to live in this world
you must be able
to do three things
to love what is mortal;
to hold it
against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go
-Mary Oliver, New and Selected Poems, Vol. 1
As a parent, you are not supposed to have a favorite child, and since some of us physicians feel a strange but kindred protectiveness for our patients, likewise we …
My favorite patient died last night
Patient noncompliance.
I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time.
We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often …
Physicians are noncompliant too
Health care reform is a reality. The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today. The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans. Certainly these are noble and lofty goals: But have we completely missed the mark?
Today, many remain uninsured and the majority that have signed up for the exchanges are simply …
The salaries of health executives: What can doctors do?
The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you’re still happy. What’s so wrong with that? If I wanted to be miserable, I’d have gone into primary care.
When a surgeon screws up, his/her role is clear: Admit it, make it better, or as good as possible, and stick with …
Managing unhappy patients after surgery
It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.
“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.
There are …
How do we fix the high blood pressure problem?
Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there …
Can doctors ever work together with insurance companies?
This letter was received and edited for clarity by Pamela Wible, MD.
Dear Dr. Wible,
This will be my last email to you because I am giving up on my dream of being a doctor.
I’ve contacted so many colleges and medical schools hoping to find one that would help me become a doctor for my tribe. Today, I finally got a response from the …
Is medical school just for rich kids?
The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution — unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing.
While working as an assistant …
Ignaz Semmelweis and the lessons of fear and medical innovation
I received a fax recently, from the office of another hematologist-oncologist, at another academic medical center. Attached to the fax cover page, with my name and fax number scribbled in slanted script, was a five-page consultation report on one of my patients. That oncologist — I’ll call him Dr. Z — had seen and evaluated my patient to provide a second opinion on the patient’s diagnosis and treatment.
The lengthy report …
The art of writing a good consultation letter to another physician
When one hears the words “language barrier,” it usually brings up images of a person who is in another country of which the national language is not his own. If you have visited a foreign country without fully knowing the primary language, you can start to feel out of place fairly quickly. Despite one’s best efforts to navigate the country, a part of the cultural experience is lost without knowing …
Breaking down the language barrier in medicine
Next in a series.
How many patients can a primary care physician (PCP) reasonably care for? I have been interviewing PCPs: Here are some of their thoughts when asked this question.
Responses were widely divergent ranging from about 300 to 3,000 or even more. Yet many are clearly conflicted. Some say they can manage about 2,000 with little difficulty — but then observe elsewhere in the conversation that they have no …
How many patients can a primary care physician care for?
Imagine you go to work one day and your boss says all employees will be evaluated based on the performance of a new set of job skills that require additional training and, perhaps, new computer hardware and software. The boss also announces that some employees will be reimbursed for the cost of acquiring these skills and tools. You aren’t among this privileged group.
In government, this is called an unfunded …
Psychiatric hospitals need meaningful use incentives
An obstetrician is found dead in his bathtub. Gunshot wound to the head. An anesthesiologist dies of an overdose in a hospital closet. A family doctor is hit by a train. He’s decapitated. An internist at a medical conference jumps from his hotel balcony to his death. All true stories.
What are patients to do?
When they call for appointments, patients are …
Physician suicide etiquette: What to do when your doctor dies suddenly
Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life.
Linda is an elderly woman with moderate dementia. She is blind …
It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured.
As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room …
Being a nurse is the noblest profession
Round and round and round we go yet again. The system is broken. Do something. Health care reform!
“Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means — and that everyone else agrees with them. Wrong.
Quality is very much in the eye of the beholder, and …
Health care quality can be surprisingly subjective
Let’s face it. A hospital is a place where nobody wants to be. By it’s very nature, it is somewhere scary and not too nice. Those of us who work every day in hospitals can easily forget this fact: Those who we serve would rather be anywhere else (and so they should). Think of all the things our patients would rather be doing — enjoying a leisurely afternoon with the …
How to design a better hospital
Next in a series.
Good question. You call for an appointment and are told it will be about 20 days. You arrive on time only to sit in the apt named waiting room for 40 minutes. Finally you get to see your primary care doctor (PCP). You begin to explain why you came in but are interrupted within about 23 seconds even though it would have only taken you about …
Why do I only get 10 minutes with my doctor?
Nobody stands up to argue against quality and value in health care. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or (worse) by the government.
There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict …
Why the quality measures used in health care are deeply flawed
Before the 1980s, drug testing was uncommon. It was widely viewed as an invasion of privacy and an infringement on fourth amendment rights. Today, a medical student is likely to be drug tested before entering medical school, before clinical rotations, and/or before residency. If preventing drug use among medical students is the goal of these tests, they have failed miserably. Urinalysis drug tests are ineffective. But more importantly, they are …
Medical school drug testing is a moral and scientific failure
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