Stop shoving metrics down nurses’ throats

Policy
January 5, 2019

One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”

“Enforce.”

My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”

I didn’t get the job. Someone told me I wasn’t “MBA enough.”

Yet, I stand by …

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Non-therapeutic relationship or human kindness?

Physician
January 4, 2019

About two months ago, a 15-year-old Native American male was riding around in a stolen car on the reservation. “M” and the driver were drinking. And somehow, after he exited the vehicle at 4 a.m., the car struck him. Hours later, it became clear that something was wrong. M was transferred to our pediatric hospital as a trauma and was found to have an unstable vertebral fracture. Conservative treatment with …

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What’s the biggest problem with medical education?

Education
January 4, 2019

There has been a profound deterioration in the education of our medical students. I only make this contention after having taught over a hundred medical students across five continents, often one-on-one and for extended periods. Although the majority of those I’ve taught have been students educated at international medical institutions, a substantial number have been those from U.S. medical schools. While I do recognize that those that find their way …

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What’s barbaric in medicine?

Education
January 3, 2019

Late one evening, I received a text from my oldest daughter.

“What in medicine, that we do now, will we think is barbaric in 50 years?”

Wow. They play more provocative bar games now than they played when I was in my 20s.

I promptly texted back my knee-jerk response: “chemotherapy.” As we are on the brink of precision medicine, what will the next generation think of our “slash, burn and poison” paradigm …

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68 laws of the ER

Physician
January 3, 2019

1. Murphy’s Law as it applies to the ER: If something can go bad, it will do so in a hurry. If it can’t possibly go bad, it will still find a way.

2. Clock’s First Rule: All the patients will crash at the same time. Usually when the computer system goes down.

3. Clock’s Second Rule: The sickest patients will come just before the shift change.

4. Haste’s Theorem: The healthier the …

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Go quiet into the night

Conditions
January 2, 2019

I know what you’re thinking: She’s cold-hearted, cruel, and unkind.

But am I? Or are you?

Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered.

Her family can’t talk …

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The myths and truths about med-peds physicians

Physician
January 2, 2019

Yes, med-peds is a real residency! It is a real specialty! And it is a practicing profession by many physicians today! It can open doors for so many wonderful professional opportunities. It is a discipline that can provide patients and communities extremely comprehensive medical care. People need to know more about this unique and sometimes under-recognized field. And here is why:

Like many people today, I didn’t even know what med-peds …

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The generational differences of physicians

Physician
January 2, 2019

It is a known fact, but every generation feels that they had it worst and that other generations have it made.

“When I went to school we had to walk uphill in the snow both ways!” says every grandparent

I identify myself with the Generation X physicians, finishing medical school in 1997 and my radiology residency and fellowship training in 2003.

During this time I have seen quite a change in the medical …

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Not all pathologists are created equal

Conditions
January 2, 2019

Pathology and laboratory medicine services play a vital role in global health care and continuously improve patient care around the world. When it comes to your medical care, you have many options, and choosing the right professional could improve your health. So what exactly does a pathologist do, and do I have the power to choose my own pathologist?

The pathologist’s role

A pathologist is a medical doctor who studies the causes …

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MKSAP: 55-year-old man with severe COPD

Conditions
December 29, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man is evaluated in follow-up for severe COPD, which was diagnosed 2 years ago. He has had two exacerbations in the past year requiring hospitalization, and his baseline exercise tolerance is low. He completed pulmonary rehabilitation 3 months ago without much improvement in exercise capacity. He quit smoking 1 year ago. …

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What physicians should know about umbrella insurance

Finance
December 28, 2018

Asset protection is a term that gets tossed around quite a bit when we discuss how long and difficult the journey is for doctors to establish their careers.  You always want to protect what you’ve worked hard for, right? The principles for asset protection apply not only to doctors but essentially anyone who wishes to have some sort of security for their assets. The key is to make sure you don’t over …

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Does coffee lead to cardiac arrhythmias?

Conditions
December 26, 2018

Coffee —”because of the caffeine which it holds,” described Dr. Henry Elsner in a 1911 review article in the journal of Hypertension and Arteriosclerosis — causes “increased rapidity of the heart’s action. It makes the heart irritable, it increases the power of the heart’s contractions, it places an extra load upon the kidneys, increasing the urine flow. Because of these effects, I have for some time …

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12 things you’ll need for a smooth credentialing process

Physician
December 25, 2018

Physicians receive rigorous medical training for the better part of a decade. However, we emerge unprepared for the real-world job application process to which our friends in other professions are accustomed. One of these logistics includes credentialing and verification for hospitals and clinics where your group intends to practice — a process that can take up to three months.

There are a number of items that are requested during the credentialing …

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The 3 goals of clinical documentation

Physician
December 25, 2018

A lot has been spoken and written about clinical documentation already. In spite of that, many hospitals still struggle in getting the best out of their doctors when it comes to documentation quality. And although we can cite various reasons for this, we can all safely agree that the hospital EMR is the single biggest influence when outcomes to efficiency and quality of documentation — both in terms of compliance …

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A patient sues when a DNR is ignored

Physician
December 23, 2018

A New Mexico woman, suffering from Dercum’s disease (adiposis dolorosa) which causes painful fatty tumors, is suing a Santa Fe hospital and an emergency physician claiming she was the victim of two negligent acts in 2016.

One, according to the Albuquerque Journal, she told hospital personnel she was allergic to Dilaudid but went into cardiac arrest after receiving an injection of the drug.

Two, despite the presence of a lawfully …

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A medical student after an OB/GYN rotation: Here’s what he learned

Education
December 23, 2018

On one of my first days on the labor and delivery ward, one of the attending obstetricians asked me what area of medicine I was interested in. When I said that I was applying into neurology this year, she said, “Ah! The other end of the body!” After a pause, she continued, “Well, this rotation will be … different.”

It wasn’t the first, or last, time I had heard a similar refrain during …

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The rewards of being a designated airman medical examiner

Physician
December 21, 2018

For the last 25 years, I have had the privilege of being a designated airman medical examiner by the Federal Aviation Administration. To earn that privilege, it required flying to FAA headquarters and taking a one-week training course followed by refresher training material every three years.

The FAA grades medical examiners annually by our judgment and decision-making. The nature of the questions we are required to ask the pilot candidates, and …

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