One good thing about doing anything for three decades or longer is that you get to see cycles and repeated events, things that fail and things that work. I hope that over the last thirty years of learning about psychiatry and mental health (and yes, I am still learning and hope to acquire that one last little piece of knowledge on my deathbed) that I have paid attention to the …
My best teachers are my patients
Improving patient satisfaction and enhancing the hospital experience is all the buzz today in health care. Every hospital executive across the country is talking about it, and coming to terms with how their organization’s reimbursements will be directly tied to their performance in this area.
A decade ago, none of us had ever heard of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, the core metric by which health …
Hospital medicine doctors are key to improving patient satisfaction
A respiratory physician who I worked for had an uncanny ability of predicting the diagnoses the admitting junior doctor would fail to consider in patients presenting acutely with difficulty in breathing. He was using a checklist, which he developed after years of observing his housestaff.
As a surgical intern I was once praised for my presence of mind in cross matching blood for a patient with a rare blood group who …
Checklists alone do not produce a culture of vigilance
Most physicians will be sued for malpractice during their career. A group at Harvard has estimated that by age 65, more than 75% of physicians in low-risk specialties such as family medicine and 99% of physicians in high-risk specialties such as surgery will have been sued. Over 95% of physicians do experience emotional distress during some or all of the process of litigation. Malpractice suits can take between …
4 keys to manage medical malpractice stress syndrome
Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients. As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor. Despite her instructor’s recommendation to ask …
Self-censoring of patient information may be a public health hazard
“I’m so sorry, but it looks like the cancer has spread.”
As I heard these words come out of my mouth, I knew that in a split second, a new reality was created in the mind of the patient that I was talking to. I looked at his face and saw that he was trying to remain strong, but in his demeanor, it was apparent that dreams were crushed and that …
Unexpected lessons from an unexpected patient
Summer, 1998
Three Rivers Stadium
Pittsburgh, Pennsylvania
It was a typical Saturday morning on call. We’d finished rounds and I’d taken the sign-out from the resident who’d worked the night before. I headed to the library, planning to do some board prep before the inevitable beeper call to the ER or ICU. I was a PGY-4 neurosurgery resident, with many previous weekends on duty to my credit. No reason to think this one would be …
What a World Series MVP taught me about practicing medicine
I recently spoke to a quality measures development organization and it got me thinking — what makes a good doctor, and how do we measure it?
In thinking about this, I reflected on how far we have come on quality measurement. A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or …
Can we measure what it takes to be a good doctor?
Malcolm Gladwell thinks we should tell people whats it’s really like to be a doctor. And by God I have invested the last seven years in doing just that. I have written countless blogs, given lectures, and traveled to Ireland. I have coined the term Caring 2.0 to describe the bidirectional flow of empathy. Patients will tell us what it is like to suffer with disease, and we …
Assure patients that we are on their side
I have a confession.
It is a secret I have held for more than 10 years and it is a lesson I have learned from other women.
As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise …
New feminism is about women, work, and the will to be authentic
Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients.
But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, …
They used to tell us, as physicians, that “if it isn’t on the chart, it didn’t happen.” We could protest all day, to billing companies, insurers or attorneys, “I did that. It’s assumed. I always do the same thing every time.” But they would retort, “nope, it’s not in the chart.” So we learned to detail everything, every time, every movement. Every consideration and justification. The idea being, our ‘thought process’ …
If it’s not in the computer, you didn’t order it
“I walked in a person, and out a cancer patient,” my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine — the side on the exam table or gurney, as opposed to the one standing over it. As a physician I was used to the latter. This is my family’s story in our new position, and how the cost of medical care has impacted …
A struggle against cancer becomes a financial worry
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Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way …
A 10-step process to finding a good doctor
Next in a series.
As a general rule, PCPs like people. This was true of them long before they started medical school and it will have only blossomed further during training. Ask PCPs, as I have with in depth interviews, and they will tell you that certain types of individuals are drawn to primary care careers.
They like to converse with people. They enjoy getting to know about a person — …
What are the characteristics of a good primary care physician?
“Medication mishaps cause a huge number of hospitalizations and in fact the majority of hospital readmissions. Making more time for visits with aging and complex patients is critical to avoid mishaps of poor communication and rushed decisions. A dose of ‘slow medicine’ may get us to our goal of system sustainability faster,” writes colleague and fellow blogger Dr. David Moen.
Dr. Moen distills Dr. Dennis McCullough’s ideas about slow medicine down …
How to make practicing slow medicine a reality
Have you ever had a conversation that rattles around in your head for days? Maybe, it changed what you thought you knew about the world. Perhaps the ideas or comments did not make any sense. I had a discussion last week and it seemed that logic stood on its head. The means was defined by the end, with no connection to the beginning, or more exactly, the tail wagged the …
When insurers dictate medical decisions
In a recent article, Malcolm Gladwell dissected and diagnosed American health care.
Throughout our interview, he tackled controversial topics from the Affordable Care Act and medical malpractice to the contrasting Canadian health care system and much more. I expected him to dive deep below the surface and provide new and intriguing perspectives. He didn’t disappoint.
But it was his closing comment that caught me off guard. When I asked Gladwell …
Help people understand what it is really like to be a physician
With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead.
This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages.
Response in the press has already raised issues with this, suggesting that this move would do little …
Is it any wonder why young doctors shun primary care?
Imagine — where would elective surgery be today if patients still worried about operating rooms exploding or developing liver and kidney failure from anesthesia?
Having major surgery would be a very different experience without anesthesia. Before the advent of safe anesthesia techniques, the world of surgery was basically limited to amputations and other attempts at life-saving maneuvers. Dr. Bigelow’s publication describing the safe administration of ether changed everything, and the New …
Physicians specializing in the patient experience
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