Retirement is an intensely personal decision. I have done virtually nothing but medicine for the last 35 years. Oh sure, I have made some money from writing, or giving lectures and expert case reviews, but most of these are tied to medicine as well. Having just turned 65, my financial advisor says from his analysis, I can retire any time now. I have a contract with my cardiology group, which …
How can a physician retire gracefully?
I have outstanding, compassionate and dedicated partners; rarely goes by a day that they fail to teach me by their intelligence and example. Nonetheless, yesterday, in the middle of 30+ patient office hours, one of them said, “You know there are times when I just can’t stand to listen to another complaint.” He took a deep breath, straightened his coat, and opened the exam room door and, smiling, greeted the …
The difference between playing doctor and being a doctor
Recently, way beneath all the press about Obamacare, there have been articles panning the president’s pick as the next Surgeon General of the United States. Wait a minute. What happened to the last Surgeon General?
Six months ago, family physician Dr. Regina Benjamin stepped down as the first Surgeon General under President Obama. Quick! Name one accomplishment under Dr. Benjamin. I can’t either. What happened?
Dr. Benjamin was a rising star in the …
Why Regina Benjamin was an ineffective Surgeon General
I use my computer a lot, so I see a lot of advertisements. Many of them are for the latest two or three items I’ve priced online (which I find somewhat creepy but fairly easy to ignore). Many of them are generic, casting a wide net. These generic ads frequently talk about “one ridiculously easy trick” to halve your car insurance payments, lose 50 pounds, learn a foreign language, look …
Doctors need to do a better job in the PR department
Improving patient experience is all the rage these days. Hospital administrators across the land are talking about it. This can only be good for our patients and for the health care system at large. Satisfied customers are what every industry strives for. It is a bit sad however that it has taken the threat of looming financial penalties to make this happen.
Now that hospital reimbursements are directly tied to HCAHPS …
Patient experience is about the people behind the statistics
When I graduated residency and started my first job, I walked around the ED confidently, chest slightly pumped up at all times. I knew I was well-trained. If there was a sick patient, I was going to resuscitate them. If there was an impossible central line that was needed – I was going to get it. Difficult intubation? No problem. There was no procedure that was too difficult for me.
Many …
The conversations can be more difficult than the procedures
As a fourth year medical student I did my “sub-internship” in oncology. I hoped that this rotation would help me choose what specialty to pursue: internal medicine or psychiatry.
One of “my” patients was a woman with breast cancer that had spread to her liver and lungs. Fluffy brown hair fell to her shoulders. Wrinkles surrounded her puffy eyes that held jade green irises. Though she was in pain, she was …
Recognize the blessings that you previously overlooked
Suffering ceases to be suffering in some way at the moment it finds a meaning.
-Viktor Frankl
It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.
-William Osler
Back in the 1990s when pain was the newest vital sign, physicians were mandated to treat it, often with powerful medications and without truly understanding the cause and significance of the …
Treating pain without addressing suffering
I was invited to give a talk about patient satisfaction at a recent grand rounds. I have written previously that satisfaction is a pretty low bar, and so I spoke instead about the patient experience.
I opened my talk with the cartoon above.
As I anticipated (and intended), it got a few chuckles from the audience, and I pointed out …
Performance measuring tools aren’t up to the task
The field of medicine is one of the most rewarding occupations out there. Few occupations allow such an incredible opportunity to directly impact the life of a fellow human being and see the amazing results of something you did. Few occupations are allowed inside the most intimate and vulnerable moments of the human condition. In a word: amazing.
But medicine for people has quickly given way to medicine for business.
Business needs …
What happens when doctors lose their calling?
John and Eva had ongoing conversations about their home which was now far too big for their needs and lots of trouble and expense to repair and keep up. John said, “It’s the yard, the leaves, the painting, and general repair and replacement problems. What’s next to go? The refrigerator or me?” Eva was tired of shopping and cooking. Her arthritis was slowing her down. She told John, “Ok, you …
Are we prepared as the Boomer generation downsizes?
I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn’t recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I didn’t it was ok. She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation.
She went on to tell …
You can’t legislate doctor-patient relationships
Recently, I spoke with a primary care physician (PCP) about a young runner who had a syncopal episode. Because of the increasing awareness of sudden cardiac death in athletes, she had an electrocardiogram and an echocardiogram to look for structural abnormalities of the heart.
The PCP was inclined to dismiss the syncope as an isolated episode. However, the echocardiogram, otherwise normal, equivocated: “possible hypertrabeculation of the left ventricular apex, consider cardiac …
Radiologists and primary care doctors need to talk to one another
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Practice medicine like the bumblebee.
We also know the basics of the beehive containing a single queen bee, hundreds of worker bees, and several hundred to several thousand drones with their only function is to mate with the queen (and after they perform this function they die!), each with their own degree of specialization and place in the honeybee society. However, there is …
Doctors: 10 lessons from the humble bumblebee
“Throw grandma under the bus” clearly conveys anger, sympathy, and fear when health care decisions are made outside the realm of medical professionals. Within the doctor-patient relationship, alignment of physician expertise with an individual’s personal decision should keep insurance company executives, hospital CEOs, and government authorities from interfering.
Are we naive to believe interference isn’t already occurring?
A doctor orders a breast MRI to further evaluate an abnormal mammogram, but the insurance …
We’re already throwing grandma under the bus
Early diagnosis, preventative care and aggressive disease management are mainstays of American medicine today. Proponents argue that early diagnosis and prevention are the keys to healthy living. Skeptics suspect that many of the screening tests for early asymptomatic disease and preventative treatments we undergo lead to overdiagnosis, unnecessary expense, exposure to diagnostic and therapeutic interventions which themselves have risks, and that often cause more harm than good.
As a physician and …
5 preventive services to do, and 5 to avoid
I recently stumbled across a blog post by Dr. Jay Parkinson, an entrepreneur and founder of Sherpaa, who reflected on a recent private breakfast with New Yorker and best selling author Dr. Atul Gawande.
The question posed by Gawande: Can technology be a change agent for health care?
The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who …
Change will happen when millennial doctors step into leadership roles
We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.
The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …
An anesthesia practice is sold, and a warning to young doctors
Partial liver donation is the only life-saving deed that a non-surgeon can do for another person suffering from end stage liver disease. On the other hand, a major operation on a healthy individual with no indication for surgery has been viewed by society with caution and skepticism.
One could wonder why a young, healthy individual would succumb to an elective high risk procedure. Simple answer: they want to save a life. …
The personal costs of a living donor liver transplantation
I don’t remember three days of my life.
I have generally felt in control of my life and behavior. Although I understand the future is always uncertain, I do as much as I can to plan for it and minimize risk to myself and my family. This includes focusing on avoidance of stress, healthy eating, and daily exercise. Despite this, anything is subject to change at any time for no apparent …
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