I recently went to an “admitted student day” with my eldest son at the university he plans to attend in the fall. On our campus tour, our guide pointed out a block on the ground in the center of campus (which incorporates a symbol of the university) that no one steps on because “stepping on it will cause you to fail your first exam.” In the winter, it is the …
Remember that our patients frequently feel a lack of control
“I see you haven’t had your flu shot this year, Mrs. Adams. Would you like to get it now?”
“Nice try!” she replied playfully, her warm smile conveying a serene confidence forged by seven long, difficult decades on this earth. “But you know I never get the flu shot.”
“I know,” I said, still hopeful I could change her mind, “but influenza can be very dangerous, particularly in patients over the age …
Medicine and its tension with faith
Speaking only for myself (but guessing I’m not alone), I can say when a patient develops post-op problems, there’s a strong tendency to deny it: not to deny there’s something wrong; not to dismiss the patient’s concerns or symptoms. Just to grasp first at the less dire set of possible explanations. Maybe it’s just the flu, constipation, drug reaction. That sort of thing. It’s not about blowing it off — …
For better or worse, doctors are human
Have you ever thought of an x-ray technologist as a key player in promoting high-value, cost-conscious care?
Recently, an x-ray tech saved one of my patients from unnecessary imaging. Here is the story. Last fall we had set up a 6 month follow-up ultrasound to check on a patient’s abdominal aortic aneurysm, an aneurysm that was too small to require surgery, but too large to ignore. The day before the ultrasound …
Health care is ultimately a social enterprise
As physicians, we’re all pressed for time, with patient demands, family conflicts, and personal moments of stress. Many of us were acculturated in medical school to ignore our own stress and burnout and instead to devote ourselves to our patients. That tactic may have worked in an earlier world, but with a more complicated and demanding practice environment, it’s no longer tenable today.
Two activities help me maintain my personal health …
Incorporate other hobbies and passions into physicians’ daily lives
Round and round and round we go yet again. The system is broken. Do something. Health care reform!
“Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means — and that everyone else agrees with them. Wrong.
Quality is very much in the eye of the beholder, and …
Health care quality can be surprisingly subjective
“Are you more or less cynical than when you started residency?”
This was the question my program director asked our senior internal medicine residents at a recent dinner with Dr. Bob Wachter. If you aren’t familiar with Dr. Wachter, he is widely acclaimed as the “father of hospital medicine” and a renowned champion of patient safety and quality. His blog, Wachter’s World, is chock full of insightful commentary on the American health …
Residents need to feel empowered by their hospitals
Despite the political angst, the doomsday predictions and a very rocky launch, the Affordable Care Act has enabled more than 8 million Americans to acquire insurance coverage through the public exchanges.
Health insurance increases the probability that patients will access the medical care they need. And my colleagues at Kaiser Permanente are already seeing some positive stories emerging as a result.
They’ve shared dozens of stories with me about patients with undiagnosed …
Learn from the success of Medicare Advantage
You were supposed to die of cardiac arrest as you circled toward home plate. Or of a brain aneurysm in the summer during one of your countless hikes through the mountains.
You weren’t supposed to die here. Not in a hospital bed, inhabiting this fragile new body, with an oxygen tube in your nose and tumors in your lungs.
Two days before you left us, I traveled home to visit you. I’d …
I have often spoken of the doctor-patient relationship as a covenant. Our patients bear their bodies and souls in exchange for a thoughtful, engaged, respectful partner in navigating health and disease. This dyad, this trusted space, allows for the breaking of cultural norms and full disclosure. Proper healing is an agreement, it is a relationship.
Although often not spoken of, any successful flourishing health care system also requires another …
The covenant between physician and society is being broken
Another backboarded body rolls in. I slip from my perch at the computer and greet the emergency medical technician.
“Seizure. Lasted a few minutes, done by the time we got there. Fell and cut his face. Vitals stable. Sugar fine. Oriented but postictal. Didn’t take his meds.”
Approximately my age, the backboarded man’s chin bears a ribbon of red laces.
“Dammit,” he says. A glance at the cardiorespiratory monitor shows me suitable hemodynamics, …
Playing a game of Russian roulette with his life
Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death costs a lot, and society can go broke providing costly medical care to everyone. Society saves money and lives when everyone sees a primary care doctor who works to keep people well.
But we don’t and won’t have enough …
How to stop losing primary care physicians to burnout
It’s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction, burnout and even suicide. In fact, some believe that up to a third of the US physician work force is planning to leave the profession in the next 3 years — an alarming statistic.
Direct primary care practices are touted as the best …
Can locum tenens work solve physician burnout?
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Three months ago, Anne finished chemotherapy. She is tired, overweight, anxious and her feet burn. Anne sleeps poorly, cannot concentrate at work and her relationship with her husband is distant, let alone intimate. In my office for a “survivor’s” visit, Anne asked the glaring question. “Will I recover? Will I ever be the same?” After a moment of thought I answer, “I hope not.”
Okay, I was not really that cold. …
Cancer takes so much, but can its passage give back anything good?
Let’s face it. A hospital is a place where nobody wants to be. By it’s very nature, it is somewhere scary and not too nice. Those of us who work every day in hospitals can easily forget this fact: Those who we serve would rather be anywhere else (and so they should). Think of all the things our patients would rather be doing — enjoying a leisurely afternoon with the …
How to design a better hospital
Medicine has always had it regulatory fiefdoms, but in 2002 they were greatly expanded. At that time, a charter on “medical professionalism” was published by the American Board of Internal Medicine, the American College of Physicians, and the European Society of Internal Medicine in the Annals of Internal Medicine that touted three fundamental principles:
The first set of professional responsibilities for physicians was a …
Physician regulators get paid so much more than front line doctors
Next in a series.
Good question. You call for an appointment and are told it will be about 20 days. You arrive on time only to sit in the apt named waiting room for 40 minutes. Finally you get to see your primary care doctor (PCP). You begin to explain why you came in but are interrupted within about 23 seconds even though it would have only taken you about …
Why do I only get 10 minutes with my doctor?
Did you ever read a seemingly inconsequential sentence somewhere and it then just refused to leave your mind for days on end, triggering avalanches of thoughts way beyond the original intent, if there even was one? It just happened to me a few days ago when I read one more industry article about the recent Medicare data dump.
The following remark was attributed to a primary care doctor: “The U.S. is …
Translucency by design and turbidity by negligence
A column entitled “The Questionable Link Between Saturated Fat and Heart Disease” appeared in the Wall Street Journal recently. To spare you any guessing about where this is headed, I’ll tell you right away: The column itself was pretty darn questionable.
The article starts off very dubiously when the author, Nina Teicholz, tells us that a now somewhat infamous study published in the Annals of Internal Medicine concluded, that “saturated fat …
Don’t take dietary advice from non-experts
A few days ago I decided that since I have been officially retired for two months, it was time to change my profile on the LinkedIn social network. After all, the purpose of that network is to link business and professional people to potential opportunities and ideas. I needed to let contacts know that I am no longer with the university where I practiced for the last seven years, while …
Keys to creating a community cancer center
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