Though I had a less than comfortable childhood, I did not know what I missed in nurturing until I played football at around age 10. The coach, a big burly man, with a voice as huge as his girth, put his hand on my shoulder as he explained something to the team.
I have never been able to explain the feeling that went through me that day, that moment, like a …
The art of medicine and the power of human touch
A response to Concierge Practice: Unjust for Patients and Doctors Alike.
Like the shots fired at Concord and Lexington in 1776, concierge medicine and direct pay practices are the initial shots fired by concerned primary care physicians in the revolution against health care systems which limit access to physicians and destroy the doctor / patient relationship. Concierge medicine arose as a result of government, private insurance, and employer intrusion into …
Why concierge and direct pay medicine is not unethical
As a physician, I was inspired by the Lesley Alderman article –”The Doctor Will See You … Eventually” – that appeared in the New York Times recently.
There is a great deal of emotion in this country surrounding the debate over waiting-room delays in physicians’ offices. Doctors feel as though they are being unjustly blamed for making patients wait when physicians are now forced to see more patients in less time, and …
Are doctors to blame for long waiting room times?
Picture this: A medical journal receives an unsolicited manuscript from an unknown author, and then … Type 1 medical journal.
The peer review process employed by Type 1 medical journals uses secret, anonymous peer reviewers working behind an opaque shield hiding clueless and spineless editors who may use either no reviewers, or a few cronies, or those reviewers known to be opposed or known to be in favor of some …
Peer review at medical journals, from a former JAMA editor
Some hospitalists are in denial. Some hospitalists have become methodologic critics. But all hospitalists should take the findings of the recent Annals of Internal Medicine article seriously. We should not argue about the article, but rather ask whether these findings point out a weak point in our care of patients.
This article provides an opportunity, not a scolding:
In an accompanying editorial, two other researchers from the VA Medical Center in …
An opportunity for hospitalists to improve patient care
It may sound obvious. But many years working in and with hospitals has taught me that many health care providers, although they want to treat their patients in a culturally and spiritually sensitive manner, often don’t know how. It seems that every day as our country becomes increasingly diverse, health care clinicians are confronted with someone from a cultural or ethnic group they have never encountered before.
At the same …
Cultural competency leads to better patient care and higher patient satisfaction
What do you regret about your medical training or specialty selection?
Anything?
One thing I regret is not taking advantage of the Masters degree in Health Administration program at my medical school. At the time, I was focused solely on medicine and on being a doctor. I didn’t think the business side of medicine was all that important. In fact, I didn’t consider the business side of medicine at all.
I regret …
How can doctors understand the business side of medicine?
“I’m sorry.”
I said that phrase a lot last night during evening patient hours.
With an overfilled schedule, I mostly said it to patients who waited twenty, thirty, even forty-five minutes for me to see them. “I’m sorry for your wait. I appreciate your patience.” I say these sentences far more often than I should. Why is it so difficult to stay on time?
I could blame my inadequate supply of nursing staff; …
Why is it so difficult for doctors to stay on time?
I’ve heard patients say, “How could she smoke and she’s a doctor?” Alarmed and bewildered by the fact that an agent of health could partake in one of the most harmful acts of bodily destruction. In medical school, a sizable number of my classmates smoked and I always found it so counter-intuitive, mind-boggling that they would be learning about smoker’s lung in pathology and on class breaks would huddled outside …
Doctors sometimes fail when practicing what they preach
I was working in the bone marrow transplant clinic of an internationally known cancer center. When I looked into the patient’s faces, I saw hope as they were being worked up for a possible transplant.
I went into see a new patient. She had leukemia and had relapsed after her remission. Her sister would be the donor.
Gretchen, age 19 came in with her mom for the appointment. She was tall, youthful …
Taking the time to answer patient questions
“My grandson has HDHD.”
This was intriguing. I had just asked her one of my standard psychiatric interview questions about family history of mental illness. Maybe I hadn’t heard right, but it sounded like she was telling me about a new flat screen. Had her grandson just bought a fifty-two inch LED set in time to watch the Final Four this weekend? Had he mounted it on the wall on …
Doctors diagnose, sometimes we dispense, often, we teach
Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.
In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …
Female doctors and the physician shortage
I had a patient once—a fellow physician—who came to see me complaining of mid-back pain. When I examined him, I found I could reproduce his pain by pressing firmly on the spot he said was hurting him. He said pressing there also made the pain radiate around to his stomach, a phenomenon known as “referred pain” that meant his pain was almost certainly caused by a trigger point. I …
How early closure can cause doctors to misdiagnose
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Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
1. Medication questions and requests for a prescription change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009 (Kaiser Family Foundation calculations using data from …
6 reasons why doctors won’t call patients back
A reader writes, “Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last 3 doctors I went to, I realized they didn’t …
There is no such thing as a complete physical examination
A cover story by Gardiner Harris in the New York Times spotlights the changes in modern psychiatry, from extensive, psychotherapy-based interaction to brief, medication-oriented “psychopharm” practice.
The article shares nothing new, particularly to anyone who has paid any attention to the rapid evolution of the psychiatric profession over the last ten years (or who has been a patient over the same period). While the article does a nice …
Do patients accept hurried, fragmented, disconnected care?
Doctor D has been blogging about the doctor-patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.
Doctor D recently found himself on the patient side of a nasty injury.
Even as Doctor D looked down and realized his leg wasn’t …
What this doctor learned when he was a patient
Recently, the American Journal of Medicine published a study with the unexpected conclusion that hospitalized patients were more likely to die or stay long in the care of an experienced physician than in the care of a recent graduate from residency: “When doctors weren’t very busy, they kept patients in the hospital for roughly the same average time no matter how many years of experience they had. But when they did have a …
Why you would want a younger doctor in the hospital
As I point out in The Medical Profession Is Dead and the Doctor Is “Critically Ill!“, more factions are able to charge for and be reimbursed for healthcare delivery than ever before. This has come about through creating boutique health care niches. The demand for boutique care is being driven by entrepreneurial interests, and, once brought to fruition, then being managed with corporation business tactics — i.e., for profit.
One of the …
The problem of hospice in nursing homes
It takes its toll on me, being a doctor.
I think as I wait in the Indian restaurant buffet. My son is curled on my lap. Uncharacteristically tired. Later he will develop a fever and I will realize why he is so warn out.
It takes it toll on me. I wouldn’t say I am a stressed out person but I certainly live with stress. Most of it is self inflicted.
It’s …
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