Following a relatively routine doctor appointment, I received my bill for over $1,000. I rubbed my eyes, hoping to find an overlooked decimal point. I didn’t.
My experience is not unique. We have a problem in the U.S. We pay over $3 trillion annually for health care — about 18 percent of our GDP. No other developed nation spends more than Read more…
3 reasons why health care costs are rising
Patsy loved playing bingo every Wednesday night. Her boyfriend of three years loved watching her daughter Jenna who was a tiny and pretty six-year-old her momma called “princess.”
Even though they weren’t related, Jenna called Patsy’s boyfriend “Uncle Billy” at her mother’s behest.
And Uncle Billy made Jenna shyer and quieter than she usually was. He’d walk in on those Wednesday nights and demand a big hug and kiss on the cheek …
I’ll never forget the eyes of a 6-year-old sexual assault victim
If patient-centered care is the current winning game plan for health care, then shared decision making (SDM) is the secret weapon. But we physicians need a new way to approach it.
SDM, as defined by the Society for Medical Decision Making, is “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patients values …
A new approach to shared decision making
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This open enrollment season, patients will be considering their health care coverage for the coming year. To ensure they are fully utilizing their primary care benefits and building relationships with health care teams that will keep them healthy, we need to encourage them to connect with a primary care practice or medical home.
A medical home is a place where a patient can seek treatment from primary care physicians and other …
Prioritize primary care this open enrollment season
Scourge:
Introduction
They say you never forget your first time. I remember mine, vividly. If only I could erase the memory. I had high expectations and higher hopes, but what I got was disillusionment. I felt violated and humiliated. I’m talking about my first time using a system for electronic health records …
The scourge of electronic health records
While doing my doctoral dissertation research at a clinic for kids with diabetes, I observed the attachment that some of them had to the physician faculty member who directed the clinic. I particularly remember one teenager who complained that this doctor “did not care” about her, as he sent “fake doctors” (residents) to take care of her, not coming himself. She was refusing to cooperate. When I suggested to the …
The doctor-patient relationship is everything
Triage Note: Fish hook in eye. No bleeding. Tetanus up to date.
It’s a sunny weekend during cottage season. A young woman is rushed into the ER as she cups both hands over her left eye. She’s in shorts, and flip-flops, and she’s hyperventilating. Her friends follow, hands similarly cupped over their mouths. I read the triage note. I’ve never seen this before. I’ve removed dozens of fish hooks — it’s …
The case of a fish hook in the eye
Healthy or not, everybody has his or her share of frustrations in life. The chronically ill don’t have a corner on that market! This piece focuses on frustrations that are unique to those with ongoing health issues. I’ve experienced all of them as a result of being chronically ill with a debilitating illness that settled in after I contracted what appeared to be an acute viral infection in 2001.
Here are …
The most frustrating things about being chronically ill
A guest column by the American College of Physicians, exclusive to KevinMD.com.
As part of my role in International Programs at the American College of Physicians (ACP), I have a unique opportunity to travel frequently and engage with internists around the world. In fact, I am writing this while almost 7,000 miles away from home, …
Physicians share same mission across cultures and countries
I was recently interviewed on a podcast and was asked the simple question, “Why are you in medicine?” In retrospect, that’s the exact question I silently ask myself in frustration and exhaustion a little bit too often while I’m in the hospital. In those moments I recognize that I feel burnt out. In those moments if someone told me that I had to repeat intern year in order to finish …
Periodically we should reflect on what challenges face patients and physicians. Over the past few days, I have worked on a list of the issues that concern me the most. I welcome suggestions for expanding the list.
1. Diagnostic errors. All patient care requires that we make the proper diagnosis. Too often we make errors. A recent paper estimated that 30 percent of cellulitis admissions did not have cellulitis. A similar …
These are the biggest medical issues of 2017
Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate …
Who’s really to blame for the obesity epidemic?
He struggled to hear when people talked to him. He asked the same questions over and over. He fell asleep when really important conversations were going on around him.
But it wasn’t until he missed an emergency call that I knew I had to act.
I spoke to a higher-up about this elderly doctor out of concern for patient …
Reporting an elderly doctor. And suffering from snitch guilt.
Many physicians have become world famous writers, and in Greek mythology, Apollo was the god of both poetry and medicine. I can personally think of many prominent physician writers I have come across in my reading over the years:
There was the 12th-century rabbi Maimonides, Copernicus in the 15th century and the poet John Keats in the 1700s.
In the late 1800s to early 1900s, there were Anton Chekhov, Sir Arthur Conan …
EMRs are robbing physicians of their writing skills
Mrs. Smith is an 81-year-old female. She worked a long time doing very physical work and is now on a fixed income and comes to my office with chronic pain. X-rays show she has degenerative arthritis in her hips, knees and lumbar spine. She has taken Norco twice a day for years and has been able to be very stable on this. She has always been compliant with her medications. …
Don’t let the opioid crisis affect the treatment course for your patients
My job as a standardized patient (SP) at several different medical schools means that I spend a lot of time being interviewed and examined by students at every stage of their education. Occasionally, the interview is of such a nature that the SPs are told to dress in a certain “costume” because it signifies to the student that there is something about our cultural representation that affects our medical care. …
Are cultural sensitivities affecting care?
How important is it for a doctor to want to be a doctor?
At first glance, that question is ludicrous. The path to becoming a practicing physician is so long and tortuous that no one would do it if they didn’t want to. Right? First, there’s the four years of undergraduate education, then four years of medical school, then at least three years of residency. No one has ever suggested that …
Why do doctors who hate being doctors still practice?
October is the epitome of academic conference season. Returning home, suitcase laden, and a belt-hole wider from lost promises of exercise, and plans to “watch what I eat” while on the road, I am ready to get back into my routine. All the same, I come back refreshed by a new flavor to the mundane routine of conference experiences past. At the three conferences that I attended this fall, women …
Women as leaders: reflections from the conference trail
My young daughter will be entering middle school in another year. However, she still likes coloring books. If she watches a scary movie, I have to lay with her in bed until she falls asleep.
She is still just a kid. Should I really be worried about HPV? Is this something you should consider for your daughter?
As an OB/GYN doctor, I know about the HPV virus and have seen so many …
Why your child should get the HPV vaccine
Measuring metrics is a common catch-phrase in health care. The goal of capturing certain data is to improve patient outcomes. But, as doctors, we were taught to treat the patient and not the numbers. While optimizing clinical outcomes is a needed goal with all the complexities in medical treatment currently, the system seems to have gone too far in its quest for targeted numbers.
If, for example, a patient suffers metastatic …
Good doctoring transcends numbers
