I received a panic call from Jim, who had been a patient for over ten years. His 5-year-old daughter had passed out. Amanda was rushed to the ICU for new onset diabetes. After stabilization, she was transferred by helicopter to a university hospital for an insulin pump insertion. He knew that her life, his life, would never be the same.
Two weeks later, I received another call from Jim. This time, …
The depressed may appear like you and me
KevinMD.com recently published the article “It’s time to make the Match disappear” written by medical student Amy Ho. I firmly agree with her that the current match system is wildly inefficient and needs fixing. However, she is throwing the baby out with the bath water in abandoning the algorithm which yields an extremely effective system.
Firstly, when one examines her data, which in itself is correct, one also …
Defending the residency Match and its algorithm
A Veterans Affairs hospital in Fort Collins Colorado, it was recently revealed, falsified its wait times for outpatient clinic appointments. In order to appear to meet the goal of clinic appointments within 14 days, the hospital taught its clerks how to falsify the appointment records to create the illusion that the appointment goals were being met. Many of the 6,300 veterans treated at this clinic actually …
The VA wait list scandal: A sign of our future?
This post deserves a caveat — health care shouldn’t be a political issue. When someone comes into my office because they have chest pain, I don’t ask them, “What’s your political leaning?” before administering care. And now after reading about the recent delay of ICD-10 in Congress, I realized that my choice in practicing direct care was the most political and least political thing I could have done.
According to Read more…
Health care shouldn’t be a political issue
I received a fax recently, from the office of another hematologist-oncologist, at another academic medical center. Attached to the fax cover page, with my name and fax number scribbled in slanted script, was a five-page consultation report on one of my patients. That oncologist — I’ll call him Dr. Z — had seen and evaluated my patient to provide a second opinion on the patient’s diagnosis and treatment.
The lengthy report …
The art of writing a good consultation letter to another physician
When one hears the words “language barrier,” it usually brings up images of a person who is in another country of which the national language is not his own. If you have visited a foreign country without fully knowing the primary language, you can start to feel out of place fairly quickly. Despite one’s best efforts to navigate the country, a part of the cultural experience is lost without knowing …
Breaking down the language barrier in medicine
A perspective that comes from continuity of care over many years. An awareness of local resources. A sense of who a family is. An appreciation of the things that give life meaning and value to a child and family. Isn’t this care a lot to offer families of seriously ill children? What happens to all of this knowledge when a child becomes more ill and spends increasing amounts of time …
Training community-based pediatricians in palliative care
As both a practicing physician and the co-founder of a mobile health startup, I’m often greeted with confusion about my two roles. It’s not that there aren’t others simultaneously involved in both endeavors — because there are lots of us. It’s that many people see a contradiction between the mindsets of the two. The way one thinks for medicine, they suggest, is not the way one needs to think for …
Medicine and business are not mutually exclusive
I wouldn’t say I’ve had a lot of revelations in my professional life, but there is one that still affects me emotionally to this day, and it’s about nurses.
I had been a PICU doctor for a number of years, and I was rounding on all the patients in the PICU with the rest of the team. The background sounds consisted of the usual beeps, alarms, and humming from the patient’s …
Nurses are the reason doctors look good
If my car insurance isn’t linked to my employer, should my health insurance? A recent projection by S&P Capital IQ, a research firm in the financial industry, estimated that 90% of Americans will receive health insurance from government exchanges by 2020. If this estimate were to come to fruition, it would represent a monumental shift in the structure of the American health care system. For over half a century, employer-sponsored …
Health insurance shouldn’t be tied to employment
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for increased hair growth on the face and chest and a 3-month history of irregular menses. She has a 5-year history of hypothyroidism. Her only medication is levothyroxine.
On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 110/72 mm Hg, and pulse rate is 80/min; …
MKSAP: 32-year-old woman is evaluated for increased hair growth
“All patients are alike. This one complains about the same things that the last one did.”
“Every patient is unique. We can never find a way to make each one of them happy.”
Remember that 1980s public health paradox: Do you focus on intensive interventions that might produce significant improvements in outcomes for a defined, high-risk group or do you direct energy to system-level changes that may achieve more …
Balancing individual care with systemic health fixes
“If you insure them, they will come.”
Those words might as well be the mantra of hospitals across the country, because they can expect an onslaught of customers thanks to the expansion of health insurance under Obamacare. A recent study published in Science showed increased emergency room use among people in Oregon who became eligible for Medicaid, compared to others who, literally by the luck of the draw, were not chosen to …
Protocol-driven observational units can reduce ER crowding
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I had a silver-and-gold Passover. Hearkening back to the old Girl Scout song I learned from my mother:
Make new friends, but keep the old;
One is silver and the other’s gold.
With no space or equipment to have a seder myself, I was nevertheless the lucky recipient of not just one, but two invitations. The gold was thanks to a quarter-century-plus friendship; the silver was from a family we met the week before …
When are doctors truly accountable to their patients?
Next in a series.
How many patients can a primary care physician (PCP) reasonably care for? I have been interviewing PCPs: Here are some of their thoughts when asked this question.
Responses were widely divergent ranging from about 300 to 3,000 or even more. Yet many are clearly conflicted. Some say they can manage about 2,000 with little difficulty — but then observe elsewhere in the conversation that they have no …
How many patients can a primary care physician care for?
Before I retired in 2000, I worked in a state agency as a peer counselor, or more formally, an employee assistance program (EAP) coordinator. The “coordinator” part was there because my job description wasn’t actually to do counseling; it was to assess the problem and refer the client for help.
But of course both of those processes involved counseling. We just couldn’t call it that.
In 1986, shortly after I’d begun the …
Every time you turn around, it seems there’s another CEO apologizing. But, when do apologies work? When does an apology help everyone learn, improve, and move on? What distinguished sincere apologies from the rest? I think it takes three ingredients:
What distinguishes a sincere apology from the rest?
While grappling with the costs and imperfections of our health care system in recent years, a multitude of experts in the field found it useful and enlightening to compare health care to a variety of more familiar industries, and to suggest that health care should adopt operational models that have been shown to work well in those other industries.
From the financial industry, we learned that health care must be computerized. …
Applying the lessons learned in other industries to health care
Many friends from my original medical school class will graduate and officially become doctors in just a few weeks. I can’t believe I’ll be at that point in only a year, and I’m incredibly proud of my soon-to-be-doctor friends. This time of year there’s always a lot of talk surrounding graduation, and in light of that I have a …
Stop calling medical school graduates newly minted doctors
DNA Day came and went this past April. On this date in 1953, the work of James Watson and Francis Crick (and, though she doesn’t appear as an author, Rosalind Franklin) describing the structure of DNA was published. The paper, published in Nature, connected a string of dots that stretched back a century, to Gregor Mendel’s work describing the heredity of peas.
That string of dots (or peas, as the case may …
Integrating genomics in your office
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