This is a topic that comes up from time to time for often spirited discussion. The most recent example comes in a couple of articles in the New England Journal of Medicine. One was a research paper; the other was a pro and con discussion.
The research paper studied cardiac arrests that happened outside the hospital. The authors tested the premise that allowing families to watch the efforts of …
Should families be allowed to witness CPR?
Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is waste. At the very least, waste is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well.
I recently saw a friend at a party. Since we’d last seen each other my friend’s spouse had died. (I’m deliberately avoiding gendered pronouns and …
How waste is directly harmful to patients
I remember going to see the movie “Oliver” in the theater when I was a kid. Since this was my first movie in a theater, my mom made me a treat: a bag full of raisins and chocolate chips (Raisinets for Dutch people) and sent me there with my sister. It was a fine film, with Oliver getting kicked out of the …
American health care: The problem of always wanting more
Of all the different criteria people use when deciding for whom to vote in presidential elections, I’ve never heard anyone talk about the importance of a background in clinical psychology—but it’s always struck me as important for a president to have as for a clinical psychologist. Certainly, foreign policy experience, a firm grasp of the principles of economics, a bold and confident leadership style, and the ability to get people …
Why politicians should have backgrounds in clinical psychology
In the wake of the Newtown shootings, as a country we are all taking a step back, looking at our laws and our policies and thinking about what we can do to prevent unspeakable tragedies like the deaths of those children from happening again.
I am not a gun owner and never will be, but I am not advocating getting rid of all the guns. I totally get that there are …
If I’m wrong about guns, can you please explain why?
I recently blogged about the question of what the difference is between a doctor and a nurse, now that advanced practice nurses can do so many of the same things physicians do. As both a nurse and a doctor I thought maybe I could wade into that quagmire. In that post I suggested that the real difference is one of ultimate responsibility. A reader pointed out that this …
The medical model versus the nursing model: A difference in philosophy
How to effectively keep tabs on a patient’s multiple medical problems? And how to do so without losing sight of the whole person?
The first question is the one I wrote about in a recent blog post. The second was the theme of many of the responses and also LinkedIn.
I love this second question; it’s an issue that’s always been of interest to me. Plus it’s especially relevant in geriatrics, where …
How to effectively follow a patient’s multiple medical problems
The unexamined life is not worth living.
–Plato
There are obstacles to dignity at the end of life. Disease inflicted pain and debilitation, cost and confusion, poor planning and fear, all aggravated by our societal ignorance regarding dying, result in unneeded suffering and isolation. In addition, it occurs to me that a hindrance to control and quality is that we are overwhelmed by the pressure of our day-to-day lives. In other words, …
When I first heard of the tragic accidental shooting death of a 2-year old girl by her 5-year old brother, at first I thought it was because some adult left their gun out and was not supervising the children properly.
Not too many things surprise me anymore, but this time I was surprised when I found out that poor supervision was only part of the issue and that the 5-year-old was …
Giving a gun as a gift: How young is too young?
As I sit on this old wooden pew, I rock side-to-side to ensure that blood flows to each part of my bottom. We’ve been at this rented church for 75 minutes listening to the sounds of my daughter’s violin class recital and now it’s time for the last piece.
A high school student with a large tattoo of a stanza on her left …
3 steps physicians use to become an expert and avoid mediocrity
The real problem is not whether machines think, but whether men do.
– B. F. Skinner
When I was a relatively junior member of the surgical faculty, an even more junior member came to my office and announced that a general surgeon and gynecologist in Georgia had performed gallbladder surgery with a laparoscope.
“Stupid stunt,” I snorted, or something equally derisive and all-knowing.
Some weeks or months later he returned to the topic, telling …
Will the da Vinci robot go the way of laparoscopic surgery?
You might think a thing sold by a huge manufacturer of children’s toys and furniture as a “sleeper” would a safe, appropriate place for a baby to sleep. It is, after all, called a “sleeper.” But it is not a safe place for your baby to sleep.
The Fisher Price Newborn Rock ‘n Play Sleeper is a sling-shaped baby holder sort of gizmo, …
Is this Fisher Price sleeper safe for infants?
A few years ago, I sat in a coding lecture for urgent care providers given by a very entrepreneurial physician assistant. An emergency room doctor, who had recently established his own private clinic, put up his hand to ask a question. He seemed puzzled.
“I can see your point about coding at a higher level for a sore throat when I was younger,” he said. “I used to take longer to …
3 ways for doctors to reclaim their value
ADVERTISEMENT
Bobby was admitted to the hospital once again with overwhelming fatigue and shortness of breath. Yet this 37 year old farmer looked the picture of health. He grew up on a farm rising before dawn, milking cows and working long days in the fields with hay or corn. He was never seriously ill as a child and was a good football halfback in high school.
But this was his third admission …
Medical problems can be uncovered by a history and physical exam
I write a lot about end of life conversations that go well or have unexpectedly positive outcomes. But to be fair and balanced, you should also hear about the ones that don’t go so well, lest you be led to believe that I have magical powers over my patients and their families.
Here are two of my attempted end of life map conversations that did not go over so well. In fact, …
4 tips to remember when end of life discussions go wrong
I was listening to CBS This Morning recently as they were interviewing Alan Alda. He was discussing his acting career and being the host of Scientific American’s Frontiers (airs on PBS stations). Alan Alda relayed a personal story of his, having an intestinal blockage while he was filming an episode in Chile.
As he relayed this incident, he spoke of the physician who told him that he was going to remove the …
4 tips to better communicate with patients
Like my fellow Connecticut residents still shaken by the Newtown shootings, I was excited and relieved when Connecticut Senate Bill 1160 (“An Act Concerning Gun Violence Prevention and Children’s Safety”) passed. The law establishes a dangerous weapons offenders registry and requires a universal background check for all gun purchases. Those wishing to purchase long guns will need an eligibility certificate which requires fingerprints, a firearms safety training course and a …
Why the Connecticut gun law does not improve care for the mentally ill
Over the past twenty years, Wall Street business has covertly taken over the medical profession while doctors have been distracted by a deluge of procedural, financial, and legal paperwork. A strategic plan was launched to extract exorbitant profit benefiting business, and is now mainstream without challenge from our profession nor the public.
Legal boardrooms were abuzz in the 1990s as a blueprint assault was made against organized medicine, redirecting a profession into a …
Is medicine a profession or a commodity?
As of early April, you can walk into Walgreens in 18 states (plus D.C.), and along with a gallon of skim milk, a pair of photo mugs, a six-pack of toilet paper, and a flu shot, you can meet your new primary care provider, get your cholesterol checked, pick up your statin, and schedule a return visit. That primary care provider will not be …
Free nurse practitioners from their arbitrary bondage
“You have to be affable, available, and able,” a senior general internal medicine physician taught me during my final year of residency. “Trust me,” he added, “when you’re in practice, you will love easy consults.”
A consult – short for “inpatient consultation” – occurs when physician caring for a hospitalized patient requests another physician to evaluate the patient and provide recommendations. Typically, both physicians are paid – one for providing overall …
Why hospital culture influences medical costs
Get free updates delivered free to your inbox.
