Health care is on a different trajectory from most other businesses. Why is that?

Health Policy
November 29, 2018

Health care is on a different trajectory from most other businesses today. It’s a little hard to understand why.

In business, mass market products and services have always competed on price or perceived quality. Think Walmart or Mercedes-Benz, even the Model T Ford. But the real money and the real excitement in business is moving away from price and measurable cookie-cutter quality to the intangibles of authority, influence, and trust. This, …

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Health care is on a different trajectory from most other businesses. Why is that?

Employee recognition: How to show your appreciation this holiday season

Physician
November 29, 2018

Holiday season is upon us, and it’s time to start thinking about staff appreciation.

A recent survey found that over 70 percent of medical office assistants (MOAs) are expecting a holiday bonus this season.  Based on the survey results, the average cash bonus in 2017 fell between $200 to $500, with a few outliers paying out in the thousands.  While a wide array of bonus and employee appreciation practices exist within …

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Employee recognition: How to show your appreciation this holiday season

Beware the hazards of over-the-counter (OTC) pain medications

Medications
November 29, 2018

A 30-year old male patient was recently admitted to my service via the emergency department. He came in complaining of abdominal pain and dark tarry stools. He mentioned a recent fall resulting in knee pain for which he had been taking 400 mg ibuprofen four times daily. He underwent upper GI endoscopy and was diagnosed with a bleeding gastric ulcer from his self-prescribed misuse/overuse of ibuprofen.

Fortunately, he recovered, but this …

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Beware the hazards of over-the-counter (OTC) pain medications

When the best prescription is no prescription

Conditions and Diseases
November 29, 2018

“Get rest and drink plenty of fluids,” might not sound like adequately aggressive medical advice. If you’ve dragged yourself out of bed to visit an urgent care or your doctor’s office, you will probably feel somewhat cheated by an admonition to head right back to bed and stay there until you feel better.

Most likely, you’ll want a prescription for an antibiotic. You might even demand it.

Don’t. Antibiotics are not the …

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When the best prescription is no prescription

Computers are the modern stethoscope

Physician
November 29, 2018

I wrote this a decade ago:

It is a brave new world. I have used an electronic health record in my office for ten years. With a click of a mouse, I can show you how your blood pressure has varied over the last ten years. I can graph your hemoglobin, track your diabetes or tell you if that was the medication we tried last time.

But with every two steps forward, …

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Computers are the modern stethoscope

The problem with mental health funding and prisons

Health Policy
November 29, 2018

Moving to the Bay Area from the Midwest was a culture shock in many ways. I was amazed by the diversity, the food, the openness of opinions. And I was struck by the traffic, the stark differences driving from one community to another and the homelessness — you could see signs of it everywhere. As time went on, I acclimated to these changes. Working in the hospital, I got used …

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The problem with mental health funding and prisons

A need for structural change to improve the safety and well-being of LGBTQ people

Health Policy
November 28, 2018

In a previous post on LGBTQ care, Dr. Carlene MacMillan called attention to the importance of respecting patients’ pronouns. As she points out, discrepancies between patients’ chosen names/pronouns and gender markers on official documents can pose real challenges to providing patient-centered care. Even if health care providers know their patients’ self-determined identities, electronic health records and insurance claims can still betray them.

The issue of compassionate and …

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A need for structural change to improve the safety and well-being of LGBTQ people

How to get the doctor to really see you

Patient
November 28, 2018

Doctors are regularly deluged with advice on how to engage patients. But how can you, as a patient, get your doctor to engage with you as a person truly? Your health — and even your life — could depend upon it.

A perceived absence of empathy can significantly harm physical and mental well-being. At a recent Society for Participatory Medicine (SPM) conference (I’m a member), three …

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How to get the doctor to really see you

Nurses aren’t commodities

Health Policy
November 28, 2018

Corporate health care mentality set up nurses up to be inhuman while holding us to superhuman expectations. We’re told to be caring — but not allowed to do it. It’s time to demand that we stop being abandoned and dismissed by dysfunctional leadership.

Early in my nursing career, I was assigned to the pediatric area for one shift in a busy emergency department (ED). Our team received notification of an incoming …

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Nurses aren’t commodities

Lead your health care organization toward a culture of sustainability

Physician
November 28, 2018

On a recent vacation, I went out to eat at a small, out-of-the-way restaurant we always visit on our trips to the Outer Banks.

There, I spotted a poster on the wall explaining why the cafe no longer uses plastic bags or plastic straws: to keep the material out of the ocean where it never really goes away.

Plastic bags, straws, eating utensils, plates, bowls, and cups are everywhere in hospitals these …

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Lead your health care organization toward a culture of sustainability

3 ways pharmacists can change your prescribing habits

Medications
November 28, 2018

As the health care landscape evolves, health care provider roles continue to shift.

Industries recognize the power of collaboration and the strength of communication between different providers; among those, the pharmacist and the physician.

Unfortunately, doctors and pharmacists have historically had strained relationships. In many cases, communication suffers, which can lead to adverse drug events (ADEs), or harm caused to a patient as a result of medication exposure.

It’s worth noting, though, that …

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3 ways pharmacists can change your prescribing habits

What is the fundamental dilemma in medicine?

Physician
November 27, 2018

In observing trends among my patient encounters, to me, there appears to be a distinct difference in clinical encounters between more “holistically-minded” patients and more “traditionally-minded” patients, for lack of better terms. One is not necessarily better than the other. There are definite benefits and risks associated with either group. Whereas the “holistically-minded” tend to see western medicine with some degree of skepticism, the “traditionally-minded” tend to be comfortable with …

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What is the fundamental dilemma in medicine?

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Advice from a “xennial” physician to aspiring physicians

Physician
November 27, 2018

I am considered a “xennial” physician. Not quite a millennial — but also not fitting into the generation of the respected preceptors I had in medical school and residency. I took my MCAT via paper and pencil. My mini boards during my clinical rotations were on paper and pencil. All of my licensing and board exams were computerized.

It was not an option to sit at home and log on to …

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Advice from a “xennial” physician to aspiring physicians

Don’t miss this adverse drug reaction when tapering benzodiazepines

Medications
November 27, 2018

“Alice Woods” is dying of metastatic breast cancer, but she cares little for awareness efforts like pink ribbons and catchy hashtags like #stage4needsmore. You see, Alice has akathisia due to an adverse effect from discontinuing Klonopin — a condition that has caused her far more suffering than her terminal cancer. It has also prevented her from receiving adequate cancer treatment and is, therefore, ending her …

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Don’t miss this adverse drug reaction when tapering benzodiazepines

A proximate cause of wrongful death

Conditions and Diseases
November 27, 2018

An excerpt from Wrongful Deaths.

“We will name Memorial Hospital, Dr. Julie Stone, Dr. Vijay Gupta, and ICU nurse Tracy Miller in a malpractice suit involving the wrongful death of Ivy Jackson.” Venjer appeared apologetic. “But Dr. Torrins is correct. It is early, and we will pursue all the facts and revisit our plans in due course.” He closed his …

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A proximate cause of wrongful death

Why this physician never considered any specialty other than family medicine

Physician
November 27, 2018

I never considered any specialty other than family medicine. I always saw the other specialties as necessary but supportive adjuncts. I always thought that the other specialties were all fascinating in their own way but saw them more as a part of a library that I could access when needed rather than ever feeling the need to delve deep into any specific subject. Specialists were the masters of the marvels …

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Why this physician never considered any specialty other than family medicine

Before ordering a genetic test, get to know GINA

Conditions and Diseases
November 27, 2018

Health care providers and even consumers who order their own genetic testing should really get to know GINA. Who or what is GINA? Is it some new virtual voice-activated personal assistant? Is she a new Italian superstar? Neither choice is correct. GINA stands for the Genetic Information Nondiscrimination Act, a U.S. federal law that was put in place to protect consumers from discrimination based on their genetic testing. GINA celebrates …

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Before ordering a genetic test, get to know GINA

The surprising thing this patient was missing

Physician
November 26, 2018

She had everything she needed.  Her husband had died long ago.  But the fortune he left her would suffice.  She had given up on mansions long ago.  There were no children, so who needed the space?  She was happy as can be in her little condo in the city.  The building had the most lavish pool, exercise room, and views.  She absolutely adored the doormen.  They would let …

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The surprising thing this patient was missing

A medical student as a patient. She thanks her support systems.

Medical Education
November 26, 2018

Two weeks ago, while I was helping with an emergency medicine course that I’m a teaching assistant for, I started feeling extremely light-headed, and the chest tightness that I had dismissed as heartburn earlier that morning got worse. I was tended to by the emergency medicine doctor who I was teaching with, admitted to the ED with a resting pulse rate of 130 beats per minute, later admitted to the …

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A medical student as a patient. She thanks her support systems.

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