Our 5 year-old keeps forgetting to draw arms on his people at school. The lack of arms has evolved since school started in September and even came up in his parent-teacher conference recently. I found it odd– he always seems to remember that humans have arms when he draws at home. We didn’t mention it to him. And when his brother …
How to foster generosity at an early age
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …
Physicians can be better doctors by being patients
I remember you the day we met. It was five years ago. I was terrified. You seemed relaxed and at peace. I’d been invited to join the Lennox Head Club, in the town where I live and work; this over-thirty-five match was the first game of soccer I’d played in twenty-five years. I was the oldest on the team. You were the youngest. For you it was just the start …
I remember you: Rest in peace, my friend
There is one aspect of our relentlessly rising healthcare costs that seems particularly out of control — administrative costs. An interesting recent editorial in the New England Journal of Medicine provides some sobering details.
Every physician confronts daily the burden of dealing with healthcare bureaucrats of various sorts. The average doctor personally spends 43 minutes each day at it, and behind every physician there is an army of coders. …
Physician credentialing needs better standardization
I only met her once; she was young—in her mid-thirties—and she had been diagnosed with ovarian cancer during her pregnancy. Following chemotherapy and the delivery of a healthy baby, she underwent a hysterectomy and staging. She was ultimately diagnosed with a rare ovarian cancer: small cell carcinoma. She underwent postoperative chemotherapy and had gone into remission.
Unfortunately, it was short lived, …
A plea to oncologists to confront the treatment of rare diseases
The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …
Common criticisms of concierge medicine that deserve to be answered
It seems both ironic and inevitable: I won’t be getting any more “meaningful use” checks. It’s not that I didn’t qualify for the money; I saw plenty of patients on Medicare and met all of the requirements. I was paid for my first year money without much hassle. The problem I am facing is this: I am probably going to be “opting out” of Medicare, and once I do that …
Behind the complex decision to opt out of Medicare
My elderly and infirm parents live 15 minutes south of my home in an assisted living facility. They moved there after it became apparent that they could not manage their affairs in their own home, have some degree of independence and socialization with friends and receive the care and supervision they needed to stay out of the hospital. Their cognitive impairment …
A doctor for the elderly: What to look for
A grandfather-father-husband-salesman-cook-gardener-hiker-gentleman, adored by many, is struck down by cancer. His disease is particularly horrible, spreading quickly though his body causing damage not only to bone and organ, but to sinew and nerve. He suffers terrible pain for weeks, relieved poorly with inadequate doses of inferior medications, thrashing in misery witnessed by his kin, always at the bedside, ages seven to seventy. Finally, uncomfortable and agitated until the end, he …
A poorly managed end of life experience can transform families
We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders?
A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend to run up higher health care bills for their patients than their more seasoned colleagues. The study, published in Health Affairs earlier this month, looked at insurance …
The age differential in medical care
I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance:
Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I am more compulsive about making sure I hit all ten systems. (Even when it’s not clinically relevant. Such is the Kafkaesque world we live in.) And I …
Medicare made the rules and now punishes doctors for following them
If you ask for a spoon in my house, you may expect to be directed towards a drawer of neatly nestled stacks of stainless.
Instead, you will likely find this a tangled mess of silver and plastic in no apparent order.
I used to be bothered by a such a disorganized silverware drawer, but that was years ago. I have let go of …
Ask your toddler to do the chores
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is seen for a new-patient evaluation. He reports a recent diagnosis of Parkinson disease made after a 2-year history of stiffness in his right arm, a tendency to posture when walking, an awkward and stiffly inverted step when using the right leg, but no tremor. During this period, his voice became …
MKSAP: 50-year-old man with Parkinson disease
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I attended a talk by the Dean of Admissions of one of the most competitive medical schools nationwide. The topic was primary care and community health. He talked at length about how not enough medical students were entering primary care. He put up some graphs showing that the most lucrative specialties tend to be the most competitive ones, with primary care among the lowest-paying and least-competitive. He said that medical …
Medical schools don’t care about the primary care shortage
Your child has a rash and is acting a little sick. You reach for your phone–not to call the doctor, but to look up rashes on Google or your symptom checker app.
This, according to the latest report from the Pew Internet and American Life Project, is the direction we are moving. As a doctor, I think it’s great.
In May of 2011, …
My smart phone helps me be a better doctor
My veterinarian answers my phone calls. The other day I called her office to ask for a renewal of the pain medication for my little dog Jack. He has been blind and deaf for over a year, but now his rear end is going and he is falling a lot and having a hard time getting up. When I asked for …
Doctors should return phone calls because it is the right thing to do
“I love the hours.”
“I want to be just like Dr. Smith. He has a sweet practice.”“I want to make a ton of money.”
“I want to make a ton of money.”
These are some bad reasons why medical students choose a specialty. Most medical students decide what specialty to pursue when they are in their mid to late 20s. While we all think …
4 bad reasons why medical students choose a specialty
The difference between a job and a profession is a matter of ownership. Anyone who is applying for employment understands that the job they seek actually belongs to someone else. It is typically offered by an individual or a corporation who defines the job and determines who is qualified to perform it. If the job holder is unable or unwilling to do the work, the owner takes the job back …
Does health reform require doctors to stray from their ethical code?
A war is brewing in the House of Medicine. It’s a war of philosophy based on how we physicians approach our patients–the people who come to us to be cared for and to be cared about. The people who come as patients to the physician as healer, a healer who also has a wealth of scientific knowledge which can be used to stamp out disease and bring long, healthy lives …
A war in the House of Medicine: Can women physicians help?
I was working in the ER this weekend when one of my nurses asked me a simple question: “How would you fix the health care system?” Obviously, this is a complex problem requiring complex solutions, but in an environment where at any minute a heart attack or a stroke could disrupt a conversation I prepared a sound bite for an answer.
“Do …
Fix our health system: Be like Switzerland
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