A few weeks ago I was brought in to speak to the staff of a local university. I gave a two hour workshop, which is even more fun for me than giving a keynote as I get to interact personally with the audience and draw their stories out. One of the sections of the workshop was about listening to your body. Every person’s body “speaks” to them in a different …
Learn to understand and interpret your body’s language
Today was a great day. Despite the shortcomings of our medical complex, when it works right, it is a beautiful thing. Actually, it’s not just beautiful, it can deliver the best care available anywhere in the world. I know. I saw it happen today.
Today, Mr. X presented with a troublesome history and an even more threatening physical exam. I was afraid that the disease I was about to diagnose would …
When our health system works, it’s unbeatable
Greg Smith, formerly of Goldman Sachs, has described a positive organizational culture as being the “secret sauce of greatness.” What is the nature of this secret sauce? A simple, popular definition is that “organizational culture is the way we do things here.”
The relationship between organizational culture and organizational success is unassailable. In our commercial dealings, has not each of us easily recognized when a business culture is truly customer-focused, and …
The secret sauce of great health care organizations
Is the placebo effect something that demands the presence of a living human – or can we program it into a cell phone app? What happens to healthcare if we can?
I must admit I have always been fascinated by the concept of placebos. You give a research subject with a documented medical condition a sugar pill – and they get better. They heal themselves despite the fact they have not …
Can digital medicine have a placebo effect?
I recently experienced my first Facebook-era death. It had been several years – long before the ubiquity of social media – that I had last lost a relative, and I quickly discovered that experiencing loss and grieving online comes with a unique set of pros and cons.
I learned of my uncle’s stroke the old-fashioned way: via phone. My parents and I kept in steady contact that way over the next 36 hours, but it was Facebook that filled me in …
Experiencing my first Facebook era death
As this is the season for spanking-new physician trainees to flood hospitals around the U.S., I decided to chronicle my own very first 24 hours as a doctor so the reader can get a better insight into this annual event.
2000 hours, evening before: With my newly starched white coat, stethoscope and light pen packed neatly into my Tumi man-purse, I make believe that I am sufficiently prepared for the first …
The first 24 hours of being a medical resident
After years of breaking down, my sedan recently died. Finding myself in the market for a new car, I did what most Americans would do – went to the web. Reading reviews and checking rankings, it quickly became clear that each website emphasized something different: Some valued fuel-efficiency and reliability, while others made safety the primary concern. Others clearly put a premium on style and performance. It was enough to …
Which hospital should I choose? How to use hospital rankings
It was a challenging transition, when I shifted from being a medicine resident to supervising medicine residents. There is much to be said about this shift (and similar shifts of ever-increasing responsibility at various stages of doctors’ training). The aspect on my mind at the moment is the role of clinic preceptor.
When I was new to the role and new to the clinic, I was paired with a more experienced …
The delicate balance of supervising medical residents in clinic
Something that has been on my mind recently is obesity, specifically obesity in doctors. This may be because we cover obesity in a high percentage of our stories (1 in 3 Americans is obese, after all) or because I recently discovered that I gained ten pounds since moving to New York City. Either way, after watching Dr. Snyderman speak her mind on national television about how obese leaders are unfit …
Would you accept obesity advice from a fat doctor?
I have been installed as President of the Alabama Academy of Family Physicians. The work should not be too hard and on occasion should be rewarding (or at least ego-boosting). Such was the case the other day when the executive director asked me to recall a patient from “my early days” that had made an impact so he could publish my thoughts, thus officially making me an old geezer. I …
Lessons I’ve learned from a colon cancer patient
If you follow sports media, you have no doubt heard of PRP by now. Hines Ward made it popular in 2009 when he received PRP treatment for a knee injury just before the Super Bowl. Kobe, Tiger, A-Rod, and many other high profile athletes have reportedly received PRP treatments. But what is it? Why are these athletes receiving it? Can you get it, too? Let’s discuss.
I’ll begin with the basics. …
Does PRP work for knee injuries?
My son had been having episodes of belly pain right around his belly button for several weeks. I watched and waited. Between these bouts of mild abdominal pain he was completely fine – healthy appetite, active, happy. But I had a feeling something was brewing. I was waiting for the other shoe to drop. The disease finally declared itself: several nights ago his belly pain was severe and unremitting. He …
Why I’m thankful for my son’s surgery team
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Even though September is “back to school month” and students won’t get their report cards for a while, I have a report card to share with you now. In September 2006, my practice went “live” with an EHR, so I thought that the sixth anniversary of this …
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Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …
Striking the balance between the public good and patient privacy
If you’re a fan of star surgeon overachiever Atul Gawande, then reading his New Yorker article “Big Med” is a must. The rest of us skeptics should still use the article to signal our health care adroitness by knowingly referring to the “Cheesecake Factory” in our policy medical meetings, conferences, PowerPoints and bloggery.
What he wrote
Dr. Gawande uses the successful restaurant chain to extract lessons and draw health system parallels, ultimately …
Did Atul Gawande unwittingly support specialty hospitals?
Once again, legislators are meddling into healthcare. This time, it’s in my own home state, where Governor Cuomo has just signed a bill requiring radiologists to notify women when their normal mammogram also shows that they have dense breasts. In such cases, the following text must be included in the lay summary mammogram report given to the patient:
“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very …
Mandatory breast density notification violates physicians’ free speech
Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves. They will need extra help with their activities of daily living either from …
Any doctor can make the decision for mental capacity
If you think health care is expensive now, wait until you see what it costs when it’s free.
-P.J. O’Rourke
I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free. You may have had a similar thought at the same age. This idea was supported by an incontrovertible rationale, namely that I really liked candy. Tragically, it only took a moment for …
How will doctors handle the flood of newly insured patients?
Imagine this scenario. A young child is playing in the yard when her pet dog bites her face. Bleeding, the child is rushed to the ER and the doctor offers to suture up the child’s face.
A parent will probably ask for a plastic surgeon to suture the face instead of the emergency room doctor.
As such, the plastic surgeon is called in and sutures up the face beautifully.
The child and family …
After the ER visit, the financial nightmare begins
Many recent conversations in the advancing world of health care delivery have integrated the term “disruption.” At first glance, this is perhaps quite jarring and counter-intuitive to the mind of the forward or progressive thinker. It is ever the more uncomfortable to the medical mind that is trained to carry on in the face of adversity, through exhaustion, and despite resistance. Paradigmatically, the medical world has recently been presented with …
Family physicians are patient specialists
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