Our 13-year-old woke up feeling lousy two days ago. He had a sore throat and sinus pressure, and felt really tired and generally icky. He didn’t look toxic — just a little tired. I gave him a zinc lozenge and told him to get ready for school — a method that generally can tease out exactly how bad one of my kids feels. He just sat at the table.
We generally …
The art of medicine lies in knowing when a little time is needed
We hold these truths to be self-evident:
A hospital administrator with a clipboard is in search of a physician who isn’t following “evidence-based guidelines.”
There are fads in medicine just as there are in fashion — today’s ”evidence-based guidelines” may be tomorrow’s malpractice.
Did your hospital, like so many, abruptly switch from povidone-iodine antiseptic solution to ChloraPrep® for cleaning a patient’s skin before surgery? If so, I’m sure the staff was told that ChloraPrep would …
Evidence-based guidelines today, malpractice tomorrow
On December 23, 1971, President Richard M. Nixon signed the National Cancer Act of 1971, and declared the “war on cancer.” The allusion to combat appealed to the soul of the American people not long after their success in World War II and the humiliation of Vietnam; they intuitively understood the sacrifice, teamwork and massive effort, which is implied in the concept of War and they were ready for another victory. Committing dollars, …
Defeating cancer is not an armed conflict
Here’s a question I’m almost afraid to ask: when you go to a doctor (not one you see all the time), does the doctor usually introduce himself (or herself) and explain what they are there to do?
And, do they sit down?
I really hope that you are answering yes … but I know that the answer is often no.
In a study recently published in the Journal of Hospital Medicine, researchers observed 29 …
What to do if your doctor isn’t polite
The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish.
The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of …
Is there a downside to open access scheduling?
Ms. Smith (name changed) is 82-years-old, but currently looks about a hundred. I met her, intubated, in the ICU two weeks ago. She lived alone, hadn’t told family she wasn’t feeling well, but had called 911.
In the emergency department, she was struggling to breath, and was intubated, having gone into respiratory failure. She was found to have a severe pneumonia affecting the majority of both her lungs. She also went …
The true service your doctor is providing is thinking
Patient satisfaction and improving the hospital experience is being discussed in hospital boardrooms across the country. Now that financial reimbursements are directly tied to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores, there is a significant incentive to do so. A multitude of ideas are being put forward into how this can be achieved, and hospitals are investing heavily to get tangible results. Many involve complicated and …
5 straightforward ways to improve patient satisfaction in hospitals
A guest column by the American College of Physicians, exclusive to KevinMD.com.
A couple of weeks ago, a television commercial caught my attention. It was an official-sounding announcement, a “national healthcare alert” that if you have Medicare, you might qualify for a knee brace “at little or no cost to you.” I found it interesting because a week earlier, a durable …
The high cost of “free,” unnecessary medical equipment
Doctors are tough critics — as well they should be. The news that CVS Caremark pharmacies will no longer sell tobacco brought about quite a bit of rapid online dialogue. Even President Obama chimed-in with praise, a response that some in the business world say is worth billions for CVS. Having a good reputation, particularly when you’re in the business of delivering health care and lending health advice, seems essential. In my …
CVS stops selling tobacco: Let’s keep it in perspective
Are you a practicing primary care physician, board-certified in either family medicine or internal medicine, and in good standing with your state licensing board? Do you have concerns about the relative lack of primary care professionals, especially now that 40 million new patients have been added to the U.S. health care system this year?
What if I told you that you, simply by carrying on with your usual daily …
Reentry physicians are an invisible minority in American medicine
It started with a dead laptop. For the first time in more than 3 years I felt like a doctor again. I had forgotten what it was like.
Having neglected to plug in my laptop the night before, it was without power. (Without power!) An opportunity for an uprising, of consciousness if not full revolt.
For the first 1½ hours of clinic I entered each exam room without the weight of the …
Entering the exam room without the weight of the computer
Recently, CVS Caremark announced that starting October 1, they will no longer be selling tobacco products, including cigarettes, in their CVS stores. Taking a bold and unexpected stance on the issue, CVS’s CEO Larry Merlo reasoned to ABC News that “We’ve come to the conclusion that cigarettes have no place in a setting where health care is being delivered.”
What does he mean by that?
Here, he is referring to CVS’s robust market of …
Banning cigarettes is a start but CVS still has a long way to go
I was 8-years-old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning, reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been …
The influence of Janis Babson can be felt by many physicians
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He does not want to talk to me, that much is clear. He has had enough of doctors. He is a man of few words. His eyes do not meet mine. His coarse, calloused farmer’s hands play purposelessly with the starched white of the hospital bed sheet. The gentle hiss of his oxygen is barely heard over the hum of the city traffic below. Out of his element.
“Tell me, what …
Palliative care: The first conversation
I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.
Why have so many patients lost trust in their doctors?
You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question. I haven’t …
Why patients have lost trust in their doctors
I have been doing admitting shifts at a large hospital, as hospitalist. It is flu season, so volumes are large. Even people without the flu are sick. It often happens that way. And they are so very sick!
The thing about the very sick patients I see is that they are generally what might be called medical “train wrecks.” They are very sick because they have had interventions over the years …
The wisdom of Dr. Bernard Lown and sick patients with chronic diseases
By now the world has heard the remarkable news. CVS Caremark will no longer be selling its tobacco products in any of its stores. Locked and loaded with the news, the American Heart Association, American College of Cardiologists, local public health experts, Phillip Morris, and even the former-smoking president of the United States was quick to applaud the news by publishing press releases.
But when press releases and major announcements of …
One cardiologist on CVS and cigarettes: Let’s not fall for the spin
A couple of weeks ago my nurse came to me with a request for a consultation. Since our schedule has been packed full lately, she’s been asking me where I can squeeze patients in.
She said, “I’m not sure about this one — he says you treated him twenty years ago and he wants to see you. But there is no new pathology so I don’t know how urgent it is.”
I …
A cancer patient return visit after 20 years
In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:
For many of us, Cooper wasn’t even the cheapest way to go to school…So the question is: why did we go? We went not because of the financial value of free–that is, zero tuition–but rather, because of the academic value of free. At Cooper Union …
Why monetary carrots and sticks are detrimental to health care
“Do you mind telling your legions how long you intend to work?”
Certainly. The short answer is, “Indefinitely.”
The more detailed answer (technically, the answer to “Why do you answer that way?”) has two parts.
First, I love what I do. Just about every part of it. I love it. I wake up eager to get to work each morning. Being continuously on call is an opportunity, not a chore. I love my …
I am in a long term relationship with my patients
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