Who watches the watchers? It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well. It means, “How do I know that the people guarding me are worthy?” It has also been translated, “Who guards the guards?”
But it seems to me that it applies to medicine quite appropriately. Who watches those watching physicians? We …
Who watches those watching physicians?
We will all someday die. No matter how good our doctors are, how many scans we get, how compliant we are with medications, how many cutting-edge surgeries we undergo, we will all die. That scares us. Most of us fear death: We do everything we can to avoid it, and when it inevitably comes, we struggle and refuse it. Similarly, when someone we love is dying, we want to do …
Addressing death is an important aspect of public health
With new revelations emerging every day about the botched execution of a prisoner in Oklahoma, even those who favor the death penalty (I am a strong opponent) may have some reservations about the way it is carried out. Despite the uproar from both sides, I believe there are some major ethical considerations that have been overlooked in this case.
Setting aside for a …
After the botched execution: It’s time to lift the veil of secrecy
She looked like a whipped puppy that had had a garden hose turned on it and slunk off to a far corner of the yard to dry out in the sun.
She sat there, wizened but hard, thin and wiry, dressed in standard issue blue emergency room scrubs, thin tanned face, long stringy, wet prematurely gray hair falling limply around her shoulders. She looked down at the floor, but when her …
Out of the many he has seen, he will do his best to help just this one
An obstetrician is found dead in his bathtub. Gunshot wound to the head. An anesthesiologist dies of an overdose in a hospital closet. A family doctor is hit by a train. He’s decapitated. An internist at a medical conference jumps from his hotel balcony to his death. All true stories.
What are patients to do?
When they call for appointments, patients are …
Physician suicide etiquette: What to do when your doctor dies suddenly
Greater discontinuity equals greater dissatisfaction.
On Wednesday afternoon, one of the residents stopped in my office to talk about a patient he had just gotten off the phone with. It was a patient of his who had asthma and a recent upper respiratory tract infection for which she had received treatment at an urgent care center with an oral antibiotic and a course of steroids.
She told him that she was still …
Continuity of care increases patient satisfaction
Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life.
Linda is an elderly woman with moderate dementia. She is blind …
Yes, it really is time to revoke the health care mandates issued by bureaucrats who are not in the profession of actual healing.
Daniel F. Craviotto Jr. writes in the Wall Street Journal, “In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship.”
Craviotto, Jr. is a doctor who embodies the fight of …
Say no to bureaucrats and yes to direct care
It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured.
As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room …
Being a nurse is the noblest profession
As I work with more and more doctors around the country, I am encouraged by what I am witnessing:
What doctors can learn from Russian dolls
I recently went to an “admitted student day” with my eldest son at the university he plans to attend in the fall. On our campus tour, our guide pointed out a block on the ground in the center of campus (which incorporates a symbol of the university) that no one steps on because “stepping on it will cause you to fail your first exam.” In the winter, it is the …
Remember that our patients frequently feel a lack of control
“I see you haven’t had your flu shot this year, Mrs. Adams. Would you like to get it now?”
“Nice try!” she replied playfully, her warm smile conveying a serene confidence forged by seven long, difficult decades on this earth. “But you know I never get the flu shot.”
“I know,” I said, still hopeful I could change her mind, “but influenza can be very dangerous, particularly in patients over the age …
Medicine and its tension with faith
Speaking only for myself (but guessing I’m not alone), I can say when a patient develops post-op problems, there’s a strong tendency to deny it: not to deny there’s something wrong; not to dismiss the patient’s concerns or symptoms. Just to grasp first at the less dire set of possible explanations. Maybe it’s just the flu, constipation, drug reaction. That sort of thing. It’s not about blowing it off — …
For better or worse, doctors are human
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Have you ever thought of an x-ray technologist as a key player in promoting high-value, cost-conscious care?
Recently, an x-ray tech saved one of my patients from unnecessary imaging. Here is the story. Last fall we had set up a 6 month follow-up ultrasound to check on a patient’s abdominal aortic aneurysm, an aneurysm that was too small to require surgery, but too large to ignore. The day before the ultrasound …
Health care is ultimately a social enterprise
As physicians, we’re all pressed for time, with patient demands, family conflicts, and personal moments of stress. Many of us were acculturated in medical school to ignore our own stress and burnout and instead to devote ourselves to our patients. That tactic may have worked in an earlier world, but with a more complicated and demanding practice environment, it’s no longer tenable today.
Two activities help me maintain my personal health …
Incorporate other hobbies and passions into physicians’ daily lives
You were supposed to die of cardiac arrest as you circled toward home plate. Or of a brain aneurysm in the summer during one of your countless hikes through the mountains.
You weren’t supposed to die here. Not in a hospital bed, inhabiting this fragile new body, with an oxygen tube in your nose and tumors in your lungs.
Two days before you left us, I traveled home to visit you. I’d …
I have often spoken of the doctor-patient relationship as a covenant. Our patients bear their bodies and souls in exchange for a thoughtful, engaged, respectful partner in navigating health and disease. This dyad, this trusted space, allows for the breaking of cultural norms and full disclosure. Proper healing is an agreement, it is a relationship.
Although often not spoken of, any successful flourishing health care system also requires another …
The covenant between physician and society is being broken
Another backboarded body rolls in. I slip from my perch at the computer and greet the emergency medical technician.
“Seizure. Lasted a few minutes, done by the time we got there. Fell and cut his face. Vitals stable. Sugar fine. Oriented but postictal. Didn’t take his meds.”
Approximately my age, the backboarded man’s chin bears a ribbon of red laces.
“Dammit,” he says. A glance at the cardiorespiratory monitor shows me suitable hemodynamics, …
Playing a game of Russian roulette with his life
Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death costs a lot, and society can go broke providing costly medical care to everyone. Society saves money and lives when everyone sees a primary care doctor who works to keep people well.
But we don’t and won’t have enough …
How to stop losing primary care physicians to burnout
It’s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction, burnout and even suicide. In fact, some believe that up to a third of the US physician work force is planning to leave the profession in the next 3 years — an alarming statistic.
Direct primary care practices are touted as the best …
Can locum tenens work solve physician burnout?
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