I don’t like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician. I like to play Sherlock Holmes and figure out what’s going on with people, and I think I’m pretty good at it.
So I lied. I do like to brag … a little.
In most people’s mind’s eye, the role of diagnostician …
When diagnosing patients, Occam’s razor sometimes fails
As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult.
But the importance of this task should not be overlooked. …
The unhealthy behaviors of physicians
In a recent post, I wrote about the value of a yearly checkup with your child’s doctor — it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips.
First, and most important at all, go to the visit. You’d be surprised how often children are brought by …
How to get the most out of your pediatrician’s checkup
California is contemplating requiring physicians to submit to alcohol and drug testing. Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired. Physicians, as members of the human species, have the same vices and frailties as the rest of us.
I have no objection to this new requirement, if it passes. This will not be …
Drug testing doctors: Will Californians see through the smoke?
“Dad, you have the nicest patients!”
She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what’s important in medicine. In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives.
It had been over ten years since I had my first “bring your daughter to work” experience. Her first time …
Bring your daughter to work: A reminder of what’s important in medicine
We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact.
– Dr. William Mayo
The practice of medicine involves a lot of details, but details without the big picture are meaningless at best and distracting at worst.
The expression, “the devil is in the details” implies that the details can …
Medicine has lost sight of the big picture
During her annual physical exam, one of my patients recently asked me, “Are urgent care centers any good, Dr. P?”
She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care — at least some medical attention — more imminently than she could get from waiting to speak to my office in the morning. She …
Incorporating urgent care into the medical home
Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle-scarred chests. Occasionally, when …
Consider the messages that tattoos are sending
Not too long after setting up shop in this town, I shared a tough case with one of my favorite intensivists.
(By way of diversion, I’ll add there were only two of them at the time, and they were both my favorites. Practical and canny, surgical-patient-wise, they were a pleasure to work with. Over the years we developed great mutual respect and affection; to the extent that caring for critically ill and deeply …
A relationship between a surgeon and an intensivist
Have you ever had a situation where your perception of some event or entity changed dramatically in an instant?
I specifically remember an instance of this happening to me while working as a junior medical student in a family practice clinic.
It was a typical day and I was doing the typical thing that you’re supposed to do as a medical student — feign interest in the clinic’s goings on and try …
How perception of the patient transformed in a single visit
“Daddy, I think we have a flat tire.”
I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting.
How could she possibly know what a flat tire sounds like? Now? Right now? She’s …
Chest pain and what we can learn from changing flat tires
If you’re a doctor, I bet you speak doctorly. You act doctorly. And dress doctorly. And spend your days in clinic with other doctorly doctors.
But life is what happens while you’re busy staring at computerized flow sheets, algorithms, and billing codes.
Real life happens outside of man-made medical institutions. Patients live in the real world. And I always wanted be a real …
Drop doctorspeak and get real with patients
When I was a medical student, I worked with an non-government organization (NGO) in Rwanda to provide medical care to women with HIV. Nearly all had witnessed their family members murdered during the genocide, and many became afflicted with HIV as a result of rape. Our initial focus was on getting antiretroviral therapy to these women, but we quickly realized that while it was important for them to have access …
Help patients by addressing the health of the community
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We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few …
A letter from a hospitalized patient to a hospital CEO
There are doctors that patients see. And there are the doctors that patients almost never see.
Patients see me, an obstetrician, at prenatal visits, in the ultrasound unit, or on the labor floor. But they don’t see all the wise radiologists reviewing their imaging studies, or the educated pathologist assessing whether their biopsy is cancerous. Some of the most important doctors that our patients don’t see are the ones in the …
Recognize the doctors patients often don’t see
Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me.
I went to visit a patient who was admitted over the weekend to see what was going on. She was a bit upset about the confusion of the hospitalist service and how orders apparently didn’t get written for her care by the admitting physician. …
At the hospital, I’m Dr. Nobody
Call it concierge, call it direct care, boutique, fee-for-service, call it what you will. I call it a solution. As physicians, we’re all solutionists, are we not? With every differential diagnosis, assessment, and plan, we are creating solutions. In accordance, one does not become a doctor for any reason other than changing the world. Perhaps this change happens one patient at a time, but working toward a greater cause and putting …
Solutionist medicine: How the concierge model can reinvent primary care
Nearly every day we read headlines about the serious prescription drug problem in America. Increasing heroin addictions and deaths from illicit drug use are taking a severe toll on far too many families and communities. While we must feel enormous sadness for the families experiencing these tragedies, we must not overlook the other major health crisis that is often associated with the opioid abuse problem: chronic pain.
The chronic pain crisis …
Intimidating doctors won’t solve the chronic pain epidemic
I was taught in medical school (some 50 years ago) that doctors had a special duty to protect the patient. That seemed self evident and logical. “Do no harm” was a first principle dating back to Hippocrates. However the teaching I received extended the concept to also protect the patient from bad news, and to make “the right” decision for them — not necessarily including them in the conversation or …
The evolving physician role in end of life decision making
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist. Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician. Once we get into the discussion, patients are also surprised to learn that …
A primer on the anesthesia care team model
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