The conversation was almost comical, until I thought more deeply about it later. Apparently I was on “the list.” Insurers make such lists for customers who are searching for a doctor who accepts their coverage. Every so often my name comes up on these lists, and I get a smattering of phone calls from perspective patients. Maybe a few times a …
Our health care system makes no sense. But what if it did?
Once upon a time, in a medical school far far away, I was taught that my sacred oath was to the patient. The one patient; not the patient down the hall, in the next town, or in a country halfway around the world. I would commit my heart, soul, sweat and blood to the suffering and healing of the person directly, immediately in my care. This was a noble calling …
Physicians must expand the vision of their role
An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …
Why does treating heart attacks cost so much money?
Standing in front of my patient’s home, I reach out to ring the bell. On the other side of the door live a man and his wife, who have been waiting patiently for my arrival. I hesitate for a moment before pressing the button.
As I wait uneasily for the door to open, I think to myself that this is the first time I make a house call on my patient …
The last house call: Turning off the defibrillator
On September 4th, 2014, iconic comedian and TV personality Joan Rivers passed away due to complications following what seemed to be a routine visit to her gastroenterologist.
Up until now, a wave of speculation and mystery has surrounded her case with a trove of unanswered questions. What happened on that tragic day? What kind of procedure did she have? Was it a dangerous surgery? Who was in the room?
On October 16th …
After Joan Rivers: How we can make patients safer
There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest Read more…
Ferguson: What should physicians do?
The recently released report, Shooting at Sandy Hook Elementary School, from Connecticut’s Office of the Child Advocate offers a searing in-depth account of the holes in our mental health care system. The report is careful to point out that no causative link exists between their findings and the events at Sandy Hook. However, this in-depth investigation offers an opportunity, if we are able to hear and take action on its …
The Shooting at Sandy Hook report: 4 things we can learn from it
We’ve all heard or used the phrase, “Leave it to the professionals.” It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a toolbox at home, but it is stocked similarly to the first aid kit that your new car …
Get help: Most physicians are not good at business
There are times when who you are and what you do are inseparable. A photographer views a scene from the camera’s point-of-view even when the camera is not in hand. A police officer assesses situations with an “on duty” reaction, even when off-duty. And a health care professional rarely turn off the knee-jerk reaction to assist when someone requires help.
That immediate …
A walk in Central Park: Contemplating physician burnout
A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could …
Physicians are treating the well, and nurses are treating the sick
As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.
In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …
Why teaching anatomically correct words matters
This courageous physician blows a whistle on the human rights abuse in hospitals. Doctors forced to work 8 consecutive days. No sleep. No access to food. Doctor forced to work in ICU after having seizure. Is this the care you want in American hospitals?
Full transcript:
The hospital administration and the national hospitalist company that I worked for made this agreement that the shifts would be 24 hours. And they would …
End the human rights abuse of medical students and doctors
Middle-aged lady, twenty pounds overweight.
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada.
Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …
Two patient result letters: Which one did this physician send?
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You treat a disease: you win, you lose. You treat a person, I guarantee you win – no matter the outcome.
– Patch Adams
Health care reform sounds like a great idea, in theory. Get more people the access they need. Improve the quality of health care provided. Get doctors on electronic health records so they can more easily coordinate care between specialists. …
Regulations are changing the very heart of medicine
When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to …
Everyone cries when they bury their dead
The reports from India read more like the review of a horror movie rather than a detailing of a government funded surgical program: 83 women receiving a surgical sterilization leaving 11 dead and another 50 hospitalized, 20 of whom (as of this posting) are seriously ill. And all of this happened in six hours with one surgeon at a government sponsored sterilization camp.
As an OB/GYN I want to tell you how bad this actually is.
The …
The sterilization deaths in India: It’s worse than you think
Even after so many years, I take the process of starting someone on anticancer treatment very seriously. The drugs we use can cause damage, and that damage can persist long after the end of the last planned treatment. Platinum salts can cause neuro- and nephrotoxicity. Taxanes can cause neuropathy. Angiogenesis inhibitors can result in hypertension. The lists of potential …
Trivializing the significance of losing one’s hair during cancer treatment
Not too long ago before I was unexpectedly dismissed by my organization, I had the audacity to complain and request change for the betterment of my patients. Forgoing the traditional route of a solo practice, I wanted to join a large organization which supposedly provides a worry free investment that normally comes attached with starting an independent medical practice. I agreed to the terms and conditions of any large …
When joining a medical practice: The importance of autonomy
I am presently doing locum tenens shifts in a lovely community in Oregon as a hospitalist. I have been to this hospital before and was glad to return when they needed some help. I like this place and noticed on my first go around that patients got good care and that physicians and nurses all seemed to get along pretty well together.
When I first worked here, 2 years ago, they …
Should hospitals manage hospitalist programs?
I recently visited a friend who works at Google and was pleasantly surprised by the Bay-area tech giant’s health-promotion efforts. Its crowded cafeteria offered mostly healthy food, with low-fat, low-carb, and high-fiber delicacies. Any dietitian would have appreciated the plethora of organic dairy products, the salad servers filled …
Why do hospitals feed their staff so poorly?
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