During the four weeks of my ICU rotation, I came to know Mr. S well. I was the medical student on the intensive care team, managing patients alongside the primary surgeon. Mr. S was on the road to recovery when I started to follow his hospital course.
Every morning we rounded, one more of the numerous tubes attached to his body were removed. He grew stronger, gradually able to speak clearly …
Developing a culture of cost effective care
Several years ago, a young woman I’d been seeing in clinic weekly for about a month to initiate treatment for depression called late Friday afternoon to cancel an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who cancel and do not reschedule. It gave me a bad feeling that she was not following through on her treatment plan and …
A gracious note, letting a doctor know she made a difference
A guest column by the American College of Physicians, exclusive to KevinMD.com.
A few months ago, I attended a social event and ran into a few colleagues whom I had not seen in a long time. In the interest of privacy, I won’t reveal their specialties but I will note that I was the only primary care specialist in the group. As …
How I changed my private practice glass from half empty to half full
One of my favorite aspects of my developmental pediatrics practice at the Children’s Evaluation and Rehabilitation Center (CERC) at Einstein is that I have the opportunity to follow children and their families in the clinic over the long term — often for many years. Because I am the director of the Read more…
Milestones of children with developmental disabilities should be celebrated
Radical change often happens suddenly, the result of a single decision or event.
The fall of the Berlin Wall and the dissolution of the USSR stand out as two dramatic political examples. In a social context, Supreme Court decisions in Brown v. Board of Education or Roe v. Wade both radically changed our society.
Then there’s the U.S. health care system. We know it can take 17 years for a new, proven treatment to …
4 scenarios that would dramatically improve health care
Donald is large. Very large.
At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks.
“My stomach hurts,” he says, his voice surprisingly high and childlike.
It is 10:00pm in the emergency room, and I am already swamped with patients I’m trying to move through the ER before my shift is over.
Asked if he’s ever felt this kind of pain before, …
A patient trapped in his own body
A recent research article in the Journal of General Internal Medicine, and the gap between its findings and the real world, helps point up the usefulness and limitations of research. The article, by Susan H. McDaniel, PhD, and coauthors, set out to determine how often doctors speak about their colleagues in supportive or critical ways.
Their method is one widely used in the field: simulated patients, actors, were prepared with lifelike …
When doctors disagree: What should you tell patients?
If the Obamacare health insurance exchanges are not able to get a good spread of risk — many more healthy people than sick — the long-term viability of the program will be placed in great jeopardy.
Given the early signs — far fewer people signing up than expected, enormous negative publicity about website problems, rate shock, big average deductibles, narrow provider networks, and a general growing dissatisfaction over the new health …
Why Obamacare isn’t at risk for a death spiral anytime soon
Months before my life was upended, a doctor friend tried to explain my forthcoming role in terms I’d understand. “Imagine being on call 24 hours a day, seven days a week,” he said. “You’re in charge of a single patient, but she is needy as hell.”
Medical training prepared me for motherhood in some ways (the assortment of facts blurrily retained from my pediatrics rotation in medical school; the skill, or delusion, …
Reflections of a new mother in medicine
Lebron James makes over $19 million per year playing basketball for the Miami Heat. Not surprisingly, this salary is peanuts compared his endorsement earnings, which in 2012 topped $42 million. Although perhaps peanuts is the wrong word to use when discussing James outside earnings, which to my knowledge have not involved foods anywhere near as healthy as peanuts. Instead, according to …
Lebron James: The king of junk food
Every once in a while a brilliant investigative journalist can get us back on track when we have been led badly astray. I hope that a recent New York Times front page story, “The Selling of Attention Deficit Disorder,” by Alan Schwarz will have that kind of special societal impact.
Schwartz has previously written a series of accurate and hard-hitting articles exposing the over-diagnosis of ADHD and the consequent careless and …
It is time to re-evaluate ADHD and return to safe practice habits
The infant mortality statistics are out again. This always depresses me because: 1) The rates are atrociously high, and, 2) There is so much legislation passed to restrict abortion in the name of “life,” but politicians and judges seems awfully silent on infant mortality.
In the United States 6.4 infants out of every 1,000 born will not reach their first birthday. This is more than 24,000 infant deaths a year. The United States is also the leader …
What are politicians doing about the shameful infant mortality rate?
“Doctors are crooks.”
“They’re getting worse than lawyers.”
“I don’t go anymore. They’re just out for a buck, and they don’t really do anything for you anyway.”
“I stopped getting checkups when my old one retired. He was good, took his time. I haven’t found anyone like him since.”
“They always think they know everything … a bit too much self-importance there, without ever walking in my shoes.”
“They all say the same thing; it’s …
A culture of contempt has led to medicine’s downfall
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I am consistently bemused by those who recommend more rigorous or more pervasive standardized testing as the primary means for insuring physician quality. The vast majority of physicians have already passed through a complex gauntlet of multiple choice exams, extended credentialing and certification processes, and lengthy tests of knowledge and skill. And yet, some physicians (to put it bluntly, sorry friends) are very bad at what they do.
Intellectual …
Can social media help measure physician quality?
An excerpt from ASSUME THE PHYSICIAN: Modern Medicine’s “Catch-22”.
“What did you learn today?” I asked, fearing the answer.
I was suspecting a recitation about the new methods of documenting nursing competencies, or a delineation of the process by which she helped the hospital maintain its “magnet” status to attract …
A nurse masters the art of medical slang
This post is a question, an invitation and a challenge. How can we bring technologies we take for granted back home to those in the developing world? Many before me have spoken with outrage about the reality of two worlds: one of abundance, and the other where people live like they have in centuries past.
The situation is more complicated since even poor people may have some technologies like cellphones now, but vital lifesaving technologies …
Bringing health care technology to the developing world
Each time I reach the point of recommending radiation treatment for someone with a brain tumor or head and neck cancer, I ask for a higher level of trust from each patient than usual: let us make a mask to keep you safe.
Radiation therapy is already a leap of faith — who wants invisible rays shooting through them? Fear of unknown …
Radiation therapy is a leap of faith
Incoming telephone calls should be a good thing in a medical practice, right? Requests for appointments from new patients and established patients are the lifeblood of the practice. But for many practices, the phones are an overwhelming burden for everyone, from the receptionist and nurse to the provider with an inbox full of patient messages to sort through.
In general, approximately 25% of incoming calls to a medical practice are repeat …
Increase patient and provider satisfaction by reducing phone messages
Standing in the middle of a massive hotel convention center hallway with thousands of people wearing name tags.
Not where I usually spend my days.
I have been asked to join senior management at a national client conference for the company that is providing patient survey data to our institution, those surveys patients get in the mail asking about their “experience” during their visit to our practice.
Everybody here wants the same thing, …
For the medical home to be successful, listen to the patients
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for exertional chest pain of 3 months’ duration. He describes the chest pain as pressure in the midsternal area with no radiation that occurs with walking one to two blocks and resolves with rest or sublingual nitroglycerin. No symptoms have occurred at rest. Medical history is significant …
MKSAP: 68-year-old man with exertional chest pain
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