Here’s a doctor’s health tip for patients that I’ll bet you haven’t heard before.
If you’re a patient who walks into a hospital for an elective procedure of any kind — surgery, or a diagnostic test — and you find out that Joint Commission reviewers are on site, reschedule your procedure and leave. Come back another day, after the reviewers have left.
Why? …
When the Joint Commission is at the hospital, leave
Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call.
Granted. However, these awful events are part of …
Should doctors be paid overtime for taking call?
There is a growing recognition in medical education and practice that the spiritual component of human existence must be recognized and addressed. The American College of Physicians has concluded that physicians are obligated to attend to all dimensions of suffering: the physical, psychosocial, spiritual, and existential.
Similarly, the Joint Commission on Accreditation of Healthcare Organizations (JAHCO), which accredits hospitals, recognizes that spiritual concerns are often important for patients and that hospitals …
Physicians should recognize patients’ spirituality
Complicated medical procedures can be dangerous, even when done by highly skilled and experienced people. Why? Because, irrespective of the procedural risk itself, all of us are human and we can overlook or forget things, no matter how many times we have done the procedure. This was recognized many years ago in the airline industry. Flying an airplane is a complicated and potentially dangerous activity and their are many steps …
Procedure checklists work only if they are used
I recently talked about how we might approach the idea of our own death. I wanted to start a discussion about how individuals engage with, think about and plan for the end of their life. In offering a medical perspective on what death is like, I hoped to stimulate self-reflection about this scary and foreign topic.
However, when we think about death, we don’t just think about our …
Have a conversation with your family about the end of life
Dear Mr. Will,
I read your recent column on the “supposed campus epidemic of rape, a.k.a. sexual assault” and am somewhat taken aback by your claim that forcing colleges to take a tougher stand on sexual assault somehow translates into a modern version of The Crucible that replaces witchcraft with rape hysteria.
I was specifically moved to write to you because the rape scenario that you describe somewhat incredulously is not unfamiliar to me. …
College rape: A response to George Will
While rotating through the local Veterans Affairs (VA) hospital during my residency in radiology, I noticed a curious phenomenon. When the weather was pleasant a large number of veterans would not show up for their scheduled CT scan or MRI. When the weather was miserable or dangerous the attendance would be maximum.
We named this phenomenon the “VA paradox”: a paradox because this is the opposite of what usually happens.
After deeper …
The VA “works” because veterans are less demanding patients
It’s a cold and rainy morning, and we’ve traveled to the middle of Central Pennsylvania to see a presentation at a conference about a patient-centered medical home product produced by one of the largest health care systems and insurers of the region.
There are clinicians and administrators from all over the eastern half of the U.S. (plus one from California), and also a large contingent visiting from the U.K., on a …
The patient-centered medical home isn’t ready-made
In my line of work, it’s not uncommon for a civil debate about the evidence for a cancer screening test (such as the PSA test for prostate cancer) to rapidly degenerate into the other person questioning my motives or suggesting that the real reason I oppose disseminating or requiring insurers to pay for a test is because I secretly want patients to suffer lingering and painful deaths. (“He obviously doesn’t care about …
What does it take for a cancer researcher to know cancer?
I have a love-hate relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based.
A recent piece in JAMA and the editorial that Read more…
A love-hate relationship with practice guidelines
I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery. The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa …
A perfect thank you note to an oncologist
It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look.
The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered …
The bus driver and the destiny of the children in the bus
Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, “Are Children Overmedicated?” seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the “usual” explanations given for the increase prescribing of medication. In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy to provide …
Young children are silenced by psychiatric medication
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In an article entitled, ”Why the ER admits too many patients,” Dr. Michael Kirsch tries to explain that emergency department admissions are inflated due to emergency physicians acting in their own self-interest. Many emergency physicians have read this and taken offense, feeling that his assertions point unfair blame on them for a significant portion of excesses in medical care and costs. I share this visceral reaction in part, but …
Emergency physicians are blamed for a broken health system
From the moment some patients arrive in your office, nothing seems to suit them:
So why are some patients so grumpy?
I believe many patients come to us with a wall of fear around themselves. They are worried about the outcome of their …
Medicine isn’t about pleasing all of the people all the time
It’s one thing to ask a doctor to stay current on his knowledge, it’s quite another to insist he survey his patients for a private enterprise, especially if that survey represents unvetted independent research.
Recently, a colleague of mine was attempting to maintain his board certification credential with the American Board of Internal Medicine (ABIM) and signed up for the ABIM’s requirement for a practice improvement module worth a required 20 …
Maintaining board certification: Stop with the patient surveys
Every time I see a GlideScope, I can’t help but lament, “why didn’t I think of that?” To me, the GlideScope exemplifies how physicians can apply their practical knowledge of medicine to create technology that improves patient outcomes.
I had a front-row seat to physician-designed technology prior to my residency, when I worked at an early-stage venture capital fund advising on health care investments. We invested in a number of physician-founded …
Initial steps for physician entrepreneurs
A few months ago, I walked into work on a late-night shift. One of the nurse practitioners came up to me and said, “There’s someone you need to see right away.”
The patient was a woman of about 60, and it was clear that she was critically ill. According to her husband, she’d been diagnosed with cancer six months ago. It had metastasized throughout her body. Her oncology team made several …
Empowering patients: Emergency department palliative care
There’s no arguing the fact that evidence-based medicine (EBM) is moving us in the right direction as far as treating and preventing illness in medicine as a whole, but what does EBM, in its current interpretation, mean for medicine as an individualized art?
Everything new or controversial in medicine seems to have a swinging pendulum. From vaccines to hormonal treatment to alternative therapies, the pendulums of medicine seem to be in …
How does evidence-based medicine affect the art of medicine?
Nearly all physicians are now subject to patient satisfaction ratings. In my case, and many thousands of my colleagues across the country, it is via the survey tool sold to health care facilities by the Press Ganey Company. There are also many, many online sources that rate physicians.
The idea is a good one: Physicians should be subject to feedback from patients about patient perceptions of how good a job the doctors …
Why patient satisfaction surveys are riddled with problems
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