Experienced-based medicine has value

Physician
December 17, 2019

There was a time, before treatment algorithms, when physicians would rely on the detailed bedside and/or office observations of their patients in conjunction with the most recent published peer-reviewed studies.

Time spent with each patient was considered essential and appropriate to reach a proper diagnosis and treatment plan. Now, due to corporate mandates to produce higher RVUs, time is regarded as an unnecessary luxury, to be controlled and curtailed. Yet recent …

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5 improvements needed to modernize the American hospital landscape

Policy
December 16, 2019

Over the past 40 years, the number of U.S. hospitals declined by 12 percent, from more than 7,100 in 1975 to 6,200 in 2017, according to the latest American Hospital Association survey. And, yet, despite shuttering nearly 1,000 facilities, hospitals remain the nation’s largest source of health care spending, accounting for $1.1 trillion annually (or 33% of all national health care expenditures). Much of that money goes …

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A roadmap for physician career transition planning

Physician
December 15, 2019

Many physicians will decide they want or need to make a transition from the practice of clinical medicine to “something else” at some point during their career. Whatever the motivation for their job transition, most doctors appreciate a rational, structured process that enables then to get from where they are to where they want to be. Fortunately, there are some easily accessible resources that can add value to your work/career …

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The burden of prior authorizations and denials in health care

Physician
December 15, 2019

Prior authorization — a utilization management (UM) process used by health insurance companies to determine coverage for a prescribed procedure, service, or medication — is now becoming a mandatory requirement by the vast majority of large insurance companies.

While prior authorizations are pursued at the front-end for almost all planned medical services, there has also been a steep increase in denial of payment for services at the inpatient level for both …

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What I learned from starting medical school in January

Education
December 14, 2019

I graduated from an international medical school this past spring. I’m currently in the midst of a preliminary year as an internal medicine resident at St. John’s Riverside Hospital in Yonkers, N.Y. Next year, I’ll start my dream residency in anesthesiology at Brown University.

Like many physicians, my journey to medicine has had its share of twists and turns. But my story is slightly different than the …

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The tension between hospital administrators and medical residents

Physician
December 12, 2019

One of the least motivating requests I received routinely as a new intern was something like, “… and can we make sure this is a discharge before noon?” I recall a particularly eager nursing manager surveying the resident teams on her unit to gauge our interest in arriving even earlier each morning (5 a.m., perhaps?) in order to prepare potential discharges before pre-rounding. We shared a nice laugh.

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A physician’s favorite money quotes for the holiday season

Finance
December 12, 2019

This is one of my favorite times of the year. Thanksgiving dinner with my family, cool air that calls for cute winter clothes, and holiday festivities that invoke the spirit of love and positivity. As we embark on this season, inevitable holiday sales may tempt us more than we can imagine. In order to deal with this temptation and stay within our budgets, we may need a little motivation to …

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A physician got a DUI. The physician health program didn’t help.

Physician
December 11, 2019

A physician health program, PHP, is a state agency that is responsible for advocating, treatment referral and physician monitoring, residents and medical students who have substance abuse disorders, psychiatric disorders and/ or boundary issues. There are two ways of becoming a part of these programs, self-referral or be reported. Currently, 47 states have a PHP, and the issue is that there is no set guideline and several variables in the …

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Taking food and drink away from doctors and nurses is just cruel

Physician
December 10, 2019

It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.

If you haven’t worked there, or haven’t for a …

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A letter to a cancer patient in palliative care

Education
December 10, 2019

I heard about you a few times before I ever met you in person. It was my first day on the palliative care service — a week that felt like a relaxing break from the sixteen-hour days I was used to on surgery. Many people don’t know what palliative care is. But I suspect these days if you are still living that you know it well.

I first heard of you …

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The gender imbalance in nursing

Policy
December 9, 2019

The gender imbalance in nursing, our nation’s largest profession, is a slow-to-change and complex problem steeped in stereotypes, economics, unconscious bias, power, and privilege in health care and society. Along with other diversity gaps in the nursing workforce, gender imbalance is another missing piece to achieving the highest quality patient care. Solving the gender imbalance could accelerate the profession in reaching its full potential.

Diversity improves quality

Addressing the gender gap represents …

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How physicians can become self-actualized

Physician
December 7, 2019

What really makes a person complete?

What do we want in our lives, and what is it like to become our best, most fulfilled selves?

In the 1960s, psychologist Abraham Maslow tried to answer this question. This eventually led to his well-known hierarchy of needs. You might be familiar with the pyramid.

The premise of the theory is that once we fulfill our basic needs …

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There is a profound lack of self-esteem in the medical profession

Policy
December 4, 2019

I have noticed a profound lack of self-esteem in our profession. I am concerned. Concerned for us, and for our patients.

We are the most noble of professions. However, we have compromised our morals, values, ethics, and virtues. We are now living, operating, and existing in a constant state of contradiction. It is tearing us apart from within.

We continue to work for less, with fewer resources and ancillary staff, all while …

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What challenges do you see yourself facing as a doctor?

Education
December 3, 2019

“What challenges do you see yourself facing as a doctor?”

I’m sitting in a suit, facing a young Asian woman with black, round glasses across a desk. On the desk in front of her is an iPad, and she sits cross-legged, hands resting on her legs. I’m in my interview for medical school, and the woman across me, who introduced herself as Angela, is awaiting my response.

I pause and mentally check …

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3 lessons physicians can learn from adversity

Physician
December 3, 2019

This time last year, I took the podium at conferences as far away as Dubai to deliver my keynote speech entitled, “On The Cusp Of Life And Death, Choose Life.” My talk highlighted the professional and personal development opportunities that show up as doctors, nurses, and parents navigate the challenges in the neonatal intensive care unit (NICU) caring for preterm and term newborns on the cusp of viability due to …

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The unintended consequences of #MeToo in medical education

Physician
December 3, 2019

Harvard Medical School student Chloe Li typically dressed in scrubs or an efficient, professional outfit as she went about learning to care for patients in the intense, year-long clerkship program where I teach.

For her capstone presentation on graduation day, though, she wore a cream-colored wrap-around dress of luscious silk, tasteful jewelry, and an up-do hairstyle. She had clearly put a lot of care into these preparations. She …

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Drugmakers discover tardive dyskinesia. And they profit in it.

Meds
November 30, 2019

Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are “unbranded” ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a …

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The stethoscope is not just a prop

Physician
November 30, 2019

Stock photos of “health care workers” who attend patients — physicians are no longer distinguishable — usually feature a stethoscope draped around the neck.

But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”

The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence and the rubber tubes by sophisticated …

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Doctor: You were strong. You are still strong today.

Physician
November 29, 2019

You were strong in college

You were strong enough to get through weed-out classes in undergrad.  You were strong enough to balance the extra-curricular activities and clinical shadowing expected of you while crushing a 21-hour semester.  You were strong enough to say, “no, I have to study” when friends wanted to go out because you had a dream of becoming a doctor someday.

You were strong enough to pay for the applications, …

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