“It should be in my chart.”
I’m sure we have all heard this statement uttered with a subtle (or not so subtle) edge of frustration from our patients after asking a question such as “what medications do you take?” I find clinicians despise this comment because it is interpreted as (a) the patient is not making an attempt to recall his or her medical history, or (b) that the patient doesn’t …
A case for computers at the bedside
Next in a series.
In prior posts, I described my Healthcare Incentives Framework. If you haven’t read those, I recommend you check them out first to have the full context for this post. But here’s a refresher of the main points of the framework without re-explaining all the rationale:
The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating …
What would an optimal libertarian health care system look like?
Like all doctors, I’m a lousy patient. My doctor is a lovely man, but going to see him? That’s right there with weighing myself, getting a flu shot and doing my taxes, and behind celebrating Thanksgiving with the in-laws and getting a root canal.
And I’m not the only one. If I had a dollar for every patient who told me they hate doctors (no offense), I’d be long retired.
If you’re …
Working as an emergency physician at a level 1 trauma center and as an Army reserve officer, you learn to expect the unexpected – but working as the ER doctor taking care of patients impacted by the most deadly and destructive wildfire in California history last year changed me.
As I walked into work last year to start my clinical shift as the attending emergency physician, our hospital began receiving multiple …
A physician’s perspective on California’s Camp Fire
Janelle had overdosed 32 times.
Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She …
A call to increase the availability of the Butrans patch
Many health care organizations across the country are taking leaps to address burnout. There are advisory boards formed solely to tackle the issue, access to yoga and meditation, as well as online programs and interactive workshops — just a few examples of efforts aimed at curbing this epidemic. These are steps in the right direction. However, physician burnout is a systemic problem, rooted deep in medicine’s culture, and these steps …
Asking physicians this one simple question may hold the answer to burnout
So many primary care patients have several multifaceted problems these days, and the more or less unspoken expectation is that we must touch on everything in every visit. I often do the opposite.
It’s not that I don’t pack a lot into each visit. I do, but I tend to go deep on one topic, instead of just a few minutes or maybe even moments each on weight, blood sugar, blood …
How this physician does less in primary care and accomplishes more
An excerpt from With Mirth and Laughter: Finding Joy in Medicine After Cancer.
I am sitting in the waiting area for the one year follow up appointment with my oncologist, Dr. Anne Blaes. Using the handy phone app, “How Long Ago,” I see it’s been eleven months, nine days, five …
A diagnosis that creates an instant bond with others
When my obstetrician told me I was not going back to my clinic that afternoon due to severe preeclampsia, I was so indoctrinated that my first thought was of the inconvenience to my patients who would need to be rescheduled. Only a few minutes later did it register that I would be giving birth sooner than I had anticipated, and my new life as “working mother” would begin.
I was due …
Choosing family over medicine: Why I decided to leave clinical medicine
Health care is big business, with medical practices vying for contracts, hospitals undergoing facelifts in order to cater to patient experiences, and insurance companies making deals with pharmacies. Some of these arrangements are negotiated in the name of reducing health care spending, but there has to be some skepticism when for-profit entities are implicated. Physician salaries aren’t exactly growing with inflation—some fields have had massive cuts in spending over the …
The problem with reducing physician salaries
In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment …
3 things every hospital should invest in
In the service industry — which as physicians, we certainly are a part of — a popular saying is that the customer always comes first.
The implication is that in order to thrive in an industry, you have to cater to the customers/patients as it is they who will ultimately decide where they take their business.
In medical school, the emphasis on prioritizing the patient was evident, culminating in the Hippocratic Oath …
Does the patient come last in health care?
After spending much of the first 40 years of my life poring over textbooks and medical journals, I decided to start reading literary fiction. At the time, I had no ulterior motive — only a vague sense that I had been missing something important, a metaphoric vitamin without which my development would not be complete. I certainly did not expect that the great novels would make me a better doctor. …
Great books make better doctors
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It’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era. I remember in the United Kingdom, where I went to medical school, Google only became a thing perhaps midway through university. Since then, of course, the internet has exploded and penetrated every facet of our lives. And …
Don’t judge patients for researching their health issues
Who remembers Jack Kevorkian, Doctor Death? He was found guilty in 1998 of second-degree murder. Still, it was because of his advocacy that the terminally ill patient’s right to die by physician-assisted suicide was propelled into the public arena. And who can forget Brittany Maynard? It was her advocacy for physician-assisted suicide that reignited the debate on its legality in 2014 — …
Physician-assisted suicide is a collaborative process
From October 25 to October 29, 2019, more than 10,000 pediatricians from all over the world gathered in the city of New Orleans, Louisiana, to attend the American Academy of Pediatrics (AAP) National Conference and Exhibition.
As the world’s largest pediatric medical education event, the AAP National Conference draws pediatricians, like me, to network with mentors and colleagues, learn about the latest clinical guidelines and policies, and be inspired to renew …
“How are you doing?” A simple question with a big impact.
As my husband passed the milestone birthday of 40, he thought it would be a good idea to get a physical exam as it had been several years since he saw a physician. Easy task, right? We soon came to find that the landscape of health care had been changing even faster than we thought.
We had just moved and needed to establish care in a new area. Multiple phone calls …
Where have all the doctors gone?
Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets.”
I told him not to worry and that we understood and that “these things do happen.” His response has stuck with me: “Doc, but there is still some shame.”
I nodded, told him not to worry since he was going to get a catheter anyway, …
Don’t forget to manage your patients’ dignity
I am a middle-aged, full-time emergency physician, and part-time law student. Usually, I practice medicine during the day and attend law classes in the evening. Sometimes I have law classes in the afternoon or early evening then work in the emergency department all night.
So, what’s harder: medical school or law school?
Absolutely the most common question I am asked by physicians, attorneys, and students at all levels of training.
The other most …
Doctor by day, law student by night
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman is evaluated during a follow-up visit for primary membranous glomerulopathy. Diagnosis was made by kidney biopsy 4 months ago, and she was found to be positive for anti–phospholipase A2 receptor (PLA2R) antibodies. Medications are furosemide, losartan, and simvastatin. Recent age- and sex-appropriate cancer screening tests were …
MKSAP: 38-year-old woman with primary membranous glomerulopathy
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