A guest column by the American College of Physicians, exclusive to KevinMD.com.
One of the things that I dread the most about January 1 is that it’s the start of “prior authorization (PA) season” for prescription medications. It is time consuming and frustrating, plus it often jeopardizes patient safety and quality of care.
A recent Viewpoint in the …
The pitfalls of prior authorization for prescription drugs
The redefinition of a potentially functioning medical system in which each individual is able to utilize financially non-prohibitive care into a disjointed balkanized realm of income-based insurance tribes is aided by the protean definitions of the political buzzword “access.” Access to medical care does not entail the ability to reliably obtain medical care much as medical insurance reform is not, in point of fact, healthcare reform. Regardless, the conflation of …
The emergency department and “access” to care
Contrary to what my wife and colleagues think, it is not all about me. Well yes, I do get lonely sitting at my desk late at night, when my wife is busy, and the long-ago-moved-away kids are not available, and there is nothing running on NASCAR. Nonetheless, it is not really about my needs. I am talking, of course, about why I give patients my cell phone number.
It is printed …
This doctor gives his cell number out to patients. He explains why.
Despite living in Michigan for over 30 years, my cold hands disclose my Southern California origin. As a physician, these cold hands have touched many lives. For my pregnant patients, they usually sigh with relief as I touch their bellies, the coolness of my hands offering them respite from the inferno growing inside them. They smile when I tell them I can feel their baby squirming and how it is …
The phones, the phones, the phones.
Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can’t lick, a continual thorn in the side of our practice, something that’s hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.
Without …
Solving the telephone problem in primary care
Think about it; athletes aren’t the ones who document their performance. It’s other people that keep the score. That’s a whole science in itself. People talk for hours after the game or tournament is over about how each athlete did this or that in whatever way they did it, and the numbers are in many cases captured by extremely sophisticated electronic equipment.
Physicians work hard to diagnose and treat their patients, …
Let’s pay doctors like we do athletes
I am working hospitalist right now. On Friday, a man in his 80s was admitted with difficulty breathing. He had a complicated history, including a heart attack at age 35 with all the subsequent sequela of heart disease. He had an abnormal heart rhythm and was taking a blood thinner for stroke prevention. In addition, he had scarring of his lungs (cause unknown).
He was transferred to us from another hospital. …
Death is a blessing in its right time and place
“I’m going to write a column about dating you and call it ‘Sleeping with the Enemy,’” I announced from my rocking chair. His rocking stopped. “The enemy?” The rain was falling on the trees in front of my porch and on his parade. “Why am I the enemy?” “You know, clinicians vs. hospital administrators.” “Really?” he naively asked. “Why don’t clinicians like us?”
I was surprised he was so in the …
Sleeping with the enemy: When a physician dates an administrator
The stretcher was wheeled into the operating room. I had been in this room on three prior occasions, under very different circumstances. But today, as I lay flat on the table, listening to the small talk around me, I tried to breathe against the weight of the baby and the pressure of the procedure. My husband will later tell me it happened so quickly, but for me, time stood still …
A physician-mother on maternity leave learns how she can’t ignore her job
It will start as a minor curiosity. Maybe a student will seem slightly too close to the resident on your team. When the grades are posted, you’ll wonder why you didn’t get honors, but he did. You might wallow for a few days. Make an offhanded comment to your fellow students. Then you’ll let it go and move on. Or so you think. Until during surgery when the scrub nurse …
Angry? Welcome to being a doctor. And here’s how to fix it.
As the millennial presence in health care becomes more prominent, the climate of the health care system will inevitably change. Speaking from a personal perspective, there is a growing emphasis on lifestyle in the conversation of career choice. Medicine is becoming less and less of a life, and more of a part of life, a part of the work-life balance. We (millennials) also place emphasis on impact. We want to …
Here’s how to help create the future of medicine
Being in a hospital is a scary and frightening time, and it’s easy for those of us at the frontlines — doctors and nurses — to forget that as we go about our busy work days. Patients are at a very low point in their lives and will remember everything about their hospital stay, including all their interactions, for a very long time.
As someone with a keen interest in improving …
In the hospital? Here are 7 things you must keep in mind.
I’ve had many opportunities to address physicians across the spectrum of health care settings, from those who run private practices, to those who work in large and small groups, to those who are hospital affiliated and employed. I often ask them the question “who controls the practice of medicine?” The answers I receive vary: government, insurance companies, hospitals, health systems, lawyers, employers and, rarely, patients. But one answer I never …
Why physician-led organizations work
I burned out early. I was done being a doctor at the end of fellowship. Although I took a job as a critical care physician, I desperately sought to alter my career somehow. I looked into website development, something I had been good at in high school. I took a few refresher classes on my days off and started coding my own sites. Luckily, my first job out of fellowship accepted many …
I was done being a doctor at the end of fellowship
I’ve always wanted to be a pediatrician because I love kids; if you ask most people who work in pediatrics whether nurses or physicians they may say that. It’s a very common response to the question “Why pediatrics?” Or how can you do pediatrics?” when students and physicians are asked. Yes, we love working with children for many reasons. Some love the unexpected unrehearsed things kids say; they will shock …
When healthy children die: Pediatricians are not superhumans
“Why do you eat so healthy?” or “Where’s your kale today?” I would hear regularly.
For as long as I can remember, my colleagues and friends have often smirked at my lunch choice. To me, I always ate what I enjoyed (even if it was the occasional french fry), and my diet and lifestyle were all about balance. Growing up, I played competitive soccer for 10 years and knew my performance …
The irony of the “sick” caring for the sick
Many patients are referred to me as a psychiatrist to treat their depression. The new patients that come to me for depressive symptoms usually expect that I will be recommending and prescribing an antidepressant for their depressive symptoms because that is what a psychiatrist does, right? Not always.
Often times these patients come to me having gone through several antidepressant trials without any successful resolution of their depressive symptoms. Well, sometimes …
The answer to depression isn’t always an antidepressant
Wellness. It’s all the rage these days as we try to manage our crazy work schedules while still maintaining balance in life. We have wellness committees, wellness workshops, wellness coaches, and wellness apps for our smartphones.
So, then, what does it mean to be well?
To the average person, and to the dictionary, to be well is to be “in good health” or “in a good or satisfactory way.”
However, to those suffering …
What does it mean to be well? Ask an opiate addict.
So, how do you do it all?
It’s a Monday morning. After a flurry of activities, I am walking into the office at 8:00 a.m. I think back to the past 2 to 3 hours. I was up at 5:30 a.m., and in my workout clothes soon after. I managed to squeeze in a 20-minute workout, thanks to a video on YouTube. I then reviewed my schedule and patient charts for …
How do physician-mothers do it all?
As a medical student, I had nightmares about my first day in the OR: scrubbing incorrectly, contaminating a sterile field, forgetting the anatomy I had so carefully studied the night before. It seemed like the only thing I could do in that artificially lit room was mess up. After a few cases I came to love the routine and ceremony of each surgery: the timeout; the rhythmic pattern of suture, …
A resident’s guide to being a medical student: In the OR
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