I could hear the morning call to prayer as I drove toward the Aramco Hospital in Dhahran, Saudi Arabia for my early morning rounds in the ICU. I was hoping that my young asthmatic on a ventilator might be ready to be weaned off and that the medications had kicked in sufficiently. My young Saudi medical student met me on the way in and said, “I think she’s doing better, …
Caring for the patient despite a vast difference in culture
There’s a push-pull happening right now in the evolution of health care and it’s all about you. The question under debate is simple: can you handle being the first to know your own test results?
Are you smart enough to read the results? And are you emotionally capable of handling the situation?
Do you need someone next to you when an over-the-counter test tells you whether or not you have a disease? Can …
Can you handle being the first to know your own test results?
I’m sweating and silently wondering how the chewing gum in my mouth has chemically changed to sand. My mouth is so dry I can barely speak. I may be silent, but thank goodness my patient is talking to me, because all his monitors and machines seem to be bleeping and bopping and malfunctioning at once.
I reach for my eyeglasses, which have become hopelessly entangled among pens, alcohol wipes, and other …
When teamwork takes more than the usual share of effort
While there is an extensive literature on how tired, overworked physicians provide lower quality medical care, one thing that has been ignored by advocates of quality improvement is that overwork financially harms hospitals as well. Just as tired physicians sometimes fail to attend to certain clinical details, they are also more likely to commit errors when writing the notes which ultimately are used during the coding process. If hospitals consider …
The influence of fatigue on claim quality
It always has broken my heart to see a person bankrupted by the costs of their healthcare. I remember my outrage when I first learned the only people who pay full price for their medical procedures are the ones paying cash. Insurance companies use their market muscle and patient volumes to negotiate discounts for their patients that have always been unavailable to the uninsured, individual healthcare consumer.
If you have been …
Hide your health insurance status and pay cash instead
“Oh, by the way” are four simple words that cause most docs to shudder. Yes, shudder. Your patient signed in for a sore throat, congestion, and cough. The nurse did her job. She’s recorded the patient’s chief complaints. She’s taken the patient’s vital signs and readied the patient to see me, the doc.
I take a history, asking questions about the problems that brought the patient to the office. I ask pertinent …
What patients think is not trivial
One of the most memorable discussions regarding the cost of care was at 4:45AM during surgical morning rounds.
As usual, the interns would present the overnight events of their patients to the chief resident and a plan for the day would be agreed upon. These morning rounds were particularly intense: in addition to the 30 patients that an intern had to manage solo over night, the brutal hours that the surgical …
Is the daily blood draw in the hospital truly necessary?
I recently attended my first AA meeting. It surpassed many of my expectations; however it ruined others and left me slightly dumbfounded.
My imagination, with the help of television and movies, painted a picture in my mind of what an AA meeting would be like. It portrayed a room filled with people that obviously looked like addicts; unkempt appearances, borderline offensive hygiene, and at least one person emitting a radiance of …
Reflecting on the first AA meeting
Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients.
Recently I put together a talk about recommendations for …
The problem of conflicting professional medical guidelines
As I like to remind my women’s heart health presentation audiences, I am not a physician. I’m not a nurse. I am merely a dull-witted heart attack survivor. I also warn them that a lot of what I’m about to say to them is already available out there, likely printed on some wrinkled-up Heart and Stroke Foundation brochure stuffed into the magazine rack at their doctor’s office.
So when the organizer …
The power of engaging peer-to-peer health care
I share this post here to point out the discrepancy in physicians’ average salaries based on their specialties. In particular, I would like to highlight that the three lowest-paid specialties are the three primary care specialties: pediatrics, family medicine, and general internal medicine.
This post is not written to argue that physicians must be paid more. I would submit that if …
We must redesign our health care payment systems to value primary care
All kinds of behaviors can have an effect on your weight, and the solution to each is different.
Maybe portion size is your biggest issue. Maybe it’s hard to get moving, even though you know you need to get some exercise. Maybe you have a sweet tooth that you can’t shake. Maybe you’re completely stressed out, and you never get a decent night’s sleep. Maybe you are a nighttime snacker. Or …
Solving the different behaviors that lead to obesity
“Doc, I’m going to the Olympics do I need anything?” It happens every 4 years. Millions of people converge upon a city to watch athletes compete. It seems easy enough, but did you know that this year there is a concurrent UEFA soccer championship in Poland and the Ukraine too? So how do you help your patients prepare to be in close contact with thousands of people from all over the …
How do you prepare your patients for travel to the London Olympics?
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Are you a frustrated patient because you get little time with your physician each visit? Are you a frustrated physician who would like to spend more time but can’t make it work financially? Here are some developing approaches.
Reimbursement rates for primary care visits are low, so primary care physicians (PCPs) need to see many patients to cover office expenses. There are many ways that PCPs are using to escape the …
Primary care does not need to be expensive
I am not a huge baseball fan to begin with, and when I am, I root for the Nationals. Thus, I pay little attention to the New York Yankees, and was not aware that Yankee player Mark Teixeira had been suffering from a cough for the past month until it the story from the New York Times came through one of my Twitter feeds. According to the story: “Mark Teixeira had …
Using Advair to treat postinfectious cough
Some things in medicine are obvious. Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right. I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of dollars and heroic clinical effort to our continued goal of staving off death. Why is this? Do …
When self-evident truth in medicine is systematically ignored
So you’ve decided to take the plunge (or at least, dip your toes) into the Twitterverse. Congratulations! Welcome to a vibrant interactive community. You’ll find plenty of different personalities here and lots of opinions. But if you are like I was back in January 2011, you currently have no idea how to actually use Twitter, let alone how a physician might want to use it.
There are plenty of places to …
How to get started on Twitter: A primer for doctors
It seems that study after study has been touting the benefits of chocolate – eat more of the (delicious!) dark stuff and you might find yourself losing weight, suffering fewer or less severe heart attacks, possessing cleaner arteries, and having a lower blood pressure. Despite the theoretical explanations for chocolate’s health benefits, it is usually found packaged and processed along with some other not so healthy ingredients including saturated fat, …
Is chocolate really associated with better health?
In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed …
Protecting patients by solving the problem of defensive medicine
A guest column by the American College of Physicians, exclusive to KevinMD.com.
I will never forget asking my teenage son what appeared to be a simple question. His answer, after a long pause, was “It’s complicated.” If you ask many of us about health care in the U.S., there is often an answer that points quickly to a particular villain …
ACP: Reducing expenses at the ground level of health care
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