An excerpt from Pet Goats and Pap Smears.
Life changes in a heartbeat.
In the “Events of the Cardiac Cycle” lab, four students are assigned to each dog. Instructions: Inject the live dog with epinephrine and study the EKG. Sever cardiac nerves. Carve open the chest and shock the heart. As the dog’s blood pressure drops, remove the heart. Now, stab …
A 33-year-old woman in Indiana, Purvi Patel, presented to an emergency room with vaginal bleeding and when it was obvious that she had very recently delivered a baby the doctors on call notified the authorities. The body of her 28-week gestation infant was recovered. The pathologist believed the baby had taken a breath so Ms. Patel was with charged with neglect of a dependent. …
Feticide laws force birth and punish women
Contrary to what you may have heard, pain is not the fifth vital sign. It’s not a sign at all.
Vital signs are the following: heart rate, blood pressure, respiratory rate, temperature.
What do those four signs have in common?
They can be measured.
A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers …
Pain as a vital sign has contributed to the opioid epidemic
She was having excruciating pain in her pelvic area. I pulled the sheets down cautiously and noted the bruising encircling the waist and inching towards the thighs. I finished my exam and retreated to the nursing station of the skilled nursing facility to comb through the chart. ER records, floor notes, consultations, but no x-ray of the pelvis. There was no mention of pelvic pain.
The emergency room physician had dutifully …
There is no concern for the discomfort of the patient
7:00 a.m. Lights on.
Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday.
Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range …
What’s it like to be an oncologist? This is just one day.
You have to think fast in medicine. Not that most doctors handle life and death emergencies all day long, but even seemingly mundane clinical situations require a lot of rapid gathering of data, processing of applicable information and attention to detail in formulating a plan.
I have always been bemused by the so called E&M (evaluation and management) coding that dictates payment by requiring documentation of how doctors think. Ironically, the …
Doctors must speak like accountants
I came across an interesting article in the New Yorker last week: “Why Chinese patients are turning against their doctors.” It is a fascinating account of the evolution of the health care system in China, highlighting the major changes that have led to increased patient-doctor homicides.
In a nutshell, in ancient China, traditional medicine reigned king, and people scoffed at the idea of Westernized medicine. This started changing in …
When patients attack: How safe are health care workers?
There were many things I pictured myself doing as I endured four years of medical school: building relationships with my patients and their families, performing complicated procedures, sleeping with my shoes on so I could jump up at any moment when I was on call. One thing I didn’t imagine was that I would be learning about and becoming a part of the labor movement.
My experience at UCSF Benioff Children’s …
From the bedside to the bargaining table
The ALS Association, and the British version, the Motor Neurone Disease Association, have made boatloads of money off of the ice bucket challenge. Originally the idea was that a person would challenge another person to donate money for ALS research and if they hadn’t done so in 24 hours, they would dump a bucket of ice water over their head. It turns out that people like dumping ice buckets over …
ALS and the ice bucket challenge: A matter of priorities
Even in the 21st century, talking to your doctor about your symptoms matters. This is something I tell my medical students. Talk to your patients. Listen to your patients. Use their story to determine what tests and imaging tests to order, if needed. Don’t get fooled by technology or be in awe of its importance. It is the patient’s experience that matters. It isn’t the other way around as we …
Medicine in the 21st century: Talking to patients still matters
A few years ago, as I prepared for neurosurgery, a nurse who worked there told me, “Spend as little time in the hospital as possible, because the longer you stay, the more likely you are to get sick.”
In a way, that statement seemed quite telling of what was to come for me and an indicator cost of care — the added cost of additional care, additional hospitalizations, and the additional …
Miscommunication added to the cost of neurosurgery
There’s a patient I don’t like very much. I’ll call her Mrs. X.
Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur.
Every time she makes an appointment, …
A frustrating patient, and how that affects her physician
“Dr. Sevilla, what do you think about the Ebola virus,” a patient recently asked me. My patient and I talked about the recent news reports stating that over 1,500 people have died because of the virus.
“There’s a vaccine that’s being developed,” I told my patient.
“Well, that’s great. I’m definitely going to get it, if …”
“If?” I asked my patient.
“Well, you know how these things go. If it’s covered …
4 reasons why the Ebola vaccine won’t matter
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Even if you don’t live in a city yet that offers Uber’s rideshare app, you probably have heard about it, because the media has widely reported on job actions by taxi cab drivers — and the gridlocked traffic that resulted — that has taken place in Washington, DC and in other major cities across the world including London, Berlin, Paris and Madrid.
Uber is an “on demand” smart phone app that allows users …
Physicians on demand: The Uberization of medicine is underway
Dr. Sandeep Jauhar, a cardiologist, believes with good reason that many physicians have become “like everybody else: insecure, discontented and anxious about the future.” In a recent, widely-circulated column in the Wall Street Journal, “Why Doctors Are Sick of Their Profession,” he explains how medicine has become simply a job, not a calling, for many physicians; how their pay …
So doctors are sick of medicine: What can we do to fix that?
Actionable items.
Today I decided to take a look at one of the dashboards that the information technology (IT) department built for our electronic health record, to help us a look at our patients enrolled in the multiple registries of diseases and conditions we are following for the patient-centered medical home.
I booted up the program, and with just a couple of clicks of the mouse the program began running, checking with …
Actionable items: Reduce the work for physicians
Part of a series.
Helping employees improve their health is right for the company’s bottom line and is doing right by our employees. Healthier employees are happier, demonstrate less absenteeism and presenteesism, and are more productive. This is a win for everyone involved.
– John Torinus, Jr., a retired CEO and current board chair of Serigraph, Inc., a mid-sized Wisconsin company with about 500 employees
In my earlier posts in this series …
A business approach to controlling health care costs
A recent report from the Commonwealth Fund, which placed U.S. last amongst developing nations in health care, analyzed Britain’s high score on the management of chronic conditions. The authors attributed care coordination to the widespread adoption of health information technology in the National Health Service (NHS).
That’s like someone saying Chinese food is tasty because chopsticks are widely used.
Like quants so fastidious about decimal points they’ve missed the overall point.
Where do …
To those who admire the NHS: Empower primary care physicians
Adapted from a keynote address given to the graduating medical class at the University of Toronto.
When I was asked to give the keynote to graduates of the class of ’14, it was an honor that nevertheless filled me with terror and a bit of wistfulness.
My sense of fear in giving advice to these amazing young doctors comes from not being sure I belong in the same company. They are whip smart, …
The human cost of physician burnout is almost unfathomable
Dear NICU nurse,
I couldn’t have done what I do without you, and the time to thank you publicly for all the ways you have helped me is more than overdue.
Thank you for teaching me how to handle 500 grammers when I was a medical student and had no clue. This showed me your tolerance and good nature.
Thank you for speaking up …
Appreciate your NICU nurse: A letter from a neonatologist
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