Consider this scenario.
You are getting older, and are concerned about the costs of nursing homes and long term care. So, you decide to get expensive long term care insurance to protect your family from these costs. The policy will pay some of the cost of long term care if you develop cognitive or physical disability. All you have to do is keep making payments on the policy until you have …
Long term care insurance: The premium catch
This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.
In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in …
Everyone should have a pleasant mammogram experience
When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.”
Patients in hospitals do a lot of waiting. They wait for physicians. They wait for nurses. They wait to use the bathroom. They wait to undergo procedures. They wait for their IVs to stop beeping. They wait for the person next door to stop …
Don’t take patients’ patience for granted
Hi. This is doctor Rob, and you have reached my blog. If you are here to read my blog, then continue to do so. If this is an emergency, please call 911.
That is one of my pet-peeves. Every single doctor’s office I call I am told the same thing: “If this is a true emergency, please hang up and dial 911.” I even got that message when I called the ER.
When I …
How can patients assess what is a true emergency?
In trying to understand my own burnout, “control” (or lack thereof) is a dominant theme. This is nothing new. In fact, I doubt I’m unearthing bones not already thoroughly analyzed. But I can give instructive personal examples.
For a while I was on the board of directors of my clinic, which was then and is even more so now one of the most successful doctor-owned and -managed in the US. During …
Physician burnout: The additive effect of bureaucracy on the psyche
There’s a piece in the Atlantic entitled “The Psychology of Lululemon.” I probably would not have read that article but for the fact that I was in Lululemon recently buying my wife some yoga clothes. This turned out to be an interesting read. The premise of the piece is that athletic clothing makes people want to work out — that in some way, clothes have power over the wearer.
Of course, I …
Infection control versus psychology: To white coat or not
In retrospect — always in retrospect — it should have been obvious that, when it came to Dr. Charles Denham, something was not quite right.
In a remarkable number of cases of medical errors, it’s clear — again, in retrospect — that there were signs that something was amiss, but they were ignored. The reasons are manifold: I was just too busy, things are always glitchy around here, I didn’t want …
Inside the first scandal in patient safety
I have never been involved in a medical malpractice case, but I have recently been the victim of a sociopathic legal abuse situation entirely not related to medicine. It involves a no-good attorney with the ethics of a camel, a multiply convicted felonious sociopath, and his long series of victims including his own prison guards who he is suing because his feelings were hurt.
As my small part of it, I …
The legal system has serious problems, but who are we to complain?
Two decades ago, a decision was made by Medicare policymakers that carotid endarterectomies would not be allowed. Their claim was too many were being done costing Medicare money. The following year, data revealed a sharp rise in debilitating strokes, so wisely, surgical criteria was developed recommencing the use of this quality-of-life saving operation.
For years, there have been other misjudgments against Medicare patients that are only now becoming apparent. Let me clarify …
Observation status: When you’re not a hospital inpatient
Today, I hesitated to refer a patient to hospice. The patient is perfect for that model of care. She has strong family and friend supports, multiple opportunities to maintain quality, independence and dignity, and while she has a disease we cannot fix, she will do very well with personal palliation. Nonetheless, I almost did not recommend hospice, because I realize that hospice is going to completely fail to take care of a …
After hospice takes over, what happens to the physician?
Ben’s first symptom was coughing up blood. The cancer had been silently growing for months, if not a few years. He had no pain or shortness of breath. The chest x-ray showed a “5cm L hilar mass” and the subsequent CT scan showed enlarged lymph nodes and likely spread to the liver.
“So Doc, what is it? A cancer? How much time do you give me?” All these questions on a …
After a cancer diagnosis: Giving a patient time
In medicine today diagnostic testing and advanced imaging is readily available and widely utilized in most every clinical setting. Many physicians have given up the stethoscope and physical exam in favor of an echocardiogram and a CT scan. Fear of missing something pervades every emergency department and has resulted in hundreds of thousands of unnecessary testing costing billions of dollars in healthcare expenditures.
Of course, the driving causes of increased testing …
Test overuse: Why does it happen and what can we do about it?
I am a huge fan of the winter Olympics, partly because I grew up in Canada (where most kids can ski and skate before they can run) and partly because I used to participate in Downhill ski racing. Now that I’m a rehab physician (with a reconstructed knee) I’m thrilled to have the opportunity to interview Team USA’s chief medical officer, Dr. Gloria Beim. As we enjoy the Sochi Olympic …
An interview with Team USA’s chief medical officer
ADVERTISEMENT
The decline of medicine as a profession began when it became legal for doctors and hospitals to advertise.
Apparently it all started when an Arizona lawyer sued for his first amendment right to advertise his services. In 1977, the US Supreme Court ruled that states could not prohibit advertising by lawyers.
This opened the floodgates for all professionals. Soon advertising by doctors and hospitals became common.
I don’t know what it’s like where …
Why doctors and hospitals shouldn’t advertise
Cardiologists are causing patients to get cancer.
It’s true.
Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever.
As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual.
And cardiologists routinely subject patients with normal …
Did a New York Times column unfairly attack ER doctors?
When, a couple times each year, dozens of our county teenagers train to become EMTs, they know they are taking on a challenging, heavy responsibility. But probably none of them are ready for the kind of horrible death our community experienced a week ago, when a 15-year-old-girl walking home from school in Rockville was struck and killed in a crash involving two cars that news reports say may have been …
Thank an EMT for their courage, their dedication and their spirit
The future of robotic surgery can be determined only by probing the possibilities. To ignore the potential for extending the boundaries and safety of surgical care with robotic technology seems unwise.
-“The Future of Robotics,” Bulletin of the American College of Surgeons (July) 2013; 98:9-15.
It is a spring morning in July 2047. Jenny, a nursing assistant, emerges from an exam room and gently closes the door. She is wearing scrubs tastefully covered with …
Removing a suture: What the future may bring
Home visits are hard, there is no doubt about it.
I felt like I had been driving for hours. The thirty minute travel time showing on my GPS was woefully understated due to the arctic temperatures and colossal snowfall. My jacket and clothes felt caked with dried salt rubbed off from the car or somehow accumulated from the ether. I pulled the key out of the ignition and braced for the …
A few short years ago, my wonderful father-in-law Bill was diagnosed with an inoperable cancer.
My husband and I traveled to the Midwest to visit Bill and my mother-in-law Betty. We were happy to be able to spend a little time with him, and he knew we were there.
Sadly, he passed away the night before we left.
We believe he held on until my husband arrived; all his other children lived nearby.
Later, …
Grateful for the pennies from heaven
I feel …
Much better than I did after my last chemo cycle.
I feel tired, but not bad.
I feel really glad that using a smaller needle for the lumbar punctures spared me the headache.
I feel thrilled to have a port and have that PICC line out. There’s nothing like having medical tubes dangling out of your arm to make you feel extremely cancery. Plus, with the port buried under my skin, water …
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