I heard this on the radio recently: Mom takes her new baby to the emergency department on a weekend because she thinks her daughter might have a urinary tract infection. She’s right, but regulations say the baby has to stay in the hospital for two days to ensure the infection clears. Afterwards, the mom is surprised by and concerned about a $7,000 hospital bill for the baby’s care.
The …
Are the benefits of price transparency overstated?
The debate over e-cigarettes has been heating up. Are the smokeless, battery-powered, nicotine-dispensing devices a gateway to smoking for young people or a helpful way for smokers to quit? Public health experts can be found on both sides of the debate.
An article in the New York Times cited two leading figures, Dr. Michael Siegler from Boston University and Dr. Stanton A. Glantz from the University of California, San …
E-cigarettes lack scientifically based guidance
I recently spoke to a class of undergraduates about the benefits, harms and politics of screening smokers for lung cancer using low-dose CT scans. Afterwards, a student asked how I felt about the Affordable Care Act’s requirement that Medicare and private insurers cover U.S. Preventive Services Task Force “A” and “B” recommended screening tests and other preventive services without co-payments or deductibles, making them free at the point of care.
I admitted that …
When free preventive screening tests aren’t really free
People suffering from chronic pain are often angry. They are trapped not only by an unpleasant sensation, but also by their limited treatment options. The experience can lead to feeling not only like there is no end in sight, but also as through there is no hope. So strong are the associated emotions that I often call this state of mind “the abyss.”
All too often, when that frustration becomes too …
Chronic pain and the effect on patients’ families
Earlier this year, I completed a medical rotation in Africa. It was an amazing, eye-opening experience. While I expected it might be difficult to acquire newer, more expensive medications and procedures, I had anticipated that, given limited resources, there would be some rationale in deciding which medications and procedures would be available. I was deeply mistaken in this assumption.
During my time abroad, I watched several patients with heart attacks pass …
Ask if new technology will make a difference in patient outcomes
Going to the doctor starts as a disconcerting experience: Getting naked, physically and emotionally; talking about your weight, your smoking, your divorce. You count on your doctor’s ear and her discretion. Often enough, a patient will apologize for taking my time or for crying or whatever. I remind them that this is what the exam room is for, this is what they pay me for.
How far does this special relationship …
The conundrum of communication and uncompensated care
Hospital medicine has rapidly become one of the largest specialties in the United States. As the number of practicing hospital medicine doctors soars above the 30,000 mark and health care reform takes hold, the specialty finds itself at the forefront of American medicine. And for good reason. It is a young, dynamic, varied and flexible specialty that can be practiced in a number of different settings. Hospital medicine doctors are …
5 ways to improve hospital medicine
Doctor: “Phil, you have pneumonia.”
Phil: “Oh noes. What shall I do?”
Doctor: “Just take these red pills, here.”
Phil: “Great! I feel better already! When can I go back to work?”
Doctor: “I think in about 2 weeks. Or maybe 2 months. And actually, don’t take those red pills — these blue ones are better. It could take a few years for you to get better, and I’ll be retired by then. Here, …
A tough time to be a doctor, but a tougher time to be a patient
Next in a series.
Beginning with a deep understanding of medical science and years of training and experience, the primary care physician (PCP) needs to delve deeply into the patient’s personal, family and social setting in order to fully understand the context and causes of the patient’s illness. The PCP also needs to know when it is important or even critical to call upon others with specific knowledge, techniques or …
The role of integrative medicine in primary care
Is being a physician a good gig, or not?
In a piece that’s gone viral, internist Daniela Drake writes a strongly-worded column in the Daily Beast about how miserable it is to be a physician:
To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and …
Why you need to hear from miserable doctors
In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence. Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is, learning to learn in new ways.
Learning to unlearn
In med school, learners amass an …
Teaching doctors: Learning to learn in new ways
A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things.
This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I …
Why should practicing medicine be compared to any other occupation?
If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, “the entire education sector, including college and mid-career training, represents nearly 9 …
Testing doctors is big business
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The janitor approached my office manager with a very worried expression. “Uh, Brenda …” he said, hesitantly.
“Yes?” she replied, wondering what janitorial emergency was looming in her near future.
“Uh …well … I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer …” He cleared his throat nervously, “Uh … his computer had something on it.”
“Something on his computer? You mean on top of the computer, or on …
The fatal error in health care
Hegira: To take flight to escape. To travel from a place of danger to a place of safety.
“You have cancer.”
You hear the words. Your mind does not understand.
“You have cancer.”
Shock. Distance. Isolation. Someone else. A mistake. A lie. Bizarre, strange, you float above the room. Everyone speaks; nothing is said.
“You have cancer.”
A fog-like curse, a venomous reality, a phantom idea. A cold ghost foreign to the soul. I must run. …
To emotionally survive cancer, we must create perspective
Barron Lerner thinks he understands doctor’s motives. In his recent article in the Atlantic he laments that physicians act on tradition and emotion over adopting new science. In defense of his position, he sites the example of how cardiologists use angioplasty and coronary artery bypass to treat coronary disease.
He states,
… cardiologists have been remarkably slow to abandon the old hypothesis, continuing to perform hundreds of thousands of bypass operations …
Physicians should not be expected to blindly follow guidelines
Where I’m from, you can have someone killed for $5000. I will do it for $1110. I’m a hand surgeon.
I practice (or practiced, by the time you read this) in an area that is what we often refer to as “underserved.” Rather, the area isn’t, but the people I treat are. I work in a large urban referral center that has a very high proportion of Medicaid as well as …
A patient nearly died to save him $1110
It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery.
Do you know where you are right now?
Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon …
A recent ProPublica expose co-published with the Boston Globe typifies a growing gotcha genre of health journalism that portrays doctors as the enemy in a struggle for honesty and openness in medicine. These reports make unfounded leaps in their efforts to subject doctors to levels of skepticism once reserved for politicians and lawyers. They’re going to end up doing patients a disservice. For this particular hunting expedition ProPublica set its sights on …
Did ProPublica unfairly target Dr. Yoav Golan?
The creatures cause pain by being born, and live by inflicting pain, and in pain they mostly die.
–C. S. Lewis
The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.
The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem …
Caught between patient satisfaction and prescription drug abuse
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