As I enter the hospital in which I work, I am struck by a number of signs that denote that my place of employment is a Christian hospital, with Christian values, and a Christian “vision” of health care. I don’t have the vaguest clue as to what that means. And I don’t really mind either, it’s not like they’re paying me with Jesus biscuits and Christmas ornaments, nor does it seem …
A Hindu physician in a Christian hospital
I’ve just come back from my semi-annual renewal in my belief that family medicine is the foundational solution to make healthcare more affordable in America: the interim session of the Texas Academy of Family Physicians. The most important activity at these meetings is the networking: the chance to bounce ideas and experiences off colleagues from around the state.
The issue of cost came up and two colleagues in private practice told …
The unintended cost consequences of patient centered care
Fed up with our health care delivery system? Maybe even angry? What should a person do? What can a person do?
I recently wrote a post on drivers of change in health care delivery such as the aging population, adverse lifestyle behaviors, shortages of physicians and developing consumer expectations. I planned to follow up today with what those drivers will produce as change in the delivery system. But a commentator responded …
Take charge of your healthcare quality and costs
People often wonder what causes children to bully. Why is it that some children feel the need to hurt and humiliate other children? What do they really stand to gain from this cruel behavior?
Some studies indicate that some (not all) bullies have naturally aggressive and/or hyperactive personalities from the start. Some. But that doesn’t mean that all “spirited” kids will bully while all “mellow” kids will be perfectly empathic and …
Bullies are not born, they are raised
There was no mistake, but a bad thing has happened. Despite the best efforts of the doctors, Bob’s wife is very sick. Due to a rare side effect of treatment, her liver is failing. Bob believes this could have been prevented. He is very mad.
“When we go to see the doctor, he stares at the computer,” says Bob. “He does not look at us. Most of the time, the doctor …
The computer had stopped the doctor from communicating
As a child, the only physician I ever knew was our crusty opinionated and entirely trustworthy family doc. His physician career spanned almost five decades, in one unbroken line from his first days as a GP in solo practice until his retirement, which occurred way past the age at which most of us would like to stop working.
His was the typical physician career, representing continuity, professional satisfaction and a lifelong commitment …
Why the physician path today is far from linear
Imagine you’re a physician, and you have a full schedule of patients to see the day after the Supreme Court has thrown out the entire Affordable Care Act. Imagine you never liked “Obamacare” in the first place, so you are feeling pretty good about the Supreme Court decision.
Your first patient, an elderly retiree named Mrs. Jones, comes in for her annual Medicare wellness visit—one of the new Medicare preventive benefits …
Chaos for doctors if the Affordable Care Act is struck down
Every career has that one question that is notoriously hated by all. For nurses, that question is, “So, why didn’t you want to be a doctor?” For teachers, it’s questions about the age-old adage, “Those who can’t do, teach.” For medical students, that question is, “So, do you know what you want to do?”
It’s not that people who ask medical students about their career plans are ill-intentioned or nosy; in …
The residency journey is just getting started
Some people critique Continuing Medical Education (CME) programs as spoon-feeding. As a young physician struggling to learn a lot of material, I actually appreciate a bit of ready-to-consume content that I can learn quickly and effectively. The American College of Cardiology (ACC) and other reputable institutions provide CME programs that, overall, help to keep physicians up on the literature and integrate new findings with existing knowledge. However, despite the basic …
CME limitations and how we can improve Continuing Medical Education
One of the most common stressors for physicians is the sheer toxicity of what are considered full time hours. While the rest of the world considers full time to be 40 hours a week, we all know a full time doc starts at 80 plus, if you include all the hours you must be available on call.
In physician surveys, schedule flexibility and the ability to function as a part time …
Part time medicine and birth of the new normal
“So, the doctor told me I have breast cancer. I just wanted to let you know. I’m doing fine right now, but I have some decisions to make regarding my treatment options. I’ll keep you posted.”
This may be a typical email sent to family and friends after receiving a breast cancer diagnosis. Sending emails seems more practical at this point. With so many friends and family to update, unless a …
What to say to a newly diagnosed cancer patient
An old colleague once told me: “When you assume it makes an ass out of u and me.”
Many of us would consider being an ass a bad thing. If so, why are we making so many assumptions about digital health? Belief in the power of digital technologies to solve a host of pressing problems in health has us poised to devote billions of dollars to their adoption and development. But …
We need to systematically evaluate digital health technologies
Even though I love my job, I’ve been feeling a little burned out lately. I think it comes from being stretched too thin, which is something I’ve coped with off an on ever since med school.
As the saying goes, there are never enough hours in the day, and sometimes that really gets to me. While my practice is incredibly important, I also place a lot of value on my family. …
Tips to fight depression during medical residency
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Everyone suffers when communication fails at the end of life. Though we may “know in our hearts” what to do in difficult situations; anxiety and bias close us down. We lose our ability to say and act on what we know is best.
Physicians and nurses suffer when they “know in their hearts” that they are doing harm performing CPR on people at a natural end of their lives on people …
What does it take to have successful end of life conversations?
Hello, Pandora. What do you have in that box?
Yes, I am going to talk about … autism. The last time I did so I was inundated with people trying to convince me of the dangers of immunizations and their causal link to autism. I really, really, really don’t want to go anywhere near that one.
No, I am not going to talk about the cause of autism; I am going to …
Making sense of the rise in autism diagnoses
I have been asked a lot lately, owing to the release of my novel Altamont Augie, what writing fiction and being a doctor could possibly have in common? Patients and colleagues seem shocked that the rational, left-brain doctor they have come to know and depend on to deliver technologically complex medical care to patients with kidney failure could produce such a right-brain thing as a novel. Where did this …
What does writing fiction and being a doctor have in common?
Will we – you and me and our parents and neighbors – be a significant force in quelling the tide of over-testing for the early detection of disease?
When you have had cancer as many times as I have, you become suspicious that there are more cancer cells inside you waiting for some obscure signal to make them leap into action and start multiplying out of control. So you develop a …
Have cancer screening tests been oversold?
Stephen Wolfram’s essay, The Personal Analytics of My Life, begins, “One day I’m sure everyone will routinely collect all sorts of data about themselves.”
A Pew Internet survey suggests we have a long way to go: a September 2010 survey found that 27% of internet users age 18+ track their own health data online. There may be more self-tracking happening offline — please post any measures of that phenomenon in the …
The gender divide when it comes to health tracking online
I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply.
“Medical provider” is part of the Newspeak of America’s industrialized medical machine. …
The implications of provider versus doctor
An excerpt from Born With a Junk Food Deficiency, (Prometheus Books, 2012).
Can anyone remember life before Direct-to-Consumer (DTC) advertising with its notorious “Ask Your Doctor” ads? The only thing laypeople knew about prescription drugs came from the ads they peeked at in the Journal of the American Medical Association (JAMA) in the doctor’s waiting room. The ads were full of vaguely ominous terms—nulligravida? hemodialysis?—as well as side …
Has direct to consumer advertising improved patient care?
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