Physicians writing on KevinMD about the life of the profession: the work itself, the exhaustion, what women physicians are paid and asked to carry, the losses the profession has been slow to name, and who decides how physicians work. Five maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Primary care: what physicians say, in their own words, Women in medicine: what women physicians say, in their own words,, Physician suicide: what physicians say, in their own words, and Physicians and administrators: what physicians say about who runs medicine, in their own words.
We have known for quite some time now that the patient’s environment in a hospital matters to his/her outcomes. The concept of biophilia was applied by Roger Ulrich back in the 1980s to surgical patients in a series of experiments. Famously, this work showed that looking out your hospital room’s window on a bunch trees is associated with better and less eventful post-operative recovery than staring at a brick wall, …
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Private rooms in the ICU can reduce length of stay
Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?
Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …
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10 ways to make a difference in the lives of your patients
The airlines, in an effort to recoup revenue, started charging passengers to check luggage a while back. Seems like a great strategy. Not only are they recuperating revenue, they are giving passengers a reason not to bring luggage they don’t need. This of course saves money on fuel.
The result? More bags in the main cabin.
Since there is an incentive not to check a bag, more people bring their bags as …
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Medical practice unintended consequences
People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.
Got into the room late? Blame Anesthesia. (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)
Patient craving ice cream when she woke up? Must be Anesthesia’s fault.
No …
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Don’t always blame anesthesia for problems in the OR
I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work help. A couple of weeks ago, they published their results.
It turns out that in about 90% of cases, it didn’t matter.
A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades …
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The CSI effect and high tech medicine are driving up tests
“Doc, it’s only $10. I can’t believe you’re throwing me out of the practice for a measly $10. You, docs, are all the same. It’s all about the money!”
Unfortunately, the money is important. It costs money to keep a practice running. It costs money just to collect the money owed to the practice.
So, let’s look at some simple facts. Your physician’s office is one of the few places where you …
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Money keeps a physician practice running
I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive …
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How managed care is bad news for pregnant women
Osler said that exams were something of a menace to the true student of medicine:
“Perfect happiness for student and teacher will come with the abolition of examinations, which are stumbling blocks and rocks of offense in the pathway of the true student.”
— William Osler, from Aequanimitas, 3rd edition, 1932.
Perhaps this is because no examination can be passed by knowing the subject matter alone. One must also master the “hidden curriculum,” …
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William Osler and the necessity of the exam
I was driving into work recently listening to the radio and heard one of the fancy ads that our hospital has been airing over the last few years of it’s “Good People, Great Medicine” campaign. The ad was talking about getting results for a patient recovering from a heart attack. Around central PA, this patient is far too common. And listening to the ad brag about how quickly this …
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Family medicine needs to take advantage of buzzwords
When I completed my overnight shift and left the medical ICU the morning of July 1, I raised my arms victoriously. I uttered, “Finally, internship is done!” I may have been one of the last to speak such words.
As of July 1, 2011, intern year forever changed. In the world of medicine the first year of residency, or intern year, is when doctors earn their stripes. Traditionally it is …
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Work hour restrictions seem painful now, but are a gift
Can you properly examine and treat a 400lb patient in your office setting? How about a four-year-old in your ED? A deaf woman in Labor and Delivery? An 82-year-old in the endoscopy clinic? Do patients who present with challenges beyond their immediate health issues increase your risk for a diagnostic or treatment error?
Once-accepted practices, e.g., jerry-rigging adult medical equipment for a toddler, guesstimating the weight of a patient who exceeds …
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Malpractice risks with special needs patients
Not long ago, I was working for a pain management firm with 19 clinics scattered throughout three states. I was fast approaching my three year mark as the travel PA and more recently, the compliance officer. Little did I know that my career path was about to go off-road, into a new world of clinic ownership coupled with the unchartered territory of no-insurance accepted.
What a difference a few months can …
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Converting a practice to a no insurance accepted model
Upon finishing my second residency at Hopkins in Baltimore in September of 2007, I moved back to Williamsburg to start a new kind of practice:
- Patients would visit my website
- See my Google calendar
- Choose a time and input their symptoms
- My iphone would alert me
- I would make a house call
- They’d pay me via paypal
- We’d follow up by email, IM, videochat, or in person
It was simple, elegant, and affordable for me to start. But …
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Why medicine actively and legally stifles innovation
In the interest of full disclosure, I’m not a family physician. I never aspired to be one – I wanted to be a superhero as a kid. When I got older, I realized that all the best ones (like Spider-Man and Superman) spent their non-costumed hours as newspaper reporters or photographers, so I decided to go into that line of work instead. It eventually led me to the Pennsylvania …
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Why my family doctor is a superhero
