As a consultant, I spend a lot of time on airplanes and subsequently get to meet a new “person in the next seat” almost every week. Once the small talk is over, the conversation is nearly the same every time. “Oh, you work in healthcare! What do you think about all of this reform stuff anyway? Is there an answer?” I’m always very cautious how I frame my answer. As those …
Concierge and primary care medical home hybrid model of care
I see a lot of patients who are sent to me for evaluation of dizziness. On the surface you wouldn’t think a cardiologist would have much to do with a symptom that relates more to the head than the heart, but there is some logic to it—poor blood flow to the brain could lead to dizziness and, since blood flow starts in …
Evaluating dizziness in the cardiologist’s office
by Henry Dorn, MD
In 1974, the noted obstetrician Marcus Filshie published a review of the relatively new electronic fetal monitoring in the British Journal of Hospital Medicine. He stated, somewhat fatefully:
Now that the appropriate technology is available, the obstetrician may virtually eliminate intrapartum stillbirths and reduce morbidity to a minimum.
Similar statements were made in the United States by leaders in the obstetrical …
Uncertainty in the diagnostic methods of the obstetrician
Huge holes exist in the health reform law you can drive an 18-Wheeler through. These holes are not “devils in the details.” They are so obvious nobody talks about them. They are the proverbial elephants in the room. I suppose this makes sense. It takes an 18-wheeler to transport …
Huge holes exist in the health reform law
If we ever slow health care cost inflation to a sustainable pace, it will be because we learn how to ask 3 simple questions when thinking about a medical treatment.
Asking the questions are of course much simpler than figuring out the …
Slowing health costs requires answering 3 simple questions
We badly need effectiveness research — which medical treatments work and which ones don’t. After all, some reasonable estimates are that a third or so what we spend on medical treatments is for things that aren’t known to work, or worse, don’t work. Effectiveness research means comparing two competing therapies to see which works better; if both work the same, our preference …
A global view on effectiveness research
by Tayson DeLengocky, DO
The landscape of healthcare delivery has changed so drastically over the past three decades with the proliferation of allied health professions, increased in medical specialization, managed health care, and technology advancement.
The direct doctor-patient relations have been relegated to the relations between healthcare providers and patients, in which doctors are only participants among other healthcare givers. A healthcare consumer, patient, can be easily further confused when visiting medical …
Osteopathic medicine and the growth of D.O. graduates as physicians
Medical school is a wonderful, but at times difficult experience. As you start this fantastic journey, there are a few “rules” I think might help.
1. You can drink from a fire hydrant, but you’ll need to learn how. The amount of information you are going to be exposed to in medical school is logarithmically more than you had to learn in …
Rules to help you during medical school
When Clarissa was 13 she entered Johns Hopkins Hospital to be treated for relapsed acute leukemia knowing full well that she had only a 40% chance of survival. Today she is 16 and in excellent health. But it took 2 1/2 years of incredibly rigorous treatments to get there. Equally importantly it meant riding an emotional roller coaster for her and her parents.
Clarissa had …
Emotional issues that come with cancer during the teenage years
From Medicare/Medicaid incentives to EHR industry ads, it is hard to cut through the hype and determine if your practice is even ready to try to select and implement an EHR.
Implementing an EHR is a transformational exercise for any practice that requires redesigning every aspect of charting, clinical workflow and interaction with patients. However, in too many cases, practices approach EHR …
Supportive physicians and management to implement an EHR
Why do my patients with cancer get better care than my patients in primary care? As the senior resident on my hospital’s inpatient leukemia service recently, this question troubled and intrigued me daily.
Despite the sheer complexity of treating leukemia (administration of chemotherapy, bone marrow biopsies, stem cell transplantation), the resources required (transplantation routinely costs $1 million), and the severity of the illness …
Cancer patients get better care than patients in primary care
I received my Masters in Public Health from Johns Hopkins in 2006. I took a course on transportation safety where we focused on designing roads for safety, making airlines safer, and decreasing the risk of medical helicopter crashes.
In 2007, I worked for Public Citizen, Ralph Nader’s consumer advocacy group. Ralph’s book, Unsafe at Any Speed, forced the automobile industry to focus on converting their cars from …
The next generation of public health won’t involve the medical world
Match Day marks one of the most important days in a medical student’s career.
A computer algorithm “matches” prospective doctors with the residency program they’re destined go to.
It’s also a look at the future trends for various specialties. With a major part of health reform about to be implemented, one naturally gravitates towards primary care, where there currently is a …
Match Day 2011: Family medicine grows, but enough to save primary care?
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Before I had even begun medical school, I already knew that I would enter primary care when I finished. I had successfully applied for and received a scholarship from the National Health Service Corps Scholars program. By the time I graduated, I knew that after my three years of residency training, I would practice in an underserved area for at least four years, one year of service to America for …
The National Health Service Corps impact on primary care doctors
Kevin Pho, at KevinMD.com, posted a commentary about encounters with “difficult patients.” He correctly notes that physicians themselves contribute to these interactions. To reduce the likelihood of these encounters, he suggests that physicians would benefit from more training in “psychosocial skills.”
Kudos to Kevin for adjusting his own language by the second sentence of his post: He makes the distinction between difficult patient and difficult encounter.
A vital step in decreasing …
Label the interaction as difficult, not the patient
by Dawn Barker, MD
Until recently, it was easy to reply when an inquisitive acquaintance asked, “What do you do?” I would answer that I was a child and adolescent psychiatrist. Easy.
The most difficult part was trying to explain that yes, a psychiatrist is a medical doctor, and no, I’m not a psychologist and there is a difference. But when …
When doctors take time off to become parents
I think that I am missing a gene from one of my X chromosomes.
I attended my sister-in-law’s baby shower recently. I love my sister-in-law dearly and was happy to be there to support her. If only I could have supported her in another way.
I detest showers. Once I was engaged, I stated clearly to everyone I knew that I did not, under any circumstances, want a bridal shower. Naturally, everyone …
Your medical career and the waning interest in bridal and baby showers
fatigue |fəˈtēg|
noun
1 extreme tiredness, typically resulting from mental or physical exertion or illness : he was nearly dead with fatigue.
• a reduction in the efficiency of a muscle or organ after prolonged activity.
No, this post is not a part of my twenty six installment Psychiatry A to Z series.
You’ll have to wait for the next one in that group, which by the way will be looking at a “T” word. …
Should doctors be like workers on factory assembly lines?
It is hard to imagine that someone can emerge from intern year – 12 months of chaos, little sleep, and hours upon hours spent responding to pages and putting orders in a computer – and know something, anything, about medicine. I did not believe in this training system until now, after my first night as a supervising resident. The knowledge I have absorbed over the …
Gratitude from patients and their families
What is the physician’s most precious possession? Some might answer that it is his patients.
Others might respond it is the training and education that the physician has obtained to practice his (or her’s) craft.
But the real answer is that it’s the physician’s reputation.
Doctors live and die by their reputations. Reputations take years to …
Physician reputation management in the age of social media
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