What is happening in medicine? How will these changes affect our patients? How will they affect how we deliver health care? These seem to be the questions asked most often amongst physicians across the country. I do not profess to have a crystal ball nor can I state with any certainty what the profession we chose to dedicate our lives to will look like in the near future. However, there …
Physicians need to get involved or risk irrelevance
In February 2015, the British Parliament approved the creation of a human embryo from the DNA of three people: mother, father and a donor mother. The modified in-vitro fertilization (IVF) technique, called mitochondrial replacement therapy (MRT), would help some mothers with known rare mitochondrial mutations avoid passing on unhealthy defects. These defects can cause severe or deadly diseases, which are often incurable, such as muscular dystrophy, heart and kidney disease, liver …
The unknown impact of changing a person’s genetic makeup
For a moment, let’s forget about his unfiltered voice, bullying, flip-flops, ego, and violence-focused rhetoric. I know suspending this discussion might be interpreted as some as my supporting Donald Trump. I do not.
I would rather, however, look at how Donald Trump in the White House might affect the day-to-day lives of physicians. And by this I am not referring to his support or opposition to universal health care, for I …
How a Trump presidency may affect physicians
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American businesses hold a solution to one of the most fundamental flaws of American health care: misalignment of incentives. We live in a nation where profit-seeking behavior can be more alluring than high-quality patient care. To date, major health care reform efforts have paid little attention to the business community’s potential to address this issue.
Status quo
Currently, the status quo is such that health insurance companies and health care providers act …
How employers can lead the way for health reform
As health care settings become more focused on patient experience and care for the whole person, issues of culture, diversity, personal beliefs, and values have come to the forefront. Staff are expected to deliver not only high-quality clinical care but to do so with compassion and care. Neither of these elements are new, but they are gaining attention as health care is increasingly measured on a number of quality indicators, …
How chaplains are a valuable part of the health care team
Part of a series.
Here is a model for the delivery of primary care which offers certain rights balanced by responsibilities for patient, provider and insurer alike.
First the rights of each party. As a patient, you deserve a high level of care in a satisfying manner without frustrations. The insurer and your employer want to see the total cost of health care come down. The physician wants the satisfaction …
What does a new model of primary care look like?
5 a.m. on a Friday morning, during a lull in my overnight shift, I got a text from my friend Julie (name changed).
“Steve had a massive heart attack.”
Me back: “OMG, what happened.”
Julie: “Not sure, he called my mom, he thought he was going to die. Now they are doing a CT scan.”
And so it went on. As I waded through the information, Julie thought she understood I realized that she …
Why I cherish my role as a medical translator
Three (and a half) years ago, when I left my old practice, I was near burnout. I was exhausted, not because of the amount of time I was spending — it was actually about the same, if not less than I had worked before — but because of an ever-increasing gulf between me and my patients. I have always tried to give care that focused on the person with me …
A physician’s journey to true patient-centered care
Health care is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year.
What’s a poor patient to do?
For starters: They can talk to their doctors about these costs. According to a study my colleagues and …
Talk to your doctor about health costs. It can save you money.
Science, to use the term correctly, isn’t a body of knowledge or a bunch of facts written up on a whiteboard by a crazy-haired professor. It’s a method, or way of figuring out things. Thinking and reading and learning from experts are all important, sure. But real science relies on experimentation.
First, make an educated guess about how something works. Then design an experiment to test your guess. (I’m oversimplifying here. …
The best defense against the influence of crappy science
Hi Pamela,
I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel …
Medical school has killed my soul. What can I do?
The debate over the safety of giving birth at home, both for the mother and for the infant, has been debated for years. I’ve written about the issue myself. From time immemorial until about 75 years ago or so most babies were born at home. Now it’s around 1 percent in the U.S., although it’s much higher than that in many Western European countries.
The shift to hospital births …
How safe are home births? A pediatrician explains.
Currently, in American health care, experts are wringing their hands in confusion. I mean, people have insurance, right? And yet, health care is still expensive and dang it, people just keep going to the ER. Visits are climbing everywhere, and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century.
I’m not a …
The “go to the ER” mentality of American medicine
A surgical resident writes:
I’m sure you have read several recent studies suggesting that current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency.
My questions for you:
1. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?
2. What should we do differently? I personally don’t feel that “more simulation activities,” which …
Are today’s surgical residents poorly trained?
Over the last several years since I graduated from residency, I’ve worked in many different hospitals up and down the east coast. These have ranged from large urban medical centers to rural community outposts. In all of these places I’ve felt the inevitable conflict that exists between physicians and administrators — to varying degrees.
It almost seems like a rite of passage that the world of clinical medicine and administration are …
Why the best administrators are doctors and nurses
Even as a child, I noticed that many people, especially my Depression-era grandmother, feared aging and the imminence of death. Death was no stranger to me growing up; I lost my then best friend, my Nano, and my uncle as a child, both traumatically. Yet, death was sad, but natural.
Because of this, I never understood our society’s stigma against dying, something that I’ve struggled with even in medical school. In …
The importance of palliative care in surgery
You have a persistent cough and poor appetite, but for six months your doctor has prescribed an assortment of antibiotics after an initial chest x-ray showed a small pneumonia. Finally, short of breath, you go to the emergency room where a CT scan reveals untreatable lung cancer. Later you find your doctor has received a bonus from your HMO insurer for not ordering a CT scan earlier.
Physicians count on experience …
Make sure you know who signs your doctor’s paycheck
Physicians today are increasingly viewed and treated as skilled workers instead of professionals. The difference is fundamental and lies at the root of today’s epidemic of physician burnout.
Historically, there have been three learned professions: law, medicine, and theology. These were occupations associated with extensive learning, regulation by associations of their peers, and adherence to strong ethical principles, providing objective counsel and service for others.
Learned professionals have, over many centuries, worked …
Doctors are more than just skilled workers. Here’s why.
Hope is a tricky thing. On the one hand, false hope can lead patients to opt for painful, futile treatments at the end of life. On the other, unnecessarily bleak outlooks can lead to depression and inaction. When health is at stake, presenting information with the right amount of hope can guide patients away from both suffering needlessly and/or succumbing to treatable disease.
I was reading a sad story about a …
Why we need hope in health care
This question has been circulating in the academic medical world for years. As an intern and resident, I would hear complaints about how “unready” they seemed. The grievances often include adjectives like ill-prepared, lazy, or uninterested. The complaints have burgeoned over time, and the examples are numerous in my institution: Students show up late to rounds with coffee in their hands; one med student had the gall to go directly to the attending and …
What is wrong with medical students today?
