When is an advocate not an advocate? When should a spouse step back and let the husband make a treatment decision? When should an adult child of a man with prostate cancer let their father decide what is best for him? These are questions that, fortunately, I don’t have to ask all that often. Most men I see for prostate cancer …
When an advocate goes too far in the exam room
“How many patients do you have?”
I’m not sure what you mean. How many patients do I see on average each day? About twelve.
“No. How many patients do you have?”
Let’s see: Last week I saw about sixty patients altogether. Five of them were new patients.
“No, no. How many patients do you have on your panel?”
My panel? I don’t know what you mean by that. I don’t work as an employer in …
Why a patient panel is an outdated concept in primary care
Studies have varied in their estimates of depression in medical school students, but they all show a similarly startling trend. Medical students have a higher depression rate than their non-medical counterparts. This culminates later in life with physicians with higher than average alcohol abuse problems and higher than average suicide rates, with male MDs 1.5 times as likely, and female MDs twice as likely to commit suicide than their Read more…
Medical students are depressed, but they’re taking the wrong drugs
The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”
The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …
There is no oversight for prior authorizations. There should be.
In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value — above and beyond anything else — the general radiologist.
Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the …
The general radiologist is still valued. Here’s why.
Receiving medical school interview offers simultaneously provides relief, justifies the incredibly hard work you’ve put into your primary and secondary applications, and confirms that you are indeed cut out for medicine.
In other words, you’ve convinced them — at least on paper — that you will succeed in their program and make an excellent doctor.
So why do they even want to interview you?
Consider what schools can only learn about you in …
Use the power of psychology to ace your medical school interview
With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with …
5 health questions every presidential candidate should answer
While slogging through a crappy first draft of a document about the value of psychiatrists in mental health and substance use disorder services, I did a literature search for supporting evidence.
I found nothing. (1)
“So how exactly are we helpful?” I mused out loud. Maybe we aren’t: There are groups out there who do not believe that psychiatrists can or do help anyone.
I am an N of 1. …
Do psychiatrists have value? Yes, they do.
The first posting on my blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of …
Listening to the patient is the first part of the physical exam
Dear AMA and state medical boards,
The last few years have been a period of unprecedented change in the world of health care. The need to reign in costs, expand access, and ensure higher quality care — all at a time of rapid medical and technological advancements — has changed innumerable aspects of the practice of medicine.
Throughout this, one common theme has been the dedication and determination of hundreds of thousands …
Physicians are not providers: An open letter to the AMA and medical boards
Most people who apply to a graduate school and/or graduate medical programs apply to get accepted the first time of applying. No one wants to have to apply a second time and definitely not a third time. After a second rejection, a lot of people would probably recommended someone picking another field to enter or even giving up altogether. For me, both of my rejections were taken hard and still …
I got rejected from medical school twice. It was the best thing that happened to me.
Part of a series.
Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart.
Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or …
If urgent care centers don’t innovate, how long will they last?
A continuing series on physician online reputation. Created in partnership with the Doctors Company as part of their social media resources for physicians.
There are so many online platforms that doctors can get involved in today, and some may not know where to start. I want to share my approach.
The first step would be going on physician rating sites and making sure your information is accurate on …
How doctors can establish an online presence: A step by step approach
Recruitment season is my favorite time of year. The CVs pile into the database, and we sift through the resumes, searching for candidates that would make a great fit for our organization. Next, I get on the phone and assess their level of interest and try to sell them on everything we have to offer. We fly them out for a live interview, and the negotiations begin.
Last year was a …
Physicians looking for a new job should beware these 4 red flags
I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or …
Who’s in charge of the patient? It’s a question increasingly difficult to answer.
“How far did you go in school?”
This is a question that I ask every new patient as a matter of course.
Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients.
Now, leaving the …
The question about education that this doctor asks every new patient
It’s no secret that I have a special place in my electronically-regulated heart for evidence. There’s a good reason for that. Our primary job as physicians is to avoid harming our patients, but it’s followed closely by our calling to help them in some way. The problem is that, until we test our theories, we don’t really know which treatments will help our patients (or which ones might harm them), …
A physician’s personal experience with evidence-based medicine
When a wife suddenly comes in for her husband’s appointment, I usually worry a little; when a husband shows up for his wife’s visit, I sometimes worry a lot.
I have come to expect that when I enter an exam room, and a male patient has his wife with him in the room, she is there to make sure I hear some part of his symptom history that he has never …
What worries me about husbands and wives in the exam room
Last week I was playing golf with some friends. The Boston area has been having a bit of an Indian summer, and we are lucky to still be getting out there (long may it last). The conversation during one of the holes turned to health care information technology, when my friend, who is also a physician, told me about his experiences with a (certain famous) new electronic medical record that’s just been installed in their …
The bait and switch of health care IT
Christine Sinsky, MD, from the American Medical Association interviews Pamela Wible, MD, after her TEDMED talk. Watch periscope video here. Fully transcribed below:
Dr. Sinsky: This afternoon we’re here in Palm Springs, and I’m delighted to be here with Dr. Pamela Wible, who gave a terrific TED talk last night. I’m Dr. Christine Sinsky, the vice president of professional satisfaction at the …
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