Physician

Here’s what’s wrong with time-based billing in the hospital

Physician
April 17, 2018

Consider this hypothetical addendum to a hospital discharge summary:

”ADDENDUM @10:56 a.m: In considering the accurate billable discharge time involved in this case (as I have recently been instructed by hospital coders that I must record the exact time required for a patient discharge, rather than simply “greater than 30 minutes” or “less than 30 minutes”), I feel I have stumbled upon a troubling quandary, having failed to note the exact …

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The human touch in medicine: good or bad?

Physician
April 17, 2018

Humans need human touch

Patients sometimes need a shoulder to cry on. When I say that, I normally mean it on a completely figurative level.

However, at times, it needs to be interpreted differently. There are instances in a medical encounter where an actual shoulder could be of service — a physical crutch that takes off an emotional load — and that’s when the popular adage can be beneficially carried out in …

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Sexual assault in the emergency department: What can you do?

Physician
April 16, 2018

It has been documented that 1 in 3 women will experience rape in her lifetime, and this is most common in women under the age of 25.  Over 95 percent of victims of sexual assault are women worldwide, while in North America estimates place that at 85 percent.  These are the assaults we know about — generous estimates say that, at most, 10 percent of rapes are reported to police …

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Emergency physicians are glorified secretaries with medical degrees

Physician
April 15, 2018

We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously — one for paging, one for order entry, and one for admissions. I haven’t been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I’ve seen around the country in my …

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Push back on toxic behaviors from other doctors

Physician
April 13, 2018

“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”

That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …

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How physicians dress matters. Here’s why.

Physician
April 11, 2018

Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …

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A physician thanks those who made her who she is today

Physician
April 11, 2018

To the intern on the trauma surgery service when I was a medical student: Thanks for occasionally wearing leather pants to work. Thanks for smiling and having a sense of humor despite having to round on thirty patients. Thanks for teaching us medical students while running a significant sleep deficit.

To the internal medicine resident who wanted to become a cardiologist: Thank you for indulging me and telling me how you …

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What happens to the kids of child abuse when they grow up?

Physician
April 11, 2018

As he sat in the driver’s seat and started to whistle that dreaded Willie Nelson song, my heart started racing, and my world started to spin. While most kids may be annoyed hearing their father whistling that toneless noise, terror started seeping into my very bones. I knew what that sound meant and it was no Pavlovian response, but rather a foretelling of the horror coming. Simply put, it meant …

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Why your physician wellness programs aren’t working

Physician
April 9, 2018

The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?

According to the 2018 Medscape …

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The many benefits of self-rooming patients

Physician
April 7, 2018

In 2017, the flagship multispecialty practice of Oregon Medical Group, moved into its new digs — a 46,000 square foot redesigned medical office building. Practice leaders and the 30-odd clinicians in six different specialties were committed to a coordinated patient experience. They wanted to ensure that patients could move smoothly between sequential visits with different care providers — on the same day. To this end, the group invested in a …

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The referral system to specialists: It’s a nightmare

Physician
April 7, 2018

I need your help.

I’m trying to figure out how to get rid of something that’s terribly broken in our process of taking care of patients, and I can’t do it alone.

It’s time to kill the referrals process, get rid of them altogether.

Every day, a huge proportion of the messages we receive through the electronic health record are requests for us to “put in a referral.”

Patient has low back pain, has …

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When you leave primary care, you leave people behind

Physician
April 4, 2018

“The ones you leave behind …”

That phrase often connotes loved ones who have lost a family member, friend or colleague through death.

I have thought of the same phrase often lately in a different context — one of increasing prevalence.

Here, I refer to the patients and colleagues left behind by the loss of a primary physician.

No one would begrudge the retirement of a physician who has served his or her patients …

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Physicians must learn to say no

Physician
April 4, 2018

As a physician, is it acceptable to say no? After working as a hospital medicine physician across five different states and internationally, I’ve realized that saying no is actually imperative. Physicians are stretched thin, abused, demonized and expected to be superhuman when it comes to patient care. We secretly complain in online forums, we commiserate with other physicians in on-call rooms, sometimes we even seek mental health help, but rarely …

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Doctors wear white coats. But what do their spouses wear?

Physician
April 4, 2018

When we first met and got married, my husband Josh wanted to be a math teacher. Since I was also pursuing a career in teaching, I thought this was a great idea. I envisioned both of us teaching together in the same school district for forty years, becoming local superstars! We would know all the kids in town and spend our summer vacations traveling to exotic locations around the globe. …

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Is surgical training stuck in the past?

Physician
April 4, 2018

When we look back on the last century, the pace and number of advances in our ability to treat disease and injury is truly astonishing. The exponential growth of technology has contributed to this greatly, as we see new advances often come in the form of new technologies. Amazing innovations in the fields of endoscopy, catheterization, robotics, imaging, navigation, 3D printing and more allow us to do things that were …

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5 things pathologists want other doctors to know

Physician
April 1, 2018

1. Clinical history is important. What did you see when you took the biopsy?  Was there a mass there?  Does the patient have a history of malignancy?  These are all important questions, and they help pathologists arrive at the most accurate diagnosis possible.  Rarely, the best we can give you is a differential, but the more clinical information given to us, the more likely we can narrow things down and pinpoint …

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The first time this doctor hated a patient. And what he did next.

Physician
March 31, 2018

“Dr. WHAT?!” she spat.

“Gold … man. Gold, like the precious metal, and, y’know — a man.” This carefully crafted response was curated and vetted by countless returned pages, and it rarely failed to produce a chuckle. The patient was not amused, and she referred to me, instead, with a disdainful, “Rosenberg.” Every day I re-introduced myself, and every day — “Rosenberg.”

This 36-year-old female admitted for road rash and multiple rib …

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