What do we want in the last days of life? We want no pain. We want simple dignity, the physical kind where we clean ourselves, organize our medicine and command our bowels. As important is the complex dignity of choosing where we spend our final days, make tough decisions for ourselves and, as much as possible, live as a person, not a patient. It occurs to me that these critical …
What is quality in end of life care?
The Institute of Medicine in 2010 famously recommended that nurses should be encouraged to practice “to the full extent of their education and training.” Often, you’ll hear people advocate that every health care worker should “practice at the top of their license.” What this concept is supposed to mean, I think, is that anyone with clinical skills should use them effectively and not …
Preventing doctors from practicing at the top of their license
The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you’re still happy. What’s so wrong with that? If I wanted to be miserable, I’d have gone into primary care.
When a surgeon screws up, his/her role is clear: Admit it, make it better, or as good as possible, and stick with …
Managing unhappy patients after surgery
The world is a big place and here in the U.S., we are fortunate to live in a part of it where we have access to technology and advanced medical care, clinical trials, and new therapies, even before they are approved by the Food and Drug Administration. Indeed, even new agents approved for one indication can be prescribed off-label in …
Cancer care for international patients
Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there …
Can doctors ever work together with insurance companies?
Why does is seem that so much information given to us comes with disclaimers? The weight loss product ads on TV that promise more than they will deliver, are always accompanied by 5 nanosecond disclaimers in a font size that can’t be discerned by the human retina stating that the results are not typical.
It seems deceptive to be advertising a product by showcasing a performance that the vendor admits is …
Maybe doctors should have disclaimers
The doctor-patient relationship is under threat from state laws that try to shape what we can and can’t do for our patients. Many state legislatures are proposing laws that limit the questions doctors can ask patients in our confidential clinic visits. Do you smoke? Drink soda? Exercise? Do drugs? Is there a gun in the home?* Do you want to be pregnant? Is there fracking near your home?*
The questions followed …
State legislatures should not enter the exam room
Recently, there was an issue in my O.R. No, the surgery went well. The patient was healthy and tolerated the procedure just fine. And, yes, we had the proper equipment and it all functioned perfectly.
This was another kind of issue, something that I had not encountered before. It turned out to be a life lesson. My team and I were getting started in the O.R., for a fairly routine day. …
A life lesson in the operating room
Pamela Wible, MD, a family physician who is an expert in physician suicide prevention, recently asked other physicians why so many in the profession kill themselves. The answers were plentiful, tragic and not at all surprising.
One physician confessed to having post-traumatic stress disorder after medical school. Another cited constant sleep deprivation. Yet another mentioned the combination of a crushing workload, a difficult boss and payers who are more …
A physician’s story of mental illness
The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution — unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing.
While working as an assistant …
Ignaz Semmelweis and the lessons of fear and medical innovation
I received a fax recently, from the office of another hematologist-oncologist, at another academic medical center. Attached to the fax cover page, with my name and fax number scribbled in slanted script, was a five-page consultation report on one of my patients. That oncologist — I’ll call him Dr. Z — had seen and evaluated my patient to provide a second opinion on the patient’s diagnosis and treatment.
The lengthy report …
The art of writing a good consultation letter to another physician
When one hears the words “language barrier,” it usually brings up images of a person who is in another country of which the national language is not his own. If you have visited a foreign country without fully knowing the primary language, you can start to feel out of place fairly quickly. Despite one’s best efforts to navigate the country, a part of the cultural experience is lost without knowing …
Breaking down the language barrier in medicine
A perspective that comes from continuity of care over many years. An awareness of local resources. A sense of who a family is. An appreciation of the things that give life meaning and value to a child and family. Isn’t this care a lot to offer families of seriously ill children? What happens to all of this knowledge when a child becomes more ill and spends increasing amounts of time …
Training community-based pediatricians in palliative care
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As both a practicing physician and the co-founder of a mobile health startup, I’m often greeted with confusion about my two roles. It’s not that there aren’t others simultaneously involved in both endeavors — because there are lots of us. It’s that many people see a contradiction between the mindsets of the two. The way one thinks for medicine, they suggest, is not the way one needs to think for …
Medicine and business are not mutually exclusive
I wouldn’t say I’ve had a lot of revelations in my professional life, but there is one that still affects me emotionally to this day, and it’s about nurses.
I had been a PICU doctor for a number of years, and I was rounding on all the patients in the PICU with the rest of the team. The background sounds consisted of the usual beeps, alarms, and humming from the patient’s …
Nurses are the reason doctors look good
Next in a series.
How many patients can a primary care physician (PCP) reasonably care for? I have been interviewing PCPs: Here are some of their thoughts when asked this question.
Responses were widely divergent ranging from about 300 to 3,000 or even more. Yet many are clearly conflicted. Some say they can manage about 2,000 with little difficulty — but then observe elsewhere in the conversation that they have no …
How many patients can a primary care physician care for?
Every time you turn around, it seems there’s another CEO apologizing. But, when do apologies work? When does an apology help everyone learn, improve, and move on? What distinguished sincere apologies from the rest? I think it takes three ingredients:
What distinguishes a sincere apology from the rest?
Much of the news we hear about primary care is disheartening at best, frightening at worst. Most of us have heard that there is a shortage of primary doctors, and with over seven million new patients enrolled (and counting) through Obamacare health exchanges, that shortage is going to get much worse. On the horizon, while medical schools are increasing their enrollment, there continues to be a dearth of students willing to apply to …
The resurgent interest in primary care
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Mission must have always been in my blood, but it took me a while to discover it. I considered going on a mission trip to Bungoma, Kenya, in 2009, but the timing coincided with one of the major conferences at the New York State Society of …
A mission trip to Kenya: Challenge, success and heartbreak
This article was originally published on May 12, 2014 in MedPage Today’s Ivan Today.
My brother would have turned 37 today.
But he didn’t. On January 9, 1995, he died in a car accident, at the age of 17.
That was the day he became a statistic.
I don’t usually need any reminders this time of year. If I somehow forget, May 12 is …
The day my brother became a statistic
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