Pilots never expect to hit a flock of birds on take off, or flame out an engine in mid-flight. No one plans to get disoriented in the air or have an equipment malfunction miles from the nearest airfield. And, it certainly isn’t routine to fly into hostile airspace with a heightened awareness of the known ground threats, the position of each member of your formation, and the safety of the …
Time for surgeons to earn their wings
As a physician, not a day goes by without a new acronym I need to look up, a new policy I need to follow, another box I need to click or another criteria I need to meet — and this is just to keep up. While the health care picture and its various unknowns loom ever larger in the news, and health information emails overstuff my inbox, it is worth …
Finding the right EMR vendor can help navigate mandates
I recently struggled with an interesting patient care issue related to my illness. I had to cancel several weeks of clinical sessions, which I realize is a hardship for my patients.
A few weeks ago, when seeing a long-time patient of mine — a warm woman with several chronic conditions — I …
Physician self-disclosure about illness
Many years ago, Alfred Korzybski wrote that “the map is not the territory.” Gregory Bateson went on to argue that the map, which represents reality, is not the reality. This distinction has implications for the role of patient voice in health care planning and policy.
Today, many organizations are making serious attempts to include the patient voice in policy and decision-making. Unfortunately, more than a …
Speaking on behalf of patients is not the same as speaking as a patient
Not long ago a woman in my community, who was a patient of an esteemed local oncologist, died. Let us call her “Beverly” and let us say she died of “breast cancer.” I am familiar with the details of the case because one of my partners saw her in consult, but HIPAA and common courtesy forbid me to be any more transparent. Beverly was very popular in our town and …
Doctors often don’t have the time to address social slander
As an orthopedic surgeon, I’m acutely aware of the data and conversations surrounding sports-induced concussions, particularly in football. Encouragingly, the medical community is experimenting with proper treatment, diagnosis, and assessing the long-term effects of concussions; recently the NIH announced details of how it would begin using a sizable grant from the NFL for just this purpose. Yet preventing them continues to be a challenge not just at the professional athlete …
Kids and concussions: The dilemma facing a doctor
When I was first diagnosed with cancer several weeks ago, I didn’t have much time to think. I was just trying to survive after getting punch to the gut after punch to the gut of bad news.
First I went to the ER thinking I had pneumonia, and was told that no, I had cancer. Then I was told instead of it being a more common, more …
Thoughts after being diagnosed with cancer
At first glance, no diagnosis seems more terrible than cancer. Although it remains a huge killer in the developed world, cancer has also taken on new meanings in modern medicine. As an ordinary person, I certainly fear the word and would dread the diagnosis. Cancer. It has such a damning and unforgiving ring to it. After 3 years of residency in a tertiary referral center, where I’ve seen …
Prevention, detection, and treatment of cancer has become more nuanced
“Welcome back. How was your trip? Or exile … you were away for a long time.”
“Almost a year,” my nine o’clock patient answered. A woman just over forty, she looked tan and physically strong. Her short hair was peppered with gray, different from the last time I saw her. She had gone abroad on assignment for a magazine and a film production company, and before she left, she had joked …
The greatest miracle a physician is privileged to be part of
In 1950 Ernst Wynder, MD and colleagues began to produce convincing data that cigarette smoking caused lung cancer. Over the ensuing many years evidence has arisen linking cigarette smoking to many different cancers, chronic lung disease and heart attacks.
In 1964 the surgeon general reported that cigarette smoking was the most important risk factor for development of lung cancer and that quitting smoking reduced that risk. Since that time a concerted …
Reflecting on the history of smoking cessation
When the American Academy of Pediatrics came out with new guidelines a couple of years ago extending the age of diagnosis of ADHD (attention deficit hyperactivity disorder) down to age 4, it seemed as if Pfizer might have been waiting in the wings. Soon after, a new preparation of ADHD medication in an oral suspension, for kids too young to swallow pills, became available.
I was a lone voice expressing opposition …
Rising ADHD rates is a symptom of our broken health system
One of my Physician’s Weekly posts last month was on the subject of surgeons possibly losing proficiency for doing open cases because of the ever-increasing popularity of laparoscopic and other minimally invasive techniques resulting in declining numbers of open operations for residents during their training.
Although some suggested that knowing how to do open cases would be unnecessary in the future, to me that is wishful thinking.
Another commenter said, “We are …
The problem of fellows in surgical training
The governor of Vermont, Peter Shumlin, devoted all of his annual speech to the problem of drug addiction. On the national news, Shumlin points out the link between prescription painkillers and death, and he calls for treating opiate addiction as a medical problem no different than cancer. The White House praised the governor’s position.
Meanwhile in another part of Washington, I’m involved in the federal effort to link the law enforcement Prescription Drug …
Make the EHR a safe harbor from criminal prosecution
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I was just recently in Guiyang, the capital of the Guizhou province in China and had a chance to visit the Huaxi District People’s Hospital (HDPH), one of the largest “secondary” hospitals in the province. Like the rest of China, it has been gripped by the construction boom, recently opening a new surgery center and revamped medical facilities. They had a terrific EHR from a local vendor — probably …
What can we learn from health policy in China?
I recently read an article in the New York Times titled “When Doctors ‘Google’ Their Patients,” which details one physician’s thoughts on whether or not doctors should look up their patients on the Internet.
What struck me was the fact that despite growing up with the Internet and being able to find information about practically anyone using Facebook, LinkedIn, Google, or Instagram, I have never once been tempted to find out …
Should doctors ever Google their patients?
When it comes to the health care of a frail older person, families really need a good personal health record (PHR) system. So I am once again preparing to take a look at what’s available, in hopes of finding something that I can more confidently recommend to the families I work with. (To see what medical info I urge families to track, see this Geriatrics for Caregivers post.)
I have …
What I’m looking for in a personal health record system
In recent months, news reports focused on the number of new enrollees as a key test of the law. Although the troubled performance of the Healthcare.gov website during October and November delayed enrollment for hundreds of thousands of potential subscribers, Obama administration officials and congressional Democrats hailed a surge in enrollment at the end of the year as proof that the law would fulfill its promise of providing affordable coverage to …
How should we define the success of the Affordable Care Act?
During the four weeks of my ICU rotation, I came to know Mr. S well. I was the medical student on the intensive care team, managing patients alongside the primary surgeon. Mr. S was on the road to recovery when I started to follow his hospital course.
Every morning we rounded, one more of the numerous tubes attached to his body were removed. He grew stronger, gradually able to speak clearly …
Developing a culture of cost effective care
Several years ago, a young woman I’d been seeing in clinic weekly for about a month to initiate treatment for depression called late Friday afternoon to cancel an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who cancel and do not reschedule. It gave me a bad feeling that she was not following through on her treatment plan and …
A gracious note, letting a doctor know she made a difference
A guest column by the American College of Physicians, exclusive to KevinMD.com.
A few months ago, I attended a social event and ran into a few colleagues whom I had not seen in a long time. In the interest of privacy, I won’t reveal their specialties but I will note that I was the only primary care specialist in the group. As …
How I changed my private practice glass from half empty to half full
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