It’s a Monday morning, and two patients wait expectantly for the cardiologist. Instead, they get me, a fresh resident. “I don’t know why I’m seeing you,” says the first. I bumble through the chart and find a note indicating he has a large atrium on his most recent echocardiogram.
“So, what surgery do you have coming up?” I offer, to get …
Are preoperative consultations worthless?
In the world of health care, we face a lot of questions and challenges. Hospital administrations across the country are grappling with these and always on the lookout for solutions. As far as raising the standard of health care quality, there’s been great progress over the last several years in the areas of patient safety, adhering to best practices, and trying …
Want to solve health care problems? Ask the right questions.
This piece will likely draw ire from many, but I do not intend it to be inflammatory. I write it to explain why Bruce Jenner’s recent, and very public, transformation into Caitlyn shouldn’t necessarily make us feel all warm, fuzzy, and optimistic. This is not meant to insult or degrade any individuals who are transgender or merely confused about their own …
Why I’m not celebrating Caitlyn Jenner
There’s a simple way to define value. Ask why we exist.
Imaging exists because clinicians are uncomfortable with uncertainty. Imaging exists because emergency physicians feel that being 98 percent correct about the absence of pulmonary embolism is not good enough. Radiologists exist because imaging is not an assay on a Western blot with a 100 percent accuracy. Radiologists exist because information is …
It’s time for radiologists to stop hedging
Dr. Quinn, Medicine Woman, was my first physician role model when I was a kid. She had full scope of practice in the Wild West, and what kid doesn’t like a good Western? But it wasn’t until later in high school that I started considering a career in medicine. A great biology teacher sparked my love for science. That, coupled with my passion for helping others, made medicine seem like …
Learn to be a primary care mentor. Our future depends on it.
Our job — though many of us actually see it more as a calling than a job — is to care for patients.
Documentation is a process whose primary purpose is to support the patient care process. Coding, billing, population management, meaningful use and many other processes may be important to an institution but are of little or no use (and provide …
The absurd barriers to good patient care
Dr. Margaret Wood, who chairs the Department of Anesthesiology at Columbia University Medical Center, has published a wonderful article titled “Women in Medicine: Then and Now,” in the journal Anesthesia and Analgesia.
I think I speak for many of us in admitting that Anesthesia and Analgesia doesn’t occupy a prominent place on my bedside table. Many readers may have missed Dr. Wood’s …
Questioning the commitment today’s physicians have to medicine
In the last several shifts I’ve worked in the ED I’ve had more people stop and compliment me on my care. I’ve heard the usual, “Do you have a private practice?” compliment and, “I’ve been here a lot and you really took the time to hear what I was saying, I appreciate that.”
Kudos are nice. They are what makes a tough …
How to improve patient satisfaction in the emergency department
One Google search can sometimes change everything.
After learning something new about our child’s health or condition, especially for worried parents and caregivers, leveraging online search as a resource in diagnosis, clarification and education is typical behavior. Searching out support, camaraderie and tips online just makes sense. In fact, 2013 data from the Pew Research Center finds that 1 in 3 …
A Google search can make all the difference in the world for patients
My inbox has been flooded lately with emails from fellow pediatricians begging for help fighting the American Board of Pediatrics MOC program. These are doctors with decades in the care of children, now threatened with complete loss of their ability to practice because of the onerous ABP MOC process. In trying to help my colleagues, I visited the ABP website today and …
Our most celebrated pediatricians are not maintaining certification
Being related to a famous person is somewhere between a cruel joke and a minor distraction. My father was immensely talented and worked very hard at his writing, but the degree of his success was a fantastically unlikely bit of luck. There are lots of talented, hard-working artists who don’t make it.
The important thing in overcoming mental illness, whether or not …
A doctor shares his story about overcoming mental illness
Recently I was asked to talk to a special group: the doctors and staff who teach new doctors. I reached out to my community and the suggestions that came pouring in of how to improve physician burnout were amazing.
What I learned is that a key element of guiding young doctors and avoiding burnout is to stop for a minute.
Can you believe …
This is the key to avoiding physician burnout
The morning after his brother’s bachelor party, standing on the fourth floor of his family home, Dr. Arvind Goel, felt the ground move under his feet. “First it was minor vibrations and then it built up in a crescendo and then the couch where my four-month-old son was lying began to shake.”
“It was creepy,” Goel, 32, continued. “The furniture began to …
A physician survived the Nepal earthquake. Here’s what he learned.
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I enter through the sliding doors, my flip-flops slapping the linoleum as I search for the information desk. “Can you point me towards the apheresis center?” I ask, noticing my voice rise a notch. I am clearly uncomfortable. My feet feel naked and exposed without my Dansko clogs, and I can’t remember the last time I wore jeans in a hospital. Two medical students scurry by, their stethoscopes bouncing around …
Being a bone marrow donor: This is what it’s like
If I had groused two years ago that we were getting doctored to death, you would’ve thought me obtuse. When I claim today, though, that every head bump doesn’t need an MRI, you get it.
There’s a growing buzz about Americans receiving too much health care. In fact, overtesting and overtreatment are the main source of health care’s amazing expense. You can …
Doctors are short on curiosity. Here’s why.
Quintessential Messi. One moment he is standing over the ball, in a seemingly harmless position at midfield, the next thing you know you are picking the ball out of the back of the net. How did this come to pass? How did things change so rapidly? When you watch it the first time, it’s disorienting. It makes no sense. How does …
The physical genius of Lionel Messi, and how it relates to surgery
The best way to avoid being sued for malpractice is to make certain that all your patients are happy and all their outcomes are good.
Reality is seldom so rosy. Patients aren’t necessarily happy even when their clinical outcomes are as good as they can get. In the event of an undesired outcome, an unhappy patient may easily become a litigious one. A 2011 study in the New England Journal …
Following evidence-based guidelines won’t protect you from malpractice
Recently I’ve been asked to write about rural surgery, what it’s like, what’s good about it. Everything has its ups and downs.
First of all let me say that whatever your job is, the money you get paid to do that job is for the crappy part, and every job has a crappy part. The trick is to find a job that …
What’s it like to be a rural surgeon? Read this to find out.
It could be the title of a new prime time show (maybe it should be): The Great Discharge Paperwork Makeover. Assemble a group of bright and creative minds from across the country and put them together in an exotic location for a week to talk about something that will affect all of us one day — either ourselves or a relative. …
It’s time to give discharge paperwork a makeover
As a little kid, I used to love the bedtime story about Humpty Dumpty and his fall from the wall. “Humpty Dumpty sat on a wall. Humpty Dumpty had a great fall. All the king’s horses and all the king’s men couldn’t put Humpty together again.” Until recently, I never thought about this story as a logical and sad analogy to …
Stop the Humpty Dumpty approach to health care
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