I do not provide health care. What we physicians do is practice medicine, and what we do for patients is called medical care.
No one says, “I want some health care.” What they think is, “I don’t feel well. I want to see a doctor.”
People get sick and they get hurt. It’s true that many these conditions occur as a result of things they do (smoke, eat junk food, drink too much alcohol, …
We do not have a health care system
Physicians today are challenged with the unique task of navigating the fundamental incompatibility between patient autonomy and the goals of public health. A few months ago, I faced that challenge when my elderly patient declined to receive the recommended influenza vaccine.
“I respect my patients’ right to choose, but sometimes I’m concerned that they make choices based on fiction rather fact,” I reflected in a recent post. “It’s been quite a challenge …
Vaccines and public health: Can we have our cake and eat it too?
Whenever new physician salary data is released, reporters and policy experts often compare doctor salaries in the United States to those of other countries: most notably, France.
And on cue, Vox’s Sarah Kliff — normally an excellent health care writer, by the way — is uncharacteristically lazy in framing physician salaries through a biased lens.
After presenting the …
Pay me like a French doctor. You know you want to.
A newly minted physician, one who has just graduated from medical school, is not yet ready (or licensed) to practice medicine. The next phase in medical training is called residency, a 3 to 5 year span of time during which the new doctor is given teaching, supervision, and increasingly allowed to function independently in his or her chosen specialty.
Since 2003 residents have been limited to working 80 hours per week, averaged over …
Are today’s newly graduated residents ready to practice medicine?
The other day I received my copy of the periodic newsletter of our neighboring Canadian medical society. It made me realize that both countries’ primary care doctors, in spite of our entirely different health care systems, are facing some of the same issues.
The bulletin warned Canadian doctors not to enforce a one-problem-per-visit policy, but to offer more comprehensive care to their patients.
The way doctors and clinics are paid in most …
When doctors become mercenary about their time
The New York Times has a recent piece on the practice of doctors Googling their patients. The author, Dr. Warraich, intimates that essentially all doctors have done it at some time. He also writes:
I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence …
Is Googling patients the same as stalking them?
It seems that in the past few weeks, physicians across America have reached the breaking point.
Internist Daniela Drake wrote in the Daily Beast about how miserable it is to be a physician. She talked about the lack of respect, the lack of time to see patients due to increasing paperwork and the ever-present board certification processes.
Orthopedic surgeon Daniel Craviotto Jr. wrote “A Doctor’s Declaration of Independence” in the …
How to respond to the despair from physicians
Remember personal responsibility? There actually was an era of responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes. I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault. In today’s culture, this is not scapegoating, but the pursuit of justice. Welcome to the era of big victim.
In the …
Our broken medical malpractice system from a moral perspective
Concussion expert Dr. A. Chainey Umphrey has assessed the damage youth sports can inflict. He has seen it ruin lives.
It happens in one form or another every day: A high school senior leaps to head a soccer ball. She takes an elbow from an opposing player going for the same ball. Woozy, she shakes it off and stays in the game.
Six months later, her blistering headaches have subsided but she still experiences …
Recognize and minimize the concussion damage from youth sports
During ACP’s annual meeting in Orlando recently, the American College of Physicians released a new position paper on reducing injuries and deaths from firearms — the first comprehensive update of College policy since the late 1990s. (I am a co-author of the paper.)
Published as an online-first article in the Annals of Internal Medicine, the paper is the result of an extraordinarily comprehensive review of the evidence of the causes and …
Evidence-based policies to promote gun safety
A well-to-do patient recently boasted to me about an expensive insurance plan that he had purchased to “guarantee” that he had access to the best health care in the United States. Coverage included access to elite academic centers (all the usual suspects) and a private jet service for emergencies. He was utterly confident that his investment was worth the price, but I withheld my own misgivings.
Hospital quality data suggest that …
Why an elite academic medical center may not provide the best care
We have long had abundant reason to believe that most of us living in the modern world consume too much sodium and would benefit from consuming less. But whether the topic is salt, or saturated fat, or calories, or even the health effects of consuming vegetables and fruits — saltation (the jumping from one position to another) seems to be the prevailing inclination in modern nutrition. Certainly it …
Salt in our diet: The impact of recent studies
Heisenberg uncertainty principle: A principle in quantum mechanics holding that increasing the accuracy of measurement of one observable quantity increases the uncertainty with which another conjugate quantity may be known.
Perhaps it is because I just got back from Albuquerque, a city which has become like a second home to me, that I have Heisenberg on my mind. For the one or two of you out there who are not Breaking …
The uncertainty of monitoring prostate cancer post-prostatectomy
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My family’s world changed instantly upon receiving Annie’s diagnosis of apraxia and autism spectrum disorder (ASD) a day before her second birthday. Hearing three words, “she has autism,” we suddenly faced a lifetime of uncertainty. I knew that I had to embrace my role as a mother of a child with autism, and as an autism champion — and more critically, find a physician that I could form a trusted …
Autism treatment requires a collaborative patient-doctor relationship
The danger of diabetes is not only the immediate risk of very high blood sugar. Diabetes also has many dreaded long-term complications. (In this post I am referring to both type 1 and type 2 diabetes mellitus.) Diabetes greatly increases the risk of stroke, heart attack, and amputation. In the US it is the leading cause of kidney failure and of blindness in adults.
A study performed by researchers at the …
Despite positive trends, diabetes care has a long way to go
As the Center for Medicare & Medicaid Services prepares to enhance its Physician Compare website to include quality of care information, practices across the country are getting ready to share data on the care of their Medicare patients or face penalties come 2015.
Publicly reporting performance measurement data is something we have been doing for the past seven years with 16 communities across the country as part of the Robert Wood …
From denial to acceptance: Getting doctors behind performance data
“The plastic surgeons tell me that women who like to swim do much better with reconstruction than with prostheses,” says a young breast surgeon at our weekly breast cancer tumor board, the working conference where we discuss every new breast cancer patient before starting treatment.
There’s a slight note of surprise in her voice; to her, it’s simply another consideration when advising women before mastectomy.
For decades, the only option after a …
Responding to cancer as the surgeon or the survivor
“Doctor, can I record this conversation?”
It’s happened to me a couple of times already. But the question above was never asked. Rather I was informed later on that my conversation with a patient or family was recorded without my knowledge. Smartphones have made it all too easy for patients to secretly record conversations with their health care providers. Simply hit a button, lay it innocently down by your side in …
When patients secretly record their doctor visits
His wife thinks he looks like Tom Cruise. There is a resemblance, I can see him riding a motorcycle off the side of a burning building, jaw fixed, eyes on fire, ready to save the damsel … only he is not so short. Funny, brilliant and genuine, we have known each other for exactly two decades, sharing the growth of our families, the anxieties of middle age, and the vicissitudes …
What a shame: Reimbursement rates are going up for private Medicare Advantage plans.
Contrary to its April 7 announcement that private Medicare reimbursement rates would be reduced, the Centers for Medicare & Medicaid Services has just reversed course and announced that it will increase overall Medicare Advantage rates. The change in policy came after pressure from the political parties and insurance companies. As Medicare spending per beneficiary grows at a …
Demand parity among Medicare programs
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