Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of …
When is making the decision to be DNR appropriate?
You need a doctor, and I love what I do. But this work just isn’t sustainable.
In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a …
Don’t make me leave primary care
Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.
These stresses, if unmanaged or poorly managed, can …
Dealing with psychological stress of being a doctor
Add to the growing list of reasons antibiotics might not be good for you and your children: a recent study showing a statistical link between early ear infections and inflammatory bowel disease (IBD).
Researchers in the UK analyzed data from about a million children, looking specifically at the 750 who developed IBD (Crohn’s disease and ulcerative colitis, mostly.) They then compared the kids with IBD to children without that …
The link between early ear infections and inflammatory bowel disease
I live in Louisville, KY, which is the epicenter for heart disease in the United States. My state ranks 49th out of 50 states for heart attack mortality. This is a complex issue with many contributing factors, including access to care, patient education, health insurance, cooperation between EMS and hospitals, among others. The thing is: heart disease is our number one …
Allowing EMTs to perform an ECG should not be controversial
A few years ago, I was sued. Yes indeed, I can now shout it from the rooftops. I know what it feels like to sit in the fire and burn into ashes of self-doubt, regret and emptiness; staring into the soulless, Cyclopean eye of a deposition camera, recounting my sins, defending my pride. I know what it’s like to live with fear, up close and personal. And I know what …
I was sued and lived to tell the tale
Not everything that is faced can be changed. But nothing can be changed until it is faced.
– James Baldwin
She sits in the examination chair reeking of cigarette smoke. “I had a new sore under my tongue last week,” she tells me. “It was bad.”
A year ago, she finally developed a large throat cancer from her years of smoking and drinking. The cancer had spread to the neck lymph nodes and …
I will talk to my patients about smoking: Again and again
For around four years in a row, starting around 1996, my husband and I rented one of those inflatable bouncy houses for my son’s birthday party every August. We invited a whole bunch of his friends and cousins to bounce in it for a few hours (and let them play in the sprinkler and fed them cake). Nobody got hurt.
Which, in retrospect, …
The problem of bouncy houses and the injuries they cause
“You’re not sorry.”
Within two days two different patients said this to me, each with hatred in his voice. Each time I was alone, each time I had known the patient for only a few minutes, and each time the rage was directed at me and only me.
For seven months, I had avoided being the bad guy. When a patient got upset, he accused my superiors, and I hid behind their …
Be the bad guy with good intentions
Many older patients fall in the hospital and these falls often lead to injury. Hospitals are under a lot of pressure to reduce falls. Generally, these falls happen when patients transfer such as when an older person tries to get out of bed or get up from a chair. While hospitalized, many patients are weak, dizzy, or confused, and they can be at risk of falling when ambulating …
Bed alarms don’t work and won’t reduce patient falls
I review a lot of cases in my professional life. Some of them are just ones that our QA group comes across in our practice. Some are cases related to our liability policy. Some are cases I’m sent for review, or educational cases I present. We see a lot of cases which could have been done better, or in which the …
Medical malpractice: Equating standard of care to best practice
Internal medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of well people. It is an excellent field, full of opportunities to think and feel and connect with people, mysteries to be solved and an endless variety of stuff to be learned. …
The recipe for a great hospitalist program
The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …
Your doctor has sold his practice: 6 tips for patients
My heart began pounding as I listened to the sound of the dial tone in my ear. After three rings a woman answered groggily and uncertainly, “H-hello?”
“Mrs. Peterson?” I asked. My voice trembled slightly. It was 2 a.m., and I’d awakened her from what I imagined had been a troubled sleep.
“Yes?”
“This is Dr. Lickerman. I’m calling from the hospital.” I paused. “I’m calling about your husband.”
There was silence. Then a breathless, “Yes?”
“Mrs. Peterson, …
How to deliver bad news to patients: 9 tips to do it better
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …
Physicians can be better doctors by being patients
The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …
Common criticisms of concierge medicine that deserve to be answered
“I love the hours.”
“I want to be just like Dr. Smith. He has a sweet practice.”“I want to make a ton of money.”
“I want to make a ton of money.”
These are some bad reasons why medical students choose a specialty. Most medical students decide what specialty to pursue when they are in their mid to late 20s. While we all think …
4 bad reasons why medical students choose a specialty
As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …
Primary care doctors may no longer be needed
One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances.
My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target.
On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for …
The insanity of pain management in the ER
She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …
What doctors can learn from working at Starbucks
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