“There’s no passion to be found playing small, in settling for a life that is less than the one you are capable of living.”
-Nelson Mandela
Amidst the chaos of our noisy world, it’s hard to know where to begin a new career as a healthcare professional who’s about to inherit an American disaster called healthcare. And it’s likely that in a few …
My advice to a new generation of doctors
Veteran analyst Vince Kuraitis recently reviewed a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect:
The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In …
Most ACOs are accountable in name only
I can truly say logging on to the National Commission on Certification of Physician Assistants website and seeing I’ve passed the boards was one of the happiest moments of my life. All of the hours invested learning to take great care of patients was worth that feeling. Like an entire generation of young new MD/DO/PA/NP graduates looking to make a positive …
We have inherited a health system that is broken beyond repair
Each of us wears many different “hats” throughout the course of the day. We are an employee, a wife, a father, a club member, a consumer and so on. It comes as no surprise that our thinking, what we say, and how we say it at any particular time coincides with the hat we are wearing at that moment. The thing about these “hats” or roles is that they come …
When patients are socialized into the sick role
I can always count on Mr. Wonderful to come up with a timely subject for my blog. Today’s quotable is, “Dear G-d, I have a problem. My problem is me!”
Some days it feels like I spend half my time trying to convince patients that they need to change their ways in order to get healthy. I often spend the other half of my time treating the effects of their bad …
I have a problem and my problem is me
As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …
Primary care doctors may no longer be needed
The long-acting beta agonist (LABA) paradox strikes again. A new article in a Milwaukee newspaper sounds an old theme. Advair, the most widely used asthma medicine, contains a long-acting beta agonist—salmeterol.
“[L]ong-acting beta-agonists have been linked to 1,900 asthma deaths from 2004 through 2011, according to an estimate provided by AdverseEvents Inc., a private firm that analyzes drug side effect data reported to …
Advair and the long acting beta agonist paradox
One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances.
My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target.
On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for …
The insanity of pain management in the ER
When you set out on an unfamiliar journey, you will need a map to get to your desired destination. You may pass landmarks, but not know exactly where you are unless you are able to identify these landmarks on your map. The same is true for the journey of life, and specifically, the path at the end of life.
You may know …
At the end of life, never underestimate the power of a map
Many years ago, I wrote this essay in which I wondered why I receive so few gifts from my patients in the holiday season. I was prompted to write the essay by the memory of my father, an orthopedic surgeon in solo practice, whose patients showered him every December with foil-wrapped bottles of booze, tins of cookies, and all manner of goodies, including a “World’s Greatest Doctor Figurine.”
I speculated …
One doctor’s holiday wish list
You try to hide it.
You leave the scrubs in the locker-room, the shop-talk at the staff dining hall and the on-call phone consults outside in the cold, away from the highly-anticipated dinner date or holiday party.
But regardless how much effort you put into leaving your career where it belongs, it is so obvious that you work in a hospital.
And here are …
3 clear signs that you work in a hospital
In this article I will show you a push button shortcut you can use to quickly create more work-life balance, no matter how busy your practice and your life feels at the moment.
When it comes to creating balance between your medical career and your life, there is a simple rule in play. The strongest structure wins. When we are talking about …
Improve your work life balance: A schedule hack for doctors
When Newtown children returned to area elementary schools less than a week after the massacre at Sandy Hook Elementary, the cameras were watching, a reality that may slow healing in the Connecticut community.
Although there’s no literature that’s specific to the effects of a media frenzy after a school shooting on children’s psychological recovery, there’s plenty of other applicable evidence, according …
Why the media will slow the healing of Sandy Hook
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Choosing the best treatment for cancer may be challenging and difficult. Patients should be well informed before making their choice. Communication between the patient and family and their medical team including their physician is very important.
The medical team should describe the available treatment choices to the patient and the expected results of each of them as well as their possible side effects. Patients should carefully consider the available options and …
Make the correct choice for cancer treatment: Questions to ask
She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …
What doctors can learn from working at Starbucks
I recently attended Primary Care Progress’s Gregg Stracks Leadership Summit. The summit brought together chapter leaders from around the country to get coaching in how to lead our chapters to accomplish our individual goals.
I went to the summit knowing that PCP values teams – the team-based model of organizing to improve the primary care profession and the team-based model of primary care delivery. In both cases, there would be a …
The deep professional rift between nursing and medicine
Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health care system; the effect on academic medical centers and teaching hospitals will be significant.
The political conscience is still being driven by …
Predicting the next 4 years of health reform
Dear Patient(s),
Thank you for educating me.
Thank you for letting me shine bright lights into your eyes and place Q-tips up your nose. Thank you for not shooting me a dirty look when I ask you to lift up your pendulous breast so I can listen to your heart. Thank you for letting me ogle at your protuberant belly—whether it contains a baby, a liver tumor, or liters of fluid inside. …
Dear patients: Thank you for teaching me
For years I’ve been asked the same question: “How can you work in hospice and be around death everyday?” As if death, like this year’s flu, were something we could all just avoid so long as we stay away from it. This question, however, takes on a bit of a different form this time of year as people’s thoughts are centered much more around family. The question becomes more of …
Learn to celebrate Christmas: Lessons from hospice patients
Four years ago, as I was making rounds on the oncology floor, one of my patients with leukemia asked, out of the blue, “Hey, Doc, who you gonna vote for?” He had an Obama T-shirt by his bedside.
Chuckling politely, I asked him why he wanted to know. “I’m curious, Doc,” he said. “It tells me your worldview.” He said that if we agreed on who should be the next president, …
The problem with discussing politics in the exam room
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