How the postmodern ethos challenges medical professionalism

Physician
April 19, 2014

Postmodern cultural values have seriously impacted medical care and the patient-physician relationship. Corporate control of medical care, computerization of medical information and consumerism in the clinical encounter, plus the destruction of the myth of the physician are all embodiments of postmodern values.

Postmodern thinkers such as Foucault, Lyotard, Levinas, and Bauman offer powerful insights  that can be applied to understand how current values have changed medical practice, including issues such as …

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5 ways to improve hospital medicine

Physician
April 16, 2014

Hospital medicine has rapidly become one of the largest specialties in the United States. As the number of practicing hospital medicine doctors soars above the 30,000 mark and health care reform takes hold, the specialty finds itself at the forefront of American medicine. And for good reason. It is a young, dynamic, varied and flexible specialty that can be practiced in a number of different settings. Hospital medicine doctors are …

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The role of integrative medicine in primary care

Physician
April 16, 2014

Next in a series.

Beginning with a deep understanding of medical science and years of training and experience, the primary care physician (PCP) needs to delve deeply into the patient’s personal, family and social setting in order to fully understand the context and causes of the patient’s illness. The PCP also needs to know when it is important or even critical to call upon others with specific knowledge, techniques or …

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What goes through a surgeon’s mind after a complication

Physician
April 8, 2014

One of the hardest things about being a surgeon is the inevitability of complications. It’s true for any doctor; but with surgery, it’s as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big …

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For all those executed, the cause of death is homicide

Physician
April 6, 2014

On March 10, I found myself at the front gate of the Florida State Prison, stethoscope and blood pressure cuff in hand, to examine Robert Henry at the request of his public defender.

Henry is scheduled to be executed Thursday evening by lethal injection. His crime was the murder of two people during a robbery more than 30 years ago.

He’s a 55-year-old African-American man with hypertension, elevated cholesterol, and a history …

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Differences between banning bossy and true leadership in health care

Policy
April 5, 2014

There’s been a lot of hype about the “Ban Bossy” campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously “bossy,” or at least referred to as such.

I can remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, “You …

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The choice between supportive and insight psychotherapy

Conditions
April 5, 2014

For more than a decade I’ve taught a seminar in dynamic psychotherapy to psychiatry residents. One tricky issue that arises every year is the apparent choice between conducting a “supportive” psychotherapy, versus an “analytic” or “insight-oriented” one. I developed a sailing analogy to clarify this issue, and to teach an important point about it.

Most patients appreciate emotionally comforting support. Many seek a therapist who will provide a listening ear, who …

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Frustrations of the primary care physician should be a wakeup call

Physician
April 4, 2014

Next in a series.

Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the …

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4 reasons why patients may become angry

Physician
April 3, 2014

Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face.

The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several …

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Introducing yourself to patients is a patient safety issue

Physician
April 3, 2014

One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine — putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle …

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Weight loss resistance is real

Conditions
March 31, 2014

Weight is not a behavior, and weight is not a choice. Nobody wakes up and decides what to weigh today. In an age when healthy and unhealthy behaviors are increasingly subject to incentives and disincentives, respectively, this is all too easily forgotten.

Of course, weight is largely the byproduct of behaviors and choices, namely what and how much we eat, and what and how much we do: calories in and calories …

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Understanding the uproar over Zohydro ER

Meds
March 30, 2014

In March 2014, Zohydro ER (hydrocodone extended-release) was introduced to the market. Never in my medical lifetime do I recall a medication stirring such angst. Worries of mass overdoses, backdoor FDA conspiracies, and blatant disregard for the public well-being abound. Is there method to this madness?

Zohydro ER is a pain pill that, when taken by mouth, is released slowly over twelve hours. The active ingredient, hydrocodone, is an opioid (i.e. narcotic) that’s been around for decades …

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4 keys to manage medical malpractice stress syndrome

Physician
March 30, 2014

Most physicians will be sued for malpractice during their career. A group at Harvard has estimated that by age 65, more than 75% of physicians in low-risk specialties such as family medicine and 99% of physicians in high-risk specialties such as surgery will have been sued. Over 95% of physicians do experience emotional distress during some or all of the process of litigation. Malpractice suits can take between …

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Choosing a perfect residency: What goes into a rank list

Education
March 28, 2014

What do you do when your ideal residency program does not exist?  This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception.  I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what …

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Don’t shorten medical school: Shorten undergraduate training instead

Education
March 27, 2014

Should medical school be shortened to three years?

I say, “no.”

Here’s why.

There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase — residency training.

I do not see how medical students can choose a career path before they have …

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When doctors care too much

Physician
March 27, 2014

Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients.

But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, …

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A 10-step process to finding a good doctor

Physician
March 25, 2014

Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way …

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What are the characteristics of a good primary care physician?

Physician
March 25, 2014

Next in a series.

As a general rule, PCPs like people. This was true of them long before they started medical school and it will have only blossomed further during training. Ask PCPs, as I have with in depth interviews, and they will tell you that certain types of individuals are drawn to primary care careers.

They like to converse with people. They enjoy getting to know about a person — …

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Weighing a patient offers a treasure trove of information

Physician
March 21, 2014

As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come …

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