In 2005, my husband and I bought a small farmhouse in northern New England next door to Tom and Sally.
They were in their early seventies, married nearly fifty years, with a large family. Tom’s grandfather had built a farmhouse in 1900 on the family’s small pig farm. In the 1970s, Tom and Sally had parceled off the land and built a modern house for themselves, a stone’s throw from the …
When medical wishes are respected
Trauma surgeons earn their patients’ respect every day, acting decisively in the face of calamity and uncertainty, heroically beating back death with steel blades and iron wills. Primary care physicians, however, have traditionally been at a relative disadvantage with regard to public opinion. After all, reconciling medication lists, reviewing lab results, and discussing health behaviors simply aren’t as exciting. In fairness, though, surgeons have always had one other advantage: anesthesia. …
Fix primary care with technology and anesthesia
The recent tragedy of Jahi McMath, the 13-year-old girl who died following complications of tonsillectomy and adenoidectomy, has focused many people on the question of brain death. Although I have no more details about this case than anyone else reading the news, I am quite familiar with the sort of things that happened to this unfortunate child. As many of you know, her family does not believe she …
Analyzing the Jahi McMath case
Hi. This is doctor Rob, and you have reached my blog. If you are here to read my blog, then continue to do so. If this is an emergency, please call 911.
That is one of my pet-peeves. Every single doctor’s office I call I am told the same thing: “If this is a true emergency, please hang up and dial 911.” I even got that message when I called the ER.
When I …
How can patients assess what is a true emergency?
The day after the temperature dipped from 60 degrees to 25 degrees, I mistakenly left for work without a winter jacket. Rushing 50 yards to the hospital doors with my arms clung to my chest in the blistering cold, my tie flew over my shoulders, my teeth chattered, and my fingers went numb.
That evening I began to sniffle. The next morning I had a sore throat, and the following day …
Do cold temperatures cause colds?
The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.
Fever is clearly not a parent’s …
5 truths about fevers in children
In trying to understand my own burnout, “control” (or lack thereof) is a dominant theme. This is nothing new. In fact, I doubt I’m unearthing bones not already thoroughly analyzed. But I can give instructive personal examples.
For a while I was on the board of directors of my clinic, which was then and is even more so now one of the most successful doctor-owned and -managed in the US. During …
Physician burnout: The additive effect of bureaucracy on the psyche
Next in a series.
Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.
Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced …
What is the main cause of the primary care crisis?
Hospitals need to overhaul their processes so they can help the un- and under-insured stay healthy.
Many people running health care institutions tell me that they have been fighting the fight, learning to be nimble, transforming their cultures, making big changes as the landscape rearranges itself like a really bad day along the San Andreas Fault.
But in comparison with the actual scale of the problems, most of the business models and …
Many will not survive the millions of new Medicaid recipients
There’s a piece in the Atlantic entitled “The Psychology of Lululemon.” I probably would not have read that article but for the fact that I was in Lululemon recently buying my wife some yoga clothes. This turned out to be an interesting read. The premise of the piece is that athletic clothing makes people want to work out — that in some way, clothes have power over the wearer.
Of course, I …
Infection control versus psychology: To white coat or not
In retrospect — always in retrospect — it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right.
In a remarkable number of cases of medical errors, it’s clear — again, in retrospect — that there were signs that something was amiss, but they were ignored. The reasons are manifold: I was just too busy, things are always glitchy around here, I didn’t want …
Inside the first scandal in patient safety
With the growing demand of patient demands, change in healthcare delivery with Affordable Care Act, physicians are asked to adapt to these changes rapidly. In order to be efficient and provide this level of care to patients, the use of digital technology in medicine has grown dramatically. New platforms for integrating medical care and digital technology have been developed to enhance doctor patient communication.
Digital technology encompasses a broad range of …
Use emerging digital technology to improve communication with patients
The death penalty has been in the news lately, what with a “botched” execution in Ohio, using a 2 drug method that Louisiana has also recently adopted for it’s administration of the death penalty.
These changes come on the heels of a new tactic by death penalty opponents: getting European countries to ban their pharmaceutical manufacturers from exporting drugs that may be used to execute people. These bans were partially responsible for nationwide …
Using drugs for executions: What really happened in Ohio?
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Imagine a teenager with a chronic disease causing frequent diarrhea, upset stomach, and hospitalizations. Her doctor explained that she had a chronic condition called inflammatory bowel disease (IBD) that she would have for the rest of her life. The fact that she has a chronic disease means that she will need to navigate a complex health care system that is expensive, has a lot of variation in the quality of …
Can texting help children with inflammatory bowel disease?
They say medicine is a hard science, based on heavily scrutinized theories and proven postulates. Medicine is supposedly made up of differentials, diagnostic workups, and medications aimed to alleviate or cure. Everything is based on evidence, everything. But, today, something happened that hasn’t been researched using IRBs; something intangible that restored my faith in humanity.
I was on my way home from a long day of being intensely questioned by residents …
Medicine can be done with words, actions, or a smile
At least 12 college students have been diagnosed with Meningitis type B (MenB) this year, and cases like this may spread to other campuses unless the Food and Drug Administration intervenes. While people of any age can contract the infection that affects the brain and spinal cord, children and people over 60 are more likely to contract the infection. So, too, are college students because of their close contacts in dormitories and …
Why the FDA should approve the MenB vaccine
I have never been involved in a medical malpractice case, but I have recently been the victim of a sociopathic legal abuse situation entirely not related to medicine. It involves a no-good attorney with the ethics of a camel, a multiply convicted felonious sociopath, and his long series of victims including his own prison guards who he is suing because his feelings were hurt.
As my small part of it, I …
The legal system has serious problems, but who are we to complain?
In 2002, two seminal papers were published simultaneously in the New England Journal of Medicine, demonstrating that therapeutic hypothermia for comatose patients could result in improved survival and improved neurological outcome after out-of-hospital cardiac arrest, which altered the course of ICU history.
One after another, ICUs across the United States and around the world adopted protocols for rapidly achieving and …
Therapeutic temperature management takes a step up
Inappropriate use of emergency departments (EDs) → congested EDs → over-worked staff members → frustrated staff members → speculation of more non-emergent ED usage → expectation to provide high customer satisfaction scores → decreased actual customer satisfaction → decreased reimbursement → higher costs of ED → budget cuts → decreased staffing → return to beginning.
Whose idea was any of this? None of it makes sense to me. The idea of providing reimbursement to healthcare agencies based on customer satisfaction scores is …
The vicious cycle of emergency department use
Over the years, many people have shared with me their disappointment at the lack of acknowledgment from their physician when their loved one died. Especially, when their loved one had been a long time patient of the physician. In fact, many people have shared that they switched physicians because of what they perceived as a slight.
When people go to a physician for many years, especially the family physician, it is …
What to do when your patient dies
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