Countless times during the course of my day, some person, entity or task vies for my time and attention.
“If I could just have a minute of your time” begins a request to also see the spouse of a scheduled patient, a sales pitch from a pharmaceutical “rep” or home oxygen vendor, a phone call from a visiting nurse, a message from a …
What is each minute of my time is really worth?
An excerpt from In the Kingdom of the Sick: A Social History of Chronic Illness in America.
For Jennifer Crystal, a thirty-three-year-old woman living with Lyme disease and two of its co-infections, life changed dramatically with one tiny tick bite in the summer of 1997. It was the summer before her sophomore year at Middlebury College, and Crystal was working at a summer camp in Maine.
“I remember the …
Digital advocacy for patients: The message must be accurate
Recently, I went straight from the hospital to the Washington DC Convention Center for the AMSA National Convention. I was there to receive the 2013 Women Leaders in Medicine Award, along with 4 other women; part of the award reception was a panel discussion on the significance of women leaders in medicine. We had received some questions to ponder ahead of time that the moderator would ask us, and then …
Celebrate what makes being a woman in medicine special
Tell me to what you pay attention and I will tell you who you are.
-Jose Ortega y Gasset
The senior resident hauled our little band of medical students down to the radiology file room. As he dug through the heavy manila x-ray jacket searching for films, he told us the patient’s story. “This 63-year-old lady was really sick when she came in. Heart attack a couple of years ago. New trouble …
The Wax Pencil Sign will soon be obsolete
Wang Li is a 48-year old farmer from Dalian, China. After a two-day trip to the major provincial hospital, he’s heading home to his village to die. Wang has lung cancer, and even with insurance, his surgery will cost him 20,000RMB—$3,000, which is twice his annual salary. The surgery would be curative, but it doesn’t matter. “I cannot burden my family,” he said.
I am a Chinese-born, American …
Health reform: China offers a cautionary tale
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Over the past several months, I have covered some controversial topics, such as electronic health records and the overuse of diagnostic testing. For this month’s column, I will address a less provocative topic: the role of non-physician …
Doctors and nurse practitioners: We’re failing the reality test
At last it was time for my cataract surgery. Having had one eye surgery done by a different physician in another New York eye and ear specialty hospital a few months earlier, I knew what to look for and could make comparisons from a patient perspective. As I noted months ago on this blog, I really had no choice of hospitals. If I wanted my trusted doctor to …
Reviewing my cataract surgery: A casual disregard for patients
My kids know that I enjoy a spirited argument. During the days when the dinner table was our public forum, I tried hard to offer a responsible voice of dissent on the issues before us. I admit now that the view I espoused was not always my own, but one that I felt merited inclusion in the discussion. I still do this with them and to others in my life …
Probiotics promise better health, but that’s hard to prove
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
During the Civil War, anesthesia was provided by dipping cloth in chloroform or ether and holding it over a patient’s nose and mouth. Today, anesthetic medications are delivered in a controlled (and more civil) manner through specialized devices to provide unconsciousness for surgery.
Over the last several …
Awareness about intraoperative awareness
Iinspired by the VA’s big bold step of going OpenNotes, I wrote a blog post titled OpenNotes in geriatrics: 6 awkward concerns.
It was written in the spirit of just about everything I write: to share the nitty-gritty complexities of what I find myself navigating in geriatrics, to bring attention to medical issues that older adults and PCPs struggle with, and to try to bridge …
Should OpenNotes become the standard of care?
Hospitals are very focused on avoiding harming patients lately. They have been moving in that direction for a long time, but with health care reform legislation, payments are on the line, which makes something that was a very good idea into an imperative.
In the year 2000, the Institute of Medicine, a non-profit organization that monitors various aspects of medical care, reported that 44,000-98,000 people died each year due to medical …
How can doctors avoid killing or hurting people in their care?
The Oxford English Dictionary (OED) identifies the first use of the term “doctour”, as the year 1303 AD, shortened to “doctor” in the 1557 addition of the Geneva Bible. The OED first defines doctor not as a caregiver or healer, not as a science researcher or expert and not even as one with an advanced educational degree. The OED, the world’s foremost English language dictionary, defines “doctor,” 700 years ago …
The best doctors teach their patients
Part of the KevinMD toolkit series.
A lot of people ask me, “What tools do you use for blogging, speaking, when you’re on the road, seeing patients etc. …” So I decided to start a series that describe what tools I use, and why.
First in this series are tools I use for my social media keynote presentations. My …
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I’m involved in a protracted and good-natured (I hope) debate about the merits of robotic surgery with a University of Pittsburgh urologist named Ben Davies. Today he tweeted the following (with translation for the Twitter averse):
“I would love for a $ISRG [stock symbol for Intuitive, makers of the robot] MD hater (like @Skepticscalpel) to actually watch 10 open RRPs [radical retropubic prostatectomies] …
Robotic prostatectomy: A debate with a urologist
The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.
One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking …
Medical apps: We are approaching the tipping point
Patricia Wen’s front page story, “Children’s Access to Mental Health Care is Growing,” in which she describes the “co-location” of mental health care services in pediatric practices, brought me back to the summer of 2011 when I attended a meeting of a working group of the Massachusetts Chapter of the American Academy of Pediatrics (MCAAP.) The task of this working group, a subgroup of the MCAAP task force on …
The co-location of mental health care services in pediatric practices
Why do you need a population health management (PHM) IT system? In our last column we discussed the fact that reimbursement tied to outcomes will demand a greater level of patient management. Greater, perhaps, than your EHR can deliver. The early focus of new pay-for-performance and bundled payment systems is on preventive care for top chronic illnesses.
The 15 most expensive health conditions account for 44% of total …
Why you need a population health management IT system
A recent report stating that one in 50 school children carries an autism diagnosis appears to confirm anecdotal evidence that we are experiencing an increase in the autism rate.
But there are a number of things that should be considered in a discussion of these findings — and leading that discussion should be methodology.
These new data from the CDC’s National Center for Health Statistics (NCHS) are culled from a …
Explaining the rise in the autism rate
Dr. Chris Nickson recently asked, if a Martian landed on Earth and looked at how we do medical education, what would she think?
Could it really be true that so many dedicated, brilliant people with the same objectives could be doing exactly the same thing at the same time without sharing their resources? … That they could put so much work put into teaching sessions that so few actually …
4 ways asynchronous learning can benefit medical students
An apology can be a powerful statement that influences how another responds to a perceived wrong. This can be especially true within the context of a doctor-patient relationship. Yet, most physicians have been conditioned to employ a “deny-and-defend” approach to adverse medical outcomes, avoiding apologies because they believe it could imply an admission of guilt or ultimately initiate a lawsuit.
Apology in medicine is neither new or a fringe concept (currently …
Resolving medical liability claims with disclosure, apology and offer
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