I was listening to CBS This Morning recently as they were interviewing Alan Alda. He was discussing his acting career and being the host of Scientific American’s Frontiers (airs on PBS stations). Alan Alda relayed a personal story of his, having an intestinal blockage while he was filming an episode in Chile.
As he relayed this incident, he spoke of the physician who told him that he was going to remove the …
4 tips to better communicate with patients
Over the past decade, patient-centered care has become a mantra for high-quality health care. Policymakers, researchers, physician-leaders, and patients have all cited the need for care to be tailored to patients’ unique needs and preferences. And there is solid evidence that patient-centered care can help improve care quality and reduce costs. However, in the rush to become more patient-centered, the health care system has misplaced its focus.
Current approaches to …
Patient-centered care requires learning from the service industries
Like my fellow Connecticut residents still shaken by the Newtown shootings, I was excited and relieved when Connecticut Senate Bill 1160 (“An Act Concerning Gun Violence Prevention and Children’s Safety”) passed. The law establishes a dangerous weapons offenders registry and requires a universal background check for all gun purchases. Those wishing to purchase long guns will need an eligibility certificate which requires fingerprints, a firearms safety training course and a …
Why the Connecticut gun law does not improve care for the mentally ill
Over the past twenty years, Wall Street business has covertly taken over the medical profession while doctors have been distracted by a deluge of procedural, financial, and legal paperwork. A strategic plan was launched to extract exorbitant profit benefiting business, and is now mainstream without challenge from our profession nor the public.
Legal boardrooms were abuzz in the 1990s as a blueprint assault was made against organized medicine, redirecting a profession into a …
Is medicine a profession or a commodity?
Ask a nurse about Nurses’ Week, and you’ll likely get a snarky answer. The sweets designed to obesify already unhealthy nurses are intended to kill them off so they can bring in a whole new crop, as they’ll be cheaper than the old experienced ones.
We need a national initiative to start giving out coupons during Nurses’ Week for plastic surgery to have smiles permanently stuck on our faces.
Nurses like to …
We need a new way to value the work of nurses
As of early April, you can walk into Walgreens in 18 states (plus D.C.), and along with a gallon of skim milk, a pair of photo mugs, a six-pack of toilet paper, and a flu shot, you can meet your new primary care provider, get your cholesterol checked, pick up your statin, and schedule a return visit. That primary care provider will not be …
Free nurse practitioners from their arbitrary bondage
This month I hit a milestone on my Sina Weibo microblog; I finally reached 10,000 fans. It took more than two years, and I suppose I could have sped it up by paying for fake zombie fans. However, I preferred to earn this honor with good old fashioned hard work. Ten thousand fans is a tiny amount compared to many Chinese microblogs, including several at my own hospital like our …
Social media in China: Does it make me a better doctor?
As the sun rises in hospitals across the nation, medical interns start their age old ritual of rounding and examining patients. While the old guard may feel that paper and pens are being replaced by impersonal interactions of mouse clicks and scrolling through the electronic medical records; the essence of the intern experience remains the same.
It is a year filled with a roller coaster of highs and lows which adds …
Fixing healthcare requires the essence of excellence
“You have to be affable, available, and able,” a senior general internal medicine physician taught me during my final year of residency. “Trust me,” he added, “when you’re in practice, you will love easy consults.”
A consult – short for “inpatient consultation” – occurs when physician caring for a hospitalized patient requests another physician to evaluate the patient and provide recommendations. Typically, both physicians are paid – one for providing overall …
Why hospital culture influences medical costs
As chairman of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Work Group on Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorders, I read the article on ADHD that appeared on the front page of The New York Times on April 1, 2013, with interest and also dismay, which was shared by my colleagues in the work group. We recognize the effort involved …
The big impact of small changes for DSM-5 ADHD diagnosis
How are you feeling today? Do you feel a bit under the weather? Maybe you have some aches and pains, or a miserable flu, or maybe you have some chronic condition like diabetes or asthma, or some other ailment. Perhaps you could benefit from medical attention, but then again getting medical care is so darn inconvenient and expensive and time consuming, and everybody knows that our health care system is …
Health delivery models that require a less costly skill mix
A young lady comes to the emergency department and wants to be evaluated for a somewhat non-urgent problem.
Chief complaint: “I’ve lost 50 lbs in the past month.”
She felt a little weak as well, but she had just lost too much weight. No other symptoms.
The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed …
Physicians are often expected to prove a negative
Radiologists care about their patients, even though most diagnostic radiologists don’t meet and greet their patients the same way direct-care clinicians do.
Some people have the erroneous perspective that radiologists and pathologists don’t care about the welfare of their patients. It is possible for us to understand that view if we look at radiologists and pathologists as isolated workers who work …
A radiologist reflects on indeterminate findings
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“Have you ever been told you have a heart murmur?” a young doctor gently asked my friend, Ben. Ben’s mind reeled. Ben was in his early 30s, relatively young and healthy. But his father had died from a heart attack before age 50. And his mother had a heart problem. What did this question signal for him, he worried.
“Um, ah, no, I haven’t,” …
It’s natural to skimp on care when it’s costly
In a time of crisis is when leaders step forward. If our nation faces one crisis, then it is that of the health care system which increasingly is unaffordable and trails other industrialized countries in quality and access. If there was a time leadership was needed then it would be now. As doctors, we should be providing this leadership. No longer can we let others dictate how health care should …
Doctors need to be the leaders of health care change
Since 1992, I have advocated for all of us to have the information, support and guidance we need to act to improve our health and get the most from our health care. I believe – and there is considerable evidence to back me up – that we do better when we participate in our care to the extent we are able.
As someone who has been diagnosed with several different types …
Twitter for the engaged patient: A curated stream of new evidence
I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.
1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category. While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …
5 critical elements of patient-centric care
In her post, “The only thing that truly separates doctors from nurses,” Dr. Leng is right that our current system creates a great deal of confusion for patients. Clothing, titles and even the word “Doctor” are no longer clear enough for people to understand which member of the health care team is caring for them. However, her suggestion that ultimate responsibility for the patient is the only distinguishing feature …
Independent nurse practitioners are not the primary care solution
Now that states have decided what they are going to do about health insurance exchanges—those new shopping carts created by Obamacare to help consumers find health insurance who do not get it through their employers—the really tough part begins. State and federal governments need to make sure that consumers understand their health insurance choices.
You probably thought that the tough part was behind us. You see, states had a difficult decision …
Health insurance exchanges will be hampered by choice overload
Lung cancer causes more deaths in the United States, 160,000 estimated in 2012, than the next three most common cancers, colon, breast, and prostate, combined.
More than 1.6 million people worldwide were newly diagnosed with lung cancer, comprising 13% of all new cancer diagnoses, and 1.4 million died of lung cancer, which was 18% of all …
ACCP: Updated lung cancer guidelines
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