“This could be big,” he said after I told him about the company who wants me to cover their 100+ employees. I pay him to give me the stark reality of things, but his optimism made me uncomfortable. ”You’ve got to go for this. I know you don’t feel ready for it yet, but this could really be huge for your business, and I don’t think you should pass this …
The transition to direct care: Considering the consequences
A recent little essay entitled “Do patients bond best with doctors who misinform them with optimism” got me thinking about balancing honesty and optimism in practicing any medical specialty in which patients not infrequently die.
Tragic things can happen in the pediatric intensive care unit. Anyone who works there — doctors, nurses, respiratory therapists, and many others — see these …
Balancing honesty and optimism in critical care
Fourth year medical students are starting the interview process to match into a residency program – their next and potentially final stage of training.
Over the next few months, these students will rank the programs they visit based on features such as geography, research funding, and hospital affiliations. But there’s another factor to consider – one that gets little attention but that probably matters more for the kind of doctors they’ll become. …
Holding doctors accountable: The role of teaching hospitals
In September the United States Preventive Services Task Force, a panel of medical experts, concluded that tests to screen for ovarian cancer do more harm than good. As a result, insurers will not be required by federal law to pay for such tests.
And the announcement was met with near silence.
Why was this recommendation greeted with such malaise when the same panel’s earlier and similar conclusions about Read more…
Screening for ovarian cancer: Where’s the outrage?
When it comes to getting parents to cut back on their kids’ screen time, we doctors aren’t doing such a great job.
Like most of my colleagues, I talk about screen time at almost all checkups. I talk about how too much screen time makes a kid more likely to be overweight and have behavioral problems. With the parents of babies and …
Cut back on screen time for kids
One of the gripes that patients have about the medical profession is that we physicians don’t communicate sufficiently about our patients. In my view, this criticism is spot on.
Patients we see in the office often have several physicians participating in their care. The level of communication among us is variable. While electronic medical records (EMR) has the potential to facilitate communication between physicians’ offices and hospitals, the promise has not …
When physicians don’t communicate about their patients
Internal medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of well people. It is an excellent field, full of opportunities to think and feel and connect with people, mysteries to be solved and an endless variety of stuff to be learned. …
The recipe for a great hospitalist program
Defined as someone “having the faculties impaired by alcohol, those of us who work in an acute healthcare facility are witness to many illustrious examples of drunk patients coming through our doors.
Underaged kids passed out at a house party? Yup. Raging alcoholics who are brought into the ER at least once a week? Sure. Elderly women who secretly binges on wine …
The role of alcohol in health costs
A new message pops up on my phone. I signal to the attending and step out of the OR. I’m on anesthesia rotation at Santa Clara Valley Medical Center, as a pediatrics resident at Lucile Packard Children’s Hospital at Stanford. But because I’m also a mom to a first grader in Cupertino, both my pager and my cell phone are frequently “on call”.
“I want to take this opportunity to update …
It’s time to stop being afraid to study gun violence
We are often pulled in different, opposing directions, and take time to find the balance between acceptance and anger, surrender and control, individual and group, being and thinking, living and dying. How we find balance and what that balance is influences our attitude.
Throughout my journey, I was struck by a number of dichotomies, or dualities, as I reflected on my reactions …
The duality that cancer patients face
Going to a new medical school working its way through the accreditation process is, by design, a bit of an experiment. A school wants to establish itself as distinctive, but in the end, it seems that doing anything radical is out of the question. The drive to conform to professional standards and expectations is a good thing. It generally prevents schools from bilking students of grand amounts of money while …
Incremental improvement in medical education is not enough
Are you or your patients sleeping well? Mine are not, and I wasn’t either. Do you ask them how they sleep? I never used to ask, and no one asked me. When I was in medical school, we had rigorous instruction in taking detailed medical histories. Sleep quantity and quality were not included.
What changed? Is it the digital age we live …
2 ways to help your patients get better sleep
As physicians, we know that no matter what care we provide, Medicare and private payers are going to do what they can to reduce payouts. For the health of the nation, healthcare spending simply cannot continue on its current trajectory. Reform measures such as accountable care organizations, bundled payments and penalties for potentially preventable complications and readmissions may help reduce expenditures, …
Protect yourself against fraudulent EHR documentation
ADVERTISEMENT
In the past, the radiology profession was seen as a very financially successful specialty, but as every businessperson knows, success often has peaks and valleys. Radiology residencies are some of the most competitive to obtain, which is due to the combination of expected financial compensation and the assumed quality of life.
In the early 1990’s, when financial pressures first appeared on the …
The increasing stress that radiologists face
As a patient, you’re entitled to ask your health care providers anything. In that sense, there are no bad questions.
But some questions will help you get more out of your interaction with your health care providers than others. This advice comes from my experience as a medical oncologist and a cancer survivor.
Before asking your questions, remember that you’re dealing with a …
How to get the most out of your oncology appointments
There has been an explosion in health apps. Patients are using them for weight loss, calorie counting, exercise monitoring, ovulation calculation and for many other health needs. But to truly integrate the concept of health apps in the health care system healthcare providers will need to get involved. There is discussion in the health IT world lately regarding physician adoption of …
Will doctors recommend health apps to patients?
The Bipartisan Policy Report titled “What is Driving US Health Care Spending? America’s Unsustainable Health Care Cost Growth” issued in September lists seven factors increasing American health care costs. The “fiscal cliff” debates include many of these arguments.
While these factors do indeed play roles in American health care, almost all are at work in other industrialized countries, all of whom provide better care to more people for half what we …
The critical factors driving up American health costs
I had a conversation with a family practice physician today, a man who is far closer to the end of his career than the beginning. He is part of a private practice group that recently was sold to one of the larger hospital groups in the area, which put him on a salary, but also allowed him to work only three days per week. He stated that the decrease in …
The physicians of today have given up their unique soul
Doctors at Memorial Sloan-Kettering Cancer Center recently declared they would not use Zaltrap (Sanofi), for advanced colorectal cancer. In a New York Times editorial, they suggested the extraordinary cost for incremental benefit could not justify its use. Sanofi appeared to cave to the pressure and announced a 50% discount – which only made things worse.
This August, Zaltrap received FDA approval for the treatment of advanced colorectal cancer. In …
Dramatically influence drug prices by positive action
When the marketing of ObamaCare began in 2009, I always believed that the end game was for a federal single payer system. Since the present Affordable Care Act, (ACA), was passed in 2010, there has been nothing to convince me otherwise. The only reason single-payer wasn’t passed two years ago was because it was hard enough to arm-twist and bribe even …
ObamaCare: All roads lead to single payer
Get free updates delivered free to your inbox.
