending physicians, learning the clinical intricacies of their specialties that could not …
Why does Medicare pay resident salaries?
It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket.
They call these messages “system notices.”
OK, maybe that’s an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic …
Communication is key between physicians and EHR programmers
Part 3 of a series. Read part 1 and part 2.
The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. “Ho hum,” says a lawyer who read my first two posts in this series. “Get out the violins.” It’s as if, because I make my living operating on …
Patients are doubly screwed by the malpractice system
Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.”
— Abraham Verghese, MD
The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, …
What a student learned: Medicine’s hidden curriculum
Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.
– Susan Sontag, Illness as a Metaphor
Words are important. …
Pathographies: Step into our patients’ lives
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Care coordination seems to be the rage these days. It is mentioned in most discussions of new delivery and payment models such as the patient-centered medical home (PCMH) and accountable care organizations. The concept is not a new one; primary care physicians have been coordinating care …
Need better care coordination? There’s a toolkit for that.
Most of the doctors I know went into medicine because they really truly wanted to help people. But medicine, long honored as a calling as well as a profession, is facing some tough new challenges. Many doctors are disillusioned or simply burnt out. Others have accepted their fates as interchangeable provider units.
The name of the game today is efficiency — i.e., …
Patients: Accept your fate as a hamburger
Jewish history has all too often been written in tears …
I am fascinated by people and groups with the capacity to recover,
Who, having suffered the slings and arrows of outrageous fortune,
Are not defeated by them but fight back,
Strengthened and renewed.
– Rabbi Jonathan Sacks, PhD,To Heal a Fractured World
In some situations, the whole idea of complete recovery from bereavement makes no sense. Bereavement can be fully expected to last a lifetime. …
The Holocaust: Bereavement takes a different course
One would expect that in an era where smartphones are more powerful than our computers were 5 years ago, health care providers would have an arsenal of health care IT solutions to enhance patient care but also optimize their own workflow.
Shockingly, in 2014 most health care IT solutions (such as EHR systems) are incapable of basic functions that we take for …
Terrifying truths about health care IT
What is a pickup basketball game? It involves players of varying skill levels forming a team on the fly and hoping to win the game. Often the players have some or no familiarity with each other or their skill levels. What is the analogy to surgery? Often, surgeons walk into an operating room and have to form teams with unfamiliar or unknown personnel, and teams may not be consistent. However, …
Perioperative team training: Can we learn from basketball?
ADVERTISEMENT
I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance …
When is it right to share our personal struggles with patients?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. …
MKSAP: 55-year-old man with nonischemic cardiomyopathy
I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal handoff process at shift change resulted in a 30 percent …
Disciplined physician communication saves lives
Man looks into the Abyss, and there’s nothin’ staring back at him. At that moment, man finds his character, and that’s what keeps him out of the Abyss.
– Lou Mannheim (Hal Holbrook) in the movie, Wall Street
We hear reform ideas all the time: Primary care physicians need to work at the top of license, physicians need to work in teams, health …
What primary care can learn from the financial service industry
Carl didn’t know what was happening to his wife. The German railway clerk from Morfelder Landstasse and his wife Auguste had been happily married for twenty-eight years. They had one daughter, Thekla, and their marriage had always been harmonious — that is, until one Spring day in 1901 when Auguste suddenly exhibited signs of jealousy.
Auguste accused Carl of going for a walk with a female neighbor, and since then, she …
How Dr. Alzheimer discovered a disease in a mental asylum
Last year the New York Times reported that the aviation industry had become so safe that one could fly every day for 123,000 years before dying in an aviation crash.
I wish we could say the same for the U.S. health care system. Nationally, problems with health care quality (doing too much, doing the wrong things, and doing too little when indicated) are pretty clear. The bigger problem is that the progress …
Patients should not have to advocate for their own safety
The alarm clock’s blast brings hours of work, running from task to task, always pushing toward the next turn. In moments of failure, the waves of complexity and anxiety batter and you question each stroke. Then you fly downhill, easy breeze in your face, as success urges you on. After the finish, the parking lot empties, the lights go out, and …
Oncologists have one of the lowest burnout rates. Why?
Get free updates delivered free to your inbox.
