Several months ago, as I was in the last few months of my private practice, I watched the Joy Luck Club with my wife. I had seen the movie many times before, but somehow at that moment in time, when I was grieving for my practice and my profession, I began to have some startling clarity.
Specifically, I was particularly struck by this dialogue:
I tell you the story because I was raised …
Primary care has lost its self-esteem
In 2010, a surgical scrub technician named Kristen Parker was sentenced to thirty years in federal prison after allegedly diverting fentanyl from operating rooms, injecting herself with the powerful intravenous narcotic, refilling the contaminated syringes with saline, and replacing them to be used on patients. She was infected with hepatitis C, and her drug diversions infected over two dozen patients in the Denver area.
In 2012, David Kwiatkowski, also positive for …
Can physicians really stop the actions of reckless caregivers?
I have kept some of my books from medical school displayed on the shelf, including suggested contemplative readings meant to tenderly inculcate students with a sense of compassion.
Like so many fledglings, we soar off into our chosen paths. Many new realities and considerations take hold. I shall refer to these as the “business, logistics and politics” of medicine. How can we ensure that we are adhering to the standards of …
Consider the quality of our caring, not just the quality of our care
Today I had the displeasure of sitting in judgment before a modern inquisition at one of the hospitals I attend. Although the grand inquisitor lacked the trappings of a monsignor or bishop, and without a physical executioner in the room, I was subjected to round after round of questions regarding my apparent disregard for system wide medical and post surgical protocols. Such protocols have been adopted by CMS (which oversees …
I am called before the inquisition board: Welcome to modern medicine
A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.
I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our …
How my geriatric practice works
The medical arena, like society at large, is permeated with self-interest. This reality makes me very skeptical that comparative effectiveness research, which I support, will get airborne. In medicine, every heath care reform, new medicine, new medical device or revised medical guideline is at some constituency’s expense. Recognizing and dismantling conflicts of interests is one of our greatest challenges and threats.
When I …
Are the days of screening colonoscopies numbered?
Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day. However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve. I really hate it when patients are late.
Now, I have to admit this is a unique …
As an oncologist, I hate running late
As defined in Wikipedia, remote patient monitoring (RPM) is: “a technology to enable monitoring of patients outside of conventional clinical settings (e.g. in the home), which may increase access to care and decrease healthcare delivery costs.”
I was a pioneer adopter of RPM as a beta site for Medtronic’s Carelink wireless system which monitors implantable cardiac rhythm devices (defibrillators and pacemakers). RPM has gained significant attention because of recently mandated penalties …
The role of remote patient monitoring in mobile health
An excerpt from Too Big to Ignore: The Business Case for Big Data (Wiley and SAS Business Series).
Unstructured and semi-structured data is, by its nature, largely text based. Even numbers are often surrounded by words, like an article on a company’s stock. This section describes some of the tools that translate what is often a bunch of gobbledygook into meaningful information, the result of …
How natural language processing can help EHRs
We recently marked the third anniversary of the passage of the Affordable Care Act by reflecting on the positive changes it has brought about and by mulling over the multifaceted challenges that stymie our efforts to build more accessibility, equity, quality, safety, and cost-effectiveness into one of the most complex healthcare systems in the world.
Reining in healthcare costs, a central element in the reforms we seek, is inextricably linked to …
Are we ready to creatively destroy medicine?
I recently wrote about some of the unintended, but positive, consequences that could result from employers dropping employer-sponsored health insurance (ESI). Following that post, many weighed in about various other consequences of such behavior from employers and what that means for health care coverage for millions of families in the US. One issue in particular caught my attention; not only because of the touching stories associated with …
A creative way to meet our health needs: Direct practices
I did not want to go to the emergency room. I really didn’t. Resisting the idea, I lay doubled over with the worst abdominal pain of my life for 12 hours, unable to eat or drink or move, and finally vomiting before I considered it. I was well aware that this sequence of symptoms made me a textbook case of appendicitis, but I still consulted an ER doctor to ask: was …
I’ll be a doctor soon, but I can’t understand my hospital bill
Research shows numerous benefits to meditation: it reduces stress, increases positive emotion, and even treats acute pain. Commonly, meditation involves focusing on one’s breathing as a way to anchor one’s attention in the present moment. Practitioners are also frequently taught to separate their experiences (breathing, pain, thoughts) from their judgments about them. Thus, with respect, for …
What being mindful will reveal to us
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A dark wind is beginning to blow through the tortured landscape of health care in America. At the confluence of the corporate cold front with the warm front of technology innovation, a storm is brewing. A storm that may grow into gentle and much needed rain showers, or the grandest tornado ever experienced by mankind, and unlike the wondrous works of nature, the path taken here is completely within our …
Does our health system really need doctors?
When I was young and foolish and just starting out in my career, I found it very hard to take “no” for an answer. If a patient needed radiation therapy, and he or she didn’t want to have it, I did my very best to talk that patient into it. I have always been a very persuasive person—if I didn’t get the go ahead on the first formal consultation, there …
Radiation therapy: Don’t let me talk you into it
A version of this column was published in USA Today on April 1, 2013.
Prescription drug abuse is a growing national tragedy. One of the biggest culprits is opioid painkillers, such as Oxycontin and Percocet. Shockingly, more than 200 million of these types of drugs are prescribed annually, and they account for more than 16,000 deaths a year. And for every death, significantly …
Curb prescription drug abuse by following Mayor Bloomberg
When you work in an urban hospital, sometimes it’s difficult not to become jaded.
There are certain neighborhoods that generate a disproportionate number of patients for some emergency departments. Meth is rampant. Marriage pretty much nonexistent. More bars than there are restaurants. Domestic abuse frequent, but prosecutions rare. Police know people more by their street names than by their real names.
South Heights was one of those neighborhoods.
The emergency department frequently treats …
Working in an urban ER: We need more moms like this one
It feels like part of me is dying. I am losing something that has been a part of me for nearly 20 years.
I bought in to the idea of electronic records in the early 90′s and was enthusiastic enough to implement in my practice in 1996. My initial motivation was selfish: I am not an organized person by nature (distractible, in case you forgot), and computers do much of the …
Let’s mourn the death an EMR evangelist
As I walk onto any one of the locked psychiatric units at our hospital I am immediately struck by the hum of intense activity. It’s like the startling feeling of stepping out of an air-conditioned apartment into the steamy height of a New Haven summer. Across from the nurses’ station, a psychologist interviews a patient retelling the story of constant childhood molestation as rivulets of mascara run down her cheeks. …
The locked inpatient psychiatry unit: What’s it really like?
In 2006, Governor Mitt Romney signed Chapter 58 of the Acts of 2006 entitled “An Act Providing Access to Affordable, Quality, Accountable Health Care.” It has been described by many names, including Massachusetts Healthcare Reform (MHR), Romneycare, or simply, as the template for the Affordable Care Act. The goal of the act was straightforward: to ensure near-universal access to health insurance for citizens of the Commonwealth of …
Our healthcare system is far more resilient than we think
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