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Waking up to the sexual violence in America’s psychiatric units

Physician

December 24, 2019

It wasn’t until I first had to manage the aftermath of a sexual assault on a psychiatric unit one night during my residency that I realized psychiatry might have a problem with sexual safety.

My fellow residents and I had never been informed of a management policy for inpatient sexual assaults, and my program’s curriculum was silent on how to handle the issue.

Because the assault involved a psychotic patient who was …

A psychiatrist can’t help patients anymore

Jamian Reed, DO

Physician

December 22, 2019

I bid farewell to four people this month who I’ve been caring for in my outpatient psychiatry practice — all under sensitive circumstances but ultimately moving in positive directions. As I write formal discharge letters, the unique role psychiatrists and other mental health clinicians play in the lives and minds of the people we care for is on my mind.

It is the nature of our healing practice to build trust …

Let’s do better for patients with limited English proficiency

Androuw Carrasco, MD

Physician

December 21, 2019

I’ve noticed a theme in my clinic since I started practicing medicine: when a patient understands what is being said about their care, treatment, and services, they’re more likely to fulfill critical health care responsibilities. No one should be surprised by this, but as our nation and hospitals increase in diversity, the issue of health care equality for LEP (limited English proficiency) patients is becoming more pronounced.

Today, this population of …

Doctors: Always be prepared to suture wounds

Nathan Whittaker, MD

Physician

December 20, 2019

Ninety minutes before my Sunday night shift, my two-year-old, Titan, comes screaming up the stairs looking like a scene out of a slasher horror movie. His older sister sheepishly admitted to chasing him into the edge of a door frame. We created an ED bed on our kitchen counter and slipped a pillowcase up his arms, behind him, with him laying …

An orthopedic surgeon goes to a bar. Here’s what happened next.

Mara L. Schenker, MD

Physician

December 19, 2019

I went to a bar last night — and I looked good: red coat, black dress, knee-high suede boots. I was feeling pretty good.

I met my best friend at this bar — he lives elsewhere now — but this is his favorite spot in the world. Like Norm in Cheers, he is also their favorite customer.

We ordered dinner, and my best friend stepped away to talk to the bartender. I …

What can a famous actress teach us about curing addiction?

Mark Leeds, DO

Physician

December 18, 2019

I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone.

Why listen to an actress about medical treatment for addiction? First of all, doctors generally …

Our optimal future U.S. health care system

Taylor J. Christensen, MD

Policy

December 17, 2019

Next in a series.

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge is shaping …

Experienced-based medicine has value

Cristina Carballo-Perelman, MD

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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Experienced-based medicine has value

5 improvements needed to modernize the American hospital landscape

Robert Pearl, MD

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 …

A roadmap for physician career transition planning

Baird Brightman, PhD

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 …

The burden of prior authorizations and denials in health care

Thejaswi K. Poonacha, MD, MBA and Fady Chamoun, MD

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 …

What I learned from starting medical school in January

Gaelle Antoine, MD

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 …

The tension between hospital administrators and medical residents

Eric Bressman, MD

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.

A physician’s favorite money quotes for the holiday season

Altelisha Taylor, MD, MPH

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 …

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

Anonymous

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 …

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

Edwin Leap, MD

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 …

A letter to a cancer patient in palliative care

Alison Vasa

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 …

The gender imbalance in nursing

Cole Edmonson, DNP and Paulette Anest, RN

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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The gender imbalance in nursing

How physicians can become self-actualized

Navpreet Sahsi, MD

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 …

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

Vincent M. Proctor, PA-C

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 …