Physician

What creates a toxic hospital culture?

Physician
October 28, 2015

Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e., disenfranchisement of medical staff, burn out, and joyless medical care) is presented Read more…

Will your anesthesiologist leave the OR? Patients deserve to know.

Physician
October 27, 2015

“For some must watch, while some must sleep.”
– William Shakespeare, Hamlet

I admit, I was taken aback at the headline that ran in the Houston Press today: “Going under:  What can happen if your anesthesiologist leaves the room during an operation.”

It’s bound to make the curious reader wonder why the anesthesiologist would leave the operating room in the first place.

Of course, reporter Dianna Wray explains that in many hospitals, one …

Read more…

Why do never events occur? It’s because of the human factor.

Physician
October 26, 2015

Wrong procedure, wrong side/site, wrong implant, retained foreign object: big problem.  No patient should ever have to undergo these types of events, and they are therefore called never events. However, these events do occur and when they do they not only jeopardize patient safety but they also breach the trust between patient and practitioner, have financial implications, and reflect negatively on the entire health care system.

The good news is never events …

Read more…

Open your eyes. Look at each other. And make the connection.

Physician
October 25, 2015

shutterstock_255266638

We’re not imagining it: We really are losing our connections to each other. It’s a huge problem. In fact, it’s life-threatening.

A recent Wall Street Journal article discussed the Brigham Young University study that found that social isolation increases our risk of death by 32 percent.

Duke University and the University of Arizona have been watching our connections go down the …

Read more…

Life and death are in God’s hands, and we are merely his instruments

Physician
October 25, 2015

I lost a very dear friend about a week ago.  She was my nurse, office manager, and friend. She was Ginny. Ginny came into my life about eight years ago as I assumed the responsibility of medical director for a multi-location clinic. I spent about as much time with her as I did my family, she was my “work wife.”

About nine months ago I became concerned with her rapid loss in …

Read more…

Should doctors be allowed to concealed carry at work?

Physician
October 24, 2015

One word: gun. That is all it takes to spark a debate between two very different camps. One end of the spectrum feels guns are an evil haunting the nation by their mere existence, and they need to be dealt with by restricting (or even eliminating) everyone’s ability to possess them. The other end believes it is a core right to keep and use firearms for sport, personal defense, collecting, etc., and that no …

Read more…

Maternity leave for physicians is a disgrace. It’s time to fix that.

Physician
October 22, 2015

Netflix listens to doctors.  Google, Facebook, and Apple listen to doctors.  The United States Navy and Marine Corps listen.

The above companies have updated their maternity leave policies — lengthening them all past 12 weeks.  And all paid.

But yet, health care doesn’t listen to doctors.  And let me tell you how.

I am pregnant.  Which is a blessing in of itself.  In fact, this is my 4th pregnancy, but I only have one child living. …

Read more…

Lab coats and scrubs don’t make the physician

Physician
October 16, 2015

I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school.

I currently sport what a family medicine resident told me was the ER mullet: khakis and polo shirt. (Who knew?) I find it much …

Read more…

An emergency in public: When should doctors help?

Physician
October 12, 2015

Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security …

Read more…

Why we need to stop calling physicians “providers”

Physician
October 10, 2015

It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor” out of the center and towards the periphery of health care. Whether we are talking about administrative communication or health care information technology order entry — it seems that we are no physicians or even clinicians, but we have all …

Read more…

The aroma of medicine can be found everyday in hospitals

Physician
October 9, 2015

As a physician, you are required to have keen senses.  Touch, smell, hearing, and sight are absolute necessities for most practicing physicians while we can only hope that taste is reserved for meals and non-professional situations.  I recently returned from a week of vacation in the great outdoors and found myself wishing that I had more olfactory agnosia.  Olfactory is a Latin adjective from olfacere that translates “of or relating …

Read more…

A patient turns down hypertension treatment. What happens next is tragic.

Physician
October 8, 2015

I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help.  Now I’m writing an update.

Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care …

Read more…

Terminal dehydration: A gentle way to die?

Physician
October 7, 2015

My father suffered a massive stroke on a September night not long after his 83rd birthday. It left him conscious yet unable to talk and communicate, unable to swallow and almost completely paralyzed.

After numerous scans and other tests, his doctors determined that there was no chance of recovery. My father would never walk, talk, or swallow food again. With nothing more to do for him in the hospital, we — …

Read more…

The surprising reason behind an early refill of alprazolam

Physician
October 2, 2015

Theresa arrived in a cloud of noise and commotion.

She had called after four o’clock the day before, but I hadn’t noticed the new message in my electronic inbox before I left the clinic.

Her almost brand new alprazolam bottle and her pain pills were missing, and Theresa was reeling. As she walked down the hall to the exam room, I heard her explain to Autumn how she had been to Walmart …

Read more…

Health inspectors should be trained to do what doctors do

Physician
September 28, 2015

This story is a great one.

It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.

Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.

Step, step, hitch. Step, step, hitch.

One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. …

Read more…

How call rooms reflect the personality of residency programs

Physician
September 27, 2015

An intern pushed open the call room door so that twelve medical students could crowd their eager faces together to see where we might sleep for the next three years. Only a few months away from medical school herself, the intern acted as if sleeping in such quarters were second nature. She gestured to the fluffy quilts the residents had brought from home to adorn their beds and giggled about …

Read more…

Do patients contribute to the God complex in surgeons?

Physician
September 23, 2015

Medical oncologist, Dr. Ranjana Srivastava wrote on the subject on how doctors treat doctors may be medicine’s secret shame in the Guardian back in February 2015.

About a month later, vascular surgeon Dr. Gabrielle McMullin used a book launch speech to expose the problems of sexual harassment in the surgical profession.  She highlighted a story of where a neurosurgical trainee had refused sexual advances and subsequent to launching a formal complaint, …

Read more…

It is time for an honest conversation about money and cancer

Physician
September 22, 2015

There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer will be rich beyond anyone’s wildest dreams. In addition, I have personally known several thousand …

Read more…

When patient-centered care becomes patient-dictated care

Physician
September 21, 2015

“I’d like an MRI for my leg pain. I haven’t had an MRI for many years, and I’m worried.”

These were some of the first words I heard from a patient I was seeing for a new patient visit. Based on this patient’s story and physical exam, her pain was most consistent with a muscle strain. My preferred approach to manage this complaint was to ask the patient to rest her …

Read more…

206
pages

CME Spotlights