Common criticisms of concierge medicine that deserve to be answered

Physician
December 30, 2012

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …

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Primary care doctors may no longer be needed

Physician
December 24, 2012

As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …

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The insanity of pain management in the ER

Physician
December 23, 2012

One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances.

My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target.

On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for …

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What doctors can learn from working at Starbucks

Physician
December 21, 2012

She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …

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The transition from resident to attending physician

Education
December 19, 2012

The patient had arrived for a urology procedure with a blood glucose in the 400’s. He suffered from a recent stomach bug and had gotten off schedule with administration of his meds. While his GI symptoms had subsided, he was feeling crappy overall. I decided to cancel his case and went about initiating treatment to get his blood sugar under control. When I informed the urologist of my findings and …

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Please don’t wear perfume to the doctor’s office

Conditions
December 17, 2012

Along with about 8.4% of the US population, I have asthma. To promote good doctor-patient communication, I can’t sit too far away from you.  To perform a high-quality physical examination, I must enter into your personal space.  Several minutes of inhaling that strong scent, however, can cause me to have trouble breathing.

I’ve never been brave enough to bring this up before, …

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Tips to examine the eardrum of the squirming, angry child

Conditions
December 14, 2012

Let me tell you a secret. Examining eardrums in a squirming, angry child is really difficult—if not impossible. If the doc in your screaming, struggling child’s ear for a half-second, it’s unlikely that anything useful was seen.

Sometimes, it is just impossible to get a decent exam. But there are ways that parents (and doctors!) can help at least increase the chance …

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My experience with a scribe in the emergency department

Physician
December 6, 2012

I have a lovely pen. It’s a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice.

It’s a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window …

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Your child hates vegetables: 3 tips from a pediatrician

Conditions
December 4, 2012

Parents worry when their children do not eat vegetables.

And, I understand why.

Parents know that vegetables are an important part of a healthy diet, and get frustrated when they are consistently left on their child’s plate.

The result? Parental “veggie-stress.”

Although veggie-stress begins at the family dinner table, it can be amplified by the rather faddish way parents talk about poor vegetable eaters within playgroups. Conversations among parents can …

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10 advances that have changed medicine forever

Meds
December 4, 2012

I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There …

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ED boarders: A new focus to mitigate overcrowding

Physician
December 3, 2012

The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system.

In the wake of Hurricane Sandy, the visual has become more familiar than we’d like – the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish …

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It’s amazing what I’ve learned from patients

Physician
November 29, 2012

Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …

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Mean doctors and nice nurses: It’s time to change our brand

Physician
November 26, 2012

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery.  She hadn’t lost weight and clearly was feeling discouraged about practically everything.  She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, …

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Why I hate the SOAP note

Physician
November 19, 2012

Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.

But sometimes, medical lingo has …

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What are the biggest issues with EMR today?

Tech
November 19, 2012

As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping.  The medical record is vital to the care of the patient.  It tells the story of each patient’s journey through the medical system.  The idea of centralizing all pertinent medical information is, in theory, a step in the right direction.  In utopia, there would be one medical record …

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The difference between complications and negligence

Conditions
November 17, 2012

A patient who was minutes away from his colonoscopy, asked me how many colonoscopies I had performed. Before I could answer, he quickly followed-up asking if any of my patients developed perforation of the colon after the procedure.

I satisfied his initial inquiry when I informed him that I have intruded into at least 20,000 colons in the past 2 decades. With regard to his second and more ‘penetrating’ question, I …

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Is it possible to ignore prostate cancer?

Conditions
November 17, 2012

Is it possible to ignore a cancer?  Prostate cancer infests almost 250,000 men in this country each year and will kill 28,000 men in the United States in 2012, over 200,000 around the world.  Many lose their lives “too soon”, dying in their 60s or even their 50s.  Nonetheless, authorities do not recommend the PSA blood test for routine screening of this disease.  How can this make sense?  Partly this …

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