The X-Files fans will remember the poster that Agent Mulder had on his bulletin board with a picture of a flying saucer and the words, “I want to believe.” That’s how I feel reading EMR notes sometimes. I want to believe, but I doubt.
I know how this happens. The EMR vendor, the practice implementation team and the doctor have a meeting to develop the “normal” template for a hospital admission …
The EMR template: I want to believe
I recently sat in a small room, in the bowels of a local hospital, training for the impending implementation of CPOE. For those not familiar with current health care acronyms, this stand for Computerized Physician Order Entry.
Nearing the end of my medical career, I could not help but admire the timing of this phenomenon. “They’ve finally done it,” I mused silently. They …
How the physician replaced the medical secretary
“Look at all those beautiful little white flowers,” I said to my wife. “I don’t remember seeing them there before.”
In the neglected ten-by-thirty foot corner of our garden, a crop of white flowers began to emerge toward the end of the summer.
“You never saw them because they are weeds,” my wife said.
“What do you mean … weeds?” I asked. “They are beautiful!”
“Weeds …
Leukemia crept into my home and attacked my wife’s body
Spring season is still many months away, but residency programs are in early heat as selection committees across the country buckle down to nominate the next batch of interns for the upcoming academic year.
Spread across these institutions’ tables one may find headshots, board scores, recommendations and interviewer comments of top candidates interested in training at their respective programs. Often, faculty members of esteemed medical centers will have only a few …
Questions to ask when selecting medical interns
Once upon a time a doctor first attended 3 or 4 years of college, then finished 3 or 4 years of medical school, trudged through 1 to 8 years of residency training to hang out “a shingle,” and finally begin to practice medicine, usually in solo practice. Those days are long gone. Time has expanded—schooling and training are longer.
Breaks are taken between and during this once but no longer traditional …
5 ways to adapt to an evolving healthcare workforce
Even doctors must become patients eventually, and often challenging patients at that. We know enough to be dangerous but not enough to be in charge. We want to question everything but try not to. We can tend to be catastrophic thinkers because that is how we are trained to be, but fear being alarmists. We want our care providers to actually like us, when we know they inwardly cringe knowing …
When doing nothing makes the most sense and is the least risky option
On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services. The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is, in the court’s view, not subject to …
The RUC survives and now our health system is worse off
“I’d really feel better if we got the MRI,” Ms. James said. “I understand you think it’s a migraine, but I want to know, just in case. Wouldn’t you?”
Ms. James and I sat in her darkened hospital room—the light bothered her eyes and exacerbated her headache. She was a dialysis nurse with many years of experience in the healthcare field, and I …
Medicine requires doctors to constantly manage probabilities
Two famous American women. Two missed opportunities for improved quality of care and patient safety in America.
In December, it was Hillary Clinton and in January, Barbara Walters. Both women fell, hit their heads, and ended up in the hospital. In each case, the focus of the media coverage reflected one of the biggest flaws in our American approach to medicine: readers and viewers learned about the costly and relatively high-tech …
2 missed opportunities to teach fall prevention
When listening with a stethoscope to a patient’s heart, one sometimes hears a deviation from the typical “lub-dub” rhythm. Sometimes the “dub” is too loud, or the “lub” too soft. There might be a rubbing sound, or a harsh blowing sound. By interpreting subtle characteristics such as the location, pitch, and timing of these sounds, one can sometimes diagnose things like a diseased heart valve or congestive heart failure. Read more…
Medical students: Be sure to thank your patients
The link to a recent article in Forbes magazine entitled, “Why Rating Your Doctor is Bad for Your Health” keeps showing up in my inbox with the subject, “thought you would find this interesting.” The reason is because I’m responsible for overseeing education and training related to physician communication and patient satisfaction for a large national hospitalist practice.
The article isn’t so much interesting as it is unfortunate. Its …
Is the goal of patient satisfaction to make patients happy?
This week, hundreds of our fellow physicians and medical students gathered in Washington, D.C., for the AMA’s National Advocacy Conference, which is held in the capital city each February. Attendees heard from members of Congress, top administration officials including HHS Secretary Kathleen Sebelius, journalists and other experts about the health policy issues affecting …
AMA: Join physicians and medical students in advocating on key issues
“I did it,” I mumbled to myself.
The numbness overwhelmed my immediate sense of dread throughout my body. I was trembling inside, full of anguish and at the same time, unable to contain my seething anger over an uncontrollable destiny. Just a few minutes ago, I turned off her life support system. The series of beeps had slowed down, pace by pace, like the ritardando in a finale movement of a concerto. …
Mourning the death of my medical practice
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Have you ever gone to the doctor and felt like he wasn’t listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place?
Studies show that Read more…
6 tips for getting your doctor to listen to you
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Medicine is big business. If you don’t believe me, the next time that you travel by plane, pick up the airline magazine in the seat pocket and read the ads. If the advertising is a reflection of the air traveling …
ACP: Medicine up in the air inflates patient expectations
Christmas morning at 1:30 am the phone chimes away. What the … I’m not on call.
“Please call Dr. Dred for patient Selma, perforated colon at local ER,” read the text message.
Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him.
So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, …
You’re still a doctor, even if you’re not on call
I have the privilege to work in the medical profession where astonishment and revelation awaits me behind each exam room door.
In a typical clinic day, I open that door 36 times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient. I must peel through the layers of a person quickly to find the core of truth about who they are and why …
Behind the exam room door: It will be astonishing to me
I know. I know. Medicare is the insurance that all of us love to hate. But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons:
1. Medicare’s fee schedule. It’s bad, but not that bad. Sure, Medicare’s fee schedule has only increased 3.1% over the past 12 years, while …
10 reasons why I love Medicare as a physician
Should doctors ask patients if they own guns? Currently, ObamaCare bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics …
Why doctors should not ask patients about guns: A conservative case
Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.
When there is bad air in the mine, the canary’s sensitive lungs will cause …
Doctors are the canaries in the coal mine of medicine
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