It’s been a while since my last rant about electronic health records (EHRs), so let’s remedy that right now. EHRs in their current iteration are — how to put this delicately? — an unmitigated disaster. Nevertheless, much of the criticism of EHRs, including mine, has been in the destructive category. What about some constructive criticism? How could EHR software be made better?
I am not …
Why can’t an EHR fit into a mobile device?
In every life we have some trouble
When you worry you make it double
Don’t worry. Be happy.
It will soon pass, whatever it is.
Don’t worry. Be happy.
– Bobby McFerrin
Much has already been written in reaction to Robin Williams’ untimely death, about his incandescent talent, his prolific career, his decency and kindness, his addiction and his mental illness. His death robbed his fans of many more years of his genius …
Broadcasting suicide in social media: A failure of responsibility
The worst thing anyone ever said to me was, “You think you know everything, but let me tell you: You don’t know jack!” I was six weeks into my social work internship at a hospice and it was my student supervisor who decided I needed an attitude adjustment. Needless to say, I didn’t stay there. I was angry and hurt for a long time but now I’ve come to realize …
7 assumptions about end of life care
He left a little early to stop by the cath lab to see his patient before her procedure. Cordial “hellos,” “good mornings,” and “any last questions?” were mentioned before she signed her consent. The team was working feverishly to prepare her for her procedure. “Have you met the anesthesiologist yet?” was next, and almost on cue, the anesthesiologist arrived and took over for a bit.
He hurried upstairs to the conference …
This is what lifelong learning in medicine should look like
I don’t know you and you don’t know me, but today you become one of the most important people in my life. You are the one. The one who I’ve entrusted to take care of my girl in my absence. The one who I’ve tasked with teaching her things that I cannot. The one who will make an indelible mark on her …
On the first day of school, a letter to my child’s teacher
Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.
The burned-out physician is …
The epidemic of physician burnout is heartbreaking
Oh yeah. Hot dang. All right. Groovy.
Boom goes the dynamite.
I had a very great day yesterday.
I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don’t. Each person I saw gave me a clear view of how the practice I’ve been building over the past 18 months is making a difference. A big, big difference.
The first patient was a guy who is …
I’m all for free speech and I’m very hostile to censorship. The response to ugly speech is not censorship, but is rebuttal speech. Of course, there’s a lot of speech out there that should never be uttered. Indecent and rude speech is constitutionally protected, but is usually a poor choice. We have the right to make speech that is wrong.
I relish my free speech in the office with patients. I …
The consequences of prohibiting physicians’ free speech
Earlier this year a child died following a surgical procedure in California for a condition called obstructive sleep apnea. The case generated a great deal of concern among parents about both this condition and the surgery often done to treat it. I wrote a post myself about it at the time. I still get questions about it because I care for quite a few children immediately after they have had …
Sleep apnea in children: A primer from a pediatric intensivist
It was July 2012 and I was pregnant with my third child. As an experienced mother and labor and delivery nurse, I felt very comfortable at 29-weeks gestation and anticipated the usual course of pregnancy. However, at 30 weeks, I started battling with preterm labor issues. This eventually led to the early delivery of my son, a four week and stay in the NICU, and a life lesson in cost-awareness …
A life lesson in cost-awareness of medical care
A resident once offered me this piece of advice: Find mentors whom you admire. Not just for their rapport with patients, but also for their lifestyle, their hours and their family life. Make goals that you know to be realistic because someone has already accomplished them.
My question now: Why stop there? Why not share that ounce of brilliant advice with our patients? Why don’t we link older, successful patients with diabetes …
Introduce our patients to mentors
Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: “Stop calling nurse practitioners mid-level providers.” So do I, though my reasons are a bit different. In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know …
Solving the mid-level dilemma: Call them what they really are
“If a tree falls in a forest and no one is around to hear it, does it make a sound?”
Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …
DNR/DNI: More code than status
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When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s. As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly …
When medications devalue the opportunity to listen
Several months ago, a post called, “Everything’s my fault: How a surgeon says I’m sorry,” appeared here on KevinMD.com. It was written by a plastic surgeon who feels that no matter goes wrong with a patient, surgeons should never blame anyone else.
She gave some examples such as the lab losing a specimen, a chest x-ray that was ordered and not done, a patient eating something when he was not to …
Surgeons can’t be responsible for every mistake
In an ironic analogy to the recent Occupy Wall Street movement publicizing the wealth gap between America’s elite and the general public, the health care world also has its own infamous 1%. According to the Agency for Healthcare Research and Quality’s 2012 report, the top 1% of health care seekers incurs nearly a third of the nation’s $1.26 trillion yearly health care expenses (and up to half of this expenditure …
The uphill climb of complex care management
Part of a series.
A common criticism of direct primary care (DPC, membership/retainer/concierge practices) is the added expense: “Isn’t it too expensive?” Ways to think about the cost are to prioritize expenditures and to consider potential savings that make it cost effective.
I gave examples of three direct primary care practices in an earlier post. Here is a recap of costs.
AtlasMD’s annual fee is $600 for a young adult and …
No, direct primary care isn’t too expensive
If you’ve ever worked in an emergency room, you’ve likely treated a victim of human trafficking.
We all have, often without knowing it.
With nearly thirty million people in modern-day slavery around the world, there are more slaves today than at any point in history.
Human trafficking is defined as “the recruitment, harboring, transportation, provision, or obtaining a person for labor or services, through the use of force, fraud, or coercion” for the …
Recognize the potential victims of human trafficking
A few weeks ago, my husband and I took my parents to dinner at one of my favorite restaurants. I was excited to go because the food is excellent and the customer service is top notch. In the past, I’d always had a great experience … until then.
That night, the restaurant was packed as they were offering half-priced desserts. My husband and I arrived first. I noticed when we ordered …
3 things a restaurant taught me about patient satisfaction
My high school graduation ceremony was your typical Californian high school graduation — the sun hovering lazily over us, a cool, ocean breeze bringing wafts from the sea. As I listened to my principal deliver his address, my attention waned in and out. The sun was too warm and the wind was too soft. When the student speaker came up to speak, I reclaimed my attention to listen to him …
Emphasize the attention a doctor pays to the patient
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