Recently, the New York Times featured a post about me and my practice. Titled “Walking Away from Medicare,” it describes my decision to opt-out of Medicare and create a different kind of geriatric practice.
It has generated quite a lot of comments. Most of them judge me pretty harshly. It seems that many people feel that I’m doing this for the money. And that I don’t care …
The future of geriatrics: Questions to consider
If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty-year-old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the Toprol and hadn’t taken it in over a week.
The cardiologist hemmed and …
Dissection of a needless hospitalization
You’re at the doctor’s office, and you see strolling up to the window a good-looking, well-dressed professional. They’re usually pulling a little discreet cart, and after a few words with the receptionist they’re rushed right back. Sometimes they’ll bring a tray of cookies, or they’ll be followed by a caterer with a cartful of food.
You think they had an appointment? No, but you can be they’re here to see the …
Is your physician immune to drug marketing?
What does a modern internal medicine intern do all day (and night)? It turns out they spend 40% of their time at work using a computer, another 20% on other aspects of patient care that is not in the presence of the patient, 15% in educational activities, 5% on basic needs like walking around and eating, and only 12% in direct patient care. Direct patient care includes interviewing patients, examining …
What does a modern medicine intern do all day?
Recently, I continued my crusade to make end-of-life care a basic skill, as I gave the “Introduction to Dying” lecture to third year medical students, for the twentieth time. For me it is not just about pain control, family meetings and hospice care, but rather convincing physicians that they must change the medicine practiced for the last 100 years. That medicine says that a doctor can fight all disease, give any treatment, …
End of life care is a core part of medicine
“Yeah, Doc, I drink. I drink a lot. Some nights I drink a case of beer and a half pint. Can’t sleep if I don’t drink. Relaxes me. Pure and simple. Numbs me up like novocaine.”
A toothless grin.
“It’s the feeling of floating away. I don’t know, I just keep coming back to it. Stuff goes in, feel a little flushed, a little rush, then I go somewhere else, you know? …
What keeps some people from feeling that they really matter?
If you are interested in patient safety and medical errors and haven’t read the story in the Texas Observer about a spectacularly incompetent neurosurgeon, you should. It is long but worth it. It will make you cringe.
The story includes many details about operations done poorly and patients suffering paralysis and death at the hands of Dr. Christopher D. Duntsch.
The Texas Medical Board is over-worked, slow to act and …
Lawyers are a big impediment to disciplining bad doctors
When you reach for ibuprofen for your sore back or a pill to help you sleep, are you sending a bad message to your kid?
Yes, says Bryant Gumbel in his video commentary about the drug charges against ball player Alex Rodriguez. While he thinks that Rodriguez should be punished for being a liar and a cheat, he doesn’t think that people should be shocked by the fact that Rodriguez was …
Are parents active parts of a national drug epidemic?
You probably already know that what you do know about your medicine could kill you. You may not know that what you don’t know could do so as well. Hold that somber thought — we’ll get back to it.
You, and I, and everyone else has seen those direct-to-patient drug ads that Big Pharma runs on primetime television. Invariably, they feature a person skipping through butterflies and wildflowers, demonstrating the …
Remember the side effects of needed drugs that go untaken
Annoying mall vendors have been pushing what may be one of public health’s greatest accomplishments—and few have taken notice. Behind pillow pet stations and the candle stand, mall shoppers can find electronic cigarettes, or “vapes.” Often targeted at smokers wanting to quit, e-cigarettes offer many of the joys of smoking without one of its major components: smoke.
Smokeless cigarettes have become a hot product, with an estimated $1.7 billion in sales …
Can e-cigarettes be a public health victory?
The word “doctor” derives from the Latin verb docere: to teach and, as a doctor, I do often offer instruction. But when a woman in her eighties comes in for her annual physical and tells me she’s still dancing, mowing her own lawn, and helping out her older neighbors, I have no illusions about which of the two of us should be doing the teaching.
Particularly since reading this lovely feature story about Ethel …
Is there any single secret for aging well?
In coming years the US could see growing shortages in the availability of primary care physicians (PCPs). With the number of individuals seeking care increasing and the current medical system continuing to incentivize physicians to specialize, the number of available PCPs will decline proportional to the population. To fill that gap, Ezra Klein and others have asserted that expanded scope of practice will allow nurse practitioners (NPs) …
The NP vs MD debate is missing the bigger picture
Talking with an insurance doctor, who denied a vertebroplasty for my patient with a spontaneous compression fracture, I started thinking about the dilemma of defining what a doctor-patient relationship is.
A couple of years ago a local doctor with a dwindling private practice joined an Internet medical site that promoted drugs like Viagra and offered online consultations with physicians who prescribed the medications when they felt it was appropriate. The state …
The role of physicians is set to evolve again
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Now that Labor Day has come and gone, I’ve thought about the months ahead and the major challenges I’ll face.
1. Mergers and acquisitions. Health care in the US is not a system of care, it’s a disconnected collection of hospitals, clinics, pharmacies, labs, and imaging centers. As the Affordable Care Act rolls out, many accountable care organizations are realizing that the only way to survive is to create “systemness” through mergers, …
What keeps this hospital CIO up at night
Do you know who Jay-Z is?
If not, chances are your kids do. Jay-Z is one of the most successful rap artists of all time, and has parlayed that success into a career in fashion, merchandising, his own line of vodka, as well as an ownership stake in the NBA’s New Jersey Nets franchise that he recently sold to begin a new career …
What Jay-Z can teach doctors about marketing their practice
What follows are not complaints. These are just the facts.
Here’s a recent exchange from an enlightened physician leader, one who has yet to give up: “My colleagues are discouraged and frustrated every day, leaving the office defeated and fatigued. There are other ways to practice.”
High health care costs get most of the attention, but there’s a more important crisis coming your way.
First a review, then to the looming crisis.
When Americans travel …
Can American doctors get off the hamster wheel?
Joan was 42, married, but appeared to be younger than that. Her husband was with her when we first met, as was her beautiful two-year-old son. “We couldn’t get a baby sitter, if you can believe that!” she said.
Sarah was 38 and was also married. She and I were closer to the same age, which was not lost on either of …
People who participate in clinical trials are trailblazers
When I was a second year medical student, I gave blood at a Red Cross drive and noticed a week later that I had a hard and slightly tender blue spot on my left forearm arm where they had drawn blood. I described it to my PCP through our online portal, and I mentioned that I’d had a similar occurrence a couple years prior after having an IV during an …
A medical student experiences sticker shock
I wish I had known earlier that survivorship care is neither a do-it-yourself project nor is it something that I can simply hand off to experts. There is no stable set of signs, signals and test protocols that, if followed assiduously — and that come up negative — means I am protected from a recurrence, new cancer or late effects of treatment. Observation, expertise and self-knowledge by both me and …
Survivorship care after cancer is a shared effort
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