“Um—Hi there, I’m a, uh, you know. Medical student. First year. For, you know, the Patient-Doctor—err, Patient-Physician course—”
The nurse smiled and turned to a woman of shorter stature with bony, scrunched- up shoulders. “Mary, do you want this first year to interview you?”
Mary was about to set foot in the lounge when she heard this. She let out a sigh and faced me. Her eyes looked worn; I could tell …
A medical student’s first patient interview
There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable.
I remember a particular patient from 20 years ago for a very different …
Patients are our best teachers
I have been thinking a lot over the last few weeks about all the many ways that the experience of medical school has changed me.
The most obvious is knowledge. I’ve drunk from the proverbial “firehose” of information that we experience in medical school, and apparently enough of the facts stuck with me to pass all my exams, and secure myself a residency program back in my home state of California. …
The lines of text on my laptop screen blurred together as I lost focus. I knew there was at least one error on my medical school re-application I would regret later on. My eyes scanned the familiar body of words but failed to connect the information to my brain. Frustrated, I closed the application and shut my computer off.
My bedroom door abruptly swung open, revealing my mother with the phone …
Struggling with the idea of leaving for medical school
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during my career. How a physician goes about this process can make an enormous impact in the lives of those affected by the news that must be delivered.
Precious little time is devoted to teaching this essential communication skill in the training of physicians today. I can remember back to …
How we deliver bad news is critical to how families deal with grief
The end of my residency and beginning of my practice was the most wrenching experience of my life. I was woefully prepared for the transition. Full disclaimer: I was trained many years ago when residencies were acknowledged brutal demeaning processes. Things have changed considerably, but the psychological passage I endured still holds.
I think my process of becoming a surgeon was fairly typical, with the exception that there was no one …
Medical school and residency aren’t places for human growth
From Outside Online, an article about how physicians are increasingly hesitant to provide volunteer medical coverage at athletic events:
“Last year, 13 Americans died during running races, and another eight while competing in triathlons. While those numbers might seem troubling, the deaths are attributable mostly to the booming popularity of endurance sports—13 million Americans enter running races each year, and 2.3 million compete in triathlons. But the rising participation and the …
The malpractice risk of volunteer medical coverage at sporting events
I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said, “But I must say, it’s a sincere fortune to be a doctor some days. Yesterday …
What does a perfect pediatrics practice look like?
I’ve received several inquiries from women living in various regions of the country, asking how they should choose where to go for their mammogram, and if it really matters. I cannot emphasize this enough: It matters! Here are a few tips to help your search:
The most basic requirement is whether a facility is accredited under the MQSA (Mammography Quality Standards Act). The accrediting body for most states is the ACR …
Where you have your mammogram, and who reads it, matter
The FDA is deciding whether to allow patients to purchase prescription medications over the counter for many common ailments.
This idea is controversial.
On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions – the doctor’s visit. If no doctor’s visit is necessary to receive necessary blood pressure medications or diabetes medications, then patients don’t have to wait for an appointment and the patient/government …
Go ahead, let patients buy prescription drugs over the counter
Recently I was asked, “How can I improve my Press Ganey scores?” Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals. Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS …
Tips to improve your patient satisfaction scores
He had yellow nails, leather neck, stained teeth and a deep cough. He wheezed slightly, breathed too quickly and occasionally sprinkled the white handkerchief red. No surprise his ticket to my office was a lung mass to match. We talked about tests, treatment and prognosis. About the future, probably short. Devastated, he was not surprised. He was reaping the reward of 30 smoking years. He sadly admitted, “I knew better, …
Are smokers to blame for the damage they do to their bodies?
An excerpt from The Truth About Statins.
Like all physicians, I’ve had interactions with pharmaceutical companies. Shortly after I went into private practice in Rhode Island in 1977, I received a telephone call from a drug company representative. He offered me an all-expense-paid weeklong trip to Germany to attend a medical conference. I was taken aback, knowing that the cost of such a trip would run to thousands of dollars. I …
The unholy alliance between Big Pharma and the medical profession
“You are too smart to do primary care.”
I have heard this far too many times, directed at me and at others seeking career advice. There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this. Smart, capable, successful trainees are discouraged from choosing primary care. It is perceived as a less prestigious pathway than specializing.
The knowledge base of primary …
Primary care requires more than knowledge
The more I talk to new physicians who are transitioning into practice, the more I realize how many substantial life and career shifts occur post-residency.
I experienced these changes myself several years ago, but it’s taken me a while to fully process them and realize how they’ve affected my life.
In fact, it would be safe to say that I experienced a complete 180 after graduating from residency. I know other new …
Tips for adjusting to life after residency
I met with a young patient recently, a woman who has been done with chemotherapy for lymphoma for close to a year. She was feeling well, and she had no symptoms of cancer, nothing that made her suspicious of a recurrence. After I examined her and reviewed her most recent CT scan and labs, I agreed. No recurrence. I wrote in my note, “NED,” the acronym for no evidence of …
No one told me that getting on with life after cancer would be so hard
When you ask young medical students why they want to be doctors, you will probably get all sorts of answers. Some may say they like people and want to interact with them and offer them help. Some students will believe this is their calling. Others still may state they are intrigued by the scientific mysteries the human body is filled with. From my experience, not many medical students just starting …
How money influences our decisions as doctors
Suppose your malpractice insurance company wants to settle a medical malpractice case against you – even though the case has no merit.
In many cases, insurance policy language may allow the insurance company to do just that.
In the 2011 case of Mohan Papudesu, MD v. Medical Malpractice Joint Underwriting Assn. of Rhode Island, the Rhode Island Supreme Court allowed an insurer to settle a case on behalf of the defendant physician …
When doctors are forced to accept malpractice case settlements
Medical residents have fewer labor protections than Chinese factory workers. While labor abuses at Apple’s factories make headlines, few people are as concerned about the lack of protections for doctors and medical students here in the United States. As a resident, I was subject to some of the worst abuses – intentionally misreported time sheets and gender-based discrimination – and after I complained, I was fired, so I sued the …
Medical residents are abused more than Chinese factory workers
Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future. I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions. That is, reimbursement will be based upon the quality of service delivered by the provider. For insurers, whether private or governmental, I believe that …
Healthcare reimbursement will change dramatically in the future
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