A few days ago, I received a question that stopped me in my tracks. I was giving a talk to a local church group on the importance of patient advocacy, and most everyone was nodding. Yes, doctors don’t always listen — let’s do something about it! Yes, we need to control of our health.
Then someone raised her name. Her name is Susan, and she is the owner of a mom-and-pop grocery in …
Improving medical care needs to involve the doctor
As doctors in training, we learn to think in patterns of symptoms and can often use “clinical judgement” to fit a patient’s presenting symptoms into a diagnosis. This generally works well, until we are presented with an unfamiliar pattern. For example, in the early 80’s I saw a 60 year old shoe salesman with fatigue and a low grade fever. He had general malaise and some muscle weakness. His exam …
The questions in medicine never change, but sometimes the answers do
I love being a medicine attending in the summer. It’s often more intense work since everyone’s in a new role. Bright, fresh interns. Excited new residents. And the medical students – the new third-year students who have toiled in the classroom finally get to focus on patient care.
Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it’s a …
Being a ward attending: A job I am so lucky to have
I knew it would happen sooner or later, and earlier this week it finally did.
In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and heart attack were now instantly available on the Internet. While we performed …
The upside of hospital rankings far outweighs the downside
In the debate over health care reform the issue of choice is often brought up. I’m not referring to a women’s right to choose or the birth control controversies but the simple idea of individuals being able to choose their health plan or physician.
However most physicians would probably agree that for much of health care, especially unexpected and sudden illnesses, the idea of choice is an illusion. Patients rarely choose …
A physician has difficulty choosing a primary care doctor
“The plural of anecdote is not data.”
A recent lead editorial in the Sunday edition of the New York Times was entitled “A Formula for Cutting Health Costs” and contained the byline “Alaska natives have something to teach doctors and patients in the rest of the world.”
I read the editorial with interest, hoping that a new perspective, vision, idea, or insight would be mentioned that would provide a sustainable cost solution …
Mainstream media’s sinister undertone against doctors
Ralph Coates, PhD of the Center for Disease Control (CDC) described in the June 15, 2012 issue of Morbidity and Mortality Weekly Report that by looking back at a U.S. study done between 2007-2010 called “Use of Selected Clinical Preventive Services among Adults,” health providers need to do a more comprehensive job of offering preventive services.
According to the report, only 47% of patients with documented heart and vascular disease were …
Doctors avoid comprehensive preventative questioning
In today’s healthcare environment, nearly half of all new physicians are salaried employees of a hospital or healthcare system. Now, more than ever, physician leadership is of paramount importance. With increasing pressure to increase care quality and simultaneously lower healthcare delivery cost, it is essential that physicians and administrators work together. Physicians must continue to grow into executive roles and lead both healthcare systems as well as manage other doctors …
How to train more physician leaders
Costs are spiraling out of control, access is declining, and our quality of care doesn’t match what other developed nations are delivering at half the cost.
In the search to reduce costs and bring our ever inflating health care budget under control, the powers that be (insurers, government, health policy wonks (and maybe a few doctors) have looked to individuals with less formal education to perform medical services that were once …
Go ahead and let teens read x-rays
I gently rotated his arm as the beads of sweat formed on his forehead. The pain came in waves. His face contorted and relaxed in repetitive spasms. I wondered if my exam was in vain. The cancer had spread from his lungs to his liver and into his bones. Once the blood stream had been tainted, the aggressive cells took flight and landed in various organ systems.
We already had the conversation. I …
A tragedy based on administrative decisions
On a recent trip to Philadelphia, I caught up with Dan, a friend of mine since college. He is an artist in Philly, where he lives with his wife and daughter. He had asked me about being an oncologist, told me he had read my ASCO blogs.
We spent hours discussing everything—parenthood, careers, and mutual friends, and one in particular. Her …
The circle of support in the critical moments of the cancer journey
I am a patient. Yes, and a physician; a brother, father, husband, grandfather, uncle, friend, neighbor, taxpayer and concerned citizen. What healthcare reform means to you means the same to me, or more. Maybe because as a physician I focus on it a little more than the average person, I have an additional responsibility to share my perspectives? Maybe a little knowledge is a dangerous thing, as the saying goes.
I …
Integrated care cannot change how we behave
A few days ago, I came across an article entitled “Calling Dr. Google” by Jeff Jarvis. The writer describes his experience “Googling” his symptoms and finding that the internet brought him the correct diagnosis. He uses his personal story of appendicitis to point out that physician fear of information on the internet is overblown.
One would hope that the argument that you cannot find any trustworthy information on the web is …
Dr. Google is currently only medical student Google
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When we love someone, we want for them the best. We fight for and with them. We push them to attack disease. Is it possible that our very love can cause suffering? Can we mistake our eternal love for each other with a futile fight for immortality? Does our caring crush the ones for whom we care?
In a fascinating article, the Wall Street Journal followed the terminal case of …
Does our caring crush the ones for whom we care?
Most of us will not have the opportunity to just die of “old age” or to simply fall to sleep one night never to wake again. Most often, we develop an illness which causes our death. These have changed markedly over the years. For the pioneers, accidents, infections, childbirth were times and causes of great likelihood of death. A century ago, infections were the leading causes of death. Today, we …
The dramatic change in the causes of death
When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that …
How should physicians give bad news to patients?
Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation).
I would never go to a non-board …
Why I would never go to a non-board certified physician
I had an unexpected gift this week: a not-so-sick sick day with my 5 year-old. And it really couldn’t have come at a better time.
We’ve never had a sick day like this before and he’s off to Kindergarten in September so the days were running out for preschool stolen-away sick leave.
In the past when he’s been ill he’s been well enough for me to head off to clinic or work …
Sick days: When our children show us the way
An article in the New York Times sheds a little light in a dark corner of medicine, the world of workers’ compensation. In particular, it highlights a world of doctors that dispense drugs in their offices, which improves both patient satisfaction and profits.
Though fraudulent insurance claims are always easy headline-grabbers, the real world of workers’ comp is complex and not always so tailor-made for sound bites.
Add to this …
Workers’ comp: The dark corner of medicine
The practice of medicine has changed enormously in just the last few years. While the upcoming implementation of the Affordable Care Act promises even further—and more dramatic—change, one topic which has received little popular attention is the question of exactly who provides medical services. Throughout medicine, physicians (i.e., those with MD or DO degrees) are being replaced by others, whenever possible, in an attempt to cut costs and improve access …
What could bring psychiatry to its knees, or save it
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