Which of the following events is most traumatic for a practicing physician?
Unlike EMRs, paper charts never crash
Recently, my middle school daughter has been learning about the use of the scientific method in science class. In her school laboratory, she and the other sixth graders learn how to ask a question, perform background research, formulate a hypothesis, design and execute an experiment to test the hypothesis, and ultimately synthesize conclusions. She is being taught to accurately record and interpret data; the concept of manipulating data to suit …
Regulate medical research so that it can help patients
I approached my father in the yard of his most recent home, a small, run-down duplex shack. His hair was whiter than I remembered, his old blue sweater shaggy. He was clipping the hedge in his careless but enthusiastic way; when finished, it wouldn’t look good, but it would look clipped.
One of his eyes was red and tearing up. A splinter …
My father had let me in and had allowed me to help him
Now here is a novel idea to save lives and stop the cancer plague; stop trying! Sounds as crazy to me, as it does to you, but this idea actually may have merit. Some smart people are saying that we have spent too much money for little gain, thus it is time to give up and by retreating win more battles in the war on cancer, than by charging ahead.
The …
Finding a cancer cure: Maybe we should shift gears
How can hospitals and clinics deliver care that is patient and family centered? As an emergency physician, I’ve often pondered this question after my mother died of an untreated systemic infection in an out-of-state hospital. The experience, which I write about in the January 1 edition of the Washington Post as well as the December issue of Health Affairs, convinced me that healthcare still has room to grow …
Towards patient and family centered care: Bridging the gap
Please raise your hand if you are not going to die.
If you haven’t found the fountain of youth and we haven’t perfected anti-aging technology, then you my friend are going to die. But you are not alone, so am I, and so is your mother and your father and your brothers and sisters and even little Johnny down the street.
Now that I have reminded you of your own mortality. Does …
What if I told you that you were going to die tomorrow?
A few months ago, when I thought I should throw it all away and go to law school, an acquaintance who is a lawyer said something unexpected. He said “law school is learning how to think like a lawyer and deal with the uncertainty within the law.” Uncertainty? A law is a law right? Don’t speed. Don’t drink and drive. Write thank-you notes. Turns out the law often requires interpretation, …
Don’t get frustrated with the uncertainties of medicine
Some physicians will make over 7 times what the average college dropout will earn over a lifetime. Even within medicine there are significant differences in lifetime earnings between primary care, surgery, and specialty care. With the recent Powerball lottery jackpot at a record high, there was a lot of daydreaming going on recently for many Americans, maybe even some doctors: What would you do if you actually won it all? …
If your doctor won the lottery, would he show up for work?
All professions need good communication skills. Obviously in healthcare the ability to communicate with patients should rank high in a physician’s list of talents. These days that interaction occurs in a number of ways: face-to-face, direct telephone contact or though a staff member, via emails, patient portals, or even texting. Because the communication is in the arena of medicine, the protection of an individual’s health information is paramount. Enter HIPAA, …
We speak volumes to our patients without opening our mouths
Physicians and the public are urging doctors to bring cost into consideration at the bedside when ordering laboratory tests and imaging studies. Although diagnostic testing represents an important component of the rising cost of medical care, asking what a test costs is the wrong question.
Cost-saving shouldn’t begin at the bedside, it should begin by training the next generation of doctors to think in terms of value; not bang-for-buck or potential …
Physicians have an obligation to eliminate waste
My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended by an emergency physician, two hospitalists, three gastroenterologists, a pulmonologist, an infectious disease physician and an interventional radiologist. With the exception of one specialist who had performed a procedure on …
Health information exchange is the foundation of care coordination
In my medical practice, I’ve used note writing extensively, to communicate with patients, with families of patients and with referring physicians. And yet, when I received a note, which is not related to patient care, it is always a little surprising and uplifting, and emphasizes why note writing (and note receiving) is so appealing.
In this Internet age and the age of information, we are bombarded with electronically conveyed messages, television …
Build your network by writing a timely note
I think horses can teach us some things about health promotion. We invoke them routinely, although I suspect we are unaware of it much of the time.
Three of the more salient themes in modern health promotion involve incentives, disincentives, and what/how much people drink — with a particular emphasis, of course, on less soda, and more water. I hear hoofbeats in all of them.
Incentives are particularly prominent in worksite and …
What horses can teach us about health promotion
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It is always a treat, particularly when living on the West Coast, to watch the New England Patriots football team play on national television in their home stadium, Foxborough, Massachusetts. On Monday Night Football, the match-up was between the Patriots and the Houston Texans, which had the best record in the AFC and undefeated in all away road games. As previously …
Belichick, Brady and what healthcare can learn from the Patriots
We pay a lot of attention to hearing. Newborns get their hearing tested in most states, and periodic hearing screening is part of regular checkups. We know which children cannot hear. So why is it that so many kids don’t listen?
When we’re raising little kids, we know that we’re supposed to talk all the time. We yammer on in the grocery …
How to get your kids to listen to you
When I heard in October that Superstorm Sandy was projected to make landfall somewhere in the vicinity of DC and Maryland, I prepared for the worst. I stocked up on non-perishable goods and evacuated to higher ground. (The rest of my family was already coincidentally out of town and harm’s way.)
I put fresh batteries into two flashlights and installed a flashlight app on my smartphone for good measure. Although I …
People are fallible, but health systems need not be
I review a lot of cases in my professional life. Some of them are just ones that our QA group comes across in our practice. Some are cases related to our liability policy. Some are cases I’m sent for review, or educational cases I present. We see a lot of cases which could have been done better, or in which the …
Medical malpractice: Equating standard of care to best practice
I hope my patients are satisfied. This is everything. Improving the lives of people is why doctors do what they do. How much we help our patients is the metric. It’s the peg we hang our self-esteem on.
So yes, of course, patient satisfaction is really important.
But that doesn’t mean it’s a good idea to link it with dollars.
In fact, on a list of well-meaning but really dumb …
Why linking patient satisfaction with dollars is misguided
“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
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