Most of us reject the rational argument that better medical quality costs more money. Conversely, I have argued that spending less money could improve medical outcomes. Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy. Not a day passes that I don’t confront excessive and unnecessary medical care — some of it mine — being foisted on patients.
I keep six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.
– Rudyard Kipling
Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done.
What else could explain why IT people tell doctors what “workflows” …
Are millennial doctors well trained for the 21st century? That was the question posed in NPR’s Millennial Doctors May Be More Tech-Savvy, But Is That Better? I believe how millennial doctors are educated may make them less adequately prepared than previous generations. This isn’t a reflection of medical education, but of education in general.
Do the technological tools available prevent the engagement needed to …
Dr. Kenneth Azar, a mentor of mine at the old Georgia Regional Psychiatric Hospital in Augusta, Georgia, told me something once that has always stuck with me.
He told me that in the early years of his practice, when he was living and working out in Idaho, that he was one of a very small handful of psychiatrists who served the whole state. If an adult with psychosis needed to be …
No one wants a hospital-acquired infection — a wound infection, a central line infection, or any other kind. But today, the level of concern in American hospitals about infection rates has reached a new peak — better termed paranoia than legitimate concern.
The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies. As far as I can tell, …
One of the American College of Physicians’ priority areas for the current fiscal year is to “Help ACP members experience more joy in their professional lives.” This includes decreasing what is known as the “hassle factor” that …
“If doctors do no other good, they at least prepare their patients early for death, undermining little by little and cutting off their enjoyment of life.”
These words from Montaigne are 350 years old, but, sadly, too often they describe the results of modern medicine, particularly when it is mindlessly applied in a needlessly heroic way to the end of life.
It’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient. The general consensus, unsurprisingly, was that the first was far too cheeky — not to mention insulting — to effectively convey the necessary information. The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send the …
I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the …
Each year as the holidays approach, countless medical families prepare for the dreaded release of the holiday schedule. Will the physician spouse be home this year? Will the non-physician spouse be packing up three kids under the age of five and traveling across the country alone to visit family they may only see once a year? It can be stressful. It …
The phone rang one evening and a pleasant voice was on the other end. “Hi, my name is nurse so-and-so and I’m the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?” she asked. “It’s very helpful to go over things before and after your surgery and to answer any questions you might …
There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but …
The safety concerns that keep clinicians awake at night often aren’t issues that you could fit onto a safety and quality dashboard. They aren’t the kinds of things that feed metrics on the CMS Hospital Compare website or any of the other sources of publicly reported quality measures. They are intensely local, and no less important for being so.
This reminder came to me recently during a quarterly meeting of Comprehensive Unit-based …
Is it just me, or is the world of medicine getting way more complicated?
Sometimes I long for the good old days of practicing medicine.
First, the hospital switched over to electronic medical records, which required us to attend Saturday morning classes to learn how to tell the nurses our patients could go home after surgery.
Two weeks ago, I went on an awesome vacation to Las Vegas. It was my first paid vacation of my medical career and by all accounts it went very well. I won $50 on the penny slots and got to see my old friend, the Hoover Dam. Many “Vegas vacation” lines were uttered as we walked across the dam bridge and asked all the dam questions we could think of. …
People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments.
These days, America’s emergency rooms have filled …
Recently, allegations have been spread by women who claim that as teenagers, they were sexually assaulted by Bill Cosby. Some have not made any mention of these crimes until decades later; while others have said that they did report the allegations at the time of the assault, but were not believed. Due to Cosby’s notoriety as a celebrity, this has fueled …
I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes.
Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or …
In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks.
I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life.
People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments.
