Accepting a promotion in the workplace is never easy task. One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.
Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner …
Doctors: How to improve your workplace relationship with nurses
I want to tell you a story about dying that ended up being a story about living.
A few years ago, I was an eager-beaver third-year medical student, and relished the opportunity to finally work on the wards. One of my patients was Mr. Taylor, a middle-aged man with pancreatic cancer—a disease that, of course, carries a bleak prognosis. He was emaciated, …
A story about dying that ended up being a story about living
Outrage #1: Wasting time of skilled caregivers. Everyday skilled nurses and physicians’ assistants waste hours of time on the telephone either getting approval for medications that we prescribe for our patients or trying to fight a rejection for a medication we requested.
Outrage #2: Choosing a medication for cost, not effectiveness. A child cannot breathe because the acid and other nasty stomach …
4 reasons why doctors should be outraged
An excerpt from Pet Goats and Pap Smears.
I’ve been practicing medicine nearly twenty years, but I’m still a doctor-in-training. Every patient who passes through my life teaches me something. Now doctors-in-training follow me around, but I think I learn more from my students than they do from me.
Today Brooke is here. She is two years away from applying to medical school. She has a degree in natural …
Patients don’t care what you know until they know that you care
Waking before dawn, I scurry into the study. Sitting in front of the computer, I wiggle the mouse, bringing the screen to life. Hesitantly, I call up the site for the major local newspaper. Since being notified by my attorneys one week prior that a reporter was hunting me down for comment, I am on heightened alert. Every day spent awaiting a story that could potentially decimate my life.
The home …
Waiting for a story that could potentially decimate my life
I have a lovely pen. It’s a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice.
It’s a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window …
My experience with a scribe in the emergency department
Most modern American are familiar with the classic political novel, Atlas Shrugged. Love or hate it, the novel had a great impact on political thinking in the West. If you haven’t read it, or aren’t familiar, one of the fundamental questions author Ayn Rand asks is this: what if the producers and innovators of society simply stopped trying? What if they …
If Atlas shrugs off healthcare, it will be a dark day
I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want …
Physicians must innovate to meet the needs of patients
I strolled into our noon-daily resident conference, a little late, my free burrito in hand, and noticed that “cost awareness” was the topic. The conference seemed to have the same format as our other lectures: an attending was presenting a clinical case and asking us what steps we could take to best diagnose and manage the patient. The case seemed straightforward enough—a 65-year-old healthy Caucasian gentleman with right-sided chest pain—and …
Cost should no longer be a dirty word in medicine
Healthy patients think that they are not at risk for serious medical problems. Though maintaining a healthy weight, exercising regularly, not smoking, and eating plenty of vegetables and fruits while limiting meat, fat, and fast foods does decrease the risk of developing diabetes, high blood pressure, heart disease, and cancer, it doesn’t completely eliminate it. The chance is there, just a …
Healthy patients always make the same error
“Doctor’s office; please hold.”
You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on that below.) We are also in the middle of a communication revolution. There are now so many other …
The telephone is obsolete: How my patients contact me today
As predictable as the leaves falling this time of year, another paper on the subject of unnecessary preoperative laboratory testing has appeared.
A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in the National Surgical Quality Improvement Project (NSQIP) database. Almost 2/3 of the patients had preoperative laboratory tests. Of that group, 58.6% had a CBC, 53.5% had electrolytes, 23.7% had …
Stopping extensive pre-op testing requires malpractice reform
Over at his blog Gene Expression, Razib Khan expressed his disgust with the paternalism of the medical profession. His disgust was not misplaced, but he did bypass some of the subtleties.
Razib, a respected science blogger, ran smack into a frightening piece in Time. In it, doctors discuss whether and how much genetic information should be given to parents about their kids. The doctors featured evaluated a child’s …
Hold your disgust: A nuanced look at paternalism in medicine
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The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system.
In the wake of Hurricane Sandy, the visual has become more familiar than we’d like – the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish …
ED boarders: A new focus to mitigate overcrowding
I was recently sitting on an airplane on my way to a far off destination for a meeting preceded by a couple of days of rest and relaxation.
In and of itself, nothing particularly special about that except that maybe a couple of folks will be jealous. But to me, right now it is an incredible moment, the culmination …
I admire the strength and determination of cancer survivors
At the heart of healthcare operations are their processes – processes that must run correctly all the time to avoid unnecessary risk to patients’ lives and health.
Once the healthcare industry acknowledged the fact that we all make mistakes – even physicians – it began to look into methodologies used by other industries to structure more “perfect” organizations.
Two such process improvement methodologies — LEAN and Six Sigma — are now being …
Eliminate waste and reduce variation in your medical practice
When I was ten I once found myself walking with my brother on a Lake Michigan beach when we came upon a half-empty bottle of beer. Curious, I picked it up and looked inside at the swirling dark liquid. Then, impulsively, I took a sip. It was hot, having baked in the sun for who knows how many hours or days, and tasted awful.
I never took another drink of alcohol …
How I learned to appreciate the struggles of others who don’t fit in
This is my new office. I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground. I should feel good about this, shouldn’t I? I’ve had people comment that I’ve gotten a whole lot accomplished in the 4 weeks since I’ve been off, but the whole thing is still quite daunting. Yes, there are days I feel good …
Learning to fly and getting my new practice off the ground
As a fan of free markets, I recognize that sometimes intelligent government regulations (not always an oxymoron!) can improve markets by requiring companies to provide consumers with information that will help them make better choices. Informed consumers, after all, are a central ingredient of a successful free market. That’s why even most libertarians support regulations that ban fraudulent advertising.
That’s also why, at first glance, the federal government seemed to be …
Finding the balance in calorie count regulations
Diet and exercise: they were supposed to be the answer to all that ails America’s obesity and health care cost problem.
Signs of this Utopian vision are everywhere. From entire government departments encouraging healthy lifestyles through fitness, sports and nutrition, government websites
What if, …
Should we reconsider the benefits of exercise and weight loss?
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