I can’t mention the physician by name, because he is currently in contract negotiations. But he lives and works in a Midwestern town of several thousand people, a town where the major social event of the year is a fall festival that features a parade down Main Street. The physician, let’s call him Dr. Smith, has been practicing there for nearly …
There’s a new hospital CEO in town
I often get referrals from the town’s free clinic. As you would imagine, the patients often have a unique set of problems, coming as they do from the underserved segment of society.
One such patient, Julia, was a fiftyish-year-old woman who had recently moved to town from California. She went to the free clinic (not really sure what the original complaint was) and ended up getting a physical exam that revealed …
Mental illness: Is it organ dysfunction like any other?
Americans are waking up to the fact that the $170 billion that Medicare spends on the last six months of life is not helping us die well. Instead, the way we die today tends to be protracted, undignified, and painful. Sarah Palin’s “death panel” debacle temporarily stifled all discussion on the subject, but the silence has been broken by dialogue inspired by the Institute of Medicine’s recent report, Dying in …
Moving towards a culture of care during end-of-life conversations
Let’s face it, residency is no picnic. A combination of on the job training and trial by fire, no physician who has gone through it and survived will ever forget the experience. The emotions run from jubilation to sheer terror. It is inevitable that some of the people you interact with will leave a lasting impression. In the case of the …
A tale of two surgeons: Which would you choose?
Prisoners are a common occurrence in Bellevue Hospital. This, however, was my first prisoner-patient. The hyphenation both as I write this now and as it formed as a concept in …
Reflecting on the physician’s social contract
About a year ago, there was a great commercial that depicted the slowing of time as a free-falling, but worry-free, James Franco uses his smartphone to chart a safe landing on the billowy awning of a restaurant dozens of stories below. There probably isn’t a single person who hasn’t, at one point or another, wished she or he could control time in order to navigate a better outcome. And doctors …
Physicians are the Rosetta Stone for patients
Delivering bad news is part of my job, an important part.
It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that’s very true. But even in the best of times, it’s a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and …
Delivering bad news shouldn’t be easy
Dear patients,
First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service: trust me, it’s not “free”) has probably motivated more of you to call. That’s OK. But sometimes it seems that your …
Let’s clear up the confusion about what a physical is
How many times do we start out our day with the best of intentions? It’s probably most days, if you’re at all like me.
Even when we’re going through a spell of negativity, we all try to pull it together for the sake of our patients, our staff, our families.
A couple weeks ago, I was tempted to throw in the towel.
It was one of those days when the last straw was …
Crisis averted after a tense moment in the operating room
Forty is the new thirty. Orange is the new black. And failure is the new success.
It seems these days that no success story is complete without a failure (or two) along the way: the bankruptcy that gave birth to a successful company; the entrepreneur who lost it all just before hitting the Fortune 500. Entire issues of the Harvard Business Review and the New York Times Magazine have been devoted …
Why it is critical we learn from past health care mistakes
Party Weekend
– Joe “King” Carrasco
Fight for Your Right (To Party)!
– Beastie Boys
We Just Wanna Dance
– The Flirts
My favorite radio station, WHFS, had a ritual every Friday afternoon to start off the weekend, back in the day. DJs Weasel and Bob Here would exchange pleasantries as they exchanged shifts, and would launch the same set of songs at the same …
Is it time to abandon the 9 to 5 workweek in hospitals?
The following article is satire.
LAS VEGAS, Nevada — As times have become harder for emergency departments around the country, one local hospital, Snooty Hospital and Casino (SHC), has come up with a solution to capture precious reimbursement from individuals with “enhanced diagnosis and treatment goals.” When checking into the ED either by ambulance or at the front desk, patients now have the ability …
Executive workups: The ultimate in patient-centered care
The American Board of Internal Medicine is irrelevant. It has always been. I realized this when I first certified in internal medicine in 2002. The test was largely fact-based and filled with information that I would never need to know in practice. It did not measure my diagnostic acumen, or my physical exam skills, or my ability to listen and empathize …
When it comes to the ABIM, physicians must choose wisely
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My career is based on communication and empowerment within the medical world. I educate on the patient/family side and the medical professional side. It takes understanding and empathy from both sides of the stethoscope to optimize communication. It takes communication between both sides to bridge perceived power differentials. It takes work on both sides to change a culture of uneven power dynamics.
I read two Facebook posts within the past few days dealing with a …
Change the culture of uneven power dynamics
In my travels up and down the East coast, I’ve worked with a number of health care administrators (and even temporarily been one myself, although quickly discovered that it wasn’t quite my cup of tea). The experiences that I’ve had have been highly variable, and I’ve seen the full spectrum of administrators ranging from the brilliant to the quite dire. As someone who has read many autobiographies of famous leaders, …
Good health care leaders have these 3 traits
I recently attended the David Stroud Adolescent and Young Adult [AYA] Symposium at Keck Medicine of University of Southern California. It was a very interesting symposium with experts in adolescent and young adult cancer presenting on many different topics important for this population. There was also a panel of young adult …
Should we give patients our cell phone numbers?
Popular TV doctor, Gregory House’s favorite adage about patients is: “Everybody lies.” I used to believe that this was a cynical and inaccurate statement, but I had to revisit it recently when faced with a patient whose signs and symptoms were consistent with a diagnosis that she vehemently denied.
A young woman was admitted to my rehab unit with brain damage of …
Why patients lie to physicians
My husband was in the aisle seat, I was in the middle seat, and The Man was in the window seat.
The Man had one white earbud in his ear; the other one was dangling in his lap. His right thumb swiped through several screens of his smartphone in less than a second. He heaved a sigh.
“This is f*cking lame,” he muttered.
The plane was supposed to take off 15 minutes ago. …
I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city. They are a world class medical institution whose reputation is largely derived from its cardiovascular department. Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects. The entire campus is smoke-free, as …
Can hospitals tell workers not to smoke at home?
Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the president, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after …
After a verdict: Doctors need to be taught a lesson. Really?
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