In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers.
One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on …
Bad medical care: Is it better than none at all?
When I was a boy, my dream was to become an airline pilot. The job seemed glamorous and exciting, and appeared to be held in high regard by all the people around me. I actually used to have a bit of an obsession with airplanes, and living so close to Heathrow Airport, had plenty of opportunities to see planes and visit the airport: both as a passenger and whenever we …
The future of doctors? Airline pilots provide a clue.
Next in a series.
The fundamental problem in health care delivery today is a highly dysfunctional payment system that leads to higher costs, lesser quality and reduced satisfaction. It also means less time between doctor and patient with the loss of “relationship medicine.” The core problem? Price controls and regulations that reduce the trust and core interactions between doctor and patient. The patient is no one’s customer and visit …
Paying the doctor directly is better for all concerned
An excerpt from The Demise of Medicine.
The Dalai Lama has once been quoted as saying, “Our prime purpose in this life is to help others. And if you can’t help them, at least don’t hurt them.” In a nutshell, the Hippocratic Oath can be summarized in this one phrase: “Primum …
Throwing the Hippocratic Oath in the trash
Recently I was the only witness to testify against local medical marijuana legislation. The bill, already endorsed by all members of the Council of the District of Columbia, would allow use of marijuana for “any condition for which treatment with medical marijuana would be beneficial, as determined by the patient’s physician.” As I waited hours for my turn to highlight the medical evidence about marijuana’s health effects, I sat silently, taking in …
Medicine by public opinion: Where are the doctors?
For the better part of the last two decades I have practiced psychiatry in a variety of different American health care systems, and over these years I have, on numerous occasions, heard psychiatric services referred to in manner that imply (often subtly) that such services are not medical care. These references come not only from patients, but nurses and doctors (including myself) too.
“Yes Mr. Jones you need to follow up …
Integrating psychiatric care into primary care: The VA example
Up until 1988, being board certified in pediatrics was a voluntary process of passing the board exam once in a career. The American Board of Pediatrics (ABP) apparently realized this process didn’t make them much money, so in 1989, they abruptly ended “lifetime certification” and required an open book test and the associated fee every seven years. I was in pediatric residency during this maintenance of certification …
The mission creep of maintenance of certification
Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth.
Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family.
Doctors delay childbearing and starting their own families so they can care for your family.
Doctors miss their own kids’ ballet recitals and baseball games …
Why you should love your doctor
An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.
You’ve told your story. Your doctor gets it. He has completed the physical exam. He formulates a plan to get you better. The next skill you should master may be as important as being a great storyteller. Your doctor has told you the …
A simple trick to remember your doctor’s recommendations
I am not strongly against the death penalty on principle or on moral grounds — assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals.
I don’t even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a …
The economic case against the death penalty
Whenever I talk with groups of medical professionals about job frustration and burnout, there’s a theme that shows up that’s hard to ignore. I call it “the pain of perfection.”
Most of us pursued careers in medicine to help others. And if we’re honest, we must admit that we have type A tendencies infused in our bloodstream.
Can I see a show of hands, please?
That part of us, the one that strives …
Perfection fuels physician burnout
My general internal medicine practice is equidistant from the three academic institutions and a Veterans Administration facility, and thus I have patients who receive primary, secondary and tertiary care at each of these institutions.
The notes I receive back from one of these organizations are hands down the best of the four institutions. These notes are personal, concise, precise and clear. If …
Replacing transcriptionists with physicians is a fool’s bargain
It is a trade secret among patients of many practices: If you’d like to be seen by your personal physician with no waiting and without an appointment, just ask for a free blood pressure check and then mention to the medical assistant that you are not feeling well at all. They can’t send you home without being seen and they don’t have enough to go on to call an ambulance; …
Always start your diagnostic search from the beginning
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How do you really know if your doctor, surgeon or hospital is good, bad or somewhere in between?
I frequently speak with large audiences, ranging from CEOs to Stanford business school students.
I often start by asking participants to raise their hands if they receive excellent health care. Each time I ask, about 90% of the hands in the room shoot up. But all the hands come down when I ask, “How do …
It’s very difficult to assess a doctor’s true skill or performance
The world is asunder. Iraq is sinking into a sectarian abyss. ISIS, a terrorist group, now controls a larger territory than many actual countries. Russia has swallowed Crimea and has her paw prints all over eastern Ukraine. China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines. The Israeli-Palestinian peace process is in another deep freeze. Terrorists in Sudan and Nigeria are kidnapping …
FiveThirtyEight had a provocative article: “Patients Can Face Grave Risks When Doctors Stick to the Rules Too Much.”
The subsequent comments have debates over the value of guidelines. Guidelines are like a box of chocolate, you never know what you are going to get. Many clinical questions yield competing guidelines. We all know the controversies over breast cancer screening and prostate cancer screening. Recently blood pressure targets and lipid management have …
Everything in medicine requires context
I flunk as a parent. I have no plans for my youngest kids this summer.
The older ones are working. But the 13-year-old and 8-year-old, the ones at the formative stages of their academic and skill development (if you believe what everyone says), are doing squat. No camp. No enriching activities. No special trips. Well, we do rent a house at the beach for two weeks every summer, that’s something, but …
Kids in the summer: There’s more to it than academic progress
Kasey sits alone in the examining room, staring at the drug company calendar of a perfect Caribbean beach hanging above the doctor’s desk, but not seeing it at all. She is very frightened. After three years of treatment for cancer, she is in trouble. Kasey feels fine: no shortness of breath, no cough, no pain. Still, she is there to get the report on her CT scan, and she knows …
His reputation precedes him: Meet the bad news doctor
We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long …
Why the ER is a mixed blessing for society
I really hate it when a nurse practitioner is called a mid-level provider.
“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.
The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals …
Stop calling nurse practitioners mid-level providers
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