Despite all the challenges that we, and every other nation, faces with their health care systems, it’s worth remembering that in the broader picture we really have progressed in leaps and bounds over the last several decades. How easy is it to forget that only 100 years ago the average life expectancy was in the 20s to 40s in most parts of the world (just as it was for nearly …
Communication is the core of many health care problems
“One of the most prominent definitions describes burnout ‘as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'”
– Maslach, Jackson & Leiter, 1996
In 1974, the year I started medical school back in Sweden, the German-born American psychologist Herbert Freudenberger published a journal article titled “Staff Burnout.” In it, he wrote about the physical and emotional symptoms of …
Burnout is a consequence of the deprofessionalization of medicine
I adored the physical exam in medical school. We were taught the exam by sections, and I devoured one after another. No matter how much I had learned about physiology, it was during our physical exam sessions that I finally started to feel like I was learning how to be a doctor. We were getting the tools we needed to really take care of patients. We would have the means …
Treat the physical exam with the respect it deserves
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At the end of 2015, The Leapfrog Group announced its annual list of America’s top hospitals for quality and safety; 98 hospitals receiving the honor.
Unlike some other hospital rating schemes, Leapfrog’s does not factor in reputation. You won’t find any of the usual suspects on Leapfrog’s list. Instead, Leapfrog uses surveys of hospitals and publicly available quality and safety data.
Leapfrog’s top 98 included 62 urban, 24 rural, and …
Here’s why you can’t believe “top hospitals” lists
Opioids, also known as opiates, serve as important prescription medications in medical practice. But within the last decade or so, because of their overuse, misuse and abuse, they’ve also emerged as a leading cause of addiction and death.
Sadly and surprisingly, those most instrumental in creating this epidemic — however unwittingly — are physicians and the pharmaceutical industry.
The question is, how could this crisis have happened? What responsibility should physicians take, …
How the medical profession can solve the opioid crisis
This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump. The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small hands on the button to launch our nuclear arsenal does not inspire feelings of security.
He is looking increasingly likely to be nominated by the Republican Party. Many, however, …
Should we be concerned about Hillary Clinton’s health?
These are the words that inspired me to begin my journey as a medical student blogger. Four years later and I’m still at it! The time has flown since I received my acceptance letter to now, only a few weeks away from my graduation. And as graduation approaches and I make the transition from student to resident, I can’t help but ask myself, how am I doing? How is my first patient really doing?
It’s a difficult question …
My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual.
Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a …
Improve health care services for our most vulnerable
As a primary care physician at one of the nation’s leading academic medical centers I’m still hanging on.
Over my 32 years, I’ve seen how my ability to interact with patients has been diminished by an ever-encroaching health care system. There’s a clock keeping track of how much time a patient’s chart is open. I have less than 15 minutes on average to assess my patient’s symptoms and discuss treatment options, …
This doctor has practiced for over 30 years. Here’s why he’s not burned out.
For years, many physicians have complained about the onerous nature of government-certified electronic medical records. However, thanks to the HITECH Act, the rush to digitize medical records has continued. Due to the impetus provided by the ACA and subsequently by MACRA, the mad rush has progressed into a frenzy of data-collecting and reporting activity, all in the name of value over volume.
Recently, two objective reports have surfaced demonstrating the futility of …
Physicians and patients must retake control of how health care is delivered
A friend posted an article on her Facebook page discussing a recent research study out of Sweden showing that people on the autism spectrum have a decreased life expectancy. This friend has a child with autism. Autism coupled with learning disability, according to this study, is associated with the largest decrease in life expectancy. This friend’s child has learning disabilities along with autism.
My friend is scared.
On top of her worries …
My job as a doctor is to take data and apply it to real people
Dear health care administrator,
I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage on the side while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the …
Dear health care administrator: Physicians are your friends
Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the …
Reducing health costs: Patients aren’t going to take the lead
My last post discussed the wide gulf between health care and the rest of the world in the area of customer service. To sum up what took over 1,000 words to express: Customer service in health care totally sucks because the system promotes that suckiness and does nothing to penalize docs who make people wait, ignore what they say, rush through visits, and over-charge for their care. We …
Most of the care you’re receiving isn’t patient-centered. Here’s why.
It is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question, “What will President Trump be doing when he is not building a wall?” has assumed salience.
This is relatively easy to answer when it comes to health policy. …
A physician’s health policy advice to Donald Trump
We are born with arms wide open, and we die in much the same way. It is that which we carry, in the time between, that defines us.
The newborn, caught in the primordial stew of beginnings, is unable to recognize the difference between self and other. She grasps and roots at inanimate objects with the same voracity she reaches for her mother. It is a time of differentiation, a time …
We are born with our arms wide open. We die in much the same way.
I just finished reading a very delightful A Piece of My Mind essay in JAMA. JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is …
Who are the patients that stay in the hospital for a very long time?
A few weeks ago I wrote a piece about my hero patient, a World War II veteran who landed on Normandy beach, and how he had been left in a difficult position by the whole observation versus inpatient situation while he was hospitalized.
My intention was to draw attention to these types of scenarios and how they cause intense anxiety and concern to our elderly. It’s a horrible …
Inpatient vs. observation: We have created a monster of our own making
As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues.
As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers …
How duty hour restrictions are hurting residency training
“Son, just let me die.”
Those were the first words Mr. O. told me as I introduced myself. As a 75-year-old stage IV lung cancer patient with brain metastasis, Mr. O knew his time on this planet was limited — the last place he wanted to be was in a hospital with a newly minted clinical student. Mr. O’s neighbor had found him unconscious on his porch earlier this morning, and …
The moments that define the type of physician we become
