Who’s in charge of the patient? It’s a question increasingly difficult to answer.

Physician
November 24, 2015

I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or …

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The question about education that this doctor asks every new patient

Physician
November 24, 2015

“How far did you go in school?”

This is a question that I ask every new patient as a matter of course.

Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients.

Now, leaving the …

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A physician’s personal experience with evidence-based medicine

Conditions
November 24, 2015

It’s no secret that I have a special place in my electronically-regulated heart for evidence. There’s a good reason for that. Our primary job as physicians is to avoid harming our patients, but it’s followed closely by our calling to help them in some way. The problem is that, until we test our theories, we don’t really know which treatments will help our patients (or which ones might harm them), …

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What worries me about husbands and wives in the exam room

Physician
November 23, 2015

When a wife suddenly comes in for her husband’s appointment, I usually worry a little; when a husband shows up for his wife’s visit, I sometimes worry a lot.

I have come to expect that when I enter an exam room, and a male patient has his wife with him in the room, she is there to make sure I hear some part of his symptom history that he has never …

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The bait and switch of health care IT

Tech
November 21, 2015

Last week I was playing golf with some friends. The Boston area has been having a bit of an Indian summer, and we are lucky to still be getting out there (long may it last). The conversation during one of the holes turned to health care information technology, when my friend, who is also a physician, told me about his experiences with a (certain famous) new electronic medical record that’s just been installed in their …

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We lose a medical school full of physicians every year to suicide: An interview with Dr. Pamela Wible

Physician
November 21, 2015

TEDMED-WIBLE-PHOTO-shrink

Christine Sinsky, MD, from the American Medical Association interviews Pamela Wible, MD, after her TEDMED talk. Watch periscope video here. Fully transcribed below:

Dr. Sinsky: This afternoon we’re here in Palm Springs, and I’m delighted to be here with Dr. Pamela Wible, who gave a terrific TED talk last night. I’m Dr. Christine Sinsky, the vice president of professional satisfaction at the …

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DSM-5 is psychiatry’s maladaptation in the grey zone masquerading as science

Conditions
November 21, 2015

The iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, Frances believes that psychiatric illnesses are real. To save the mentally ill, to save …

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This doctor quit residency. And now she’s truly happy.

Physician
November 19, 2015

“I quit residency.”

Three words that many physicians couldn’t ever imagine coming out of their mouth, but for me, I say it all the time, usually with a smile on my face. I was a year and a half into my family medicine residency and decided it was enough. My decision mostly revolved around the birth of my son. My husband (a resident in the same program) and I planned to …

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Value to patients and value to society: How can doctors balance the tension?

Policy
November 19, 2015

Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society.

Physicians have always been charged as patient agents to advocate for patients’ best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often …

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A surgeon blogs for one year. Here’s what she learned.

Physician
November 16, 2015

“I admire anyone who has the guts to write anything at all.”
– E. B. White

“All you have to do is write one true sentence. Write the truest sentence that you know.”
– Ernest Hemingway

“Writing is easy. All you have to do is cross out the wrong words.”
– Mark Twain

“There is no greater agony than bearing an untold story inside you.”
– Maya Angelou

“There is nothing to writing. All you do is sit down at …

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Don’t make yourself look like Barbie to fit into yoga pants. Please.

Conditions
November 15, 2015

The New York Post is reporting that women in New York are getting labiaplasties to look and feel better in tight athletic wear. They quote a patient, Veronica R., as wanting to “look like Barbie.”

According to the Post, on the Upper East Side in New York there are apparently “a large number” of women who want to look “sleeker in so-called athleisure wear, made from Lycra-like fabrics that often …

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It’s time to stop comparing health care to manufacturing

Physician
November 10, 2015

From ancient times, doctors have appreciated that, for all their similarities, no two patients are exactly alike. This understanding is what made physicians act like, and earn society’s respect as, professionals.

The commercialization of health care has brought in managers from other industries and other branches of academia, and their rise to power has been predicated on their ability to treat patients and doctors not as individuals, but as small cogs …

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4 questions about Theranos that are actually worth discussing

Conditions
November 10, 2015

Combine a hot start-up valued at 9 billion dollars, an articulate Stanford drop-out CEO with celebrity-like press coverage, and a recent Wall Street Journal report that calls into question the reliability of the company’s “revolutionary” testing, and you have the perfect storm to set the internet abuzz about Theranos.

Amidst the melee of accusations, “change-the-world” start-up jargon, and anecdotes of incongruent lab results, something has been missing: an organized, …

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You have no idea what it’s like working in the ER as a pregnant physician

Physician
November 9, 2015

When I was pregnant with my first child, I worked full time as a physician in the emergency department.  I worked mostly 9-hour shifts, but some 12-hour shifts as well. Days, evenings, nights, holidays and weekends were divided up amongst the entire group of physicians. I worked my share of those shifts as well.

I have worked in the ER while pregnant twice now, and while I am proud to be …

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A physician’s life with epilepsy

Conditions
November 8, 2015

In May 2003, during my second year of pediatric residency, I had a right temporal lobectomy to remove a seizure focus in my right hippocampus.  Although the surgery proceeded without complications, I was unable to walk unsupported for several weeks after the operation.  My experiences taught me what makes an exceptional physician.

An …

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Physician, heal thyself. A reflection on physician self-care.

Physician
November 6, 2015

Another workday comes to an end. 11 a.m. rolls around and freedom from the hospital beckons after another 24-hour call is finished. In the span of the preceding day, it is likely that numerous important decisions had to be made with the expectation that all of your mental faculties would be used, irrespective of what time of day it was or how much sleep was obtained. It is a day …

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Here are 10 patient suggestions for hospitals. Let’s make them happen.

Physician
November 5, 2015

Since undergoing a double-lung transplant at the Johns Hopkins Hospital in December 2011, Podge Reed Jr. has had four medical admissions, two surgical admissions, eight outpatient procedures requiring anesthesia, more than 100 outpatient appointments, and 700 labs and other tests. He’s amassed enough experiences with the health care system to write a book. So far, though, he’s mostly kept it to two letters, totaling 12 pages, to our patient relations …

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An emergency physician goes to the ER, and is shocked at the care she receives

Physician
November 2, 2015

I  have lately been discussing the state of health care with a lot of doctors. I’m a doctor, and I’m also a consumer of health care services.

Imagine my surprise when I visited a local ER on a three day weekend, hoping to get some advice from someone who might be able to use the panoply of diagnostic tools available in the ED to help me mitigate the pain of a …

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A physician’s open letter to Medicare patients

Physician
November 1, 2015

Dear patients,

This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away.

As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of …

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What creates a toxic hospital culture?

Physician
October 28, 2015

Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e., disenfranchisement of medical staff, burn out, and joyless medical care) is presented Read more…

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