In recent months, AAFP President Reid Blackwelder has been editorializing and debating what they see as the encroachment of nurse practitioners (NPs) and other “mid-level providers” (physicians are, presumably, “upper-level”) on the practice territory of family physicians (FPs). Dr. Blackwelder has repeatedly said that NP and physician roles are “not interchangeable.” The AAFP’s position on this issue seems to be resistance to the increasingly common decisions by state legislatures to …
A patient calls or emails me with a problem. I talk with them over the course of a few days, using whatever form of communication works best. Eventually, they need to come to the office to be seen – either for something needing to be done in-person (examination, procedure, or lab test), or because of the advantages of face-to-face communication. At the visit, I not only deal with one problem, …
Faith and reason entered my medical universe recently.
A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related …
We have come a long way in medicine, treating serious illnesses and preventing life-threatening diseases. As a hospital-based physician, I treat various severe diseases every day throughout the ICU, medical, and surgical floors. On a normal day, I roll at a fast pace — admitting, treating and, discharging patients has become fairly routine for me. On any given day, we have an …
Last week a woman told me that she had a miscarriage in her bathroom. She was terrified. She didn’t know what to do. So she flushed it down the toilet.
A miscarriage is the spontaneous expulsion of a fetus from the womb before it is able to survive on its own. One in five pregnancies ends in miscarriage. Many women don’t know they are miscarrying. Those who know usually suffer grief …
The notion that doctors can be replaced by technology has sparked a series of brawls between doctors and technologists over the last couple of years. Today, both sides continue to throw punches in the press and online.
As health care technologies become more sophisticated, the opportunity to automate medical decisions becomes more seductive. Yet, physicians are unwilling to throw in the towel. They point to the importance of human interaction and …
To the literal-minded, burning out is the fate of light bulbs and matches. But whether you read the popular press or medical journals today, you’re likely to find writers who are deeply concerned about physician burnout.
What defines physician burnout, and who exactly is suffering from it? Is burnout an actual clinical syndrome, a slang term connoting fatigue and boredom, or a hazy …
Jenny McCarthy is officially joining The View. “Do I have opinions?” one reporter asked. Yup.
My concerns center around Jenny McCarthy’s past willingness to trade-in her experience for expertise. That is, she widely shared her theories and anecdotes about her son’s experience with learning challenges and falsely placed blame on vaccines for his then-diagnosed autism. I will not discount her private experience.
There are lots of generalized complaints out there about insurance companies increasing physician workloads without additional compensation. I thought I would share a specific instance of this so everyone else can get an idea of what we’re up against.
I received the following mailing:
We want you to screen our members for cancer. Please do these things:
Call the member to discuss colorectal, skin, and prostate …
When I was a med student, the thing I loved most about primary care was continuity of care. I loved feeling like I had a sense of my patients’ lives, of the intimate details of their day to day, of their fears and dreams. I thought that this connectedness was all I needed to have a successful career as a primary care …
Guantanamo detainees on a hunger strike are now being strapped into chairs and gagged as doctors push a feeding tube through their nose into the back of their throat and into their stomach as often as twice a day. It’s a disturbing new practice, but one we must examine in full as we consider whether Guantanamo reflects American values.
Anyone who has had a nasogastric tube placed through their throat …
Nothing seems to please a fly so much as to be taken for a currant; and if it can be baked in a cake and palmed off on the unwary, it dies happy.
-Mark Twain
Returning to clinic after time off for a summer break, I worry I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake. Just maybe no one will notice I don’t …
The Mayo Clinic Proceedings came out with a study that shows that many of the treatments that doctors once swore by are useless or worse.
The New York Times did a piece on it and the commentary contained a great deal of doctor-bashing. So of course I opened my big mouth and pointed this doctor hatred out. The comment I got back was this: “It’s not hatred, it’s fear.”
I remember a time when many physicians, especially residents in various specialties, would moonlight in small emergency departments. They viewed it as a convenient way to supplement their low salaries. Some of them were excellent doctors. Sadly, quite a few were not qualified and caused more harm than good.
I did the same thing, although I was a second- and third-year emergency medicine resident at the time. Indeed, the money came …
I’ve had two jobs since I completed a fellowship is gastroenterology over 20 years ago. For the first decade, I was a salaried physician. Afterwards, I promoted myself to private practice. Each model has its advantages and drawbacks, but for me the private practice model wins out. The climate in Cleveland is extremely inhospitable to private practice, because of two mega-medical institutions that incinerate private practices as their boiling …
This is an interesting dilemma, but honestly, I could use your help. A former neighbor (not a close friend, but a pleasant fellow whom I run into less than occasionally) rented a house to a medical student and his family. They seemed reliable enough, and signed a 4 year lease. Over time, the medical student and the landlord began to feud over who does what. Usually things like landscaping were at …
Two recent articles highlight the challenges we will face as our healthcare system changes with regard to how care is delivered and reimbursed. The first article from the New York Times, Medicare Panel Urges Cuts to Hospital Payments for Services Doctors Offer for Less, notes that large hospital-centric systems of care do not necessarily serve patients well in terms of cost and sustainability.
What would you prefer your doctor to be wearing when examining and treating you or your loved ones? Most would likely reply with something along the lines of “it doesn’t really matter, as long as they are competent and do a good job.“
Except it does matter, apparently. So much so that there have been hospital/nation-wide policies surrounding the issue, and a recent surge in …
Recently, my family experienced the loss of someone very dear- Uncle Peter. Peter was an ex-Marine, father of three men, and patriarch of my spouse’s family; not to mention, husband to my wonderful and artistic Aunt Helene. He had been admitted to an outside hospital with leg ischemia and was transferred to a tertiary facility. Unfortunately, things did not turn out …
“Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff to monitor often unpredictable patients.”
