There are times when it is necessary to step up to the plate and go the extra mile on behalf of your patients. There is no job description for doing this and there is no manual that gives you instructions on what action you need to take on behalf of your patients. However, when you have the opportunity to do the right thing, at the right time and for the …
When you do the right thing, you become a better doctor
Walmart’s sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006 – more than 300 prescription drugs for $4/month or $10 for a 90-day supply – and was widely emulated, disrupting retail drug markets and generating immense social benefit. Imagine the …
Walmart’s Center of Excellence program is another innovation
My first week at my new job at a French-speaking university in a city of 95% francophones, I learned a useful new expression: vouloir le beurre, et l’argent du beurre. This translates literally as, ‘to want the butter, and the butter money.’ It’s the equivalent of wanting to have your cake, and eat it, too, but with a more explicit focus on dairy fat. (It is a French expression, after …
Let’s help patients with the tradeoffs in medicine
Many premeds take time during their undergraduate careers to volunteer abroad. Popular destinations include Mexico, various Central and Southern American countries, and Africa. These are great opportunities to discover more about underserved care and, more importantly, what you are made of. I just thought I would share my reflections on volunteering abroad during college. Hopefully, you can glean something from them.
In the backcountry of India, in the state of Maharashtra, …
Rural medicine in India: What American health care can learn
It’s natural: when you see someone doing something you long to do, you automatically search for reasons to justify why they’re doing it and you’re not. Maybe they had encouraging supportive parents and yours belittled you. Maybe they got their start at a younger age and it’s probably too late for you now. Maybe they got a great education, or were blessed with more opportunities in life.
My coaching clients won’t …
Give life a chance to amaze you with what’s possible
If you or someone you love is considering surgery or an intensive treatment, it really pays to be sure you understand the pros and cons.
While that seems like common sense, millions of people say “yes” without learning all the facts.
Some simply rely on the trust they have in their physician. Others assume the known benefits and risks are too complicated to fully understand. And some people just want to get …
Give patients the pros and cons of treatment options
The recent New York City law restricting portion sizes of sugary beverages offered in restaurants has stirred much controversy among policy makers, scientists, the media and consumers. Opponents support the freedom of choice in selecting beverage portions and contend there is insufficient evidence that legislation will change behavior or body weight. Proponents contend that something should be done to reduce the ever-expanding receptacles in which sugar-laden beverages …
Healthier menus without restrictive legislation
She was in her late thirties when her medical oncologist asked me to see her. Five years before, one of our community surgeons had removed part of her colon for cancer. She also had a recognized, single metastatic tumor in her liver at the time of that original surgery.
The contemporary standard of practice was to treat for a prescribed period of time with chemotherapy and then re-evaluate for the appearance …
From surgeon to management: Was my decision selfish?
A recent commentary in the Journal of the American Medical Association titled, “The Iron Triangle of Health Care: Access, Cost, and Quality” reflected that any health care system can only optimize two of the three elements – quality, access, cost. A health care system which provides the finest quality and best access cannot do so without raising costs to unaffordable levels. An inexpensive health care system available to …
The iron triangle of health care is not law, but an observation
With the 2012-13 influenza season underway, I want to remind my colleagues that while influenza vaccination has been around for 60 years, the times are changing, and physicians need to change too. We now have newer vaccine options targeting specific populations that were not available just a decade ago.
Alas, many providers have not taken advantage of these options that 1) potentially offer better protection for patients aged 65+ and 2) …
Ways to improve influenza immunization rates
A lot of people, many of them medical students, think that rural doctors don’t get to see many interesting cases.
The opposite is true; if you are the only doctor within a wide radius, people will come to you for help, rather than try to pick the appropriate out-of-town specialist to diagnose their problem. In this state with widespread physician shortages most specialists won’t even see self-referred patients.
Sir William Osler wrote: …
Rural medicine is the most stimulating kind of primary care
When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.
But instead, there …
Oral board exams: A window into how you behave in the operating room
The New York Times recently did an expose on hospital overbilling by a group of cardiologists at some hospitals owned by the Hospital Corporation of America (HCA). Immediately after a few days, a rather gloating article about how HCA had become the poster boy of Wall Street with its double digit growth strategy appeared. If the first story had not raised enough doubt about the …
Why healthcare is a boon for private equity
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An elderly man startles awake after a man in a white coat touches his shoulder. He looks around and sees three other white-coated people standing around his bed.
“Sir? Good afternoon, sir. How are you?” says the man who touched the patient’s shoulder.
“Oh, I’m fine.” He’s perfectly calm.
“I know this is a silly question,” continues the man, “but do you know where you are right now?”
“Of course, of course. I’m at …
How to steel myself against this profession I have chosen
I’ve written about trying to communicate acuity to families. Maybe that needs to be expanded to encompass the same to other physicians.
To be fair I’m sure some of this, perhaps much of it, rests solely on my shoulders. Recognizing that I’m still going to make an accusation that talking life and death with families and patients is a skill not fostered in many providers. More accurately for this anecdote, and …
A physician removed from the reality of acute care
It was some doctor show on cable: Nurse McCarthy bustles into the hospital room, says “Good morning!” brightly, and crosses the brilliantly polished linoleum floor to the window. Humming to herself, she sweeps open the curtains to the view of the brick wall across the airshaft, then goes to the patient on the right and checks his dressing, clucking and offering encouragement. After a few moments she does the same …
Hospitals need evidence based design
In the summer of my first year of college, I did an internship as a nursing attendant in a rehab hospital’s stroke unit.
As a premed student, I had little idea of what it meant to be a physician. But that didn’t stop me from feeling slightly superior to others who weren’t on the same path. Although I didn’t know how to take someone’s blood pressure, I often treated friends to …
My feelings of superiority were replaced by a sense of kinship
It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?
In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to …
Why doctors shouldn’t treat their family and friends
Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …
Why doctors don’t like to go to doctors
Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad.
I’d be interested to know how customer satisfaction played out in my home. “Kids, now you’ve had a week of school-work. Please fill out the attached survey …
Is customer satisfaction in healthcare a gateway to corruption?
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