Medicaid — the program that provides funding for adults, seniors (along with Medicare), children and people who are blind or disabled who can’t pay for their own health care — is expensive. It is painfully expensive. The program, along with CHIP (the Children’s Health Insurance Program), marketplace subsidies and Medicare is responsible for 25 percent of the federal budget. Total Medicaid costs in 2016 were …
To give good value, Medicaid needs help
Young, aspiring doctors are the Iron Youth of this generation. In Erich Maria Remarque’s All Quiet on the Western Front, young German soldiers are called the Iron Youth as part of a campaign to generate enthusiasm for fighting in the war; these soldiers soon realize the true horrors of war and its lasting impact on the psyche. The analogy is not necessarily to compare residency to war but to highlight …
8 things I would tell my younger self
On May 15, President Trump attempted to kill not just two, but three birds with one tweet, simultaneously denouncing the Media and the Mueller investigation, and crowing about his approval ratings. “Can you believe that with all of the made up, unsourced stories I get from the Fake News Media, together with the $10,000,000 Russian Witch Hunt (there is no Collusion), I now have my best …
Political polarization is harming America’s health
People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a …
Which of these patients should get a liver transplant?
Everybody gets nervous at the doctor’s office. Physicians ask all sorts of personal questions about what people eat, how much they drink, and how things are at home. Even questions that would seem completely harmless in another context — such as how work is going, or what hobbies a person enjoys — seem surrounded by hidden meaning and purpose. After all, who doesn’t want to “pass” their annual checkup?
Part of …
Don’t worry, medical students don’t judge
On June 10, 1963, the Equal Pay Act was signed into law by President John F. Kennedy, amending the previous Fair Labor Standards Act. Under this law, pay disparities between men and women were clearly prohibited. More than fifty-five years later, women are still fighting to be paid the same as men holding the same jobs.
Gender pay disparities exist among all professions. Not only does a pay gap exist …
Close the gender pay gap in medicine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is limited to riding to …
MKSAP: 68-year-old man with heart failure
I lost a friend this month. She was a surgeon; she was one of us.
We lost her.
So did her patients. All the ones she helped. The ones she saved.
So did her hospital, her nurses, her techs.
So did her family. All the love, coming to a screeching halt.
Another friend lost. Another brilliant healer in medicine — gone. Another one I will now refer to as “she was …” when I talk …
Address physician well-being as we would any other disease
A relative taught me to drive in a burgundy Lincoln Town Car in an empty Long Island parking lot in the 1980s. After emphasizing the need to practice driving in reverse, he also warned: “A car is a weapon. You can kill someone, or get killed, in an instant.” I am a safer driver (forwards and backwards) thanks to his warning.
This relative had purchased several handguns over the years. He …
Why guns should be tracked and studied
Drivers are distracted klutzes and computers could obviously do better. Self-driving cars will make all of us safer on he road.
Doctors have spotty knowledge and keep illegible records. EMRs with decision support will improve the quality of healthcare.
The parallels are obvious. And so far the outcomes are disappointing on both fronts of our new war against human error.
I remember vividly flunking my first driving test in Sweden. It was early …
How today’s EMRs are like self-driving cars
Physicians are notorious for being bad with money. Today we’re going to assign some blame for that phenomenon. Physician finances have three enemies, and we’re going to expose them today.
1. Financial professionals
Enemy number one consists of many members of the financial industry. These “helpers” are often part of the problem. One of the biggest problems is commissioned salesmen masquerading as financial advisors. Although some of the these “advisors” …
These are the 3 financial enemies of physicians
The doctor-patient interaction is the absolute core of clinical medicine. Maybe I’ll go much further: it’s the core of health care in general. I always try to remember, whenever I’m ever feeling frustrated with the system, the crazy bureaucracy — and of course, the debacle of our clunky electronic medical records and their data entry requirements — to separate myself from all of that when I’m face-to-face with my patient …
3 things patients really want from their doctors
Imagine, if you will, that you’re an anesthesiologist. You’ve been part of a successful practice for over 10 years. You can walk down your neighborhood street and run into mothers whose epidurals you’ve helped place. You’ve established a home, a community, and your children are in a great school system.
One uneventful day, say Wednesday, you get an email from the hospital administrators announcing that there’s going to be a meeting …
Job security in medicine is a myth
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When news broke that Dr. Atul Gawande had been named CEO of the Amazon-Berkshire-JPMorgan Chase health care partnership, industry insiders were quick to raise doubts about his credentials.
Some pointed to his limited administrative experience, questioning how someone who has never managed a hospital or health system could oversee the care of some 1 million patient-employees. They also noted that the surgeon and bestselling author doesn’t know much …
Will Atul Gawande succeed as a health care CEO?
I am not a doctor of finance. I’m a medical doctor. So when I enter an elderly patient’s home, I’m not expecting to do a wallet biopsy. Whether they can pay me or not is of little consequence. I do think, however, about whether they will be able to afford the care I prescribe. Will they have enough to pay for that extra caregiver? Is there cash to keep a roof over …
A patient dying of financial catastrophe
A speech to graduating residents.
It’s an easy thing to count the number of seeds in an apple. In our residency class of 2018 we have nine seeds, and on your graduation, we scatter you across the country. You each carry amazing potential that we have hopefully helped nurture over your years here. You will be caring doctors kneeling by bedsides. You will be national leaders changing policies. You will be …
To graduating residents: You have already exceeded our expectations
Kate Spade. Anthony Bourdain. Two celebrity icons splashed the headlines recently as both figures committed the unthinkable act of suicide. Both left behind young daughters and significant others reeling in the background wondering what had just happened. Kate Spade was the colorful fashionista of purses and dresses. Anthony Bourdain was the connoisseur of delectable eats traveling the world. How could such successful personas mask the pain hidden within? Even Robin …
Depression is personal to this physician
One of my colleagues sat on a wheeled clinic stool at the end of the examination table and told the patient, which was in this case an actor, “Everything looks great.” After, he swiveled around to face the instructor and the small group of onlooking medical students behind him. Our instructor also turned to us and said, “Very good job. But can anyone tell me what he did wrong?” He …
Don’t tell patients they look great, except in these cases
There are 168 hours in a week and 8,736 hours in a year. There are 10,080 minutes in a week, and 524,160 minutes in a year. Residents and fellows working in an academic environment often work close to, if not in large part, more than 80 hours a week, or 4,160 hours a year. They work 4,800 minutes a week, and a staggering 249,600 minutes a year. In medicine, it’s …
Where has the loyalty in medicine gone?
I came across a letter I wrote to a patient while rummaging through some old files on my computer. I flashbacked to what triggered this: a response to a letter she had sent me, one that was, shall we say, extremely unflattering and quite scathing in the way she described me and our last encounter. From the letter’s tone, I sensed she held back on using more profane language to …
A doctor’s apology can go a long way
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