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Physician voices
"Doctor, it's taken so long to get this appointment with you!" This is the opening line of so many medical visits, and I find myself constantly apologizing to my patients on behalf of our system. After the pandemic-induced lull in…
“Doctor, it’s taken so long to get this appointment with you!” This is the opening line of so many medical visits, and I find myself constantly apologizing to my patients on behalf of our system. After the pandemic-induced lull in routine medical care, we’re right back where we started—doctors booked for months, patients struggling to get appointments.
The difficulty with access to medical care is endemic to our …
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Getting an appointment with primary care is the Achilles’ heel of medicine
Physician voices
At this point in the COVID vaccination campaign, nearly all American adults who want the vaccine have gotten it, and are gratefully snapping up their boosters. Those who decline vaccination are largely impervious to public service announcements, community pressure, and…
At this point in the COVID vaccination campaign, nearly all American adults who want the vaccine have gotten it, and are gratefully snapping up their boosters. Those who decline vaccination are largely impervious to public service announcements, community pressure, and case counts turbocharged by the Omicron variant.
Public health experts emphasize that primary care doctors and nurses are the key to this last mile of the vaccination effort. …
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Emotional epidemiology of disease is as critical as clinical epidemiology
Physician voices
An excerpt from When We Do Harm: A Doctor Confronts Medical Error. One of the selling points for the electronic medical record (EMR) was that it would be a boon for patient safety. Just having all the medical records in…
An excerpt from When We Do Harm: A Doctor Confronts Medical Error.
One of the selling points for the electronic medical record (EMR) was that it would be a boon for patient safety. Just having all the medical records in one place is a monumental improvement over the days of lost charts and misplaced X-rays. Avoiding errors from inscrutable handwriting has no doubt saved lives.
But EMRs can …
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Does the EMR improve or worsen patient safety?
Physician voices
We have two ears and one mouth so we can listen twice as much as we speak,” said Epictetus. It’s clear that the Greek philosopher wasn’t a physician in 21st century America. If you watch doctors — and many researchers…
We have two ears and one mouth so we can listen twice as much as we speak,” said Epictetus. It’s clear that the Greek philosopher wasn’t a physician in 21st century America. If you watch doctors — and many researchers do — they speak more than listen.
Studies have shown that doctors interrupt or redirect patients within the …
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A positive visit with a patient with chronic pain
Physician voices
In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 -- a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings…
In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 — a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month.
This is such a familiar story by now that it hardly makes …
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The ethics and money in medicine
Physician voices
An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press. The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code…
An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press.
The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code 411, cardiac arrest, MICU.” The operator chanted the mantra over and over with studied deliberativeness, as though there were even a snowball’s chance in hell that I hadn’t heard …
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Fear is a primal emotion in medicine
Physician voices
Every illness is unique, and every person faces illness in his or her own way. Anna Deveare Smith, in her one-woman Broadway show "Let Me Down Easy," slips into the persona of twenty individuals who have faced an aspect of…
Every illness is unique, and every person faces illness in his or her own way.
Anna Deveare Smith, in her one-woman Broadway show “Let Me Down Easy,” slips into the persona of twenty individuals who have faced an aspect of illness or death. In ninety minutes, Deveare Smith takes the audience on an existential scavenger hunt, allowing us to observe, and occasionally pluck, insights from this gathering of individuals.
These individuals do …
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Let Me Down Easy and facing illness and death
Physician voices
The waiting area in Bellevue Hospital was full. Every chair was taken. But the people kept streaming in. More chairs had to be brought in. It wasn't clear if the room could accommodate everyone. This wasn't the emergency room or…
The waiting area in Bellevue Hospital was full. Every chair was taken. But the people kept streaming in. More chairs had to be brought in. It wasn’t clear if the room could accommodate everyone.
This wasn’t the emergency room or the clinic waiting area, however. It was the scene of the Bellevue Literary Review poetry and prose reading. More than 100 people poured into Bellevue Hospital on a Sunday evening to …
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A poetry reading at Bellevue Hospital
Physician voices
Every year US News & World Report publishes its rankings of the nation’s top 50 hospitals. Hospital administrators await this top 50 report with a tension and fervor that rivals the NFL first-draft pick. As soon as the report is…
Every year US News & World Report publishes its rankings of the nation’s top 50 hospitals. Hospital administrators await this top 50 report with a tension and fervor that rivals the NFL first-draft pick.
As soon as the report is released, snippets rocket their way into donor appeals, local hospital signage, and highway billboards. “Ranked X by US News & World Report” becomes a descriptor that is supposed to …
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US News hospital rankings too subjective and encourage self-promotion
Physician voices
It’s been more than a decade since the seminal report “To Err is Human” by the Institute of Medicine. The report made waves when it estimated that 1.5 million people are affected by medical errors and that nearly 100,000 die…
It’s been more than a decade since the seminal report “To Err is Human” by the Institute of Medicine. The report made waves when it estimated that 1.5 million people are affected by medical errors and that nearly 100,000 die annually as a result of medical errors. Some of those numbers have been debated, but there is no doubt that medical error is a significant issue in medicine that needs …
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The emotional resistance to admitting error cannot be legislated away
Medical education
How many hours can a doctor work? The residency regulators are back. About ten years ago, the national organization that accredits residency programs (ACGME) set out its first guidelines about how many hours a doctor-in-training can work. Interns and residents…
How many hours can a doctor work?
The residency regulators are back. About ten years ago, the national organization that accredits residency programs (ACGME) set out its first guidelines about how many hours a doctor-in-training can work. Interns and residents finally achieved the vaunted 80-hour workweek. New York State was 15 years ahead on this, having mandated an 80-hour work week in 1989, stemming from the Libby Zion case.
Every patient wants …
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The 80 hour resident work week balances fatigue and independence
Drugs and prescribing
A good chunk of every medical visit is spent writing prescriptions. Before we had an electronic medical record, this was often an arduous task, leading to serious writer’s cramp. Now the computer makes it easier on the doctor, but it…
A good chunk of every medical visit is spent writing prescriptions.
Before we had an electronic medical record, this was often an arduous task, leading to serious writer’s cramp. Now the computer makes it easier on the doctor, but it doesn’t seem to have much effect on the patient.
A recent article in the Journal of General Internal Medicine highlighted what most doctors have suspected all along, that a good chunk for …
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Be skeptical of natural and herbal supplements
Drugs and prescribing
Good health is only affordable—for the majority of the population—if it is covered by insurance. An excellent case in point is the vaccine for shingles (herpes zoster). Shingles is the revisiting of the chicken pox virus. The virus lives in…
Good health is only affordable—for the majority of the population—if it is covered by insurance. An excellent case in point is the vaccine for shingles (herpes zoster).
Shingles is the revisiting of the chicken pox virus. The virus lives in the body since the first episode of shingles as a child, and then flares up during later adulthood to give shingles.
Shingles is rarely life-threatening, but it is immensely painful and debilitating, …
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Shingles vaccine is limited by cost and coverage
Physician voices
Locking the entrance to the emergency room: there could not have been a more potent image to the final day of St. Vincent’s Hospital in New York City. After 160 years, St. Vincent’s closed because of financial problems. It was…
Locking the entrance to the emergency room: there could not have been a more potent image to the final day of St. Vincent’s Hospital in New York City.
After 160 years, St. Vincent’s closed because of financial problems. It was the only hospital serving Greenwich Village and the last Catholic hospital in Manhattan.
The closing of a hospital can feel like a death in the family. A hospital is a stalwart member …
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St. Vincent’s Hospital closes, and Greenwich Village suffers
Health policy
Counting calories as part of health care reform—who knew? But apparently it’s there on page 455 of the health-care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will…
Counting calories as part of health care reform—who knew? But apparently it’s there on page 455 of the health-care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will now be a national effort at posting calorie counts in chain restaurants.
There are many ways to improve the overall health of Americans, but tackling obesity is surely one of the …
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Calorie counts in health reform is significant for patients
Health policy
A recent article in the New York Times noted a steady migration of doctors from private practice to hospital-owned health systems. The main driving force appears to be economic, that it is too difficult to run a business, especially when…
A recent article in the New York Times noted a steady migration of doctors from private practice to hospital-owned health systems. The main driving force appears to be economic, that it is too difficult to run a business, especially when much of that entails fighting multiple insurance companies for reimbursement.
Some of the older physicians interviewed expressed “puzzlement” at younger doctors who chose salaried positions rather than private practice, with the …
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Salaried physicians become more politically progressive
Patient voices
When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into…
When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.
It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical …
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Poetry that your patient can appreciate
Social media in medicine
There is a veritable epidemic of doctor-writers out there. What is going on? Are doctors suddenly in the kiss-and-tell mode? What about confidentiality? Professionalism? HIPAA? As one of the aforementioned doctor-writers, I look upon this trend with both awe and…
There is a veritable epidemic of doctor-writers out there. What is going on?
Are doctors suddenly in the kiss-and-tell mode? What about confidentiality? Professionalism? HIPAA?
As one of the aforementioned doctor-writers, I look upon this trend with both awe and trepidation. I suspect that that this flourishing literary phenomenon relates to the public’s fascination and fear about all things medical. It also relates to the falling away of previous, pedestal-like images of …
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Telling a patient story and the issues facing physician writers
Patient voices
“Je m’a…,” I stuttered to Aristede Mezondes, the serious young man in a grey wool overcoat, standing before me with ramrod posture. “Je m’appelle Dr. Ofri.” There. I’d gotten it out. The language of Descartes, Voltaire, and Balzac had clearly…
“Je m’a…,” I stuttered to Aristede Mezondes, the serious young man in a grey wool overcoat, standing before me with ramrod posture. “Je m’appelle Dr. Ofri.”
There. I’d gotten it out.
The language of Descartes, Voltaire, and Balzac had clearly vacated my cortex. Despite those years of French classes and one brief visit to Paris, “Je m’appelle” was the best I could come up with. And even that was a struggle. Pushed …
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Talking to a patient, without a translator, in mutual non-native languages
Physician voices
Public hospitals have a bad rap. They’re viewed by many as hospitals of last resort, and most patients with private insurance do anything to avoid them. As a long-time physician in a public hospital, I’m sensitive to this reputation. I…
Public hospitals have a bad rap. They’re viewed by many as hospitals of last resort, and most patients with private insurance do anything to avoid them.
As a long-time physician in a public hospital, I’m sensitive to this reputation. I wouldn’t work in my hospital if I didn’t feel that it delivered excellent health care. I’m certainly aware that private hospitals have amenities that public hospitals can’t afford, but many of …
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Public hospitals are the unsung jewels of our healthcare system
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