I recently talked about wondering how those I had met through my own patients were doing, especially after my patients had passed on. I wondered if they were all right and whether they were able to move on. Well, I’ve been thinking about it again, though this time in the context of cancer survivorship.
The Office of Cancer Survivorship of …
When do I stop being someone’s oncologist?
The following column was published on April 1, 2012 in USA Today.
I recently saw a middle-age man in my primary care clinic who asked whether he should continue his cholesterol medication. He was reacting to new Food and Drug Administration warnings on statins, a class of drugs taken by more than 20 million Americans to lower their cholesterol. Though generally safe, …
Many medical decisions require shared decision making
Only a generation ago, medical students thought about what specialty to choose simply in terms of what interested them most. All doctors made a comfortable income; money wasn’t a primary motivator. There was a sense that cardiac surgeons or neurosurgeons could make more than most other physicians, but in fairness their training was much harder and longer. Internal medicine was held up to us as the most prestigious and intellectually …
Why the physician shortage is worse than you think
The sage doctor who stood at the bedside as I held my dying grandmother said, “We seem to die one organ at a time.” I, however, have come to believe that we are too focused on the failing of the organs to rightly perceive the dying of the person.
Death comes in many different ways, in many different packages. Sometimes it arrives wrapped thoughtlessly in advanced dementia, other times the package …
Death arrives in many different packages
An excerpt from Potent Medicine The Collaborative Cure for Healthcare.
It was mid-summer 2010 when the full scope of everything that Nancy D’Agostino did not know hit home. Still raw from surgery and missing parts of her body, she thought that all the hard choices were behind her. Then here was a new face, a radiation oncologist, outlining side effects of treatment and asking her to choose. And then a medical …
Lack of health care coordination benefits physicians
Several years ago I was hired by a plaintiff’s attorney as an expert witness on a personal injury case. He paid the fee in advance but the night before the trial, his co-counsel called me to review the case. It was clear that she did not have a thorough understanding of the case and I spent two hours with her on the phone trying to bring her up to speed. …
Lessons learned when a doctor sues an attorney
Pain, in any form, can present a difficult challenge for even the most astute pain physician. The complexity of treating neuropathic or nerve pain stems from a variety of reasons, ranging from the lack of an obvious source of the pain to the inability of the patients to explain what ails them, to a arduous history that was poorly managed with the wrong medications, allowing the pain to progress to …
Thinking differently about treating neuropathic pain
There will be some very disruptive and some transformational changes in the way health care is delivered, not as a result of reform, but as a result of the drivers of change described in a previous post on KevinMD.com. They included an aging population, an obese society, shortages of doctors, and emerging consumerism, among others.
I interviewed in depth about 150 medical leaders from across the United States to collect …
The coming changes in health care delivery
As most of the electrophysiology (EP) community is aware, device and lead recalls are a reality in today’s EP practice. In the last 5 years, both Medtronic and St. Jude Medical have had significant lead failure issues. The public responses to these recalls have been varied and quite different. As physicians who care for device patients, we must learn to quickly sort through the rhetoric put forth in the New …
The emotional effects of device recalls on patients
Patients have been arriving at the doors of emergency departments in increasing numbers over the past decade, and this trend will only grow in the future. I believe there are five key factors that suggest every ED should brace itself for a never-ending rush hour.
As the CEO of a physician group that provides medical care to over 4 million patients per year, I have the opportunity to study in great …
5 key trends to look for in the emergency department
In our world of 24/7 media, where we seem to hear about the next big cure, important dietary change or very dangerous drug virtually every day, it is hard to believe that the news people, tweeters and bloggers could miss anything that is going on in health care today. However, it appears most everyone missed a big one. This might be one of the most important stories in health care today, that no one …
Making more drugs non-prescription is bad for patients
I am on my last rotation for medical school. It is a “rural selective”, which is a required elective at a rural or underserved location. I am fulfilling it at a local community health center in the women’s health department. Fun!
I am taking part in a day long orientation today. In one of the presentations, the speaker had a point on one of the slides about mandatory reporting, and included …
Should every case of domestic violence be reported?
Medical residents have fewer labor protections than Chinese factory workers. While labor abuses at Apple’s factories make headlines, few people are as concerned about the lack of protections for doctors and medical students here in the United States. As a resident, I was subject to some of the worst abuses – intentionally misreported time sheets and gender-based discrimination – and after I complained, I was fired, so I sued the …
Medical residents are abused more than Chinese factory workers
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The following column was published on March 25, 2012 in the Nashua Telegraph.
Medical malpractice historically has been a contentious issue. Doctors have argued that the system is broken, promotes multi-million dollar awards disproportionate to the injuries suffered, and encourages the ordering of unnecessary tests to avoid being sued, a practice known as defensive medicine. Trial attorneys, on the other hand, …
Patients deserve a medical malpractice early offer
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal level and also learn how to operate our medical practices with the same transparency as any other small business.
Our patients (and our prospective patients) now define “great” doctors as those who are willing to display transparency, that is, doctors must be willing to show a human side.
For us …
Transparency defines social media success for doctors
Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future. I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions. That is, reimbursement will be based upon the quality of service delivered by the provider. For insurers, whether private or governmental, I believe that …
Healthcare reimbursement will change dramatically in the future
The phone conversation, as my dad, in the bed next door, recalls it, went something like this.
“Hello?”
“Hi, is this Jim? Where are you?”
“No, it’s not Jim. I’m John, and I’m in hospital.”
“Oh sorry, John, I was looking for Jim the refrigerator mechanic. Wrong number. Hope you’re okay!”
“I’m not okay. Just had both my knees replaced and I’m very sore.”
“John, I’m sorry. I got problems too. I run an ice cream …
The healing power of ice cream
The United States of America is an immigrant country. It is a melting pot of many peoples and has basically been so since before the Mayflower passengers laid foot on New England soil. Promise of equality, success, quality of life and freedom have drawn multitudes of professionals from all over the world to try to make it in the US. Some of these professionals are doctors.
A doctor that wants to …
What should be the threshold for allowing doctors to work in the US?
How can you determine whether you are in a “developed” or a “developing” country? We used to call these latter “un- or underdeveloped” or “3rd world” countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic.
If one objectively examines all 20 dozen or so of the world’s countries, a geographer would divide them into either north or south of the Equator. And if, …
What separates a developed and a developing country?
An IOM report makes recommendations that aim to ensure that progress in omics-based test development is grounded in sound scientific evidence and is reproducible, resulting in improved health care and continued public trust in research. Another new IOM roundtable workshop report discussed the differences in evidence required for clinical use, regulatory oversight, guideline inclusion, coverage, and reimbursement of genomic diagnostic tests and focused …
The need for evidence in genomic medicine
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