Every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice. This issue is not restricted to the medical universe. Every one of us has to navigate through similar circumstances throughout the journey of life. If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than …
Why the ER admits too many patients
When we moved to Irving, TX and I decided to join a practice in nearby Lewisville, I realized I wanted to know more about the schools in the area and get a feel for the culture of the teachers that would be teaching my patients and kids. I searched online and found great and encouraging information about Carrollton-Farmers Branch, Irving and Lewisville school districts. I also looked up several teachers …
What would a flipped checkup look like?
The doughnut shop I pass on my drive to the hospital isn’t the kind of place where you might expect to see outpourings of random kindness. It sits in the shadow of a raised highway, a few doors down from a bail bond business and a block away from a prison complex that resembles a medieval castle.
One Sunday before Valentine’s Day, the line to get served there was long, checkered …
What paying it forward in health care looks like
It’s not that I was stressed out about being alone with the kids. My wife had gone out of town before. It was the darn mornings. I’m used to racing out of the house at the crack of dawn, when the rest of my family is still asleep. My most productive hours of the day are before most people even wake up. With my wife gone, the mornings with the …
Savor the moments that make a life
When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor’s office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used …
A requiem for handwritten admitting orders
I recently got back from a brief trip to Florida. I went down there to celebrate my mother’s 85th birthday. As you might expect, her social circle has shrunk in recent years, but she did get a number of cards and calls from friends and family members. The cards were on display in her kitchen, and a few calls came in while I was there. One in particular pointed out some …
The patient offered a diagnosis, and the doctor missed it
In a recent New Yorker article about him, Dr. Mehmet Oz was paraphrased as saying that “Marcus Welby — the kindly, accessible, but straight-talking television doctor — is dead.” If he believes that, Dr. Oz needs to get out of New York.
At 51-years-old, I’m a little too young to remember the television show Marcus Welby, M.D, that aired on ABC from 1969 to 1976. A colleague told me the show was pretty …
The country doctor is alive and well
Earlier, I wrote about the tragic case of a young girl in California who was declared brain dead after what most media sources called a tonsillectomy. In fact, the patient had a much more extensive procedure for treatment of obstructive sleep apnea. In addition to having her tonsils removed, she underwent an uvulopalatopharyngoplasty (UPPP) and resection (removal) of her inferior nasal turbinate bones.
As I stated before, I …
Must a surgeon mention death as a complication?
There is, of course, stuff we can chew and swallow that isn’t food. Play-Doh comes to mind. As does Silly Putty.
My thoughts turned to those substances, among others, when my friends at Time magazine asked me recently to opine on the suggestion that junk foods should carry warning labels. My first inclination was: No, that’s too much. But then it dawned on me: Is anything that …
Should junk foods carry warning labels?
Next in a series.
As a patient, you have probably had the experience of meeting a physician for the first time and very quickly becoming comfortable that he or she has your very best interests utmost in mind. The sense comes quickly; you become comfortable, less anxious. Unfortunately you may have had the opposite experience of encountering a well-educated, well-trained physician who, although technically an expert, left you cold.
As a …
Do you trust your primary care physician?
A woman in her 70s came into my clinic recently. Her primary doc found a mass so she came to the hospital for a biopsy and passed out on the table so they scanned her head and found a mass there, too. She started radiation and then came to meet me in the outpatient clinic.
She had trouble expressing herself because she’d had a stroke two decades ago, but it didn’t …
During this visit, my job was to watch
The legislation proposals aimed at allowing physician assistants and nurse practitioners to act independently and deliver primary care services in place of physicians is a change in health care that we may face with an impending primary care physician shortage. It is an important topic for patients and physicians to discuss since ultimately those two groups will be impacted most by this change. Patients should be concerned with the quality …
The evolving models of primary care: More harm than good?
The key change in medicine that has caused a escalation of costs, a decline in the quality of care, and an increasing shortage of physicians is the shift toward an exclusively business contract with society at the expense of the social contract.
To differentiate the business contract from the social contract I will use the following example. One afternoon I see my neighbor hard at work changing her tire. If I …
The ongoing battle for the soul of health care
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“Nine of 10 doctors discourage others from joining the profession,” writes Daniela Drake on the Daily Beast.
And stats say that by the end of 2014, about 300 physicians will commit suicide.
What is going on?
A few years back, practicing medicine was named the second-most suicidal occupation. Yet, it hasn’t stopped. The level of sheer unhappiness among physicians is on the rise.
Being a doctor has become a humiliating undertaking. There …
Status quo primary care: How did things get this bad?
The last time I was in Israel, I went on some home visits with a palliative care physician in the town of Sfat near the Sea of Galilee. My colleague, a devout Jewish doctor, took me to several homes to offer advice on managing his most serious, terminally ill patients. One older Chassidic Rabbi was dealing with an advanced lung cancer, and having a difficult time accepting any kind of …
Not acknowledging death does not make it go away
I’ve based a huge chunk of my career on the assumption that evidence-based information helps people make better informed health decisions, have better health conversations with their doctors and ultimately leads to better health outcomes.
Evidence is my stock in trade. I have spent many years translating evidence into a form that people can understand. I’ve written thousands of evidence-based articles across many channels. I’ve written position statements, belonged to guideline …
The problem with evidence-based health is not what you think
Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn’t help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by …
The health care industrial complex is stronger than ever
to live in this world
you must be able
to do three things
to love what is mortal;
to hold it
against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go
-Mary Oliver, New and Selected Poems, Vol. 1
As a parent, you are not supposed to have a favorite child, and since some of us physicians feel a strange but kindred protectiveness for our patients, likewise we …
My favorite patient died last night
Fifteen years ago I got an unexpected invitation to write a column for a dermatology newspaper aimed at practicing clinicians. Because dermatology is a concrete field that lends itself to punning, I called the column “Under My Skin.”
Writing it monthly since then has given me a chance to take a humorous and sometimes cathartic look at the joys and woes of practice. It’s fun to do, and gratifying to hear …
Shared exasperation is cathartic
Patient noncompliance.
I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time.
We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often …
Physicians are noncompliant too
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