These days, the world is a very scary place.
You go to school. You go to school some more if you can afford it and you feel so inclined. Then, if you’re one of the really crazy ones like me, you go to school some more. Somewhere in that late night caffeine and chili cheese fries induced sophomoronic (no, do not adjust your set) craziness, something starts to click. At least …
Why psychiatry is the right choice for me
The American Cancer Society designated an October weekend “Suits and Sneakers Awareness Weekend” as part of its annual Coaches vs. Cancer program that featured well-dressed basketball coaches wearing “sneakers instead of dress shoes with their usual game attire during weekend games to demonstrate their support for the Society and the fight against cancer.”
The idea is to encourage people to exercise and eat a healthy diet to reduce …
How cancer awareness efforts can backfire
I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify.
The point in contention is an interesting one: we know the nation’s ERs are overwhelmed and overcrowded. That’s old news. We also …
The volume of low acuity patients in the ER is not a myth
Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.
Honest fact: The morale of doctors in the real world is low–and sinking lower.
I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”
Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:
Because …
The growing culture of hostile dependency towards doctors
I was driving home from a night shift and the scorching sound of Texas guitars flamed out of my car speakers. The group ZZ Top was old, but the song was new. It went like this, “25 lighters on my dresser, yessir. You know I gotsta get paid.”
Mostly, I was shocked that any members of the band ZZ Top were still alive, …
An unexpected tip after treating a gang member in the ER
If you want to know if restaurant food is safe, there’s help. Just look at the signs in the window showing that the eatery got an A, B or worse on its latest government inspection report. There are government inspection reports for hospitals too, but you won’t see them on the front door or any place else in the hospital, for that matter.
Hospital inspections conducted by state departments of health …
My search for helpful quality information on hospitals
The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”
The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.
The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.
Let …
Reasons why doctors overtreat and overtest
It has been a long slog since we started our war on cancer here in the United States in 1971.
At times I am not certain that this has been so much of a war as opposed to a series of skirmishes that occasionally have produced incredible moments of optimism. But there have been a fair share of frustrations …
Facing the difficult issues when it comes to high quality cancer care
When I write from my clinical experience as a behavioral pediatrician, I am careful to change identifying information to protect the privacy of my patients. It is rather freeing, therefore, to write about characters in a novel. Left Neglected by Lisa Genova, who is also a neuroscientist (perhaps she took the story from some real cases) offers some important insights into this complex subject.
The story revolves around Sarah, a 37-year-old mother of three …
Heal relationships without needing a devastating life event
Bill M. is a 22-year old college student who has had asthma and diabetes since he was a child. He comes in with trouble breathing because he has no primary care doctor and is out of his inhalers. While he’s in the ER, he also says that his diabetes hasn’t been followed for years, and now his blood sugars are out of control and he has new problems with his …
How the primary care shortage affects the ER
One of the joys of being a physician is learning the patients’ histories. A joy, you say? Isn’t taking the history simply part of the doctoring routine? You’ve all been there.
When did the pain start?
What made it worse?
Did it move around or stay in one place?
I agree that inquiries like these are not intrinsically joyful, but this is not my meaning here. I refer to history here in the conventional …
Seasoned physicians know what questions to ask
Electronic medical records have become an essential backdrop to modern medical practice. Paper charts, not long ago the mainstay of health-care documentation, have become antediluvian. Whereas once doctors used to write notes with pen and paper and insert the paper into a physical binder, doctors now keep track of patients by clicking keys on a keyboard and entering data into a computer software program.
One of the great advantages of the …
Misinformation in electronic medical records has consequences
A guest post by the American College of Chest Physicians, exclusive to KevinMD.com.
In light of Hurricane Sandy’s impact upon the east coast, and subsequent effect on the area’s healthcare delivery systems, many physicians and healthcare professionals are likely considering how they would respond if disaster were to strike their community. From the decision making process and preparation for evacuation to evacuation …
What if Hurricane Sandy came to your city?
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As both the private and public sector aggressively shift healthcare incentives from a “do more, bill more” to a value and outcome based model, healthcare providers ignore patients role in driving outcomes at their own peril. It is generally understood that patients forget 80-90% of what they are told at the doctor’s office. As incentives no longer reward outcome over activity, this is a disaster financially for health professionals. This …
Make creative use of existing technologies to thrive in the future
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
“The tragedy of man is what dies inside himself while he still lives.”
– Albert Schweitzer
Statistically speaking
When is the last day you truly remember feeling peace, happiness and a deep sense of well being? If you cannot answer this question, you are not alone among …
Recognize and manage physician stress and burnout
Stockholm syndrome, or capture-bonding, is a psychological phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness.
Now, the health care connection. As a result of the billions of …
Stockholm syndrome and Epic’s takeover of medical records
Marc Henderson, a 63-year-old African-American airport executive, isn’t afraid to ask his physician to do a blood test for prostate-specific antigen (PSA), a screening test for prostate cancer. “I’d rather know early on so that it can be treated, rather than sit around in denial until it’s too late,” he said. “If it’s going to help catch something, I have no problems with it.”
Henderson’s views aren’t unusual. For years, doctors …
Do black men need separate prostate cancer screening guidelines?
I learned a lot of medicine during residency, but perhaps I actually learned even more about how to just get things done in a hospital. If you wanted a right-upper-quadrant ultrasound done for our patient, I was your man. I had a complicated series of unwritten algorithmic flow diagrams in my head that included handwriting an order, making sure that it was faxed to the right number, calling the appropriate …
Waste in medicine is disrespectful to both patients and doctors
The Democrats and the Republican parties’ approaches to Medicare are quite different. Which approach is better? That is the wrong question. Or at least not the most important question. Instead we should consider what could be done now to actually improve patient care quality as a means to reducing costs.
Is there a good solution to the Medicare issue? Setting aside either the Democrats’ approach to basically enact price controls by …
Control Medicare costs by asking the correct question
Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing. But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care …
The micro level of health reform cannot be ignored
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