A new message pops up on my phone. I signal to the attending and step out of the OR. I’m on anesthesia rotation at Santa Clara Valley Medical Center, as a pediatrics resident at Lucile Packard Children’s Hospital at Stanford. But because I’m also a mom to a first grader in Cupertino, both my pager and my cell phone are frequently “on call”.
“I want to take this opportunity to update …
It’s time to stop being afraid to study gun violence
In the past, the radiology profession was seen as a very financially successful specialty, but as every businessperson knows, success often has peaks and valleys. Radiology residencies are some of the most competitive to obtain, which is due to the combination of expected financial compensation and the assumed quality of life.
In the early 1990’s, when financial pressures first appeared on the …
The increasing stress that radiologists face
I had a conversation with a family practice physician today, a man who is far closer to the end of his career than the beginning. He is part of a private practice group that recently was sold to one of the larger hospital groups in the area, which put him on a salary, but also allowed him to work only three days per week. He stated that the decrease in …
The physicians of today have given up their unique soul
The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …
Your doctor has sold his practice: 6 tips for patients
Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5 per visit. He doesn’t take insurance.
This led to several online threads featuring comments such as “Finally! A doctor who cares!”
Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don’t care.
I respect …
Charging $5 per visit is easy if you’re independently wealthy
I first met her when I consulted on her hospitalized son, who’d been in and out several times with transient abdominal pain. He’d already been through various tests and consultations, each time improving before a diagnosis was established. When I was asked to see him he was once again on the mend, but I concluded that he likely had the uncommon …
The role of faith in a patient beating long odds
It is increasingly becoming the year of the Thrifty Patient. People are paying for more medical care and are more responsible for the costs of getting that care via higher deductibles and co-pays. Patients don’t have a choice but to be involved in their care. Though the recent 2008 recession saw a decrease in overall medical and health care utilization as …
Are you a thrifty patient? How to get the care you need and save money
My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?”
“Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and I’d awakened her from what I imagined had been a troubled sleep.
“Yes?”
“This is Dr. Lickerman. I’m calling from the hospital.” I paused. “I’m calling about your husband.”
There was silence. Then a breathless, “Yes?”
“Mrs. Peterson, …
How to deliver bad news to patients: 9 tips to do it better
Hospitals are busy places to work. The work is fast paced, and never seems to stop. For most physicians, the work ends when the work is done, or until you fall over, whichever comes first. So as a consultant, when I am seeing a patient wherein there is no longer anything that I am contributing to a patient’s care it’s routine that a physician would “sign off” the case, meaning …
Offer hospice patients a smile
Most of us would agree that doctors should not treat patients without their consent, except in special cases like emergency care for an unconscious patient. It’s not enough for doctors to ask “Is it OK with you if I do this?” They should get informed consent from patients who understand the facts, the odds of success, and the risk/benefit ratio of treatments. The ethical principle of autonomy requires that they …
Patients have trouble giving true informed consent
Surprise! It turns out that if every woman in the US got a mammogram every year, almost exactly the same number of them would still die of breast cancer. Why? Watch this video. Read this by TBTAM. Bottom line: mammograms don’t find aggressive cancers soon enough (by definition, you can’t), while too many of the cancers they do find were never going to be fatal anyway. This is what “over-diagnosis” …
How often should I screen for disease?
A buddy of mine sent along an interesting link by a physician named Ben Brown that makes an argument that doctors actually aren’t all that well off. Salaries are down. Education costs can exceed $300,000 over the course of college, medical school, and residency. By the time you take that first job, you’re on the wrong side of 30 and Wells Fargo is demanding $1800 a month for all your student loans. It’s a topic …
Don’t devalue physicians to mere employees
The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical.
Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that it doesn’t. …
P4P: Should physicians be treated as purely economic animals?
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We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in the New England Journal of Medicine, which once again raises the question of how much screening mammography contributes to the progress we have made in reducing deaths from breast cancer in …
ACS: Finding the truth about mammogram screenings
Our 5 year-old keeps forgetting to draw arms on his people at school. The lack of arms has evolved since school started in September and even came up in his parent-teacher conference recently. I found it odd– he always seems to remember that humans have arms when he draws at home. We didn’t mention it to him. And when his brother …
How to foster generosity at an early age
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …
Physicians can be better doctors by being patients
I remember you the day we met. It was five years ago. I was terrified. You seemed relaxed and at peace. I’d been invited to join the Lennox Head Club, in the town where I live and work; this over-thirty-five match was the first game of soccer I’d played in twenty-five years. I was the oldest on the team. You were the youngest. For you it was just the start …
I remember you: Rest in peace, my friend
There is one aspect of our relentlessly rising healthcare costs that seems particularly out of control — administrative costs. An interesting recent editorial in the New England Journal of Medicine provides some sobering details.
Every physician confronts daily the burden of dealing with healthcare bureaucrats of various sorts. The average doctor personally spends 43 minutes each day at it, and behind every physician there is an army of coders. …
Physician credentialing needs better standardization
The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …
Common criticisms of concierge medicine that deserve to be answered
It seems both ironic and inevitable: I won’t be getting any more “meaningful use” checks. It’s not that I didn’t qualify for the money; I saw plenty of patients on Medicare and met all of the requirements. I was paid for my first year money without much hassle. The problem I am facing is this: I am probably going to be “opting out” of Medicare, and once I do that …
Behind the complex decision to opt out of Medicare
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