There is a moment in everyone’s life, for oneself or a loved one, when one receives the “diagnosis.” In that moment, eyes meet across the desk and the shell-shocked individual looks up and asks, “Doctor, what should I do?” In that instant, the patient is putting all of their trust in another human being who is trying nothing less than to save a life.
A good doctor has always been a …
Creating doctors practicing to the Penn State standard
Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all. We want them to be chimeras of Drs. House and Welby. But, is this possible?
I can’t say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was …
Choose your doctor: Astute diagnostician or empathic practitioner?
I spent my first two years of medical school at the University of Utah frantically cramming for Step 1. My limited exposure to patients was restricted to shadowing only. My actual interactions with them were spotty at best. Those first two years of medical school didn’t at all reflect what I would go on to love about primary care: building relationships with patients that would span many years.
I now teach …
I cherish the relationships I’m able to build with my patients
I remember my first visit home at the end of my second year of medical school. I’d just received my black doctor’s bag loaded with medical equipment. Like a 16-year-old with a new driver’s license, begging to do the very errands she’ll soon groan about, I went around my parents’ living room and took everyone’s blood pressure, looked in their ears and throats — and then made my “rounds” again.
While …
A connection is lost when we outsource the physical exam
“I have a 20-year-old with what I can only describe as a poorly repaired heart defect and, uh, suboptimal follow-up,” the cardiologist’s voice was rushed.
“That’s no good,” I said.
“Yeah, well, it gets worse. She had baby two years ago. Went into heart failure around 36 weeks. I’ve got the records. I have no idea how she made it home.” And then he added, “She had a c-section, but no one …
When politicians decide a woman’s fate
While the typical physician is now accepting of the IT changes that are intruding into their work environment, he often does not understand the reasons or the strategic underpinnings for the push for the digitalization of health care. Being a typical modern consumer, he understands smartphones, online shopping, and email, but doesn’t understand concepts such as clinical data repositories, data warehouses, decision support and business intelligence. Analogies can help, but …
What health care can learn from the military
The names of things often greatly affect our perception. In end of life lexicon, there is a movement underway to change the name of the medical order DNR (do not resuscitate) to AND (allow natural death). No change in the medical reality of what occurs, but a radical change in our emotional reaction to the each term.
DNR: “They withholding a medical intervention” (evoking negative feelings).
AND: “They are giving care that …
Artificial death extension: It means that I actually care
Really, sir. What were you thinking?
I’m talking to you—the anesthesia provider (I hate to think that you might be an anesthesiologist) who allowed himself to be videotaped while a patient injected his own induction dose of propofol. Most people know something about propofol even if they aren’t in the anesthesia business–that’s the medication that Dr. Conrad Murray gave Michael Jackson to everyone’s sorrow.
I would insert the link here, but the …
Inducing anesthesia on YouTube: How many ways is this wrong?
There are about 27 million visits by children to America’s emergency departments each year. About a quarter of those are to rural EDs or ones at some distance from a dedicated children’s facility, such as a children’s hospital. Over the last decade or so it’s become clear that, for critically ill children, early transfer to an advanced pediatric facility improves outcomes. The children do better if they can be transferred …
Are emergency department pediatric transfers always necessary?
While new doctors in Europe “enjoy” 50 to 60 hour work weeks, doctors in the US work up to 80 hours a week, and sometimes beyond that. But the situation is changing.
One year has passed since new limits on the number of hours doctors can work in their first job. For first year physicians, shifts are limited to 16 hours, and in other years, the limit is 28 hours.
There has …
Work hour reform is a moral imperative
Last week I went on my first outreach visit to the homeless. In preparation we stocked up on water, gloves, gauze, and medications, put on our sneakers and headed out to the streets. We exited the front of the building, turned right and walked three blocks until we reached the corner with the highway on-ramp. We started crossing the street and about halfway, just past the service road and before …
Most of the homeless are invisible
If you want to succeed in academic cardiology, get a federal grant for research.
Better yet: get a few well-paid industry grants, too.
These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking because grants are harder to come by and money from their academic center is getting tight. For instance, the National Heart, Lung and Blood Institute (NHLBI) of the NIH no longer accepts investigator-initiated innovative …
In a financial squeeze, a way forward for academic cardiologists
In early 1996, I sat down at my computer looking for help.
My third child, 2 months old, had just been diagnosed with a severe brain malformation called lissencephaly. He won’t be normal, the doctors said grimly. His life will be shorter, we were told. He will have seizures and other problems, they said, but it’s hard for us to say what or how bad those problems will be. We were …
We need a doctor-family partnership on the Internet
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My mother is my role model and my inspiration for what I do every day. She was diagnosed with breast cancer when she was in her forties, and fought it courageously for seven years until she passed away in 2010.
There are so many stories I can tell about my mother and her battle with cancer. Let me start with just one. Whenever she’d go to her oncologist, she would go …
My mother couldn’t advocate for herself when she needed it the most
Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense? But do you know what your oncologist cares about, and can you be sure her recommendations map onto your own treatment preferences?
A recent study lead by Michael Kozminski (I was senior author) shows that American oncologists downplay the value of treatments that improve quality of life, …
Don’t accept advice from physicians until they understand your values
Burnout is a constant threat for physicians. Research consistently shows an average of 1 in 3 doctors suffering from symptomatic burnout on any given office day. In my work with over stressed and burned out doctors, I have found that most of us work way too hard being the superhero to our staff, patients and families — and don’t have any fun at all. It doesn’t have to be …
3 simple games to lower doctor stress and prevent burnout
Here’s a little story from the early days of my first job as a chairman of surgery.
Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger …
Doctors in no win situations: Damned if you do or don’t
A recent case from Dayton, OH highlights the tangled mess of emergency department specialty coverage, federal law, and out-of-network insurance benefits. When these interact, patients, doctors, insurers and hospitals can be left frustrated and perplexed.
Here’s a brief summary.
A 6-year old boy suffered a fingertip injury and the emergency staff called the covering plastic surgeon, who repaired the injury. The surgeon, who does not participate with insurance, submitted a bill for …
Mandating care in the ER but not payment: Why that’s a problem
A guest column by the American Medical Association, exclusive to KevinMD.com.
Since the American Medical Association launched our National Health Insurer Report Card in 2008, there has been noticeable progress by health insurers in response to the AMA’s call to improve the accuracy, efficiency and transparency of their claims processing.
The AMA has been working constructively with insurers, and as a result the …
AMA works to reduce administrative burden for physicians
Mr. Omer had once held a position of social prominence, a moral influence on the lives of individuals and communities. Until one year ago. A construction accident changed everything. He suffered injuries that left him in control of only one side of his body and his mind functioning as a 5-year old child.
Most recently, he had resided in an extended rehabilitation nursing facility, until yesterday.
When the nurse tried to arouse …
We have kept Daddy out of heaven with what we have already done
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