The fallacy of patient-centered care

Physician
March 14, 2019

I often wonder what it was like before patient-centered care became a mainstream catchphrase. Was there a poor relationship between the patient and physician in the outpatient setting? Were hospitalized patients’ feelings, desires, goals, and therapy options ignored? It amazes me that we were able to care for patients more than ten years ago without using a “patient-centered” approach.

According to NEJM Catalyst, “Patient-and family-centered care encourages the …

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How Tom Brady and Lebron James can change your patients’ health

Conditions
March 13, 2019

As medical professionals, one of the most challenging things to do is to motivate a patient to make changes in their lives. We passionately want the best for our patients, and it is sometimes so difficult for us to be able to connect with and inspire them to take the next step on a path to disease prevention and longevity. The solution? Enter Lebron James and Tom Brady.

It is no …

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Why do patients call me by my first name?

Physician
March 13, 2019

For the past several years, I have been befuddled by patients calling me by my first name (Sara) instead of my professional title (Dr. Jones). At first, I ignored this, but as it became more common, I started telling some of these patients that I preferred being called Dr. Jones rather than by first name. This took some patients aback — probably thinking I was a snob — while others …

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49 ways to stay out of my ER

Physician
March 13, 2019

I’m an ER doc. I care for patients. All patients: Those who need to be in the ER; those who don’t; those who wouldn’t be there if they knew better. For them, for you and for fun, I’ve got some tips to keep you happy, safe and away from my ER. Enjoy.

1. Never, ever say “hold my beer and watch this!” Besides “I do!” they are the most dangerous words …

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A scribe’s haunting view of emergency medicine

Education
March 13, 2019

If you’re in the emergency department, it’s probably the worst day of your life. You’re scared, confused, anxious, sad, maybe emotionally numb.

You were at home with your husband and witnessed him have a cardiac arrest. He was unresponsive, and he wasn’t breathing. You felt hopeless because you didn’t know how to help him, but you called 911. They rushed him to the hospital, and you followed the ambulance. By the …

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Motrin vs. Tylenol for children: A pediatrician explains

Meds
March 12, 2019

As a pediatrician, I am asked by worried parents about what they should give their child with a fever, Motrin (ibuprofen), or Tylenol (acetaminophen) to bring down the temperature daily.

This question always requires more than a one-word response to the choice between anti-fever medications. An explanation of medication even being necessary for the fever and to clarify many long-standing fever phobia misconceptions.

Mainly, it is not necessary to treat the number …

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For future physician-activists: This is our lane

Policy
March 12, 2019

Rudolf Virchow, a pioneering physician of the 1800s, once wrote that “politics is nothing but medicine on a large scale”. Over a century later, this nexus is as apparent as ever, and many doctors engage as practitioners of both.

Twitter erupted this past fall with photos of soiled scrubs, resuscitation room floors and surgically-removed bullets — all crimson with …

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Communication in the hospital setting from a medical student perspective

Conditions
March 11, 2019

When it comes to communication in the hospital setting, I have seen many iterations. My favorite version was at the VA on the inpatient medicine unit. Every morning, we all met in the medicine team room to discuss patients on the floor. The team’s social worker, nurses, residents, students, and the attending ran down the list to identify individual patient goals, what’s needed for safe and effective discharges home, and …

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Medicare for all and the problem of health care on demand

Policy
March 10, 2019

The evolving politics of single-payer health care conflate the concepts of universal coverage, health care on demand and free health care. To the indiscriminate progressive mind, all three are part of the holy grail. The fly in the ointment is that highly attractive and altruistic politics runs into the brick wall of reality. As Thomas Sowell — a noted Stanford economist — wrote: “The first lesson of economics is scarcity: …

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A medical student’s first code. Here’s what he learned.

Education
March 8, 2019

Well, today it happened. I participated in my first code.

We were in the telemetry unit (the room where they monitor all the patients who have EKG strips) to ask about a different patient of mine only to find that a patient was coding (lost a life-sustaining heartbeat). With some coaxing from my attending, the other student and I wound our way through the around-20 people standing outside and inside of …

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A paradigm shift in acute pain assessment and management

Meds
March 8, 2019

We have embarked upon a unique strategy to assess and manage pain. “Opioids Rarely Help Bodily Pain” is not a catchy phrase but a mnemonic related to educational learning which serves as the cornerstone of a new acute-pain management paradigm. As is known, the evaluation of pain is extremely difficult due to its subjective nature. However, this new evaluation not only accounts for the patients’ self-assessment but, for the first …

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The commodification of health care is destroying the doctor-patient relationship

Physician
March 7, 2019

My elderly patients miss the days when, in an emergency, they could call their family doctor at home, and they’d be cared for. Retired doctors reminisce about the “good old days” when they were in charge of their own schedules and could prescribe whatever drug or test they felt necessary based on years of experience. While there was a strong doctor-patient relationship in those bygone days, it was not necessarily …

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How self-awareness helps with patient interaction

Education
March 7, 2019

What is self-awareness? A quick Google search says that it is “conscious knowledge of one’s own character, feelings, motives, and desires.” In other words, my worldview is different than yours. Hypothetically, I am a Republican, and you are a Democrat. You don’t believe in vaccinations, but I do. I believe in universal health care, but you disagree with my stance. You believe in stricter gun laws, and I don’t. That …

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A key tip for premedical students: Ask for help

Education
March 7, 2019

A simple Google search is all you need to do to gauge the difficulty individuals have with asking for help.

“How to ask to shadow someone.” 43.1 million results.

“How to ask for a letter of recommendation.” 66 million results.

“How to ask for help,” 3.73 billion results.

From the popularity of these topics, it is evident that people have a hard time reaching out and balancing coming across respectfully, but still receiving a …

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To parents who have lost children: We never forget your children

Physician
March 7, 2019

Her name was Callie (identifying information changed). She was four years old. She loved glitter and princesses and anything sparkly. She was affectionate and silly, and I fell hard for her. She was a patient, my patient, on the pediatric oncology unit during my very first ward rotation intern year.

On my first day, I was as scared as any person can be, palms sweating, heart pounding, faced with these tiny, …

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The most loving thing: end of life and saying goodbye

Conditions
March 6, 2019

“Grandma fell and we’re in the emergency room. She’s very distressed and does not look good. I’m going to put the doctor on the phone.”

I could hear my mother’s voice strain on the other end of the phone line as I braced myself for my conversation with the emergency department physician.

The emergency physician told me that though the work-up was still developing, my grandmother was in respiratory distress, and that …

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The reason so many physicians are retiring early

Physician
March 6, 2019

There has been a disturbing shift in how medical professionals feel about their career. I almost cringe every time I’m at a party or social gathering now and tell people I retired early from my medical practice. I try not to bring it up.

I don’t cringe out of fear for how they will perceive me or whether they will look down upon me with condescending scorn about how I left …

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Death by patient satisfaction

Physician
March 6, 2019

The new Holy Grail of business, Customer Satisfaction — CSAT to her close friends — is a measure of how products and services supplied by a company meet customer expectations. In a marketplace where businesses compete for customers, CSAT is a key element of strategy.

Why?

Money.

Satisfied customers buy. They come back and buy more. They tell their friends, who’ll buy too. If satisfied, they’ll return and buy more. That’s gold for …

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How to help your doctor with diagnosis

Physician
March 5, 2019

To treat any condition, the doctor needs to know what it is. You would not expect to have your sore ankle treated with penicillin or to have an appendectomy recommended for your sore throat. While this may be self-evident, I know of at least one patient who had a normal appendix removed because the surgeon did not notice the few telltale blisters that were warning the careful observer that the …

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