My in-laws are in town for my daughter’s graduation. When I came home yesterday I was greeted with a big smile and vigorous handshake from my father-in-law. ”I just want to thank you,” he said, standing up from his chair, “for finding us a good doctor. The one you found for us is wonderful.”
My wife smiled at me warmly. I just earned myself big points. Yay!
Her parents and mine are …
Being on the other end of finding a good doctor
I could hear the morning call to prayer as I drove toward the Aramco Hospital in Dhahran, Saudi Arabia for my early morning rounds in the ICU. I was hoping that my young asthmatic on a ventilator might be ready to be weaned off and that the medications had kicked in sufficiently. My young Saudi medical student met me on the way in and said, “I think she’s doing better, …
Caring for the patient despite a vast difference in culture
I’m sweating and silently wondering how the chewing gum in my mouth has chemically changed to sand. My mouth is so dry I can barely speak. I may be silent, but thank goodness my patient is talking to me, because all his monitors and machines seem to be bleeping and bopping and malfunctioning at once.
I reach for my eyeglasses, which have become hopelessly entangled among pens, alcohol wipes, and other …
When teamwork takes more than the usual share of effort
It always has broken my heart to see a person bankrupted by the costs of their healthcare. I remember my outrage when I first learned the only people who pay full price for their medical procedures are the ones paying cash. Insurance companies use their market muscle and patient volumes to negotiate discounts for their patients that have always been unavailable to the uninsured, individual healthcare consumer.
If you have been …
Hide your health insurance status and pay cash instead
“Oh, by the way” are four simple words that cause most docs to shudder. Yes, shudder. Your patient signed in for a sore throat, congestion, and cough. The nurse did her job. She’s recorded the patient’s chief complaints. She’s taken the patient’s vital signs and readied the patient to see me, the doc.
I take a history, asking questions about the problems that brought the patient to the office. I ask pertinent …
What patients think is not trivial
Guidelines for care increasingly help guide medical decision-making. If you’ve followed top health news over the past several years you’ve read conflicting statements about the utility of various medical procedures and tests. As a general internist I’ve devoured these reports with particular interest trying to wade through bias to formulate views that I believe will be of most benefit to my patients.
Recently I put together a talk about recommendations for …
The problem of conflicting professional medical guidelines
Some things in medicine are obvious. Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right. I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of dollars and heroic clinical effort to our continued goal of staving off death. Why is this? Do …
When self-evident truth in medicine is systematically ignored
In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed …
Protecting patients by solving the problem of defensive medicine
Patients often don’t get the respect they deserve. Take the subject of patient engagement. Just about everywhere you turn in the health care literature these days we are told how physicians and other providers need to do a better job getting patients involved in their own health.
But is that really their role?
Patient engagement is not the job of health care providers
Why? Because by the time a person (aka patient) …
What is the role of providers when it comes to patient engagement?
There was a night when I was in training that all the decisions, disasters and chaos, which are the practice of medicine, caught up to me. In those dark hours, I felt practically despondent. What I had seen left me in tears and overwhelmed by the tasks in front of me.
At that moment a wise attending physician took a moment to sit with me. Rather than tell me how wonderful …
How doctors handle fear will determine their ability to give care
Never heard of the 90-80 dilemma? That’s because I have just coined the phrase. You see, tied into soaring healthcare costs in this country, is another humanitarian crisis of massive proportions.
A huge gap exists between what Americans want for end-of-life care and what they actually receive. 90% of people wish to die at home, yet nearly 80% of us actually die in institutions (hospitals and nursing homes.)
So, how did we …
Create peace and dignity at the end of life
There’s nothing better than sitting down with a patient, going though an entire visit, and collaborating on a well thought out plan that meets everyone’s expectations.
Shared decision making is a wonderful and necessary concept in modern patient care. Paternalistic attitudes are fading away in the medical community as the next generations of doctors continue to get educated on how to manage patients who are very knowledgeable and yearn to be …
Shared decision making is a necessary concept in modern patient care
I’m currently having a chance to do one of my least favorite things: be a patient. And the whole time, I’m missing no opportunity to declare what a bad patient I am. “I’m sorry I’m such a bad patient,” I said to the phlebotomist when I winced as she drew my blood. “I know I’m a bad patient,” I said to the x-ray technician who re-positioned my fractured arm. “We …
Is a good patient simply one who never complains or disagrees?
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The show-stopping line from the Hans Christian Anderson’s 1837 fairytale is actually, “But he has nothing on!”
A brave, young, clear thinking boy in the crowd is the only person confident enough to say what he thinks and speak up. Perhaps even more simply, the young voice in the crowd has not had the life experience that often builds (and rewards) the filters of loyalty, flattery and only saying and thinking …
How we need to take risk to reduce risk in hospitals
In oncology, there are certain words and phrases that (no matter how carefully said) suck the air out of a room, like “you have cancer,” “you’ve recurred,” “incurable,” “terminal,” and “hospice.” Such phrases require careful consideration before they are spoken, and most (if not all) oncologists understand the power of these words, and use them carefully. However, there are others that can …
The power of words in cancer care
Two weeks had passed before I learned what happened.
I hadn’t seen him in several months. At our last meeting, the trees were full of red and orange leaves. He, as usual, was not interested in talking to me. He was sitting in front of a closed shop.
“Hi. How are you?”
“Fine.”
People in the neighborhood took care of him. Surrounding him were several plastic bags holding neatly stacked styrofoam containers filled with soup. …
I love when an article I read first thing in the morning gets me to think about itself all through my morning chores and then erupts into a blog post. So it was with this little gem in the statistical publication Significance. The author suggests making gambling safer by placing realistic odds estimates right on the poker machines in casinos. He even goes through the generation of the odds of …
A radical transformation in healthcare decision making is needed
For anyone in the helping professions, compassion fatigue is a common occurrence and a clear signal to take better care of your own needs.
Compassion fatigue is when you find yourself challenged to care about your patients in the way you know is proper and expected in your position. One of the key components of quality healthcare is the ability for you to connect with your patients and for them to …
Compassion fatigue is an early warning sign of physician burnout
The mass media has a long history of covering medical dramas and rarely doing so with any realism. We’ve gone from Marcus Welby, MD to a host of shows dedicated to portraying medical personnel in the most salacious ways possible. But at least with all these dramas it is understood that they are fictional. There are now though a host of shows which pretend to show real life medical stories …
Men’s health is a joke on television
You may have noticed the rash of medical news spewing from your favorite news outlets with greater frequency. As a medical professional you probably cringe as you envision the calls that are about to flood your office, “Doctor Smith, I heard a report on the news that this drug you prescribed to help me quit smoking is bad for my health!” or, “I want a referral to The Hoffenheimer Institute …
How academic press releases are being used for free advertising
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