We’re all waiting for something.
As kids, we waited for the time that we could do it ourselves, go it alone, tie our own shoelaces, order our own food off the menu, take our baths by ourselves, and walk up and down the street or around the mall without parental supervision. We were kids. We didn’t yet have enough life experience or enough insight to realize that the time we occupied, …
We will be waiting for something until the day we die
Communication is critical to success in medicine. Our patients depend on us to help them understand their disease and the risks that it may pose. In previous blogs I have commented on how vital effective communication can be in determining outcome — much of my writing has focused on the success associated with outpatient doctor-patient relationships. We now know that when doctors and patients engage, patients become invested in their …
A hospital stay provides new insights into the patient experience
One aspect of the endless vaccine debate is the aspect of coercion some parents feel about requiring children to be vaccinated before they can go to school. The government mandates vaccination. But this isn’t really an absolute requirement. Although all 50 states ostensibly require vaccination, all but 2 (Mississippi and West Virginia) allow parents to opt out for religious reasons, and 19 states allow this for philosophical reasons. (See Read more…
Vaccines: An unprecedented use of state power?
Remembering why we got into medicine in the first place can often soften the edges of long, difficult days.
My story unfolded on a circuitous route to medical school. I started with a master’s degree in sociology, and my first job after I graduated was working for the Virginia Center on Aging. I administered hour-long assessment surveys to the elderly population of the state. I would drive my old Volkswagen to …
Remember why you got into medicine in the first place
Considering that hospital medicine has only really taken off as a specialty within the last several years, it’s amazing how far the specialty has come.
The word “hospitalist” was first coined in 1996 when it was used in a New England Journal of Medicine article as a way of describing those internal medicine doctors who practiced inpatient medicine instead of primary care. Back then, hospital medicine was a strange new phenomenon.
Fast-forward to today, …
Hospitalist groups can make or break hospitals
1. Process vs. product. Computers are just machines. I repeat, they are just tools. Health information technology is a shell which houses knowledge and human ability. It is nothing more. Electronic medical records may either streamline our thought processes or make them more cluttered. They will not, however, lead to better or more perfect care. They haven’t yet, and they won’t in the future. And they are prone to be adulterated …
10 reasons to feel pessimistic about health care
During an afternoon seminar on a new paradigm for lung cancer screening in primary care, my phone chirped announcing the latest MedPage Today bit of breaking news: “Medical Homes May Not Be the Answer.”
A study in JAMA reported that cost per month per patient had actually increased, and only one marker of improved care was found to have improved after thousands of patients were followed in a large group of patient-centered medical …
Give the medical home more time before declaring it a failure
When I was a resident in emergency medicine, at what was then simply Methodist Hospital of Indiana, I was blessed with the opportunity to fly with Lifeline. While I am originally from West Virginia, where rural means mountainous, I came to love the beautiful, stark emptiness of Indiana as seen from the sky. And over time, I came to truly appreciate the small, rural hospitals that called us for help …
There is a disconcerting myth about single mothers that has been circulating in our society for some time. It was popularized in the Reagan Era as a denunciation of US social welfare policy and resulted in a pointed caricature of a woman on welfare, forever to be known as the “welfare queen” or the entitled single mother.
The narrative of such a woman goes something like this: Not only is she …
The myth of the entitled single mother remains as relevant as ever
Have you ever encountered an intrusive, insistent popup decision support screen while trying to take care of patients? Found yourself stuck in a dead end electronic hallway without egress? A situation where you had to choose an option that was inappropriate for your patient just to exit the screen?
This is the situation with my local medical institution’s “DVT Advisor,” a mandatory decision support screen for all patients.
DVT Advisor was implemented …
Can decision support tools actually harm patients?
Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice.
A few days later, I get this email: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking …
How to save hundreds of dollars on your medical bills
Next in a series.
There is and will be a need for many more primary care physicians (PCPs).
Why?
There is a shortage now and it will be exacerbated in the coming years for at least three reasons. The population is growing, the population is aging and there will be more individuals with health care coverage as a result of the Affordable Care Act (“Obamacare”).
I believe that the need will be much …
Lack of listening is the core care problem in American health care
Merrill Markoe’s reports that she was fired by her doctor in her article, “My Doctor, the Concierge,” which was both sarcastically entertaining and painfully true. She writes a powerful commentary on the divide caused by insurance companies between doctors and patients. She is shocked at the rapidly growing trend of an access fee to see concierge doctor and yearns for the Hippocratic Oath’s “May I long experience the joy …
Don’t blame doctors for going concierge
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“Just start work half an hour earlier.”
This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles.
She suggested that if we started our usual practice morning at 8 o’clock we should just have everybody come in at 7:30 to load the dashboards for the morning session …
Huddling in the medical home: Sounds good on paper
As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home.
We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about …
Medicare should cover infusion services at patients’ homes
I have just turned on my computer. It is midnight. I should be trying to sleep right now.
My 5-year-old is sick and I am on call for the next few nights. Fortunately, my daughter should get better in a day or two. She needs Tylenol for her fever, mama’s love and time to kick this virus. But as I sat in bed holding her and waiting for her fever to break, …
A pediatrician’s survival story: Remembering the children
Several years ago I took care of an elderly woman in the ER. She came in with a chief complaint of chest pain. She came in via ambulance and by the time she got to the trauma bay she said she was feeling a little bit better. She didn’t know she was about to die, usually people who are about to die look much worse.
She looked good, all things considered. …
Letting go can be the hardest thing in the world
Walking parents through the decision to vaccinate their children is a conversation. The vast majority of the time it is an easy conversation. Sometimes it is difficult.
If the conversation goes like this, then we, as doctors aren’t doing our jobs:
Pediatrician: “Are you going to vaccinate your child?”
Parent: “No.”
Pediatrician: “Get out of my office.”
The medical community has lost a lot of ground …
How to talk with parents about vaccines
The Affordable Care Act (ACA) will increase insurance coverage for the poor, uninsured and minorities, but will it improve access to care and population health? The answer depends critically on whether or not physicians are available to care for the newly insured. Many health policy experts fear there may not be.
While the ACA contains some modest pay increases for doctors willing to see patients with Medicaid (the means-tested joint federal-state …
How can the physician workforce be diversified?
I gave a talk recently to a group of my peers about addressing the needs of patients after a diagnosis of cancer, emphasizing points where transitions occur — from treatment, to end of therapy, surveillance, recurrence, and extending all the way up to the end of life — and how important it is to consider the entire journey of a person …
Are physicians ready for the e-patient movement?
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