“Thank God you’re still here, Doc! It looks like they already laid off half the pharmacy department! The line is out the door!”
“Don’t worry, Mr. Golati! It’s just a regular day at the VA!” I replied.
October 1st at the VA Hospital was like every other day in most ways. It was still hard to find a parking space in the far-too-small lot. The hallways still bustled with white coats, smiling vets, …
A day at the VA during the shutdown
As deliberations over how to make healthcare more cost-effective continue to play out in forums across the country — from the U.S. Congress to state governments to health systems and hospitals — it strikes me that we are paying insufficient attention to what should be an obvious consideration – the cost of supplies.
Supplies run the gamut — from operating tables, artificial knees, intravenous solutions, and wound dressings to bed linens, …
To cut hospital costs, look at the supply chain
I often read advice to doctors about how to screen for domestic violence. I was that woman for many years. I was that child and I know for a fact my pediatrician knew but was afraid to report it. And then I grew up and became that woman.
Physical violence while brutal, doesn’t compare to the controlling, creeping intimate fear sustained in such relationships. My then husband came with me to some of …
A patient’s perspective on domestic violence
There is a saying that you enter medical school wanting to help people but exit it wanting to help yourself. It may be a cynical view, but a realistic one. The criteria for being a good medical student are far different from being a good doctor. Medical education may be breeding a legion of self-serving, grade-grubbing, SOAP-note spewing machines rather than …
Being a good medical student doesn’t mean you’ll be a good doctor
I recently testified before the Medical Licensing Board of Indiana regarding the pending emergency rules for physicians prescribing opioids for chronic pain. The session went on for four intense hours — ten minutes of which had been promised to me.
At my turn, I stated my name, told the Board I hailed from Indiana’s prescription ground zero, gave a brief summary of my credentials, thanked the Board, the American Academy …
Physicians are fearful of fulfilling their duty to treat pain
Recently there’s been a lot of talk about the law of bundling and subsequent unbundling of web services. Many have used Andrew Parker’s brilliant image below to make the point.
Craigslist came along and bundled everything into one place and, as a result, completely dominated. They destroyed multiple businesses in the process (including the rental and roommate web service I worked with …
What the unbundling of Craigslist has to do with today’s EMRs
As the sixty-something-year-old woman and I shook hands and sat down to get acquainted during her “new patient” visit, she pulled out a small stack of papers and a thick spiral-bound notebook. I glanced at her problem list in the electronic chart: diabetes, obesity, hypertension, anxiety — the usual. She handed me the notebook and a printed Excel spreadsheet with several columns: her medications (a handful), the supplements she takes …
Trapped between two conflicting professional obligations
I recently saw a sticker on a bus shelter. It was an arrow about 10 inches long and 6 inches wide. It seemed to be pointing to the bus map. “This is Public Health,” it said. The sticker, part of a larger campaign, gave me pause. Sure, a bus stop is public health because it a marker of mass transportation; it symbolizes improved access and decreased pollution from individual cars. Looking …
Primary care has a marketing problem
Earlier this month, a candid and powerful personal essay was published by Jessica Rice, a thirtysomething woman with terminal cancer. An emerging theme of Jessica’s piece was the importance of frank conversation between physician and patient, and I was curious what a provider — someone who has difficult conversations on an almost daily basis — would think of this patient’s story and perspective.
Thoracic oncologist Kavitha Jennifer Ramchandran, MD, read the piece …
Communicating with patients with serious or terminal cancers
At long last, people are talking about postpartum depression. Dismissed for years as no more than a touch of the baby blues or else unheard of entirely, postpartum depression — or PPD, as it is often known — has become an open subject. Healthcare providers are aware of it, many nurses and physicians routinely screen mothers for it, and articles in parenting magazines and major newspapers have been written about …
How postpartum depression affects children
The lyrics to Janet Jackson’s song, Nasty, includes this line, “No, my first name ain’t baby, it’s Janet. Ms. Jackson if you’re nasty.” Miss Jackson doesn’t like being called, “baby,” and neither do a lot of patients.
Many healthcare professionals call patients by nicknames, such as, “honey” and “sweetie.” I believe these are terms of endearment and in most cases meant with genuine warm feelings toward patients. However, from interviewing hundreds …
A primer on addressing patients
The discourse on the problems of the modern healthcare system contains much vitriol and blame. There is a distinct flavor of adversarial combat in the discussion; pitting physicians, those in the trenches, with those politicians and lawmakers on the other side. With estimates of healthcare costs exceeding 15% of the gross domestic product of the United States, it is easy to understand the passion that the topic evokes. The complexity …
EMRs make it easier to just order the test
A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids.
On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 116/64 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. Oral mucous membranes are dry. There is a new firm, left parotid …
MKSAP: 56-year-old woman with Sjögren syndrome
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I remember when Susan*, a close friend of mine with breast cancer (who had been living with metastatic disease for about a year before), was told she was terminal. Beyond the shock and fear, Susan felt grief and anguish that her life would end so much sooner than she (or any of us) had expected. Suddenly, Susan had so many big …
There can be hope at the end of life
We have, it seems, moved on from acknowledging it takes a village to raise a human being. We are well into the realm of realization that it takes a village just to be one. More and more studies are demonstrating the importance of the germs that outnumber our cells by an order of magnitude at least, to virtually every aspect of physiology. But while epiphanies of this …
Examining the link between bacteria and obesity
Medicine offers you a front-row seat on life. Meaning is all around you. When you can see it, it gives you a sense of gratitude for the opportunity to do this work.
-Rachel Naomi Remen
The first-year medical student cried openly during the session. Not hard, but enough to be embarrassed.
“I’m really sorry,” she said, “but this is one of the things that scares me most about going into medicine. I cry …
It is perfectly fine to be emotional in front of patients
One of the reasons I love social media is that it keeps me up to date on breaking news stories. Here are two stories that came through my social media channels recently. Both of these have to do with immunizations, which, of course, is a healthcare and social media hot topic, especially among pediatricians.
Fear of disease needs to overcome the fear of vaccines
Discussions of resident duty hour reforms reached the point of ad nauseam a few years ago. Everyone had their say — program directors (“In 2003 we instituted an 80 hour work week, in 2011 we switched to 16 hour shifts, what’s next – online residencies!?”), senior residents (“What? I have to write H&Ps again? I don’t even know my computer password!”), interns (“I thought I was done with cross-covering after this …
The fallacy of the current resident duty hour rules
I don’t have time for this, I thought as I attempted to walk the twenty minutes from home to my Mind-Body Medicine class at a ten minute pace. I felt a sharp cramp in my abdomen, reminding me that I had just wolfed down dinner without taking a break for enjoyment or digestion. By the time I reached the medical school building the sky was dark, my face glistened with …
Our wellbeing is tied to that of our patients
There was nothing wrong with Sarah’s vocal cords. Her tumor had spread throughout the abdomen, but her voice was unaffected. Yet minutes after learning of the voraciousness of her metastases, she pursed her lips and began to communicate with head nods and hand gestures only.
I met her for the first time in the nursing home. I sat down quietly at her bedside on a Sunday morning. I was in the …
This is what’s so difficult about doctoring
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