Ordering CT, MRI, or PET scans for my patients when they feel well always makes me nervous. As a radiation oncologist, I’ve chosen to frequently make observations that potentially find active, progressive cancer. And this creates an existential crisis that scares me — but not as much as it scares my patients.
With each test, I set in to motion a real-life application …
Reduce stress for both patients and doctors: Limit tests
As someone who has recruited a very large number of physicians over the years, I am quite sold on the benefit of a “letter of intent” or “LOI” as a tool for physician recruitment.
While physicians are highly familiar with medical/surgical concepts and while many are in no way intimidated by dissection within the human body, many to most are not qualified or really desirous of dissecting a complex legal document …
How a letter of intent can help with physician recruitment
I grew up in a solidly middle class family. Our home was safe, loving, and we never wanted for anything. My parents believed in hard work and instilled in me the importance of a college education. I was the first kid on the block to have a computer. That Radio Shack TRS-80 was a marvel of modern technology and made me the envy of my friends. Today, a TRS-80 is …
Doctor dinosaur: Physicians may not be exempt from extinction
When I started my surgical internship, my chief resident told me some magic words: Whenever something bad happens, stay calm and say, “I assume full responsibility. It won’t happen again.”
As a young surgeon at the bottom of the totem pole, those words were my mantra for the times when someone’s head was going to roll. In those nascent days of my …
Everything’s my fault: How a surgeon says I’m sorry
Sometimes I’m surprised I wasn’t born with gills.
It’s like I was meant to spend more time in water than on land. I didn’t discover this until I was thirteen or so, when I started high school and had to join a sports team because of a school requirement. I arbitrarily chose water polo, because it was a fall sport. I sucked at …
7 life lessons I learned from surfing
Sometimes it’s difficult to practice what I preach. But I try.
A couple of weeks ago, I spent the evening in the emergency room with our youngest son (don’t worry – he’s fine). I hate going to the ER, but every once in a while circumstances necessitate it. I called doctor friends in the relevant specialty, as well as our son’s pediatrician, to confirm the need for the trip. They said to …
Handling the delicate balance as an ER patient
As I sat in my orthopedist’s exam room, the discussion quickly turned from my chief complaint to his: “I don’t know why I’m doing this anymore,” he said. “Medicine is just not what it used to be, and I don’t enjoy my work anymore. The bureaucracy and regulations are bad enough, but what really gets me is the hostility. My patients …
Mean patients: Do they contribute to physician burnout?
It is in our nature to lie. Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication. What happens …
What happens to us when we lie about dying?
Our health care system is broken and in dire need of reform. We all know the statistics: the U.S. spends $2.7 trillion on healthcare, 30% of which is waste in the form of unnecessary tests and unnecessary treatments. Conflicts of interest are rampant, with 94% of doctors reporting an affiliation with a pharmaceutical or device manufacturing company, and many more insidious influences including salaries being tied to productivity. Dozens of studies have shown …
Who’s my doctor? The total transparency manifesto
But doctor, ultimately it is your responsibility.
I can hear the case coordinator clicking her fingernails against the desk through the telephone line. I admit, I forgot to specify to the nurse, when she called me ten minutes before midnight, that this was a full admission and not an observation. In the absence of my order, a nurse manager reviewed the chart and decided that the 95-year-old woman with congestive heart …
But doctor, ultimately it is your responsibility
The lack of access to primary care physicians is a well known problem impacting our healthcare system. The problem sends all sorts of negative ripples through the system, not the least of which is increasingly crowded emergency rooms packed with patients whose conditions could have been addressed earlier and cheaper had primary care been available.
What is less talked about is the mixed reaction of primary care physicians to the kinds …
The primary care opposition to transition care
I will do anything not to be in a hospital bed. I checked myself out as quickly as I could each time I was admitted (three obstetrical admissions) and once, after a day-surgery procedure, got in trouble with the recovery room nurse because she found me out of bed, getting dressed, before I was supposed to be on my feet.
Still, as a doctor, I am capable of taking great comfort …
On hospital discharges: Who needs the most reassurance?
Why aren’t people in hospitals more attentive to the needs of patients?
In a post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha …
How can we reduce friction in the hospital?
ADVERTISEMENT
I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.”
This is a problem since, as an anesthesiologist, I get told what to do all the time. My kids order me around all the time. When I was a nurse I used to bristle at the term …
Who’s in control? Why both doctors and patients are frustrated
As we grapple with provider shortages, the surge in chronic illness and the quality to price (QPR as they say in the wine business) challenge in US healthcare delivery, it’s hard to imagine a future that does not include some sort of guideline or algorithm-driven care. As providers take on more financial risk, one common strategy involves team-based care, and the attendant increase in decision-making and care delivery by non-physician …
Is there a place for personalized medicine in clinical guidelines?
If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick?
It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place …
Solving the weekend effect for patients in the hospital
Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays. JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers …
JAMA removes cover art, and why that matters
Have you ever taken note of how much you or a colleague says “I” versus other pronouns? The pronoun that you choose in conversation may very well provide insight into your psyche and may determine your effectiveness as a leader. Current research has indicated that the frequency at which an individual uses the pronoun “I” speaks volumes about their self confidence, level of empathy and perceived status within an organization …
We must pay careful attention to the pronouns that we use
Pinel, the father of modern psychiatry, is famous for liberating his patients from their chains. But he did a whole lot more. Pinel spent long hours listening attentively to each patient’s life story so that he could correlate their life experiences with the onset and course of symptoms.
Pinel got to know his patients well enough to like them as people. When given the choice of joining Napoleon as personal physician …
Why psychiatry is handicapped today
Thirty three years ago my husband and I went to Jamaica for a belated honeymoon. We got married on the last weekend of my internship year, and immediately flew back to Boston for me to start my second year of internal medicine training. Seven months later in the dead of winter, we flew to Jamaica to a lux resort in Ocho Rios where I spent a blissful week drinking sweet …
For the most desperate, it’s about faith, love, and human kindness
Get free updates delivered free to your inbox.
