Be personable and make a huge difference in a patient’s recovery

Physician
June 17, 2014

I have long been a fan of the Case Records of the Massachusetts General Hospital, which is published weekly in the New England Journal of Medicine. For many years, I made a point of recommending them to medical students and internal medicine residents as a model of concise yet comprehensive case presentations.

No wasted words, no missing information, and none of the filler that trainees often added when they presented cases, such …

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Reasons why your wait time at the doctor’s office is so long

Physician
June 16, 2014

Painful wait times at the doctor’s office.  It’s an old story with few exceptions.

As a dad, I have to deal with many of the same issues of parenting that you deal with: sleepless nights , fevers and holding my kids down for shots (my wife did it once, I think, then she promptly retired from this job).  However, waiting at the pediatrician is not something I have to do.  So, I can’t truly empathize …

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The outrage over how much hospital administrators make

Policy
June 11, 2014

I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.


Hospital administrators and insurance company executives do …

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5 ways to improve the healing environment of hospitals

Physician
June 10, 2014

The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz …

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5 controversies surrounding the Affordable Care Act

Policy
June 8, 2014

The continued implementation of the Affordable Care Act (ACA) in 2014 will be as controversial as in previous years.

Here are five main areas of concern:

1. The individual mandate.  By what right does the federal government “force” its citizens to buy a product they may not want? The Supreme Court upheld the mandate in 2012, but that does not end the matter. Partly — perhaps largely — because the ACA sets …

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The problem with an anti-medication bias

Meds
June 6, 2014

“I don’t like taking medicines.”

All physicians hear some form of this opinion very frequently. Even more frequently, patients don’t state this view outright but rely on it to completely subvert their doctor’s plans.

When I was new to practice such an utterance would shock and confuse me.

“I don’t want to take any medicines,” a patient would declare.

“That’s fine,” I would reassure my interlocutor. “It’s a free country. No one is going …

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Why the ER admits too many patients

Physician
June 6, 2014

Every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice.   This issue is not restricted to the medical universe.  Every one of us has to navigate through similar circumstances throughout the journey of life.  If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than …

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What paying it forward in health care looks like

Physician
June 4, 2014

The doughnut shop I pass on my drive to the hospital isn’t the kind of place where you might expect to see outpourings of random kindness. It sits in the shadow of a raised highway, a few doors down from a bail bond business and a block away from a prison complex that resembles a medieval castle.

One Sunday before Valentine’s Day, the line to get served there was long, checkered …

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A requiem for handwritten admitting orders

Physician
June 4, 2014

When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor’s office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used …

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Should junk foods carry warning labels?

Physician
June 3, 2014

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There is, of course, stuff we can chew and swallow that isn’t food. Play-Doh comes to mind. As does Silly Putty.

My thoughts turned to those substances, among others, when my friends at Time magazine asked me recently to opine on the suggestion that junk foods should carry warning labels. My first inclination was: No, that’s too much. But then it dawned on me: Is anything that …

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The health care industrial complex is stronger than ever

Physician
May 30, 2014

Irontriangle

Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn’t help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by …

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My favorite patient died last night

Physician
May 30, 2014

to live in this world

you must be able
to do three things
to love what is mortal;
to hold it

against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go
-Mary Oliver, New and Selected Poems, Vol. 1

As a parent, you are not supposed to have a favorite child, and since some of us physicians feel a strange but kindred protectiveness for our patients, likewise we …

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Physicians are noncompliant too

Physician
May 30, 2014

Patient noncompliance.

I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time.

We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often …

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The salaries of health executives: What can doctors do?

Policy
May 29, 2014

Health care reform is a reality.  The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today.  The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans.  Certainly these are noble and lofty goals: But have we completely missed the mark?

Today, many remain uninsured and the majority that have signed up for the exchanges are simply …

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Managing unhappy patients after surgery

Physician
May 29, 2014

The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you’re still happy. What’s so wrong with that? If I wanted to be miserable, I’d have gone into primary care.

When a surgeon screws up, his/her role is clear: Admit it, make it better, or as good as possible, and stick with …

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How do we fix the high blood pressure problem?

Conditions
May 28, 2014

It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.

“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.

There are …

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Can doctors ever work together with insurance companies?

Physician
May 28, 2014

Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there …

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Is medical school just for rich kids?

Education
May 26, 2014

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This letter was received and edited for clarity by Pamela Wible, MD.

Dear Dr. Wible,

This will be my last email to you because I am giving up on my dream of being a doctor.

I’ve contacted so many colleges and medical schools hoping to find one that would help me become a doctor for my tribe. Today, I finally got a response from the …

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Ignaz Semmelweis and the lessons of fear and medical innovation

Physician
May 25, 2014

The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution — unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing.

While working as an assistant …

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