Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce.
The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really — if you had it).
This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for …
The evolution of a hospital admission
Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements,” …
Can chiropractors be saved? Only they can decide.
“Please don’t cut off my pants,” he pleaded. “I am homeless, and they are my only pants. Please.”
He could say these words as we were conducting our initial assessment in the trauma bay so at least he was hemodynamically stable with an intact airway at that moment in time. However, he had arrived seconds earlier with potentially life-threatening injuries as a level 1 trauma activation. Based on the location of …
Getting him a new pair of pants was the least that we could do
My medical student found it difficult to get any information from a patient. When she presented the patient’s medical history to me, she was quite flustered and did not know what to say. I went with here to talk to the patient and met the same wall. It is not always an easy task finding the patient within.
Often, when what a patient is saying doesn’t make sense, or it is …
How can we find the patient within?
To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In health care, incompetence can be found in odd places, such as three recent examples I encountered with third-party payers.
Case 1: Downgrading caviar to boiled salmon
A patient was referred for a CT angiogram run …
The spectacular incompetence of third-party payers
I can’t believe I’m writing something with this title. Anyone who knows me and sees my name next to that title will probably spit their coffee all over the kitchen counter. And to all the people who have dealt with me on call, let me begin by saying, I’m truly sorry for anything I might have said, done, thrown or broken. Mostly. Kinda mostly.
Those who know me will likely think …
I am very much a student of the Zen of call
Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them. Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are …
Emergency physicians: You are not alone
Dear Pamela,
You’ll never guess what happened to me today. Hours after the National Day of Solidarity to Prevent Physician Suicide volunteer web page went live, I received an email stating that I am officially terminated from my psychiatry residency program.
On this web page, I spoke about the fact that I had become interested in this event during my …
Hospital fires doctor for having cancer
“Why do you want to go into family medicine?” my internal medicine preceptor asked.
It was an innocent enough question. I’d known from day one of medical school what I wanted to do, so I answered with confidence, and perhaps a bit of a chip on my shoulder.
“I love being with people and getting to know them,” I said. “I’ve always been this way, so it makes sense that’s what I …
The kind of family medicine I knew I needed to practice
Somehow people knew he was about to enter the room. The thirty or so people in the room were seated, though people began to stand up.
“Are we supposed to stand up for the surgeon general?” I asked the person sitting next to me.
She shrugged. If we remained seated, everyone would have noticed. So we stood up.
“I’ve been in this position for a year and a half,” Dr. Murthy …
The quiet leadership of the surgeon general
Being a doctor is often more about talking to people and communicating than it is about the scientific practice of medicine. This is something that is unfortunately not taught in medical school, and it’s left to newly qualified doctors to realize very quickly as they start their careers.
Throughout the busy and hectic day of any hospital-based physician — no matter what their specialty — one of the most common requests …
The part of your day that will be most remembered by patients
Dear Hippocrates,
I want a divorce.
Let’s face it, you and I were young, idealistic, and naive when we met. Everyone said we were perfect for each other: valedictorian and humanitarian. We thought we could change the world, one sacrifice at a time. Sleep deprivation, grueling academic hurdles, delayed gratification. We proudly wore those badges as a testament to our commitment together when we started our board certified family medicine profession in …
Dear Hippocrates: I want a divorce
Sometimes, I wish I was a nurse.
As a nurse, my work-life balance would greatly improve because my three 12-hour shifts would constitute a rewarding and flexible full-time medical career. I would care for all kinds of patients, not just stick to one medical specialty. Maybe I’d go for an advanced nursing degree; I would enroll in school full-time and also maintain a paid full-time job. Like many nurses, my hospital …
Let’s learn from our nurses and make medicine great again
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A few years ago, I missed a diagnosis. I know that’s not earth-shattering, but the stakes are high for a cardiologist. Ms. A was an 82-year-old woman with chest pain. She underwent a transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. The pre-procedure coronary angiogram showed no coronary artery disease and the echocardiogram post TAVR was perfect.
However, a few months after the procedure, she reported arm pain. It was …
The art of diagnosis: How to hear more than what the patient says
We were the consummate lovebirds. We studied together, exercised together, and went grocery shopping together. When she started medical school, I took a summer job in the school’s maintenance department, just so we could eat lunch together. We couldn’t fathom being separated an entire day.
It was a magical time. We worked hard, played hard, and talked late into the night — yet rose early the next morning, energized and ready to go. …
Married to medicine: My ménage à trois
My thoughts settled on the Frank Sinatra song, “My Way,” when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings. We closed the office that Friday to allow three full days to get settled. However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck.
“All we need is a stethoscope, …
How this pediatrician practices medicine. Her way.
I was afraid. Really, I was more anxious. This wasn’t any of the typical new mother fears I had been warned about. If fact, I didn’t even see this one coming. I knew that it would be tough going back to work 3 months after my first daughter was born. I knew I would miss her terribly. I knew I had to figure out a pumping schedule with my colleagues …
A physician mother as the breadwinner. Here’s how she did it.
Can you trust online physician ratings? Many people believe you can.
But here’s what a recent article in the Harvard Business Review (HBR) about the reliability of online user ratings regarding buying a product. The authors concluded that online ratings were generally not to be trusted for three important reasons:
Can flawed doctor ratings harm patients?
Last week, a patient with severe gastroparesis came in for an unexpected visit. She seemed very upset, on the verge of tears. Instead of asking her why she was in, I asked her why she was so sad.
“My hematologist just retired; I was her last patient. I don’t know who will take care of me like she did. And she wasn’t even old enough to retire,” she said. This took …
Caring and dedicated physicians are being driven out of medicine
In July 2016, the U.S. Preventative Services Task Force (USPSTF) published updated skin cancer screening guidelines in JAMA, concluding “current evidence is insufficient” to screen for skin cancer in adults. The guidelines were formulated on a literature review of studies conducted in asymptomatic patients 15 years and older at general risk for skin cancer from 1995-2015; after identifying nearly 13,000 articles spanning two decades of work worldwide, the authors selected …
This oncologist says the USPSTF gets it wrong on skin cancer screening
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