I’ve always likened the job of a primary care physician to that of a chief executive officer of a small business. Family doctors manage the “business” of delivering and coordinating care for more than a thousand patients at an average cost, in the United States, of $8,500 per year: an $8 to $12 million business. Because the actions or inactions of the PCP impact the need for, and cost of, …
Both physicians and CEOs need time to think
One of my best friends recently sent me an article from the Wall Street Journal discussing the generation that is about to enter into retirement. The article highlighted how this generation will have an unacceptably high proportion of people who are unable to retire. Following a generation that had guaranteed pensions, this left them with the reassurance that they would someday have one, too. Left ill-prepared for retirement, this …
Learn from the prior generation that left little for their own retirement
Learners value efficiency. As I recall my residency, nothing caused more angst than unnecessarily long rounds. In the 1970s just like in the 2010s, I had much to do after rounds ended.
As an attending physician, my responsibilities involve patient care and aiding learning. I have always worked hard to do that within a time constraint. The time constraint requires that rounds run efficiently.
Like many things in medicine, efficiency only works …
When attendings come to work rounds
Repercussions.
Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave.
Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients that there is “something else that we have to do,” we often see it open up a …
Why are we treating outpatients like inpatients?
In March 2018, The Collaborative for Healing and Renewal in Medicine (CHARM) published an article titled “Charter on Physician Well-being” in JAMA. The piece describes guiding principles and lists recommendations for promoting well-being among physicians. The charter successfully pulls together, in a 2-page document, a comprehensive approach to preventing burnout and fostering well-being among physicians.
One recommendation especially caught my attention. “Anticipate and Respond to Inherent Emotional Challenges …
Why physicians need disclosure coaching
As a primary care doctor who cares for many patients with opioid-use disorder, I am invested in timely and effective strategies to curb our nation’s opioid epidemic. Because so many instances of opioid addiction and overdoses begin with or involve commonly prescribed opioids, we need multiple strategies that address the significant harms associated with prescription opioids.
I am skeptical of one strategy, however: The President’s Commission and the Food and Drug Administration are …
Are abuse-deterrent opioids the solution to the opioid crisis?
Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is …
The social determinants of a physician’s path
My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound.
Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my medication-assisted treatment (MAT) patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma, and various infectious diseases.
Years ago, working in …
The satisfaction of Suboxone treatment
My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader.
Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a …
Guidelines, multiple specialists, and the science versus the art of medicine
You can tell a lot about a job and the people doing it by asking them to describe their best day at work. For Ali, a 28-year-old pediatric cancer social worker, that day occurred one year ago. A 17-year-old cancer patient who had been given two months to live made a bucket list. On her list were graduating from high school and getting accepted into college. So Ali and her …
Social workers are medicine’s unsung heroes
When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for …
Reading the body language of your patients
I got together this past weekend with a few of my medical school classmates and ahhh, the memories. Being in the trenches together, just like in residency, tends to create a bond that remains throughout time. We picked up right where we left off and talked about the good ol’ times, how life used to be, and how it is so different now, especially because we now all had families.
That …
A medical student’s side hustles
The tragedy on a New Jersey highway in May involving a school bus and a dump truck horrified the nation while also raising familiar questions about school bus safety. The impact ripped the body of the bus off its chassis, killing two people and injuring most of the 45 passengers on board. By one witness’s account, “A lot of people were screaming, and they were, like, …
Belts or no belts on school buses?
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Even though my own internship was a decade ago, I vividly remember the transition from student to resident. Residency was monumental in my path to becoming a physician. There were obvious changes: People now called me “doctor,” my misshapen short white coat was upgraded to a more comforting full length one, and I was often the first one paged to respond to patient problems. Coupled with the positive aspects though, …
How to thrive during your residency
An 8-month-old baby fell 3 feet and hit his head on a carpeted floor in a San Francisco hotel room. He was crying and the parents, who were from South Korea, called an ambulance. By the time the child arrived at the hospital he was obviously fine. After a bottle, a nap, and a few hours in the hospital, he was discharged.
The hospital sent a bill two years later, which …
Why is trauma activation so expensive?
As of now, twenty-nine states have legalized medical marijuana use and eight have legalized recreational use. The debate rages on about legalization, but the actual effects of cannabis get much less attention. A huge issue is that cannabis can be both helpful and harmful for a wide range of symptoms and conditions, and currently, the research is incomplete. But the barriers to actually study this substance are …
Everyone knows that the process of applying and getting accepted into medical school is highly competitive. Last year, 51,680 people applied for seats in U.S. medical schools. Collectively, they submitted 816,153 applications — a whopping 16 applications per person on average. Only 21,338 applicants matriculated to a U.S. school last fall, or 41 percent of applicants.
So how do the admissions committees evaluating all these applicants make their …
Getting beyond the numbers in your medical school interview
Dear Doctor,
Please help me understand why so few of you have chosen to treat people with opioid addictions.
I’ve been following the topic of opioid addiction for years. It is one of the most common themes for First Opinion submissions. Authors routinely point to the importance of medication-assisted therapy, the standard of …
Why do so few doctors treat people with opioid addictions?
Opioid use has reached epidemic proportions over the past decade, becoming one of America’s highest-priority public health issues. With opioid abuse spiraling out of control, lawmakers, regulators, and health professionals are scrambling to better understand key drivers of this issue and develop an effective action plan. Although the devastating impact of opioids on families and communities is well known, less focus has been given to how it affects the workplace …
How employers and plan sponsors can save the U.S. workforce from opioids
Never touch your hair. It cannot be down, and it cannot look fancy. Optional styles include bun, ponytail, or braid. I might as well shave it off! I hear you thinking it – we’ve all thought it – but it’s wrong. The only thing worse than looking like a woman that’s too hot is looking like you’re not a woman at all. Woman? Sorry, I meant girl.
Never touch your phone. …
Female physicians: You’re lucky to be here
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