As a physician, I am often discouraged when I turn on the news and read about the state of health care in our country. I can see all 397 sides of the debate and some truth in all sides. The enormous cost of medicine is overwhelming to comprehend for patients and families and even to those of us in medicine.
I think it is important to know all that goes into …
This is what to remember in health reform: We are all one patient
“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart.
“Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds in class. This was my first time hearing anything abnormal on a patient, though it was …
Sometimes high-tech care can be high value
Advocacy groups have been busy lately with their fancy-pants chemical detection science instruments, and their press releases have made it into the news. But is there news here, and are these chemicals something parents really need to worry about?
First it was a big lead from the New York Times called “The Chemicals in your Mac and Cheese.” The article started:
Potentially harmful chemicals that were banned from children’s teething rings and …
Chemicals in your food? Please don’t panic.
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As is customary for every administration in recent history, the Trump administration chose to impale itself on the national spear known as health care in America. The consequences so far are precisely as I expected, but one intriguing phenomenon is surprisingly beginning to emerge. People are starting to talk about single payer. People who are not avowed socialists, people who benefit handsomely from the health care status quo seem to …
A single-payer system is the American way
Several years ago, when I was working as a hospital physician in Florida, a patient’s wife said something that has always stuck with me. The service was very busy on that day, and I was doing my best to get through everybody in a timely manner. I was with a patient whose wife was at the bedside, beside herself with worry. I was focused on the main presenting complaint, but …
Make the patient feel like the absolute center of your world
We are all familiar with the saying: “the last straw.” It refers to the fable of the camel who could carry heavy loads.
In the story, the camel is a beast of burden. Its owner, in an effort to transport as much straw as possible, keeps piling more and more on the camel’s back. Camels are strong and can handle a lot. But at some point, even the strongest camel will …
Stop piling on physicians: The last straw in burnout
There was an interesting piece published in the Style section of the New York Times this weekend; I was tipped to it by Bryan Vartabedian. If you’re a health care geek, that section may not be on your “must read” list (I know it isn’t; will explain below), so let me bring you up to speed. On July 29th, Katie Rosman published a piece entitled, “A Doctor …
Gwyneth Paltrow and the New York Times should take Dr. Jen Gunter seriously
I told you so. I also told the POTUS in my open letter, but he did not read it.
Who could honestly believe the nation would support dumping coverage for 22 million people? As David Leonhard wrote recently op-ed in the New York Times: “They [Republicans and President Trump] had only one big weakness, in fact: They weren’t dealing in reality.” When faced with reality, it is interesting what a few good …
Health reform is stalled. Here’s how to do it right.
Antibiotics save lives, but antibiotics can have negative effects. When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration. So we have a Goldilocks problem — we want antibiotic duration to be just right — neither too short or too long.
Some clinical conditions have adequate research to define the Goldilocks duration. Community acquired pneumonia only …
How long should I take antibiotics? Exploring the Goldilocks problem.
Two seemingly unrelated national policy debates are afoot, and we can’t adequately address one unless we address the other.
Health care reform has been the hottest topic. What to do about America’s aging infrastructure has been less animated but may be more pressing.
Yet even as cracks in America’s health system and infrastructure expand, political divides between parties and within parties have stalled efforts to develop policies and implement solutions. Problematically, debates …
Bridges and roads are also important to your health
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any …
MKSAP: 67-year-old woman who takes diclofenac
I get on the phone with a physician. She is stressed. Her tone is exasperated. Her frustration has been building and building. I hear the stress in her words.
She feels like she has been juggling ball after ball after ball. Living her circus of a life. Taking care of her patients. Pulling extra shifts and doing locums.
Somehow, fitting in a little bit of time when she can for her caring …
Am I using money, or is money using me?
“OK, one more patient to go,” I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major …
Inappropriate patient behavior is not OK
When I began my career as a physician in the late 1990s, I was relatively apolitical. Since then, as our health care system has crumbled, and as its demise (and our repeated failure to fix things) has increasingly affected my patients and my practice, I have become very political. In 2008, I began giving lectures in the community in support of a single-payer health reform model. My political leanings tend …
Would single payer work? The real devil is in the details.
I sit in my living room at the end of a long day. I open my laptop to complete the day’s clinic notes. I look up to see my daughter busy painting (she’s two years old, so less than half the paint is going on the coloring book and most is being smeared over her hands and feet). I hear the distant clatter of dishes as my husband loads the …
Here’s how being a parent changes you as a physician
Fireworks, champagne toasts, sparkly hats, and the ball drop are all items that we conger up in our minds as we think of the New Year. For the majority of the world, January 1st represents the transition from one year to another on the calendar. New resolutions are made, and there is a global fresh start. However, for those of us in the medical field, there is another new year …
3 reasons why July 1st should be a day to celebrate
My sister calls my name three times before I hear her. I am so distracted by the palm trees and the ocean view that I don’t feel her put the car in park. I look up at the “Physician Parking Only” sign straight ahead.
“Hurry up and get out. We’re running late, and I don’t want to have to stay after my shift ends,” she says.
“Don’t you always stay like two …
How a blanket changed the way I thought about medicine
I feel privileged to be practicing medicine. Many people consider doctor careers and imagine how great it may be. Is it the right thing for you? Yes there are days of frustration, exhaustion, and utter defeat, but at the end of the day I home and know that I helped at least one person if not two from the 16 I meet.
The fact that I alleviated one individual’s anxiety or …
10 reasons why being a doctor is a privilege
Even after all this time, the phone calls aren’t always easy to make.
“Hi, Mrs. Smith, this is Dr. Kass at camp, don’t worry, everything is OK.” I usually get that out in one breath, then immediately transition to concrete details. “It’s a finger. It might be broken.” It doesn’t matter if I’m calling about a cough, a fever or a bite from the camp pet pig — I know that …
Being a camp doctor is the most rewarding physician job I’ve ever had
Cancer treatment delays are sometimes inevitable. Here is a story, though, that haunts me.
Years ago, long before the Affordable Care Act, I was asked to evaluate a very pleasant man with hoarseness in a local free clinic. He struggled to make himself heard. “Things have been getting worse and worse,” he said.
“When did you start losing your voice?” I asked.
“About six weeks ago,” he responded. “When it started getting more …
New health policies must cover our most vulnerable
