I guess it shouldn’t have been a surprise.
Her house was exactly as I expected it to be. The door couldn’t have been more fitting; red wood with a green holiday wreath attached perfectly in the center. The carpet was so white that I almost took off my shoes on the front porch before entering through the threshold. The room was warm. The ambient temperature was accentuated by a plethora of …
Inside a home visit: Seeing her as she really was
How’s my practice doing?
I am now up to nearly 400 patients, and while Jamie and I have talked about hiring a new staff person, we seem to be hitting our stride in this different practice model and have not yet been overwhelmed. New patients are coming with regularity, some still coming from my old practice and many others through word-of-mouth from satisfied patients. Yes, people still seem very satisfied with …
A year into direct pay: It doesn’t suck to be a doctor anymore
I was recently in the break room at the hospital scarfing down a power bar between three-hour cases. The truth is, I was multi-tasking: eating, writing on a chart, and checking my email in my phone.
I had received an email from a businesswoman, whom I have known for a few years. She wanted to know if I wanted to join her for lunch next week.
I had to laugh out loud.
The …
Doctors experience the world a bit differently
We guard the privacy of patients in my hospital zealously — we take care of a lot of celebrities since we’re right in the shadow of Beverly Hills. And of course we live in terror of HIPAA violations, those federally mandated HHS rules that protect individually identifiable health care information and could bring down “civil money penalties” upon us if we don’t keep our patients’ medical records strictly confidential.
But for …
Flu vaccination by government mandate: A violation of HIPAA
Marc Lachance is the perfect consultant. Ten years my senior, he had more than mastered his specialty by the time I came to the area. He had also established himself as a mentor to Cityside Hospital’s residents and many young physicians who sent him referrals or called him for curbside consultations.
Marc used to live in a rambling farmhouse not far from where I live. But then his elderly father, widowed and …
A dying breed: When the perfect consultant retires
Perhaps you’ve seen some of the media coverage reporting that “an apple a day” would save as many lives as statins do, with fewer side effects. Or perhaps not — thankfully, this tongue-in-cheek “study” didn’t get the intense coverage received by the new statin guidelines (an issue I recently addressed on this blog). But I think this is a glaring and important …
When medical literature mislead journalists and the public
This is the time many of us make resolutions about our lives — often tied to our health and wellness.
As the health care industry enters a new era of consumerism, people are seeking more and more ways to take ownership over their health and health care. While data about doctors, hospitals and health outcomes are becoming more available and transparent, we still have a long way to go.
Perhaps in a …
5 health care resolutions to make in 2014
As I noted earlier, hospitals permit around-the-clock observation of patients. If you don’t need around-the-clock monitoring, you don’t need to be in the hospital.
Who is doing this around-the-clock monitoring? Nurses.
Therefore, whether you are a patient or a physician, one of the best things you can do is get on the good side of the nurses.
If you are a patient, a nurse watches over …
Doctors and patients: Always thank your nurses
I recently wrote about how our world is ruled by love, and circumstances conspired to show me just how true that really is.
Love is when I go to the ER at UCLA, where I work, for a cough and feeling that “something isn’t right,” and even though my complaints are mild, I’m brought right in and treated respectfully.
Love is when the chest x-ray comes …
My cancer shows how our world is ruled by love
“For someone who went into medicine to ‘help people,’ you sure do talk about dying a lot,” my mother told me one day on our brief weekly phone call. I try to get in a phone call to my mother once a week so she knows I’m alive, surviving my intern year. I had been on medical intensive care unit (MICU) service and it had been a rough week. Being …
Doctors cannot predict when the end of life truly comes
As the year comes to a close, we physicians feel tremendous uncertainty with the rain of change from Washington. As I approach my third decade of medical practice, I feel more distant from the patient who desperately seeks my attention. I struggle daily to reconnect with her, recalling the fading reasons I embarked on this field, trying to resuscitate the patient-physician relationship which is central to our broken medical system.
Often …
A large part of healing is listening, caring, and imparting hope
As my Division of Hospital Medicine has grown — now to about 60 faculty — I spend part of my time figuring out what direction we should go in. At times, the path is obvious. It didn’t take Wayne Gretzky to recognize that we needed expertise in healthcare IT a decade ago, or in cost reduction more recently.
The story of how we became the nation’s leading program for “global health hospitalists” is a very …
The dynamics of global health in hospital medicine
I am a family physician. Like most of my colleagues, though, I must sometimes step out of the comfort of my clinical role to take on the role of patient or family caregiver.
Generally, these trips to the other side of the exam table inspire a fair amount of anxiety.
During visits to the doctor, I find myself noticing many details and comparing the quality of care to that in my own …
When concierge care is reserved for pets
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A few months ago while I was working in the interventional gastrointestinal unit I noticed something because it was driving me nuts. One of the monitors in the holding area that slaved to one of the procedure rooms was beeping. Just a low, constant blip blip blip blip. The screen read, “no data.”
So I asked one of the nurses “can we turn that monitor off? No one is using procedure …
Alarm fatigue symbolizes the limits of technology
Relevant research and conventional wisdom alike suggest that, despite their irresistible perennial tug on our collective conscience, New Year’s resolutions generally have about the staying power of champagne bubbles. Pledged to ourselves and one another in the short, dark days of late December, sorrowfully few survive to see the crocuses come up. Some studies suggest 20 percent or so live that long. Frankly, I’m surprised the numbers are that good.
The …
Why it’s hard to keep your New Year’s resolution
The pediatrician Margaret Mohrmann tells the story of caring for a young girl in the ICU who developed a devastating case of meningitis. One day when she came to check on her patient, the girl’s mother asked Mohrmann why her daughter had become sick. As Mohrmann began to explain what meningitis is and how it is transmitted, it quickly became clear to her she was missing the meaning of …
Our spiritual state can influence how physical ailments feel
Everyone is familiar with the acronym HIPAA, which is the 1996 edict called the Health Insurance Portability and Accountability Act. Isn’t that a smooth and melodious name?
These are and regulations that are designed to protect your confidential protected medical information. I support the mission. I don’t think that your medical records should be deliberately or inadvertently shared with those who are not lawfully permitted to view them.
The consequences of zero tolerance: Why HIPAA is overkill
10:11am Tuesday, June 5, 2006: This was the moment Marge was told the mammogram showed a mass, which was probably breast cancer. “But, don’t worry, the tumor is very small and with surgery and radiation, you will be fine.”
1:55pm Wednesday, March 25, 2009: This was the moment Marge was told that the breast cancer had spread to her ribs. “But, don’t worry, the tumors are small, and with hormones, you …
When does false hope become malpractice?
How many times have you popped into the exam room for a quick re-check of a patient, only to get hit with a barrage of new symptoms and concerns?
My guess is that at least a third of my day is spent wading through new symptoms, rather than focusing on the problem that originally brought the patient to me in the first place.
Don’t get me wrong. I get it that once …
Teach patients to prioritize their problems
Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness” or, frankly, malpractice.
With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day …
How many patients can a doctor safely see a day?
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