I was working in the Intensive Care Unit (ICU) the other day and as I counted, I found that more than half of the patients there, for lack of a better term, brought the condition upon themselves.
I sound harsh, but there was no better way to put it. I was taking care of Mrs. B, a 60-year-old lady with COPD who called EMS for shortness of breath. As EMS readied …
Heroic measures cannot cure how people want to live their lives
I recently talked about wondering how those I had met through my own patients were doing, especially after my patients had passed on. I wondered if they were all right and whether they were able to move on. Well, I’ve been thinking about it again, though this time in the context of cancer survivorship.
The Office of Cancer Survivorship of …
When do I stop being someone’s oncologist?
Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most. All doctors made a comfortable income; money wasn’t a primary motivator. There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer. Internal medicine was held up to us as the most prestigious and intellectually …
Why the physician shortage is worse than you think
The sage doctor who stood at the bedside as I held my dying grandmother said, “We seem to die one organ at a time.” I, however, have come to believe that we are too focused on the failing of the organs to rightly perceive the dying of the person.
Death comes in many different ways, in many different packages. Sometimes it arrives wrapped thoughtlessly in advanced dementia, other times the package …
Death arrives in many different packages
Several years ago I was hired by a plaintiff’s attorney as an expert witness on a personal injury case. He paid the fee in advance but the night before the trial, his co-counsel called me to review the case. It was clear that she did not have a thorough understanding of the case and I spent two hours with her on the phone trying to bring her up to speed. …
Lessons learned when a doctor sues an attorney
As most of the electrophysiology (EP) community is aware, device and lead recalls are a reality in today’s EP practice. In the last 5 years, both Medtronic and St. Jude Medical have had significant lead failure issues. The public responses to these recalls have been varied and quite different. As physicians who care for device patients, we must learn to quickly sort through the rhetoric put forth in the New …
The emotional effects of device recalls on patients
I am on my last rotation for medical school. It is a “rural selective”, which is a required elective at a rural or underserved location. I am fulfilling it at a local community health center in the women’s health department. Fun!
I am taking part in a day long orientation today. In one of the presentations, the speaker had a point on one of the slides about mandatory reporting, and included …
Should every case of domestic violence be reported?
Medical residents have fewer labor protections than Chinese factory workers. While labor abuses at Apple’s factories make headlines, few people are as concerned about the lack of protections for doctors and medical students here in the United States. As a resident, I was subject to some of the worst abuses – intentionally misreported time sheets and gender-based discrimination – and after I complained, I was fired, so I sued the …
Medical residents are abused more than Chinese factory workers
The United States of America is an immigrant country. It is a melting pot of many peoples and has basically been so since before the Mayflower passengers laid foot on New England soil. Promise of equality, success, quality of life and freedom have drawn multitudes of professionals from all over the world to try to make it in the US. Some of these professionals are doctors.
A doctor that wants to …
What should be the threshold for allowing doctors to work in the US?
How can you determine whether you are in a “developed” or a “developing” country? We used to call these latter “un- or underdeveloped” or “3rd world” countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic.
If one objectively examines all 20 dozen or so of the world’s countries, a geographer would divide them into either north or south of the Equator. And if, …
What separates a developed and a developing country?
Hospitals commonly espouse a commitment to patient-centered care (PCC). Most fail to achieve it. Causative factors are legion. PCC is often considered a strategy or a tactic, for example, when it really should be integral to an organization’s culture, and enabled by a supportive vision. Some organizations appreciate this, yet still struggle. This is understandable. Today’s health care providers were not trained to provide PCC. They lack the requisite skills, …
Is patient-centered care an outmoded concept?
For various reasons our nation’s public health programs have been decimated. This comes at a time when the number of unemployed and health uninsured are at a record high number. Additionally, we are seeing individuals live longer and experience more chronic debilitating illnesses and conditions that stretch the resources of an already under manned and under funded health system. Emphasizing prevention and healthy living should be a lifetime necessity for …
Why we need a National Health Service Corp
Sometimes a patient interaction leaves you speechless. In my experience, that most often occurs when a patient refuses to acknowledge any responsibility for their condition despite massive evidence to the contrary. This is compounded when dealing with caregivers of patients who don’t just drop the ball, they kick it into the next county on purpose.
Here is an actual phone conversation between a fellow physician and a son of her two …
A deficit in caregiver personal responsibility
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Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis. Many articles, both pro and con, have been written regarding P4P. I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals. I also believe that …
Why patients should be paid for good health
In January, when my close friend’s lymph node biopsy came back as a rare form of T-cell lymphoma, I scoured the scientific literature. What was his prognosis?He was 56, a little overweight but otherwise healthy. He had helped us move into our home more than a decade ago, and I was like an uncle to his son and daughter.
In the literature I found jagged graphs plunging downward, indicating that my …
When doctors are incorrect in their prognosis of terminal illness
As I enter the hospital in which I work, I am struck by a number of signs that denote that my place of employment is a Christian hospital, with Christian values, and a Christian “vision” of health care. I don’t have the vaguest clue as to what that means. And I don’t really mind either, it’s not like they’re paying me with Jesus biscuits and Christmas ornaments, nor does it seem …
A Hindu physician in a Christian hospital
People often wonder what causes children to bully. Why is it that some children feel the need to hurt and humiliate other children? What do they really stand to gain from this cruel behavior?
Some studies indicate that some (not all) bullies have naturally aggressive and/or hyperactive personalities from the start. Some. But that doesn’t mean that all “spirited” kids will bully while all “mellow” kids will be perfectly empathic and …
Bullies are not born, they are raised
There was no mistake, but a bad thing has happened. Despite the best efforts of the doctors, Bob’s wife is very sick. Due to a rare side effect of treatment, her liver is failing. Bob believes this could have been prevented. He is very mad.
“When we go to see the doctor, he stares at the computer,” says Bob. “He does not look at us. Most of the time, the doctor …
The computer had stopped the doctor from communicating
As a child, the only physician I ever knew was our crusty opinionated and entirely trustworthy family doc. His physician career spanned almost five decades, in one unbroken line from his first days as a GP in solo practice until his retirement, which occurred way past the age at which most of us would like to stop working.
His was the typical physician career, representing continuity, professional satisfaction and a lifelong commitment …
Why the physician path today is far from linear
One of the most common stressors for physicians is the sheer toxicity of what are considered full time hours. While the rest of the world considers full time to be 40 hours a week, we all know a full time doc starts at 80 plus, if you include all the hours you must be available on call.
In physician surveys, schedule flexibility and the ability to function as a part time …
Part time medicine and birth of the new normal
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