It is a trade secret among patients of many practices: If you’d like to be seen by your personal physician with no waiting and without an appointment, just ask for a free blood pressure check and then mention to the medical assistant that you are not feeling well at all. They can’t send you home without being seen and they don’t have enough to go on to call an ambulance; …
Always start your diagnostic search from the beginning
How do you really know if your doctor, surgeon or hospital is good, bad or somewhere in between?
I frequently speak with large audiences, ranging from CEOs to Stanford business school students.
I often start by asking participants to raise their hands if they receive excellent health care. Each time I ask, about 90% of the hands in the room shoot up. But all the hands come down when I ask, “How do …
It’s very difficult to assess a doctor’s true skill or performance
The world is asunder. Iraq is sinking into a sectarian abyss. ISIS, a terrorist group, now controls a larger territory than many actual countries. Russia has swallowed Crimea and has her paw prints all over eastern Ukraine. China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines. The Israeli-Palestinian peace process is in another deep freeze. Terrorists in Sudan and Nigeria are kidnapping …
FiveThirtyEight had a provocative article: “Patients Can Face Grave Risks When Doctors Stick to the Rules Too Much.”
The subsequent comments have debates over the value of guidelines. Guidelines are like a box of chocolate, you never know what you are going to get. Many clinical questions yield competing guidelines. We all know the controversies over breast cancer screening and prostate cancer screening. Recently blood pressure targets and lipid management have …
Everything in medicine requires context
I flunk as a parent. I have no plans for my youngest kids this summer.
The older ones are working. But the 13-year-old and 8-year-old, the ones at the formative stages of their academic and skill development (if you believe what everyone says), are doing squat. No camp. No enriching activities. No special trips. Well, we do rent a house at the beach for two weeks every summer, that’s something, but …
Kids in the summer: There’s more to it than academic progress
Kasey sits alone in the examining room, staring at the drug company calendar of a perfect Caribbean beach hanging above the doctor’s desk, but not seeing it at all. She is very frightened. After three years of treatment for cancer, she is in trouble. Kasey feels fine: no shortness of breath, no cough, no pain. Still, she is there to get the report on her CT scan, and she knows …
His reputation precedes him: Meet the bad news doctor
We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long …
Why the ER is a mixed blessing for society
My path to medicine is tied to my family’s experience with poverty, and with the profound economic fallout a major illness can bring in such circumstances. I grew up on the Couer d’Alene reservation in Northern Idaho. My mother was a single parent who had to rely on government assistance to raise three children in subsidized housing. As the eldest, I was expected to help care for my younger siblings …
Medicine is an inaccessible career choice for Native Americans
If you put ten physicians in a room, you will get nine different opinions. It doesn’t matter if you are discussing policy, diagnostics, or politics. Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being. We battle our fellow physicians, administrators, and insurers. You can argue the pros and cons of …
Medicine is a house divided: It is time to unite on common goals
The interview had lasted fifteen minutes so far, and we’d made minimal progress. I was a medical student doing a rotation at a physical medicine and rehabilitation clinic back in my home state, Wisconsin. It was the end of the day; to save time, the senior resident, Paul, had joined me in the exam room so that we could hear Leora’s medical history together.
A year earlier, Leora, in her mid-fifties, …
Thoughts about suicide post-stroke: A most difficult intervention
I really hate it when a nurse practitioner is called a mid-level provider.
“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.
The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals …
Stop calling nurse practitioners mid-level providers
My heart sinks each time I see the subject line in this too common email I receive in my medical practice: “Sad news: Matthew was fine when he went to bed last night but his mother found him dead in bed this morning.” Matthew (not his real name) had epilepsy with seizures that persisted despite use of currently available antiseizure medications.
We started Matthew’s evaluation when the latest antiseizure medication had been …
Streamlining the process to approve new drugs can save lives
In just a few days I’ll be leaving the clinic where I’ve practiced pediatrics for the past six years. The last months have been a flurry of last visits with families, paperwork, and tying up loose ends. There have been many, many goodbyes. I’ve been deeply moved by the expressions of gratitude and affection that many families have shared with me. It seems it is always in these times of change …
A pediatrician reflects, with deep gratitude to her patients
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I am responding to the article, “Frustrations of the primary care physician should be a wakeup call.” Having practiced medicine for 25 years as a primary care physician, and accountable primary care physician for the past 10, I understand the demands on PCPs’ time and the pressure to please patients, satisfy documentation/coding requirements, manage care teams, run a practice, and earn a living. However, there are some best …
How to achieve the Triple Aim plus physician satisfaction
In 2011, Food and Drug Administration Commissioner Margaret Hamburg remarked upon a “new direction in the treatment of hepatitis C,” as a success rate of approximately 70% marked a significant improvement over the previous rate of approximately 50%, and suggested a cure was in sight.
Today, that cure has been realized as Sovaldi (sofosbuvir), a novel agent, has shown a success rate of 95% in clinical trials. Sofosbuvir comes without the …
Treating hepatitis C: Is sofosbuvir worth it?
The VA scandal over excessive waits for doctors’ appointments is an early warning of things to come. Over the last three years, the demand for primary care appointments at the VA increased by 50% while the number of providers rose by only 9%. With four hundred vacancies for primary care providers, the VA is facing a severe gap in its ability to care for its patients.
It isn’t surprising that the …
How doctors can change the way they work and care for patients
When I started medical school, a wise professor likened the amount of new information I was about to learn to trying to drink water from a fire hose. It didn’t take long until I understood exactly what he meant. After sitting through the seemingly endless hours of lecture, lab and small group sessions required in the first two years of medical school, my head was spinning from information overload. The …
Are we training medical students to be high-quality health care providers?
Recently I went to a physician and left pondering the question: “What is health anyway?”
This is an interesting question, especially one for a doctor to ask.
But it’s important because if we don’t know what health is, how do we know if we’ve got it? If we don’t know what health is, how do we know we’ve improved?
As a doctor and medical writer, I’m finding it more and more difficult to write about …
A critical question for doctors: What is health?
My business ethics class recently discussed the case of Cipla Pharmaceuticals, an Indian generic drug manufacturer drawing the ire of big pharma by blithely ignoring international patents or employing workarounds to manufacture low-cost generics in direct violation of the patents. Cipla’s founder, Dr. Yusuf Hamied, stressed that Cipla’s goal wasn’t to steal from the bottom line of the likes of Merck and Eli Lilly, but rather to serve its mission …
The divergent languages of business and medicine
A couple of weeks ago, my family was traveling out of town. I was driving and my wife and almost 2-year-old daughter were buckled up in the back seat playing with some toys. My wife pulled out a brand new container of Play-Doh. As my daughter was preparing to pull the lid off to see what was inside, I drove through a section on the interstate where there was a …
Vaccine denial: A case of toddler logic syndrome
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