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“My lifelong quest to become a healer — over 40 years as a family physician, scientist, and researcher with the National Institutes of Health, the World Health Organization, the Walter Reed Army Institute of Research, and the …
How whole-person care can make us better healers [PODCAST]
Loss of autonomy, gaslighting, abuse, exploitation, and hypocrisy are all strong words. Just writing them brings to my mind the harsh reality of my experience and the collective experience of others who have dared to speak up. These words come to mind when I think about primary care in Canada. I recognize similar sentiments are heralded by my U.S. colleagues and those in the United Kingdom.
The system is failing. …
The slow death of primary care: a Canadian perspective
Patient volume has recovered across the country, and most medical offices are back to a steady state of care delivery—but ambulatory care has changed irrevocably. We’ve entered a phase shaped by crisis and marked by even more intense cost pressure and consolidation. What steps can independent medical practices take now to help ensure stability and prosperity moving forward?
Offer employees a more rewarding work experience.
The great resignation—unprecedented turnover in the labor …
Ambulatory medicine today: Focus on what you can control
An essay posted by Fareeha Kahn, MD (“A hospitalist’s struggle to find teamwork in academic medicine“), raises an important issue. The problem of lack of collaboration is not unique to academic medicine. The problem is the result of misaligned incentives.
Having read the work of Harvard Business School professor Michael E. Porter, I better understand the goals and challenges of value-based care. If we look at the premise …
Why is collaboration missing in health care?
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“It’s not that physicians need to be more resilient. We’ve failed to provide them with the goodwill to be human and embrace their “whole selves” (people who are resilient often but not always), access to safe and …
We’re confusing resilience with grit [PODCAST]
It’s a public health win that on October 19th, an FDA Advisory Committee voted 14-1 to remove Makena, a drug intended to prevent preterm birth, from the market. The FDA usually follows the advice of its advisory committee, and the briefing documents it supplied the committee make it clear that the agency wants the drug off the market. As well it should. Makena doesn’t work.
After a preliminary trial showed that …
Depriving women of this drug is good public health
The American Medical Association (AMA) would have you believe that the biggest threat to the medical profession is “scope creep” – the intrusion of advanced practice providers into medical practice.
The way I see it, this is no big deal; the movement will reach equilibrium, and everyone will play nicely in the sandbox.
In my opinion, the biggest threat to the medical profession is “political creep” – the increasing government …
Political creep: government intrusion in health care
The recent Dobbs decision has led to strong reactions from many major medical associations arguing that limiting abortion options will significantly harm women with unexpected pregnancies. This needs to be acknowledged, and the desire to do what is best for women is to be commended and shows a true passion for providing what these organizations deem to be the best possible care.
However, there are many medical providers who are as …
It is time that medical societies acknowledge that pro-life views are legitimate
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“If you did not have a colonoscopy, I would still recommend that you do it in a conventional way and get that IV sedation. But if you are an adventurer as I am, I would highly recommend …
Meet the doctor who had a colonoscopy without anesthesia [PODCAST]
The precipitous decline in the mental health of U.S. children and adolescents has been meticulously cataloged in newspaper articles, books, and documentaries. In our own pediatrics clinic, the numbers have skyrocketed — a baseball player unable to get out of his car for practice, a teenager with aggressive behavior masking underlying depression and anxiety, and another 9-year-old unable to attend school due to daily panic attacks. Every day now, we …
Digital philosophy: a critical tool for the mental health of children
The question of addressing physicians by name has been addressed again. Yet the question about names has not been addressed.
Before addressing the name question, I will talk about how I have evolved with time.
In India, I have been used to formally addressing everyone as either “Sir” or “Madam” during in-person meetings and in virtual communications when I have known them — “Sir/Madam” or rarely …
Why we should end gendered titles
I saved a baby’s life today.
I say that not to impress anyone or to make myself out to be some kind of deity but because it is simply true.
A three-week-old baby arrived at my office, gray and limp, with agonal respirations and oxygen saturation of 67 percent. My team of dedicated office staff worked with me rapidly and seamlessly, providing oxygen, bag-mask ventilation, and emergency medical services (EMS) activation. Together, …
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“Suppose you’re getting ready to send your young adult off to college for the first time. In that case, you’ve likely been spending the summer getting college dorm and apartment essentials lined up: bedding, storage cubes, first …
Why you should add advance directives to your college freshman’s checklist [PODCAST]
To paraphrase Fat Man’s Law Number Three, “At a code, the first pulse you take is your own.”
Enduring advice, as true today as it was in the early ’70s when Roy G. Basch, MD, and his gang of hapless interns roamed the airless wards of The House of God, the mythical hospital in the infamous novel by Samuel Shem, although almost everything else about practicing medicine seems …
More than a million Americans have died since the late 1990s from drug overdoses, with the vast majority dying from an opioid overdose. This trend started with the heavy marketing of opioids to physicians as nonaddictive and effective. The number of deaths from overdose has escalated significantly in the past few years. Although many of the recent opioid-related deaths are from fentanyl, substance abuse treatment providers report that …
It’s time for a reckoning in pain medicine
My first COVID vacation last year was spectacular, except that I barely remember three days because I was drinking to the point of amnesia.
I am a physician from a multigenerational family of alcoholics, and I never wanted to struggle with alcohol use disorder. Instead, I discovered that I could avoid feelings of discomfort by overworking, achieving, and staying perpetually busy. Workaholism became my drug of choice. As an adult, I …
The story of a physician, after a year sober
Sandy was sent to me by her primary care physician for evaluation of anemia. As I reviewed her chart, I explained to the medical student that the blood work showed a lifelong benign condition called alpha thalassemia trait that she was born with. It had no potential to harm her. This would be a quick consult, meaning we would have some extra time to enjoy our lunch.
Read more…
My 5-minute conversation with a suicide hotline expert
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“Not too long ago, a circumstance occurred. I have experienced similar circumstances several times in my career. However, this time, my response was different. It was like a switch in my brain flipped. I was ready to …
What it means to leave clinical medicine [PODCAST]
The American Cancer Society released its annual report on cancer statistics, showing that we have made clear and significant progress in treating numerous forms of cancer. The overall rate of death has declined steadily since 1991, translating to over 3 million lives saved.
Despite this progress, I still see room for improvement in a care model where patients too often slip through the cracks.
The National Cancer Institute identified that …
Integrated care is the key to optimizing cancer outcomes
Risk adjustment is a statistical method used by health plans to predict an individual’s use of health care services and the associated cost of care. Unlike traditional fee-for-service Medicare, Medicare Advantage (MA) plans receive a flat monthly payment for the individual beneficiary’s cost of care, with payments partially based on risk score.
Higher risk scores mean higher payments, and plans have financial incentives linked to more thorough documentation (coding) of their …
Let’s focus more on caring, rather than coding
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