Physician

The closing of a mental health facility in Newtown

Physician

January 26, 2013

I wrote in a previous post about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured grounds crowned with stately and handsome brick buildings in a colonial architectural style. These …

When is making the decision to be DNR appropriate?

James C. Salwitz, MD

Physician

January 22, 2013

Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of …

Don’t make me leave primary care

Lydia Dugdale, MD

Physician

January 21, 2013

You need a doctor, and I love what I do. But this work just isn’t sustainable.

In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a …

Read more…

Don’t make me leave primary care

Dealing with psychological stress of being a doctor

Shadowfax, MD

Physician

January 21, 2013

Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.

These stresses, if unmanaged or poorly managed, can …

I was sued and lived to tell the tale

Natasha Deonarain, MD, MBA

Physician

January 17, 2013

A few years ago, I was sued. Yes indeed, I can now shout it from the rooftops. I know what it feels like to sit in the fire and burn into ashes of self-doubt, regret and emptiness; staring into the soulless, Cyclopean eye of a deposition camera, recounting my sins, defending my pride. I know what it’s like to live with fear, up close and personal. And I know what …

Read more…

I was sued and lived to tell the tale

Medical malpractice: Equating standard of care to best practice

Shadowfax, MD

Physician

January 8, 2013

I review a lot of cases in my professional life. Some of them are just ones that our QA group comes across in our practice. Some are cases related to our liability policy. Some are cases I’m sent for review, or educational cases I present. We see a lot of cases which could have been done better, or in which the …

The recipe for a great hospitalist program

Janice Boughton, MD

Physician

January 7, 2013

Internal medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of well people. It is an excellent field, full of opportunities to think and feel and connect with people, mysteries to be solved and an endless variety of stuff to be learned. …

Your doctor has sold his practice: 6 tips for patients

Cary Presant, MD

Physician

January 3, 2013

The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …

How to deliver bad news to patients: 9 tips to do it better

Alex Lickerman, MD

Physician

January 2, 2013

My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?”

“Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and I’d awakened her from what I imagined had been a troubled sleep.

“Yes?”

“This is Dr. Lickerman. I’m calling from the hospital.” I paused. “I’m calling about your husband.”

There was silence. Then a breathless, “Yes?”

“Mrs. Peterson, …

Physicians can be better doctors by being patients

Kevin R. Campbell, MD

Physician

December 31, 2012

Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …

Common criticisms of concierge medicine that deserve to be answered

Albert Fuchs, MD

Physician

December 30, 2012

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …

Primary care doctors may no longer be needed

Doug Olson, MD

Physician

December 24, 2012

As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …

The insanity of pain management in the ER

William Jantsch, MD

Physician

December 23, 2012

One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances.

My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target.

On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for …

What doctors can learn from working at Starbucks

Linda Pourmassina, MD

Physician

December 21, 2012

She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …

Doctors: How to improve your workplace relationship with nurses

Brian J. Secemsky, MD

Physician

December 7, 2012

Accepting a promotion in the workplace is never easy task. One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.

Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner …

My experience with a scribe in the emergency department

Shadowfax, MD

Physician

December 6, 2012

I have a lovely pen. It’s a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice.

It’s a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window …

ED boarders: A new focus to mitigate overcrowding

Ishani Ganguli, MD

Physician

December 3, 2012

The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system.

In the wake of Hurricane Sandy, the visual has become more familiar than we’d like – the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish …

It’s amazing what I’ve learned from patients

Janice Boughton, MD

Physician

November 29, 2012

Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …

Mean doctors and nice nurses: It’s time to change our brand

Karen S. Sibert, MD

Physician

November 26, 2012

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery. She hadn’t lost weight and clearly was feeling discouraged about practically everything. She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, …

Why I hate the SOAP note

Suzanne Koven, MD

Physician

November 19, 2012

Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.

But sometimes, medical lingo has …

Read more…

Why I hate the SOAP note