Four years ago after moving back to Iowa City, I needed to find a new primary care doctor. I went to the University’s website and scanned the list of general internists. There I noted a physician that I had known when she was a medical student during my prior stint at the University of Iowa 20 years prior. She had been an amazing medical student, very bright, hardworking, conscientious, and …
The pathologic manifestations of professionalism
The face of a 2-year-old Honduran girl, dwarfed by the adults who only appear as legs in the photo, communicates undeniable anguish. Used to represent the horror of children separated from their parents at the U.S.-Mexico border, the photo became a lightning rod for controversy when it turned out that this particular child was not actually separated from her mother. In an interview for CBS News the border patrol officer involved …
When family separations become a threat to existence
So out in the varied land of hospital medicine, I have noticed something that I have no clear explanation for. It turns out there is often a gap in productivity between that of NP/PA providers and physicians. The range of the gap varies wildly – I just got off the phone with a group leader who has observed a 50 percent difference to a smaller gap of perhaps 10 percent. …
NP/PA vs. physician: Why is there a productivity gap?
If Atul Gawande’s first week as CEO of a health care startup was anything like mine, I hope he is able to get away from it all and enjoy a completely relaxing weekend. He will have earned it.
After Gawande was named to head the joint venture between Amazon, Berkshire Hathaway, and JPMorgan, some critics said that choosing …
Health care needs more physician CEOs
One of the most contentious areas of health policy over the past two decades has been the safety of vaccination. Vaccines prevent the outbreak of diseases that used to be widespread, like polio, and scientific consensus strongly supports their safety. Yet many Americans refuse or delay the vaccination of their children out of fear that it could lead to autism, even …
Vaccine opponents think they know more than medical experts. Why is that?
“Expressers significantly underestimated how surprised recipients would be about why expressers were grateful, overestimated how awkward recipients would feel, and underestimated how positive recipients would feel.”
– Undervaluing Gratitude: Expressers Misunderstand the Consequences of Showing Appreciation
The past 30 days have been unusual because of the number of professional gestures of gratitude I’ve received:
As part of my job as an anesthesiologist, I get called to truly horrific airway events. Sometimes they are down in the emergency department after a bad car accident, drowning, or burn. Others are in ICU’s. Sometimes they are even in hallways or bathrooms where people have stopped breathing or collapsed from cardiac arrest. It’s part of the job.
Recently, I was called to an airway in an ICU in what …
After you die, what will your legacy be?
How smart do we want our electronic health record to be?
Somewhere between as dumb as a piece of paper and a pen, and too smart for our own good.
Many, many years ago, before we spent the majority of our office visit staring at a flatscreen LED and typing away, our charts were simple manila folders with those bendy metal bars that allowed you to insert new pages, separated into multiple …
Love smart functions in your EMR? This doctor doesn’t.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 46-year-old man is evaluated for intermittent rectal bleeding of 3 months’ duration. He is otherwise well and takes no medications. His father had a few polyps removed from the colon when he was 71 years old, but no other details are known about his father’s medical history. The patient and his wife …
MKSAP: 46-year-old man with intermittent rectal bleeding
A patient with progressive neurologic disorder had a gastrojejunal tube placed for feeding. In a nursing home, the tube fell out and was replaced with a Foley catheter. He was sent to the hospital for placement of a new tube. When he arrived in the interventional radiology suite, the Foley catheter was not visible. A new gastrojejunal tube was successfully placed, and the patient was sent back to the nursing …
Why medical errors can never be completely eliminated
When did it become a bragging right to say that you only get four or five hours of sleep a night? We would think it is ridiculous for someone to brag that their labs came back with only half the normal hemoglobin level as we would recognize that as clearly unhealthy. So when did we start equating sleep-deprivation with some kind of superpower? Does it make sense for our society …
The surprising secret to mental wellness
Engaging in an economic conversation about the conventional compensation of a physician leads one to believe that doctors are well-to-do. In the minds of most citizens, school-tuition board members and even local neighbors, if you’re a physician the presumption is that you are economically prosperous, maybe even rich. This sociological assumption probably sounds false to most whom honorably don the white coat. Perhaps a decade or two ago, when medical …
A case for paying doctors more
My last operative day was October 15, 2009. My last attempt at getting to understand my group disability policy was on May 10, 2018. I’m a disabled anesthesiologist who lost his career when my left median nerve stopped functioning properly. I had two disability policies, a private and a group. My dealings with these two companies have been day and night.
My group insurance carrier hammered my dignity for years. In …
A physician’s group disability nightmare
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In a matter of less than a decade, “shared decision-making” (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere. Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been …
Is there a case against shared decision making?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …
MKSAP: 55-year-old woman with an eating disorder
Today’s news is full of commentary about work requirements for Medicaid. Is work a prerequisite for health care or is health a prerequisite for work?
Not to complicate things, but can we even agree on what health care is? I don’t think we can, and it largely falls back on what we want to share in paying for.
A patient with an ugly skin lesion can have it removed if it might …
Balancing stewardship and entitlement in health care
No one can predict the future, but when making projections for things like retirement planning, what investment return should you expect?
What do we mean by “investment return?”
Before we get into the numbers, we need to go through a few definitions.
Nominal returns vs. real returns
These are just fancy words for before-inflation and after-inflation returns. Real returns (after-inflation) returns are equal to the nominal returns (before-inflation) minus the inflation rate. Real returns …
What type of returns should you expect from the stock market in the future?
CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”
As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction. To me the most important change is a focus on notes: “Allowing medical decision making to be …
A return to the problem-oriented SOAP note
The word “historic” is often used by PR professionals to hype something that is, well, pretty run-of-the-mill. They figure that no one is going to read a news release that announces “[Name of organization] proposes small change that really won’t make much of a difference.” The problem is that when something is done that really measures up to being historic, the recipient is less likely to believe it, kind of …
Medicare’s historic proposal to change how it pays physicians
I’m a creature of habit. My first activity every day is to read the New York Times. Depending on my schedule, some days I read more articles than others. This week I was away at a conference and found myself with some early morning extra time before the first meeting session, so I delved into the Arts section. I began to read the first article: “Women …
What is proper work attire in medicine?
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