I found out this past weekend that the VA will be making clinician progress notes available for patients to view on the MyHealtheVet portal. In other words, the VA is going OpenNotes. (Note: I was a primary care provider in geriatrics clinic at the San Francisco VA from 2006-2010.)
My first reaction was to be impressed by this bold progressive move.
My next reaction was to …
OpenNotes in geriatrics: 6 awkward concerns
Sometimes the health care system just does not work.
I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two …
An epic fail when it comes to mental health
Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston’s South End. I consult my iPhone one more time to confirm that I’m in the right place and knock on the vehicle’s glass-paned door. Ritchie, with his oversized Las Vegas baseball cap and faint smell of cigarettes, ushers me inside and I settle in across from him on …
Needle exchanges: When the perfect is the enemy of the good
If only it was as simple as looking into our old Magic 8 Balls® to find out if it is “very doubtful” or “decidedly so” that refusing to stop at the Good Humor® truck on the way home from school will be the right thing to do for our children. It is worries like this, along with the challenge of raising children …
10 reasons why your kids are picky eaters
Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position …
A patient cheats death and changes two lives
A version of this column was published on January 13, 2013 in USA Today.
Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.
I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an …
A virtual office visit for your cold is not a good idea
Labor Day weekend, a young man in his early 50s came into our hospital.
He had multi-vessel coronary artery disease. I sent him in for surgery. Every one of his vessels was blocked. The surgeon came to me and said he couldn’t find enough veins to bypass all the occlusions.
There was an artery in the back of the heart, and he didn’t have any veins left to work with. Let’s sit …
Evidence based medicine: Go beyond the headlines and dig into the data
It is estimated that over 20 million Americans have neuropathy. Many people don’t know that prior to the advent of the obesity pandemic and the associated rising rates of diabetes, leprosy was the most common cause of neuropathy worldwide. Although it is now widely recognized that diabetes is the most common cause of neuropathy, for up to 30% of patients the cause of their neuropathy remains unknown. These cases are …
Idiopathic neuropathy: 2 steps providers can take
Not long ago, I blogged about a plastic surgeon who aggressively pursues patients who refuse to pay her bills. The state is suing her to make her stop and also considering lifting her medical license. The central theme is that she makes patients who she sees in the ED to sign a form stating that they will pay her. It is unlikely that the patients are aware of …
Should we expect patients to think about costs?
Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs
–ihi.org
If you stop to think about the holy grail of health care reform, also known as the Triple Aim, it sounds like a grand challenge involving wizardry or wishful thinking or worse, propaganda for the masses, particularly the last part. It’s like attempting to build a better driving machine, with better fuel efficiency at lower cost. …
How pushing the Triple Aim ignores doctors and their patients
Health information technology (HIT) has had a tremendous – and mostly positive — impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver.
Like most of my colleagues, I can tick off at least five or six large “pioneer” corporations – companies like Epic, Cerner, Allscripts, Siemens – in the forefront of the technology explosion that yielded …
Doctors lack an analytic engine: Why we need EMR 3.0
For as long as I can remember I have tended to develop a bad cough nearly every time I get sick in the cold and flu season. I’m not sure if I have a minor tendency to bronchospasm or if my years of passive smoke exposure as a child somehow damaged my lungs. Who knows, but I seem to have the tendency for every URI become a lingering bronchitic cough.
In …
Why I hold off on antibiotics for my cough
I have come to terms with making difficult decisions. I accept the possibility of committing a mistake that will cost a life. But I never signed on to bankrupting my patients. Never!
I had been up all night tossing and turning. The stat CT scan was deemed unnecessary by the insurance company. My patient called crying saying he couldn’t afford the thousands of dollars in charges. Never …
I didn’t become a doctor to bankrupt my patients
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I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months. She was bidding me adieu, because I had referred her to hospice.
There is confusion about the role of the primary doctor, when a patient …
When should a physician obtain a palliative care consult?
An excerpt from When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.
Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a headache. When she woke up this morning, her head hurt …
When patients feel trapped by doctors and the medical system
I recently had the opportunity to read Daniel Pink’s Drive. I read it partly to understand why pay-for-performance often fails to accomplish its goals for complex tasks, such as patient care. However, the thing I found most interesting about this book was the way in which creativity is deliberately inspired and cultivated by industry.
I could not help but think about why we don’t deliberately nurture creativity in medical trainees. Why …
Why we should nurture creativity in medical residents
Lots of people are using complementary and alternative medicine (CAM) these days—things like vitamins, homeopathic or herbal medicine, chiropractors, acupuncture or massage therapy. But they don’t always tell their doctors about it.
In a study in the journal Pediatrics, researchers in Canada found that among kids with chronic health problems, 64.5 percent of them were using some form of CAM—but more than a third didn’t tell their …
Let doctors know if you’re using alternative medicine
For practicing physicians, there’s a tricky balance in believing that the Internet can help save lives.
I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the Internet. Many clinics block video-streaming sites and don’t allow for traditional email …
Dr. Google: Tips for patients who diagnose online
Recently, there was a bit of hue and cry regarding Mayor Bloomberg’s report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department.
Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians … “It prevents me …
Will Mayor Bloomberg win the war on prescription drug abuse?
For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.
Yet somehow 43 percent of newly-licensed RNs can’t find jobs within …
The nursing shortage: Why it isn’t a good time to become a nurse
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