How many times have you said to a friend or relative in need, “Let me know if there’s anything I can do to help,” and when you didn’t hear back, fail to follow-up? I’ve lost count of the number of times I did just that—fail to follow-up when I didn’t hear back from someone in need, even though I would have been happy to help in any way I could.
Yet, …
How to ask for help when chronic pain or illness strikes
We are all guilty of confirmation bias from time to time.
Confirmation is something that resident physicians in particular are guilty of more so than experienced, qualified physicians. Resident physicians and attending physicians alike may quickly form a diagnosis in their mind during a brief discussion with a patient. Now they will try to convince themselves (sub-consciously) that the other complaints and physical exam fit that diagnosis. They …
Confirmation bias in both physicians and patients
As the new school year begins, it’s only natural that there’s more awareness about learning and behavior issues. One of the most controversial topics that came up frequently is ADHD, or Attention Deficit Hyperactivity Disorder. It’s thought that 2-4% of children have this condition, and a shocking 50% of children with this condition are on some form of prescription medication. Not only is it seen in children, but adults …
ADHD and the lack of quality sleep
Our first assignment for medical school involved reading and discussing Anne Fadiman’s The Spirit Catches You and You Fall Down, which describes how a clash of two cultures (medical and recently immigrated Hmong), miscommunication, and misunderstanding led to tragedy. Poignantly narrated, the book had the take-home message: if a patient does not agree with a physician’s reasoning why a disease developed and how it can be cured, then even the best …
What do you think caused your disease?
Year: 2002
Setting: Gleneagles Hospital, Singapore
Position: Private general practitioner
I am the first and only non-Anglo-Saxon, foreign, private general practitioner in the city-state and the physician of reference for 14 embassies, consulates and a high commission from Europe, Asia, South America and Africa. One afternoon, a nurse comes into my consulting room saying that an ambassador from a European country has had an accident and that he insists on being seen immediately.
I …
You cannot treat a patient against his will
“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”
So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New …
Should Medicare pay for procedures that have no proven benefit?
More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a “professional courtesy.” According to the Office of Inspector General’s (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation.
To be sure, not all professional courtesy discounts or free …
When professional courtesy could get physicians in trouble
I’m a doctor. My mail comes with the Dr. prefix and my checks have Dr. on them. People introduce me as Dr. and when I go to conferences I am Dr. SuFu. However as of a couple months ago I’m no longer a doctor. With the donning of the white coat I paradoxically lost a degree and became a first name or Mr. SuFu. My name badge makes no …
A PhD who’s no longer a doctor in medical school
Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice:
1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.
2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and “overdiagnosis” of nonexistent diseases.
3. Lack …
False assumptions and clinical errors in modern medical practice
I wear lots of hats. Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do. Analogies help people conceptualize the complexities of medicine in a way that makes sense.
Today, I had my chef’s hat on. I was actually treating a young chef and found myself talking about food and medicine. There is a direct correlation. My …
How your physician is like a chef
I walked up to the closed door and paused, exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door, I could hear muffled conversation and movement.
A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any useful …
How our resuscitation efforts would be interpreted by fate
There is much hand-wringing about the shortage of primary care physicians. But primary care not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery.
Demand-side facts
The current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.
As baby boomers age, the increase …
The shortage of general surgeons demands attention
The British medical journal The Lancet surveyed a number of studies that discuss troubling statistics on suicide and depression among American physicians. The subject is not new, but the studies attempt to provide a few new insights.
A 2004 analysis in The American Journal of Psychiatry found that male doctors were 1.41 times more likely to commit suicide than other men. The statistic for female doctors was significantly higher, …
For doctors who suffer from burnout, the ultimate tragedy is suicide
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 81-year-old man is evaluated for the gradual onset and progression of memory loss over the past year. He says he has difficulty recalling the names of familiar people, has misplaced his wallet on numerous occasions, and is slower to find his car in large, crowded …
MKSAP: 81-year-old man is evaluated for the gradual onset and progression of memory loss
An excerpt from Balancing The Budget is a Progressive Priority.
It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent.
When I did a post-doctoral fellowship in England in the mid-1990s, a professor I met who had lived in the U.S. explained to me why he thought health policy discussions in that nation …
The root cause of why our health system is unsustainable
I thought I would give a quick overview of good ways for you to make use of Twitter at a medical conference. The growing field of palliative medicine has had a strong social media presence and the addition of more people into our online network helps get important information to people far beyond the patients and families we see each day in our work.
Twitter can be a great way to capture the …
How to use Twitter at your next medical conference
In an op-ed appearing in the New York Times on May 29th, Drs. Bach and Kocher lay out a plan for making primary care more attractive to medical students. They propose the following: “Under our plan, medical school tuition, which averages $38,000 per year, would be waived. Doctors choosing training in primary care, whether they plan to go on later to specialize or not, would continue to receive the …
Free medical school may not help the future of primary care
A torn meniscus. It did not disable but it impaired, and unpredictably. My stomach learned quickly to tighten at the sound of A.’s peculiar whimper in response to a crippling pain that would shoot through her at seemingly innocuous movements of the afflicted leg. We have health insurance of sorts, the type that will help you keep your home if tragedy strikes, but that does not shield you from the …
The inability to locate price anywhere in the hospital
Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for Medicare physician services, there will be many more of these that reach the light of day – too many if this is an indication.
What is common to major journals, media …
Primary care gets caught in the physician pay crossfire
No pediatrician can answer the question: “What’s the most important thing I can do to keep my child healthy?” without listing three of four things. I’m no different, but right now family dinners are at the top of my list. You could argue that immunizations, car seats, bike helmets, 9-1-1, sleep, or good hand washing are just as important, and I won’t disagree. But it’s hard to overlook the overwhelming …
Why the family dinner is important for your kids
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