In the United States, we train health care providers on poor people. This is no secret — most medical schools and residencies are in lower income areas. If you have Medicaid or no insurance, you are more likely to find care in an office or hospital where medical students, residents, nursing students, and other trainees rotate; Blue Cross patients don’t let interns watch their childbirth. Even though my residency emphasized …
Have you ever eaten a healthy meal, maybe some brown rice and stir-fried veggies, and found yourself ready for another meal just a short while later? Or, more often couldn’t overcome a hankering for a satisfying dessert to top off (and undermine the healthiness of) that meal?
As it turns out, this lack of satiety is not merely a function of the …
There once was a kind, humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients. He was open and deliberate, calm and thoughtful. He himself hired every secretary and medical assistant, every nurse, and biller. His staff formed a protective family who fiercely advocated …
Dear HMO,
As I prepare to #getcovered or #staycovered, I realize that as a physician, I have an advantage in that I know what specific types of insurance plans would best fit my needs. Unfortunately, this is not the case for many Americans. Most importantly, I know to avoid signing up for certain health maintenance organizations (HMOs). Although I am a strong …
I can recall, though it seems quite long ago, my first basic life support (BLS) course as a first-year medical student. The instructor dutifully demonstrated on a mannequin to eager young medical students what to do if someone is found unresponsive. Shaking the unmoving mannequin she said loudly, “Sir, are you OK?” Then hearing no response she showed us how to …
Radiologists discussing test results with patients, a subject that has been lurking under the radar for a while, recently came to light because of an article in the New York Times. The idea is that patient anxiety while waiting to find out a test result could be alleviated by an immediate discussion with a radiologist.
That would be very nice, but there are …
Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER …
I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second career path, I have been planning my career in hospital medicine since the beginning of my residency training.
The things that drew me …
Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other health care facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work …
There’s been a lot of talk recently about low morale and disgruntlement among doctors. A recent article on focused on a list of reasons when doctors know it’s time to quit. I found the article a bit sad and unfortunate, but I’m sure the feelings behind it were sincere.
Another excellent article in the Wall Street Journal last week extensively discussed the factors behind …
Old age is no place for sissies.
-Bette Davis
“I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!”
She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had …
Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death.
Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. …
“My wife died uncomfortable and alone. She died thirsty!”
The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to …
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I keep six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.
– Rudyard Kipling
Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done.
What else could explain why IT people tell doctors what “workflows” …
Dr. Kenneth Azar, a mentor of mine at the old Georgia Regional Psychiatric Hospital in Augusta, Georgia, told me something once that has always stuck with me.
He told me that in the early years of his practice, when he was living and working out in Idaho, that he was one of a very small handful of psychiatrists who served the whole state. If an adult with psychosis needed to be …
I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the …
Not long ago I interviewed Dr. Todd Sorensen, the CEO of Regional West Medical Center, a 184-bed facility serving a large swath of rural western Nebraska. I’ve known Dr. Sorensen since junior high school, and we’ve kept in touch over the years to discuss the health care system from his perspective as a physician and administrator and mine as a health …
The phone rang one evening and a pleasant voice was on the other end. “Hi, my name is nurse so-and-so and I’m the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?” she asked. “It’s very helpful to go over things before and after your surgery and to answer any questions you might …
Preventing infection after surgery is very important as not only are these infections often uncomfortable and make you feel very sick, but they also increase the risk of more serious complications. For example, if you are less mobile because of an infection after surgery you are at higher risk for a blood clot or if you need a prolonged hospitalization because of an infection in your surgical wound you are …
There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but …
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