“Daddy, a bomb blew up in Boston!”
That was how my 4-year old greeted me when I came home this evening.
Of course, I already knew about the horrific attacks during the Boston Marathon, first on Twitter, then realizing the gravity of the event as mainstream media caught up.
I practice in Nashua, NH, which is about 45 minutes north of Boston. But …
Boston rises in the wake of tragedy
It all started with my sending a tweet.
Actually, that’s not quite true. The way it really started was with my frail elderly patient calling me in mid-January, to tell me he thought he had a UTI. But that part of the story is not new and novel; I’ve often had patients contact me with similar concerns.
I did what I usually do: ordered a urinalysis (UA) and urine culture (UCx). (I …
How I engaged Quest Diagnostics on Twitter
Forget Angry Birds and other mobile apps that do a great job of helping you waste time. And set aside for now the apps that help you find information and practice clinical medicine more efficiently. It was only a matter of time before mobile apps would be developed that can actually help you prevent physician burnout.
Here are my two favorite free mobile apps to help you lower stress and create …
Prevent physician burnout with these 2 mobile apps
I can remember making rounds with a seasoned surgical attending in medical school. In typical fashion, surgical rounds were a lot like the military. The “General” (attending physician) at the front, always commanding respect (and often fear) followed by the chief resident, junior residents, interns and finally medical students. Cases were presented, statuses were updated and plans were formulated. Then came the barrage of medical fact questions–mostly directed at the …
The fallout of chance medical findings
First a disclaimer: People often receive compassionate, considerate and effective care at hospitals. They have countless interactions which impart the miracle of human caring and enrich their lives. It is also institutionally prevalent to have haphazard care with poor communication, near misses and avoidable misery.
I have been working at a university hospital emergency room as part of a mini-fellowship in bedside ultrasound. It is the first time I have spent …
Hospitals are still awful: The movement toward patient centered care
On the morning that I began this post, I read in our local newspaper that Tennessee is soon expected to have a law that would permit public school teachers to offer views on climate change and evolution that are counter to orthodox doctrine on these subjects.
No, I don’t think that creationism is science and it should not be disguised as such. Global warming, or climate change, however, is more nuanced. …
Medicine and climate change have common elements
Has anyone else noticed the growing presence of ultimatums in medicine today?
The New England Journal of Medicine published a discussion of the ethics of not hiring smokers. My hospital adopted this policy six months ago, and they are not alone. There is a tobacco blood test that new employees have to pass. If they fail, they can look for a job elsewhere. I do not know the exact details, but …
The rise of ultimatums in medicine: Do they work?
I was watching a macho shoot-em-up movie the other day; the type where everyone shoots everyone and in the final scene, the dirty blood-stained hero rides homeward on a helicopter or maybe a horse, into a red sunrise or sunset. He stares blankly, focused on nothing, focused on everything, his look reflecting the turmoil of what he has seen, done and lost. The hero’s grease-smeared face shows the understanding that …
No one asks oncologists how they feel
The General Medical Council (UK) published new guidelines that state, “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.” This has …
Why doctors should use their real name on Twitter
Every one of us feels a high level of anxiety when we are made to wait. In grocery stores, we jockey back and forth to the line we perceive is moving the fastest and easily get frustrated when we choose the “wrong” line. When driving, we will swerve across multiple lanes of traffic to avoid a line at a toll booth or …
8 surprising thoughts about patient wait times
During morning rounds on my sub-internship, we always spoke softly about TG. There was never any good news. The 56-year-old writer’s lifelong battle with substance abuse was coming to an end – her heart, liver, and kidney were slowly failing. But TG’s devoted husband was in denial. And behind the scenes, we were struggling, too. The patient needed pain control, symptom management, and psychiatric support among other things. At this …
A more sustainable model of palliative care
Columbus gets the credit, but in 240 BC, Eratosthenes of Cyrene discovered that the earth was round. In 1990, the Hubbell telescope proved that the universe is expanding. In the 21st century we know that the world is round but with the Internet and smart phones, it feels small and flat. With ease of travel and technology, all aspects of modern life have changed, including medical science, practice, and education.
The …
The flat and shrinking medical world
The dictionary defines humanism as “a system of thought that centers on humans and their values, capacities, and worth.” No sector of the economy comprehends this definition better than a small business. In a sea of competition, the small business whose primary focus strays from its customer’s best interests will surely sink. Those with business experience will undoubtedly attest that, whether in a hair salon or restaurant, a happy customer …
The largest barrier to achieving humanistic nirvana in medical care
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Flexibility is important these days, perhaps more than ever before. I’m reminded of this almost every time I order lunch at a fast food joint: “I’d like a double cheeseburger, please, with ketchup only.” “You mean ‘only ketchup,’ don’t you?” “Okay, a double cheeseburger with only ketchup.” “Right, got it, coming up!”
So many changes on the medical care horizon and everyone speaking a slightly different language — it’s bound to …
With health reform, flexibility is important
For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives except going without or going broke.
Steven Brill’s recent cover story clearly detailed the predatory health care pricing that has been ruinous for many rank-and-file Americans. In Brill’s report, a key mechanism, …
America’s health system is dangerously out of balance
I hate saying I told you so. But “patient engagement is a physician-patient communications challenge and not an HIT (health information technology) challenge.”
Just take a look at the Mayo Clinic’s patient portal experience which was discussed at a HIMSS 2013.
The headline: “Mayo Clinic struggles to meet stage 2 meaningful use thresholds for engaging patients.”
Always innovating, the Mayo Clinic some three years ago introduced a web-based portal to share information with …
If you build a patient portal, why won’t they come?
The following column was published on March 26th, 2013 in the New York Times’ Room for Debate blog.
In the coming years, health care reform will drive consolidation in the industry. Reformers, including the president himself, point to integrated health systems like Kaiser Permanente as the future of health care delivery. While this movement may improve patient care, whether it will shield …
Health reform faces tension with integrated health systems
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 19-year-old woman is admitted to the hospital because of a 2-week history of bilateral leg weakness and numbness accompanied by urinary incontinence that began after a viral gastrointestinal illness of 3 days’ duration. She has no personal or family medical history of note and takes no medication.
On physical examination, temperature is 36.7 °C …
MKSAP: 19-year-old woman with bilateral leg weakness
Just three words, a short phrase, heard from an ICU nurse that changed my friend’s well-being as she lay in an ICU bed. In fact, it is the only phrase my friend remembers from her entire hospital stay after having brain surgery to remove a tumor.
She was experiencing nausea, a sick feeling, and needing and wanting care, direction, and guidance from hospital staff. And three powerful words spoken from a …
The power of words in guiding patients toward recovery
A guest column by the American Medical Association, exclusive to KevinMD.com.
Information is a source of learning. But unless it is organized, processed and available to the right people in a format for decision making, it is a burden, not a benefit.
-Former ServiceMaster CEO C. William Pollard
The new Physician Payment Sunshine Act (Sunshine Act) was created by Congress to ensure transparency in physicians’ …
The Physician Payment Sunshine Act is here: Are you ready?
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