It seems lately that questions of medical ethics are coming up more and more in the news, things like the rights of patients to make decisions, definitions of futile care, and end of life care. The way to look at these things is not in a vacuum. All of us may have our own opinions about right and wrong, but the field of medical ethics is actually one that has …
As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home.
We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about …
Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable.
His daughter interjects, “We are having a very difficult time understanding …
I have just turned on my computer. It is midnight. I should be trying to sleep right now.
My 5-year-old is sick and I am on call for the next few nights. Fortunately, my daughter should get better in a day or two. She needs Tylenol for her fever, mama’s love and time to kick this virus. But as I sat in bed holding her and waiting for her fever to break, …
The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish.
The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of …
I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.
I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.
Why?
Here’s what I know:
A physician’s greatest joy is the patient relationship.
Assembly-line medicine undermines the patient-physician relationship.
Most doctors are burned out, overworked, or exhausted.
Many doctors spend little time with their families.
Workaholics are admired in medicine.
Medicine values …
Next in a series.
Primary care physicians (PCPs) are becoming extinct. It’s true. Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to …
There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.
A 2006 survey of emergency nurses showed that 25% …
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
February is American Heart Month. Unfortunately, heart disease is a major problem in the United States that can result in surgery. In addition to discussing your procedure with your surgeon, you want to be sure to discuss your anesthesia care with your physician anesthesiologist.
Here are …
I was 8-years-old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning, reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been …
I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.
Why have so many patients lost trust in their doctors?
You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question. I haven’t …
This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.
In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in …
The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.
Fever is clearly not a parent’s …
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Next in a series.
Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.
Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced …
During my internal medicine rotation, the medical students had the opportunity to attend intern morning report, an interactive teaching session where attending physicians walk the interns through a patient’s story, starting from the moment they hit the door of the emergency room to the final stages of diagnosis and treatment.
After discussing the patient’s symptoms, complaints and past medical history, the attendings always ask the group to think carefully about the …
Hospitals are commonly thought of as the safest place to be for sick people.
Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them.
While it all sounds safe, a hospital can be a very dangerous place to be. Here are four frightening risks hospitals pose, along with their causes and some easy-to-implement solutions that could save hundreds …
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Before the adoption of new technologies which will undoubtedly improve health care (as it has the retail and finance sectors), it must be introduced in ways which are digestible, scalable, and subject to rapid iteration.
Is mobile technology different from the adoption of any other change in health care delivery? I think not. The culture of care certainly requires change as care models are changing. The point of care is shifting to the home, professionals …
Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.
Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the …
“What’s a high-risk patient?” asked our newly hired care coordinator.
Interesting question, and, as you would expect, one without an easy answer.
One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry.
When you ask doctors or any other providers, we all know one when we see …
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‘Tis the season to be coughing …
It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season. For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.
Or just ask a primary care clinic what its waiting room sounds like these days. A chorus of coughs, high, low, dry, …
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