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.
The Institute of Medicine has been an advocate for clinical guidelines for many years.
Although the value of guidelines has never really been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past few months and I review it briefly here.
A few years ago Dr. Robert Ewart discussed the ethics of using guidelines to screen patients …
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Malpractice attorneys shouldn’t rely on clinical guidelines
A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.
So let’s take a look at compassion.
Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …
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Depersonalization of the patient and the loss of compassion
This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.
I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen …
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What your medical office can learn from Norman Rockwell
One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.
By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I …
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Can a doctor and a nurse be friends in the OR?
The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.
Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …
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How MD anesthesiologists have become victims of their own excellence
Here’s your multiple choice question to set the stage: what percentage of all physicians do you think should be sued for malpractice?
Would you say one-in-ten doctors ought to be sued? Or one-third? How about every single one of them? Let’s make it one claim per doctor, nationwide. Does that sound reasonable? Keep in mind that even defending yourself against a suit will cost on average $40,649 per claim, ranging from …
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Malpractice fails when it comes to medical errors
Here are five things that you should have on your 2011 To-Do list.
1. Start electronic prescribing. What have you been waiting for? The EMR/EHR? (See number 4 below.) Electronic prescribing can work in a stand-alone (no EMR/EHR) environment. Work flow can be modified, and you will benefit tremendously with additional nurse time available to you after the nurses realize how much phone time they save each day.
Ask your current practice …
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5 ways to improve your medical practice in 2011
Oh, those Millennials.
Also called “Generation Y,” this is the American demographic group born during and after the ’70s, that was vicariously raised by “learning is fun” Sesame Street and became accustomed to getting awarded for any effort. They don’t know about bomb shelters, walking to school, tape decks or having to get up to change a TV channel. Well, they’re now entering the workplace and their informality, disregard for rank, …
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How Millennial physicians will impact disease management
Can you succinctly state what your company does, where it’s headed and how you plan for it to get there?
In the April 2008 edition of Harvard Business Review, Collis and Rukstad ask an important question: “Can you say what your strategy is?”
Of course, they ask this because their research found that many firms’ CEOs cannot succinctly summarize their organization’s strategy. And if the CEO cannot do this, then it’s a …
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Superior customer service to grow your practice
by mdstudent31
One of the hot topics occurring in the health care debate deals with figuring out appropriate leaders of the Patient Centered Medical Home (PCMH). With the recent report by the IOM advocating for independent practice by nurse practitioners, many physician groups, including the AAFP and AMA, have come forth with strong statements advocating against the IOM report and independent practice by CRNPs.
A recent editorial …
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Worsen the nursing shortage with more nurse practitioners?
Have you ever been frustrated by an unproductive or inopportune visit with your doctor that wasted your time and money?
Here are a few tips to keep that from happening again.
The problem
Many visits with healthcare providers are poorly timed and less productive than they could be. Why? Because nobody is looking out for you between visits. It’s not that your doctor doesn’t care. He or she is simply too busy with …
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Save time and money with your visit with healthcare providers
by Louise Marie Roth, PhD
About one third of all births in the contemporary United States occur via c-section. Physicians and the public at large often attribute this to a “malpractice crisis,” whereby obstetricians perform c-sections routinely to avoid malpractice litigation. Over the last couple of years, I have been conducting research on obstetric practices and malpractice.
One of the things that I have learned …
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Are malpractice lawsuits really responsible for the rise in C-sections?
I was sitting on one of the hospital’s nursing units having a difficult telephone conversation. Anyone working nearby could have easily discerned the situation from my end of the call.
Patient’s family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.
Having never had to make such a decision in my own life, I am left to imagine how …
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Kind and thoughtful words from a fellow physician colleague
Does patient satisfaction matter? The answer is a resounding “yes.”
In fact, as the director of an emergency department, feedback from dissatisfied patients has provided both me and our group with an early warning about several physicians who were not performing up to our standards. Studies show a clear correlation between decreased patient satisfaction and increased medical malpractice risk, so meeting our patients’ needs is not only in their best interests, …
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Do satisfaction scores really measure quality care?
When I was an intern in internal medicine, I admitted a patient to my service with pancreatic cancer.
Pancreatic cancer is a bad one; back then, only ten percent of patients with it would be alive within five years after being diagnosed. My patient was a farmer in the full bloom of late middle-age health when he began rapidly losing weight. An abdominal CT scan ordered by his primary care physician …
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Doctors play a role in helping people through transitions with rituals
An interesting article in JAMA by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.”
Basically, are we motivated by virtue, by self interest or are we just passive victims? The authors suggest that this is a good question not only for physicians to contemplate but …
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Are physicians motivated by virtue or are they passive victims?
The many benefits of utilizing virtual assistant in the physician’s office have become clear to many. Physicians report greater job satisfaction, patient retention and cost-efficiency as some of the most obvious areas impacted by the use of virtual assistants in their practices.
Physicians preparing to shift some of their staffing needs to a virtual assistant or virtual assistance company have many questions and concerns that will be addressed by the person …
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Employing a virtual assistant in your medical practice
I sat at the checkout desk in my practice last week for the first time and as always, it was a revelation. If you haven’t worked your check-in and check-out desks recently, I highly recommend it.
An insured patient that I checked out was shocked when I said the charge for her visit was $100. She said, “But he was only in …
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Your 10 minute office visit needs 8 people and 45 minutes of work
My father, although retired, is a general and thoracic surgeon, triple boarded in critical care, who ran a trauma unit. My brother is a pretty successful lawyer. Whenever I visit them, inevitably at least one night ends with the three of us around a table, and the two of them going at it about who is to blame for the malpractice system.
My father, of course, blames the lawyers; my brother …
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Doctors can reduce malpractice by being better people
I sat at home with a sense of relief. I had just finished my first month of residency – a grueling inpatient hospital month where I was pushed to new limits.
I now finally had my first “golden weekend” (meaning I had both Saturday and Sunday off). More importantly, I had survived my first month without any patient deaths on my service. Given how sick people are when they come to …
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Measuring health outcomes is important but needs caution
