Recently, both my husband and I came away from a conversation with my doctor positive that we understood my new weight gain plan. Funny thing: Each of us recalled a different plan. I am always struck by how our memories of the words spoken by my doctor can be so dissimilar. No, not all of them, but enough of them to be wary of going to any appointment without a …
Is the time right for e-caregiving?
I will do anything not to be in a hospital bed. I checked myself out as quickly as I could each time I was admitted (three obstetrical admissions) and once, after a day-surgery procedure, got in trouble with the recovery room nurse because she found me out of bed, getting dressed, before I was supposed to be on my feet.
Still, as a doctor, I am capable of taking great comfort …
On hospital discharges: Who needs the most reassurance?
Why aren’t people in hospitals more attentive to the needs of patients?
In a post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha …
How can we reduce friction in the hospital?
I was recently chastised by a colleague for being too negative in one of my pieces on hospital care. His is a remarkable story of what happens when things go well, and it has made me think a lot about why, in some places, things seem to work while in others, not so much.
He told me how a few months ago, soon after returning to Boston from a trip to China, he …
How do hospitals build a culture of quality?
I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.”
This is a problem since, as an anesthesiologist, I get told what to do all the time. My kids order me around all the time. When I was a nurse I used to bristle at the term …
Who’s in control? Why both doctors and patients are frustrated
As we grapple with provider shortages, the surge in chronic illness and the quality to price (QPR as they say in the wine business) challenge in US healthcare delivery, it’s hard to imagine a future that does not include some sort of guideline or algorithm-driven care. As providers take on more financial risk, one common strategy involves team-based care, and the attendant increase in decision-making and care delivery by non-physician …
Is there a place for personalized medicine in clinical guidelines?
There are just a few key reasons why Medicare has become inordinately expensive. There is no end in sight for cost escalation. But there are some obvious solutions and they all begin with chronic illnesses.
Chronic illnesses — diabetes, heart failure, cancer, chronic lung disease, etc. — are increasing at exponential rates; are caused largely by lifestyle behaviors; and consume 70-85% of all claims paid. Medicare enrollees tend to have chronic …
5 recommendations to achieving a grand bargain in Medicare
If you knew you were going to be admitted to the hospital for a serious and unexpected medical problem, which day of the week would you pick?
It sounds like a silly question. You don’t get to pick the day you will become sick, of course. It’s unexpected. And why should it make a difference? Isn’t a hospital with a 24 hour nursing staff and on call physicians the safest place …
Solving the weekend effect for patients in the hospital
Beginning in 1964 the Journal of the American Medical Association (JAMA) started publishing full color images of art on its cover accompanied by insightful essays. JAMA’s former editor, George Lundberg, wrote that this was part of an initiative to inform readers about nonclinical aspects of medicine and public health, and emphasize the humanities in medicine. Now after almost 50 years of covers …
JAMA removes cover art, and why that matters
The cold ultrasound probe pressed uncomfortably onto my abdomen. “It looks like an ovarian cyst,” the pleasant technician told me, “But of course we’ll run it by the radiologist.”
For the past few months, I had felt a dull, heavy pain in my right lower quadrant that sharpened when I coughed. I’d put off having it checked during my busy schedule as a third year medical student. However, the nagging knowledge …
I felt abandoned by the system to which I had committed my career
I am furious.
For anyone hiding under a rock the last year or so, the latest recommendations about prostate cancer screening have changed from earlier iterations of “screen everyone with a prostate with a PSA (prostate specific antigen) and a DRE (digital rectal exam, where the “digital” equipment referred to is a finger) every year” to don’t do it at all.
The United States Preventive Services Task force reviewed the literature and …
A urologist’s hypocrisy on prostate cancer screening
Have you ever taken note of how much you or a colleague says “I” versus other pronouns? The pronoun that you choose in conversation may very well provide insight into your psyche and may determine your effectiveness as a leader. Current research has indicated that the frequency at which an individual uses the pronoun “I” speaks volumes about their self confidence, level of empathy and perceived status within an organization …
We must pay careful attention to the pronouns that we use
Recently, colleagues and I published what I consider a very important paper in the American Journal of Public Health, indicating that tens of thousands of relatively young women who have undergone hysterectomy are dying needlessly because of an over-generalized fear of hormone replacement. Publication in the Journal of the American Medical Association of a rich compilation of findings from the Women’s Health Initiative (WHI) trial does nothing to change …
Hormone replacement and the profound importance of maybe
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Pinel, the father of modern psychiatry, is famous for liberating his patients from their chains. But he did a whole lot more. Pinel spent long hours listening attentively to each patient’s life story so that he could correlate their life experiences with the onset and course of symptoms.
Pinel got to know his patients well enough to like them as people. When given the choice of joining Napoleon as personal physician …
Why psychiatry is handicapped today
I think I am like many practicing physicians in my love-hate relationship with clinical practice guidelines.
On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice.
On the other …
A solution for clinical guideline overload
For employers, the Affordable Care Act takes two distinct approaches.
First, for small employers (those with 50 or fewer full-time employees), the ACA does not penalize, but rather incentives the purchase of insurance with subsidies available through the Small Business Health Options Program (SHOP). Second, for large employers (those with 51 or more full-time employees), the ACA does very little. Recognizing that the overwhelming majority of these large employers already offer …
Obamacare’s effect on small business: An unintended consequence?
While the Affordable Care Act ends the era of denying people with pre-existing conditions access to health care, it allows insurance companies to charge tobacco users up to 50% more for their monthly premiums. Tobacco use for this purpose is defined as any self-reported tobacco use four or more times a week within the past six months. There are excellent intentions behind this policy — smoking is the number one …
Should smokers pay higher health insurance premiums?
Thirty three years ago my husband and I went to Jamaica for a belated honeymoon. We got married on the last weekend of my internship year, and immediately flew back to Boston for me to start my second year of internal medicine training. Seven months later in the dead of winter, we flew to Jamaica to a lux resort in Ocho Rios where I spent a blissful week drinking sweet …
For the most desperate, it’s about faith, love, and human kindness
Ask physicians if our messed up malpractice system causes them to practice “defensive medicine,” and most will probably say yes — hard not to be paranoid with so many lawsuits affecting so many physicians. Some experts even contend that major reforms of our malpractice system could go a long way towards controlling spiraling healthcare costs. On the other hand, if you ask physicians whether they ever order unnecessary tests …
It’s hard to get a handle on the true costs of defensive medicine
Doctors are burned out and they don’t enjoy their job as much as they used to. But looking broadly, physicians are still spared the economic difficulties and loss of autonomy that are present in most other sectors where people are still lucky enough to be employed. There are issues that doctors rarely face: unemployment, inability to pay their rent and food with their paycheck, and lack of health insurance.
These …
What we value as a society is reflected in how doctors are paid
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