Being a physician has served me well. It has given me purpose and identity throughout my career. It has also provided me with a stable income. I knew, however, from the beginning that things were changing. From the earliest days of practice, I pursued lazy side hustles and real estate. I learned about investing. You might suspect that I did this …
Physician compensation is on the chopping block
For centuries, doctors felt that their notes were their property, and none of the patients’ business. This attitude slowly shifted, and the Health Insurance Portability and Availability Act (HIPAA) of 1996 put into law the fact that patients must be allowed to review and get copies of their medical records. Despite this, access to records has remained a daunting task for many. A study done in 2017 of 83 hospitals, …
Why patients should read their medical notes
“At least seven children are known to have died in immigration custody since last year,” according to a NBC News report last month.
I recently spent a Saturday working with amnesty-seekers that had been detained at California detention centers in the desert. They were dropped off at bus and train stations in the desert in Southern California, most with no money and no ability to …
A physician volunteers with migrants. Here’s what she saw.
“I want to see the doctor. Not you. I don’t like your kind. I want to see a white doctor, a man,” a patient gasping for air in an emergency room says to the dark-skinned resident assessing her vitals.
“Speak slowly, I don’t understand you people,” a male patient says as an ethnic attending discusses a complicated procedure to obtain consent.
“Are you sure you are old enough to be a doctor?” …
Discrimination against doctors is costing us
Earlier this year, California’s new governor, Gavin Newsom, promised to pursue a smörgåsbord of changes to his state’s health care system: state negotiation of drug prices, a requirement that every Californian have health insurance, more assistance to help middle-class Californians afford it and health care for undocumented immigrants up to age 26.
The proposals fell short of the sweeping government-run single-payer plan Newsom had supported during his …
Can the states fix our national health care disaster?
I recently graduated from medical school and will soon start residency. Yay! Although I’m happy with my decision to become a doctor, I can’t help but notice that there are several ways that going to medical school and becoming a physician helped — and hurt — my ability to build wealth.
Ways it helped me build wealth:
1. I will have a high income. Most of us doctors will make at least …
How becoming a doctor can help and hurt the ability to build wealth
My husband and I are nearing the completion of a fifth and final year of residency. I say “we” because, as all residents know, the training years involve the entire family. As I reflect on the struggles and successes over the past five years, there are a few things that I know have helped us cope with the challenges, and one of those things has been travel.
We made significant life …
Travel during residency: perspective of a resident’s spouse
Yesterday, I went into an exam room to print out some orders for a patient who needed to get his labs done at an outside facility.
Due to his insurance, he cannot get his labs drawn in our office during a scheduled appointment, but must do it at one of the laboratories that his insurer has contracted with.
Not a terribly big …
Medicine is the last bastion of faxes and printers
The incidence of brain trauma has been rising in recent years. According to the Centers for Disease Control and Prevention (CDC), emergency department visits related to traumatic brain injury (TBI) increased by 53 percent in the U.S. from 2006 to 2014. For 2014 alone, the CDC reported about 2.87 million TBI-related visits, hospitalizations, and deaths. Reports of concussions in high school athletes have also increased in recent …
Concussion treatment centers: 5 red flags to watch for
We’re all gonna die.
It’s a simple truth that an astounding number of people neglect to acknowledge or accept. Some people die sudden, unexpected deaths, but most eventually fall victim to chronic or terminal conditions like COPD, heart failure or cancer. As a palliative care physician, I often meet patients who have had conversations with their families about their end of life wishes and have completed supporting legal documents.
While I appreciate …
How to have an exciting death: 5 tips from a palliative care physician
I recently had the pleasure of participating in an administrative law judge (ALJ) hearing. Novitas, the Medicare administrative contractor had denied the E/M code 99291, critical care.
The case was appealed to the qualified independent contractor, who also believed that the care, in this case, did not meet the CMS and CPT definitions of critical care. Subsequently, the case was appealed to the administrative law judge. The encounter occurred in an …
A lack of understanding for what physicians really do
It is probable that primitive man’s curiosity markedly increased soon after he stood up and started walking on just his feet. He could both peek into caves and drop back onto all fours to peer down badger holes. Looking into his family’s mouths and ears soon followed. Many generations later, his progeny developed metal tubes and glimpsed human interiors through all of our natural orifices. Lighting, however, was always an …
The history of viewing bones through telescopes
The first time I spoke to her was in the hospital when I was a relatively new intern caring for her. She was ailing for a while with complications of liver cirrhosis. She was new to the area. She had relocated from a different city to live close to her family. I eventually ended up becoming her primary care physician in the ambulatory setting as that was the quickest way …
Losing my first patient as a primary care physician
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As July draws near, it is a moving day in medicine. For physicians, it signifies entering the next level of professional growth.
Let’s think about what moving entails. When we move from one physical location to the next, like into a new apartment or from one city, state, or country to another one, there is the process of sorting through our belongings. We make two lists: what stays and moves with …
Packing for the next level of your medical career
Our 20-bed ICU finally captured 10 intensivists — all board-certified in critical care medicine. We were fortunate enough to have one of these doctors in our ICU 24-7.
Of course, they all practiced professionally with expertise.
But I remembered this one the most: Dr. Jason McKenzie (name changed for privacy).
He easily became our friend and “go-to” person.
Clocking in at night and finding out that Dr. J was our doc, would give me …
Remembering a physician, suddenly taken away
For many years after I became chronically ill, I blamed myself for failing to recover my health. I told myself: “You get sick; you get better. It’s as simple as that.” As a result of this stubborn attitude, I refused to set limits, even though it would have been a tremendous help, not only in managing my symptoms but in keeping them from flaring.
Learning to set limitations
I have a background …
If you’re chronically ill, setting limitations can make your symptoms manageable
Today’s fee-for-service oncology business model misaligns incentives by rewarding practices for keeping margins and service volumes high — even when it’s wasteful — rather than for optimizing patient outcomes.
While discussions of drug pricing dominate the cost control conversation, we, as practitioners, have been abdicating responsibility and missing the opportunity to address cancer’s financial toxicity. We can do better. The practice-level assumption of financial risk for patient care — or the …
Cancer care costs everyone too much. What can we do about it?
I can tell you why there is a high burnout rate in the medical profession, but to do so, I have to explain why there isn’t one for small private practices.
When I was finishing up medical school, I went to see a general practitioner. Now, this doctor had an unbelievably high level of charisma. To say he was engaged in his patient’s health care would be an understatement. Not only would …
Physicians have been reduced to overpaid dairy farm labor
An excerpt from Human Rights Violations in Medicine: A-to-Z Action Guide.
From sex trafficking to censorship, the range of human rights violations is immense, some more heinous than others. Abuse may be perpetrated by dictators in war-torn countries and administrators in first-world hospitals. Inside this action guide are the top …
Our doctors are suffering from human rights violations in medicine
Back in medical school when you chose a residency, you probably thought you had to do most everything that came with your chosen specialty.
Then in residency, they for sure made you do every last part of your specialty (and more!).
Now you’re out of training, and you’re a practicing physician. And what you may not have realized is that at this point — something glorious happens.
You get to choose what you …
How to Marie Kondo your medical practice
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