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A geriatrics-driven health care system

Physician

April 29, 2015

We have all seen the statistics; America is an aging country. The baby boomer generation is retiring, and families are having fewer and fewer children.

In health care, we often hear about this issue in the context of an inadequate health care workforce. An aging population in conjunction with the ACA has created a quickly growing pool of patients that outpaces the slow growth in the supply of health care providers.

But …

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A geriatrics-driven health care system

I temporarily went back to paper records. And it wasn’t so bad.

Steven Reznick, MD

Health Technology

April 29, 2015

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On Monday March 30, 2015 our Greenway PrimeSuite electronic health record had a system-wide failure at the level of the Edgemed Computer service center in New York State. It meant that I was back to using pencil and paper to interview patients and record the answers and physical findings.

With much trepidation, I began seeing patients with two sheets of white blank …

Burnt out physician? Creativity can help.

Starla Fitch, MD

Physician

April 29, 2015

Those of us in health care face tough decisions every day. Should we spend less time with patient A so we can have more time to tell patient B about a bad pathology report?

Should we work through lunch to see a few more patients but risk burning out our office staff at a time when morale is at an all-time low?

Should we skip our child’s piano recital to attend that …

We’re going to need more medical chaperones. Here’s why.

Edwin Leap, MD

Physician

April 29, 2015

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For my entire life as a physician, from medical school, through residency and now until this 22nd year in practice, I have subscribed to the idea that I should have a chaperone when performing breast, pelvic or rectal exams on women. I was taught to do this from the beginning, and I still do it.

Why is this? On some level, the …

What value do primary care doctors offer to our health care crisis?

Andy Lazris, MD

Health Policy

April 29, 2015

When I was a resident at the University of Virginia, my wisest mentors gave me one piece of advice that far exceeded all the scientific and statistical jargon that others expected me to swallow. Consider this: When patients walk into your room and sit down, shut up and look into their eyes. When they are done talking, have a conversation. The key word is conversation. The visit should not include a lecture or statistics …

Being a doctor sometimes extends far beyond our own patients

Susan D. Klugman, MD

Physician

April 29, 2015

I boarded the 8:30 Metro-North railroad train home from Manhattan recently after leaving a medical meeting. It had been a long and productive day, but now I was searching for a mint in my pocketbook because I had a weird taste in my mouth. All I found was a lollipop.

Just before the train left Grand Central, a family of three hurried on and sat near me. The father said, “My …

Trust and faith are essential to physician-patient relationship

Kathryn A. Hughes, MD

Physician

April 28, 2015

Have a little faith in me.
– John Hiatt

Spring ushers in major holidays in many faiths and religions. The rites of spring and the vernal equinox, new life and rebirth are springtime themes and touchstones across many cultures. Faith is important to many people and across many cultures and religions. I would assert faith is even important to atheists and agnostics, and those without a formal religious tradition.

Faith is important …

The right, or freedom, to die

James C. Salwitz, MD

Physician

April 28, 2015

The theater darkens; children stop laughing, adults sit forward in their chairs. Framed by a single light in the center of the stage, he stands; tuxedo, white shirt, black tie. He stares into the silent crowd, slowly turning his head, lips touched with the slightest, smallest, cruelest of smiles. His gaze fixes upon you; he is just feet away. His hand rises to the brim of his tall hat and …

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The right, or freedom, to die

Learning to be a teacher on medical rounds

Jenna Kay, MD

Medical Education

April 28, 2015

How to insert a central line had been drilled into me long before my first attempt, and I was admittedly nervous performing my first procedure as an intern. But, as a senior resident, watching the intern in front of me insert his needle into the patient’s neck was ten times more anxiety-provoking. I wanted to guide him successfully through the first of many procedures he would need to master, in …

How will I know that you’re not dead?

Raymond Abbott

Patient

April 28, 2015

I never thought it would go on for so long — seeing Donald Wyatt, I mean. I certainly didn’t plan it this way.

More than six years ago, I retired at age sixty-six from my social work job at a mental-health agency. Donald had been my client there for about eight years.

As I was cleaning out my office, his mother called. She explained how Donald’s father had left when Donald was …

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How will I know that you’re not dead?

Why CMS should get out of measuring health quality

Rocky Bilhartz, MD

Health Policy

April 28, 2015

This is important to you. Trust me.

If you’re young at heart, it matters because it’s your tax dollars this April. If you’re wiser in years, it directly affects your health and the system you’ve been pumping money into for decades. This is the same medical system that you thought would take care of you later in life. Again, this is about your money and your health, so read on.

Government-funded health insurance in the United States is administered …

Tomatoes, ketchup, and direct primary care

Margalit Gur-Arie

Health Policy

April 28, 2015

According to OECD data, Americans see doctors less frequently than people in any developed nation. We are hospitalized less frequently, and we stay in the hospital less time than citizens of other nations. The vast majority of Americans, more than any other nation, describe themselves as healthy, and America has the largest percentage of young people in its population. So why is health care in America so much more expensive …

Why code status should be modified

Natalie Wilcox

Conditions and Diseases

April 27, 2015

“Good morning baby,” she said to me each morning I when I came into her room.

Ms. K was an educated woman in her early 50s with three children. She loved drinking tea in the morning. She also had a very advanced case of lobular carcinoma of the breast that had extended into her abdomen. A cluster of cancer cells was obstructing her small intestine, causing her to have nausea, vomiting, …

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Why code status should be modified

What Uber drivers can teach health care

Suneel Dhand, MD

Physician

April 27, 2015

A couple of months ago I finally joined the swelling ranks of Uber customers. Several friends had been trying to persuade me for some time to start using the service, but me being generally skeptical of new technology (what they call a “late adopter”), it took an extreme situation to get me to finally download the app.

It was a freezing February …

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What Uber drivers can teach health care

Mental health for medical professionals deserves more attention

Michael McClurkin

Medical Education

April 27, 2015

Every year roughly 400 physicians take their lives: a group of physicians greater than the size of two graduating classes at my medical school. Let’s be clear, physician suicide and medical professional mental health awareness is a neglected issue in medicine. We are twice as likely to commit suicide than our non-physician counterparts. Women physicians are up to three times …

We should strive for a good death that occurs at the proper time and place

Allen Frances, MD

Physician

April 27, 2015

Count no man happy till his end is known.
– Herodotus

This was true in ancient Greece 2,500 years ago. It is even more true today — aggressive end-of-life hospital care, the lack of sufficient palliative care, and unduly restrictive assisted suicide laws make it impossible for most people to die with dignity.

There is no worse death than a hospital death. Dying well means dying at home. This requires preparation and preparation …

Our time on this earth is finite

Jordan Grumet, MD

Physician

April 27, 2015

Everything eventually expires.

I looked down at the bottle of natural spring water in astonishment. It had an expiration date. Scanning the empty hospital cafeteria on an early Sunday morning, I wondered what on earth about spring water could go bad? It had no living parts, Nothing that serves as nourishment for wayward bacteria or fungus. The container was sealed. Pristine.

I figured it was another fiscal hoax, perpetrated on unsuspecting consumers. …

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Our time on this earth is finite

Hillary Clinton’s hormones have nothing to do with her qualifications

Jennifer Gunter, MD

Physician

April 27, 2015

Time magazine published this article about why Hillary Clinton is the perfect age to run for president.

The author, Dr. Holland who is a psychiatrist, chose not to focus on Ms. Clinton’s vast political experience or her education but rather on Ms. Clinton’s menopausal status.

Yes, you read that right, when it comes to qualifications for president of the United States menopause trumps a …

When a CT scan misses cancer

Michael Kirsch, MD

Conditions and Diseases

April 26, 2015

A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist. I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus.

I expected a benign explanation for her swallowing issue. She was relatively young and not particularly ill. She had seen my partner years in the past for a similar complaint, which he …

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When a CT scan misses cancer

Who gets to call themselves family physicians?

Lucy Hornstein, MD

Physician

April 26, 2015

Who is a PCP? (And does that second “P” stand for “physician” or “provider”?)

Who gets to say? Does it matter?

Perhaps we should start with some basic qualifications: The degree of MD or DO, the satisfactory completion of an accredited residency in family medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those.

How …

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