In 1978, as I neared the end of high school and readied myself for medical training, a book called House of God was published by a doctor under the pseudonym Samuel Shem. By the time I read it as an intern eight years later it had become a cult classic among doctors. Everyone I knew in my hospital read it, passing around the single copy we had, writing our names in …
Social media and the modern day House of God
My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.
So we gave medication to start labor, and the nurses placed …
Why do doctors cling to continuous fetal heart monitoring?
If death was the end zone, George had been on the one yard line twice in the last five years. And I, as part of his team of doctors, watched as he stubbornly maintained his goal line stand. Miracles rarely happen in medicine. They certainly don’t happen to the same person more then once.
Yesterday as George glided into my office you would have never known that eternity’s grip had been …
My good intentions had helped start a reaction
All medical students and residents, those with any sense of introspection anyway, wonder if we (they) should be on the front lines. We wonder if we should be meeting, examining, trying to diagnose and treat families and children when we know that an experienced clinician just around the corner or in the next room could see the patient, perform the procedure faster and with more panache than our feeble …
Why I left a top children’s hospital for a private office
I was tempted to avoid venturing into this topic, only because I strive to keep my website and blog away from politics and religion. In that light, I am going to stay away from the politics and religion of this topic and just stick with the main theme of the story and respond based on my own experiences, which includes assessing patients who are known to have or are suspected …
Divorce after the diagnosis of Alzheimer’s disease
Whether you are a physician saddled with the task of spearheading the recruitment efforts of your practice, a group practice administrator, an in-house physician recruiter, or an agency recruiter like myself, you have probably heard the following at least once (if not several times, as in my case) in your career from a prospective physician candidate you are seeking to recruit:
“You know, I just wanted to say that I really …
Why a physician recruiter needs to consider the spouse of a doctor
On a recent international flight to London, a passenger required medical assistance. I don’t know if it is the karma of London but this is the second medical emergency on a plane headed to London that I have encountered.
I was only a couple rows behind the passenger and could see even before the crew announced the need for a doctor that he needed assistance. I jumped over the woman …
Attending in flight emergencies is part of our Hippocratic Oath
It was 1976 and I had just started my solo practice. I employed only a receptionist and a nurse. My nurse was absent because of an illness and I asked my middle-aged mother to come and serve as my chaperone for the afternoon.
The first patient was a young lady and I asked her to give a urine specimen and place it in the turnstile in the restroom. My mother, wearing …
The day my mother became a saint
Always covered by an employer health plan, I had never given a thought to prescription costs – my medications had been covered by moderate copays. This changed when I retired and enrolled in Medicare (and a Medicare Part D plan).
Just prior to retirement, my eyes suddenly began tear and swell so much that it impacted my vision. The eye doctor diagnosed an allergic reaction and prescribed prednisone drops to …
The impact of hiding medication costs from patients
People living along the Gulf of Mexico are still feeling the effect of the BP oil spill disaster, the largest oil catastrophe in history. To learn more about the spill’s health effects, I spoke with Dr. Gina Solomon, an Associate Clinical Professor of Medicine at the University of California, San Francisco, and Senior Scientist at the Natural Resources Defense Council. Dr. Solomon was on the Louisiana coast during …
Health effects of the BP Gulf Coast oil spill
Rationing is defined as the controlled distribution of scarce resources, goods, or services. In health care, rationing is not a new concept and has been occurring for years, most often in times of emergency but also when resources are merely limited or demand is greater. For example, an increased need for ventilators in the winter months during flu epidemics; organ transplants are dictated by the availability, or the shortage, …
In health care, rationing is not a new concept
A white paper from The Beryl Institute reveals a 10% increase in general patient satisfaction and over 40% improvement in satisfaction with educational materials at hospitals when interactive technology is provided.
The publication examines six different hospital systems using the industry-standard Hospital Consumer Assessment of Healthcare Providers and Systems survey for evaluation. According to a press release on the study, the technology gave patients faster access to hospital staff and services by submitting …
Mobile technology will be omnipresent in health care
Since it strikes at the very core of what this blog is all about, I couldn’t pass up the opportunity to comment on Dr. Karen Sibert’s recent op-ed piece in the New York Times.
She argues that, especially given the current shortage of primary care doctors in this country, being part of the medical profession confers one with the moral obligation to serve and, as such, conflicting …
Do doctors have a moral obligation to serve?
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At a recent committee meeting, my hospital’s administration announced new quality measures and targets. Striving for top performance, the board of the hospital system set the bar extraordinarily high. The bonuses of senior management are tied to achieving the targets, so the announcement had everyone’s attention.
One target that caught my interest was for achieving a door-to-balloon time of less than 90 minutes in STEMI patients. As an interventional cardiologist who …
Achieving a 90 minute door-to-balloon time in STEMI patients
“I need you to do me a favor,” my nurse asked me at the end of our day on Friday.
“Sure,” I answered, “what do you want?”
“Please have a better week next week,” she said with a pained expression. “I don’t think I can handle another one like this week.”
It was a bad week. There was cancer, there was anxiety, there were family fights, there were very sick children. It’s not that …
The spending of emotional reserves is tough for doctors and nurses
Over the past several months I have read several online discussions and comment threads on the medical-legal issues raised by EMR, including an HIMSS brochure on the subject. Most of these discussions miss what I consider to be the most important legal weaknesses of an electronic medical record. I finally came across an online discussion that comes closer to covering what I consider to be the most important …
Legal weaknesses of an electronic medical record
Urban myths come in all shapes and sizes. Recent medical scares include a rogue politician claiming that a vaccine is no good, based on someone they met in the audience who was not trained in medicine or science. How many physicians know patients who are scared of taking a medication or getting a needed procedure based on an Internet story or a friend of a friend?
Recently, there has been controversy …
Elimination of industry support for CME is an urban myth
Pity me as I wish to be pitied. That is the plea of the tortured protagonist in Leo Tolstoy’s brilliant 1886 novella, The Death of Ivan Ilyich.
Tolstoy was born in 1828 into Czarist Russia’s landed gentry. Though orphaned at a young age, he enjoyed the typical privileges wealth and title afforded—passive income, summers in the country, and enrollment at Kazan University. But it was later, after dropping out of school and …
Ivan Ilyich gives voice to the agony of the afflicted
The outsourcing of work by businesses to the cheapest available workers has received a lot of attention in recent years. It has largely escaped notice, however, that the new labor force isn’t necessarily located in Southeast Asia, but is often found here at home and is virtually free. It is us, using our laptops and smart phones to perform more and more functions once carried out by knowledgeable salespeople and …
Interactions about our health care are increasingly conducted online
This post is first and foremost a thank-you note.
Thank you to everyone who posted a comment, emailed me, or tweeted a suggestion in response to my request for input last July: Crowdsourcing a Survey. Six new topics came directly from those conversations. Thank you to Veenu Aulakh and the California HealthCare Foundation who provided funding for the survey. Thank you to Lee …
The online health information divide
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