With the crash of the Asiana 777, we’re hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line. This isn’t a new concept, and isn’t unique to aviation. Many parallels have been drawn between aviation communication and healthcare team communications, …
Cockpit culture and using the two challenge rule in the OR
One tired early morning, during my residency, I had been up all night in the ICU with a sick patient. Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn’t leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: “The sign of a good doctor is when you can’t go to sleep at night worrying about …
Separating work from home life makes for happier doctors
The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex. Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped. Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling. The lung cancer has spread, metastasized. Really bad news.
A …
A guide to giving bad news to patients
As I shopped for a new car last year, I realized that my priorities were considered odd by most car salesmen. The three most important characteristics I desired in a new car were good gas mileage, good crash safety, and relatively low concentrations of “new car smells.” The often celebrated (but particularly noxious) new car smell is actually a synthetic blend of respiratory irritants and potential carcinogens off-gassing from the …
Beware of that new car smell when shopping for a new car
Sometimes it’s the simplest things that can make all the difference. Unfortunately, when it comes to informing patients with a new diagnosis of pulmonary fibrosis what to expect, things are anything but simple.
For years, pulmonologists have dreaded the moment when we inform patients of a diagnosis of pulmonary fibrosis. The discussion invariably involves informing them that this disease (which they have probably never heard of) may either kill them or …
Determining the prognosis of patients with pulmonary fibrosis
As a healthcare consultant, it is not unusual to be asked about HIPAA regulations on a weekly basis. Three questions come up regularly and seem to cause the most confusion when discussing HIPAA. I call them the Three Big HIPAA Myths – you can’t place medical charts on exam room doors, you can’t use sign-in sheets, and you can’t leave messages on patients’ voice mail or answering machines.
Here, then are …
The 3 biggest HIPAA myths debunked
Who is responsible for mistakes in health care? Who should take credit for success or blame for failure? Most families, patients and obviously the courts, hold the doctor responsible. It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect. However, is this changing because of the Internet and big data?
In 2013, most patients have spent hours on the Internet …
Are physicians still responsible for mistakes in health care?
On June 10, 2013 a 32-year-old pregnant woman was reported to have died after having an ovary removed instead of her inflamed appendix. As the infected appendix festered, she became septic and succumbed to multiple organ failure. This tragedy occurred in the UK in late 2011, but has just come to light.
How could this have happened?
Let me count the ways.
The surgery was performed by two trainee surgeons. Their …
An ovary removed instead of an inflamed appendix: What happened?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman is evaluated for a 6-month history of progressive fatigue and dyspnea on exertion. Over the past 2 years she has noted episodes of hand swelling, joint pain, blue color change of her fingers with cold exposure, and difficulty swallowing. She takes no medications.
On physical examination, temperature is 36.9 °C (98.4 °F), …
MKSAP: 38-year-old woman with fatigue and dyspnea on exertion
Tests like cholesterol levels are considered screening tests because they are cost effective, have high sensitivities (a low rate of false negatives), and have been proven to be beneficial in the identification of conditions that may require treatment before symptoms occur. The vast majority of medical tests are not considered to be “screening” because they violate one or more of these principles, …
Should drug testing be considered screening tests?
Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …
Primary care doctors need 35 hour work weeks
My shift is over, and I’m ready to head out the emergency department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, “Get …
A ruptured eardrum turns out to be something much more
Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.
About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. …
When does a teen girl need a pelvic exam?
Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are …
Should the Sunshine Act be celebrated?
An interesting conversation recently took place among residency program directors in my field of internal medicine.
At issue was the declining pass rate of first-time test takers of the ABIM Certification Exam.
It’s a mouthful to say, but the ABIM exam is the ultimate accolade for internists. One is only eligible to take the exam after having successfully completed a three-year residency training period (the part that includes “internship,” right after medical …
Declining board exam pass rates: Blame millennial doctors?
My time as a medical student has quickly come to an end. This past winter, with nearly four years of arduous study, countless examinations and numerous clinical rotations under my belt, I couldn’t help but think, Yes, I’m ready to be a doctor.
And then I became a patient.
I’d always thought I knew what it’s like to be the patient. For much of my childhood, my father suffered from chronic fatigue syndrome, …
It’s hard to grasp the experience of being a patient
I recently celebrated my birthday with a 9-hour picnic and for the first time in my life I was aware that some of my friends were starting to wear large hats and sunscreen. In fact, one of my friends was asking me about tinting her windows to block out excess sun.
Finally we are all now realizing what our mothers have been telling us since day 1 and what was popularized …
This is why you should wear sunscreen
In October of 2011, I left my job of 17 years, which I loved, mostly, and started a 2 year sabbatical. Since sabbatical implies that there is one year of rest every 7 years, I have built up at least 2 years since finishing medical school in 1986. Nobody in my office or medical community did sabbaticals, but we discussed that it would be a great idea when we first …
Why doctors should take sabbaticals
It is increasingly difficult to find real ice cream. When reading the ingredient list it is discouraging how many cheap fillers, consistency modifiers, and shelf life extenders are included. One ingredient, namely guar gum, seems fairly ubiquitous. So what is guar gum, and why is it found in so many products including ice cream? Is it “bad” to eat?
Herbal medicines make most doctors cringe, laugh, or want to put blinders on and pretend they don’t exist. This is understandable. While allopathic medical education hammers pharmaceutical formulas and mechanisms of action into our brains, we learn little-to-nothing about herbs in medical school. Quite the opposite – we are most often told to uniformly discourage our patients from taking herbs out of concern for safety; a conversation stopper with little …
Herbal medicine: 6 tips to consider when talking to your patients
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