Quality, cost, and value in health care: How to solve the puzzle

Policy
June 14, 2013

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.

“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.

“What exactly were you trying to do before?” some have asked, in that wonderful way …

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Reflection after attending an Alcoholics Anonymous meeting

Education
June 13, 2013

I’m two weeks into my psychiatry clerkship, sitting quietly in the back of a crowded Alcoholics Anonymous meeting and watching a middle-aged man discuss his past struggles with alcoholism. He starts with his difficult childhood, describing his abusive father. When he was eleven years old, his parents divorced. Soon after, he resorted to alcohol as an escape from his loneliness, drinking to “fit in” and impress his friends at social gatherings. As …

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How to stop medical students from becoming jaded

Education
June 12, 2013

Recent research suggests that medical students lose empathy during the third (the main clinical year) of school.

Talking with end of the year third year students might make you think differently. Understanding the psychological changes that likely occur during the third year should make you think differently.

Medicine seems easy during the pre-clinical years. You get smokers to stop and prevent COPD and coronary artery disease. Patients just need to listen to …

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The spiritual bond between two souls

Physician
June 12, 2013

Being a part time hospitalist, I am frequently on overnight call in the hospital, spending the night admitting sick patients from the emergency room, or dealing with any calamities that happen on the medical floors. I would have to say the that the most dreaded events are: “Code blue” (this means a hospitalized patient in cardiac or respiratory arrest waiting to be resuscitated), followed closely by a nurse calling with: …

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What should a surgeon do with an impossible case?

Physician
June 12, 2013

For the first time in my career I asked myself that question. Over the years, I’ve had more than my share of difficult cases. I’ve had patients with life threatening conditions whom I wished I could offer more than to just shake my head and speak empty words of encouragement. They stare back at me and I see their eyes full of hope. How many times have been forced to …

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Grilling with aluminum foil: What are the health risks?

Conditions
June 10, 2013

grilling aluminum foil

As the weather heats up and the allure of grilling returns, it is important to consider some of the potential health risks. One of the great joys of my life is “manning” the grill – beer in hand, wafting smoke rising through the air, a delicious anticipation building. It seems worth the risk of consuming carcinogens present in the smoke …

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How to know if your baby has autism

Conditions
June 8, 2013

Autism is a communication disorder where children have difficulty relating to other people. Pediatricians watch for  speech delay as a sign of autism. Even before your child is expected to start talking, around a year old, you can watch for communication milestones. Problems attaining these milestones may indicate autism or other disorders such as hearing loss, vision loss, isolated language delay, or other developmental delays.

By six weeks of age, your …

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Prescription labels need to come in languages other than English

Meds
June 8, 2013

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As the saying goes, “With great power comes great responsibility.” That applies to physicians when prescribing medications, but it also should apply to pharmacies when they’re dispensing medications.

In December, after seven years of exams, lectures and rounds, I received my medical license. Finally, I had the power to prescribe medications without the co-signature of my supervisor. “Be careful,” she advised, “remember the …

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Is medicine a choice or a calling?

Education
June 7, 2013

Over the last couple months, I have often been asked what I plan to do as a recent college graduate. My response has been that I will be attending medical school in Chicago.

“Oh! Medical school!” many exclaim as their eyes light up, “So you’re going to be a rich doctor.”

This response as well as most others I have received seemed to imply that medicine is an ideal profession if one …

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The ultimate DIY project: Create your own EMR

Tech
June 7, 2013

There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber.  Yes, that hole has been there about a year, and it has been on my to d0 list for the duration, daring me to show if I inherited any of the fix it genes I got from my father.  Why not hire someone to come fix it?  I …

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Is self-rationing of medications a good or a bad thing?

Meds
June 6, 2013

In America, the conventional wisdom is that we don’t ration health care. But we do, and there’s no better example than patients rationing themselves when it comes to the medicines they take.

Recently, a young twenty-something I know had a nagging cough—seasonal allergies, her doctor said and prescribed a generic medicine for asthma and allergies. She did not fill the prescription—the $160 price tag was too steep. Although she had health …

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Letting your infant cry it out: Will it hurt your baby?

Conditions
June 5, 2013

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Jess, like many parents, has been hearing conflicting information about what crying can do to your baby.

She wrote: “So, my husband and I accidentally let our kiddo (5.5 months) cry it out. So of course, I’m spending all sorts of time on Google finding out that I’ve caused long-term damage to my son and he’ll be more likely to get ADHD and …

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Doctors think about their patients all the time after they leave

Physician
June 3, 2013

As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.

We raced in the …

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Address the financial burden of medical treatment

Physician
June 1, 2013

Everyone is talking about health care costs these days. The presentations usually start with a chart of rising health care expenditures, the tip of the line pointing skywards. Next come exhaustive (and exhausting) tables, more charts, all punctuated with a final shrug of uncertainty from the speaker: What is the solution to rising costs? Of course, there is not just one.

But in the morass of data, we can lose the …

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Being a psych patient in the emergency department

Physician
June 1, 2013

So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security …

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