One of the terrible things about being a physician who has spent his adult life working in emergency rooms is that you have a certain terrible clarity about the dangers of this life. It’s why we’re forever pestering our loved ones with phone calls and texts: “Are you there yet!” Or telling the children, “Be careful! After midnight there are too many drunks on the road!” Met, of course, with …
An emergency physician’s brush with death
Ten years ago, I first met this patient, newly diagnosed with intermediate-risk prostate cancer. As I walked into the examination room, I was struck by the juxtaposition of his wife, crumpled in a chair and weeping silently, with the patient himself, pacing the 12′-by-4′ room with a look of either anger or frustration. This difference in response between the man and …
It’s widely acknowledged that the American health care system achieves relatively poor quality outcomes compared to most industrialized nations and at much higher cost. A new survey, conducted by Nielsen Strategic Health Perspectives and commissioned by the Council of Accountable Physician Practices (CAPP), provided important insights into why this could be the case — and more ominously, why the future may be no better.
CAPP is made up of …
Until the gap between doctors and patients is fixed, the nation will suffer
Man collapses at 30,000 feet. Quick, who’s in charge? Hint: It’s not the doctor. Last month, Dr. Tamika Cross was told to sit down when she tried to help an unresponsive man. Why? Apparently, the flight attendant was looking for an “actual” medical doctor, not a black woman. Turns out she’s not the only doc making headlines for being turned down in …
10 things you should know about airline medical emergencies
A recent story in U.S. News & World Report described how a Seattle hospital is taking a systems approach in improving health care quality and cutting costs. It said, “Virginia Mason Health System … has looked to adopt many of the much-admired and often-emulated business philosophies from Toyota.”
The best-known of those philosophies is the so-called lean methodology which is based on eliminating waste and focusing on things that add value.
Attempts …
How is lean working in health care? Not so well.
As I sit behind a computer in my office today at the physician’s workstation, I am baffled at the steady flow of pharmaceutical representatives that flow into our office on a daily basis.
Each rep comes in with a fancy glossy print detailing the data concerning their particular drug. My office is busy; patients are coming in and out, and medical assistants are busy checking vitals and verifying medications (and of …
The days of the drug rep have come to an end
Buprenorphine was a fantastic drug in the emergency department. Patients would come to our ED feeling awful from opiate withdrawal, and we made them feel so much better. We can recall so many patients coming in vomiting, anxious, sweaty, dehydrated, and looking awful — and with one or two shots of buprenorphine, we made them feel well enough to take on the task of beating opiate addiction. A clinic in …
Buprenorphine: One way works. One doesn’t.
As a family practice resident, I’ve found that a premium is placed not only on my clinical acumen but also on how well I respond to my patients’ mental and emotional experience of illness.
Yet the work of learning to be a doctor is just that — work. (And in overwhelming amounts.) Time management becomes ever more vital: As I take the time needed to gently break bad news and to …
Medicine isn’t just about accuracy and efficiency
Dear doctor mom,
I’ve been a physician for 13 years. For the past 7 years, I have also been a mom. A growing number of experiences made me decide to write this letter. I hope other moms don’t attack me. I do not mean to downplay their struggles, or to insinuate that doctor moms necessarily all have a harder time compared to other moms. I only focus on you, because I …
Doctor mom, remember that it is all worth it
Two years ago, I wrote about my experience in a London emergency department with my son Victor. That post has since been viewed over 450,000 times. There are over 800 comments with no trolls (a feat unto itself), and almost all of them express love for the National Health Service.
I was in England again this week. And yes, I was back in an emergency department, but this time …
An American doctor experiences UK emergency care firsthand
It’s hard to find time to pay attention to all the messages I receive. There are voicemails, emails (work, blog, and personal), and the nonstop notifications from Facebook and Twitter. Post-it Notes on the desk and the refrigerator. I am bombarded with messages.
Urban Meyer, head coach of the Ohio State football team, doesn’t have a lot of time to leave messages. Right now, he’s gearing up for a likely bid in the …
Urban Meyer has a message for you, doctor
In a time when the deep divisions in our country have become increasingly apparent, I, perhaps like you, have been seeking hope. I supposed hope would come in the form of an enlightened article or a profound speech, but it did not. Hope came to me in the form of my patients.
The division you have been seeing in our country is barely visible in the hospital. Here, patients are assigned …
The division in our country is barely visible in the hospital
Dear President-elect Trump,
On the campaign trail, you referred to the opioid epidemic plaguing the nation a “tremendous problem” — and it is. You claimed that this crisis could be mitigated by building a wall between the U.S. and Mexico to “cut off the source.” You promised to dedicate resources to get afflicted Americans treated. You pledged to take addicts and “work with them” to ensure they are “gonna get that …
We need to know these 3 facts to fight to opioid crisis
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OSH, or “outside hospital,” is one of those abbreviations that has crept into the lexicon of hospital jargon that merits additional scrutiny.
What are the implications of calling another health care facility “outside”; does that make your hospital the “inside” hospital? I suspect that it is, as many patient-related conditions are described, multifactorial. Or, if you like the band Fort Minor, “Remember the Name” (apologies to the band):
This is ten percent …
Give the outside hospital the respect it deserves
There is a strange feeling that every kid has experienced: the flip-flop sensation of your stomach dropping while you careen down the descent of an enormous roller coaster; the sinking swoop of a high-speed elevator dropping to the ground floor. My children find it hiding along a rolling country road, driving to the lake in our jeep. With the top down and the sun shining, they shriek and beg for …
A physician who lost a patient to home birth
I remembered staring at the computer screen with the radiologist hoping that by staring at the images, they would change in some way. It did not seem fair that a nice lady that I was evaluating in the emergency room would be consigned to such tragic images. I was rotating through the emergency room during my second year of residency, and one of the patients had come in just for …
The complexity of the white coat
It was Thanksgiving morning. My wife was standing in the living room when she received a text message from her father. Her face went pale, and her expression turned to one of anger and disbelief. She cursed. She cried. Her mother had complained of chest pain and stroke-like symptoms and was being rushed to the hospital by ambulance.
Many hours went by with few answers and endless speculation. We had moved …
When you place your faith in another surgeon
What an upset, right? Your voices were heard, loud and clear. The current system wasn’t working for you, and you won a major paradigm shift. The insulting irony of the word “progress” hidden in “progressive agenda” wasn’t lost on you. You looked around your respective communities and what you saw sure didn’t seem like progress. Employment opportunities were scarce, your health insurance costs had risen, and your infrastructure had eroded. …
An open letter to America’s white working class
Reading about the opening of the Noah’s Ark Theme Park in Kentucky brings to mind the days when I worked as a physician in that state. I had moved from an academic position in Colorado and joined a large group of private practice cardiologists in Louisville. I found that people in Kentucky were different from those in Colorado. They were much more overtly religious.
As an interventional electrophysiologist, I would meet …
Atheist doctors must come out of the closet
So, have you talked to your teenage daughter about sex?
Have you really talked to her about sex?
I’m not talking about the superficial birds and the bees conversation; I’m talking about using words like vagina, penis, and condom. Yes, those words!
As an obstetrician-gynecologist and a mother of girls, I know the challenges that our daughters face as they navigate their teenage years. I know how critical it is to have real …
When should you talk to your teenage daughter about sex?
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