An excerpt from The Choice: Medicine vs. Nursing.
An extensive amount of data now exists in the science of choice. Social researchers such as David Kahneman and Dan Ariely have conducted numerous experiments which suggest a number of ways in which humans are led …
The choice between medicine and nursing
Tele-empathy is not being empathetic over the phone. It is not crying in the sad parts of your favorite TV show. It is not beaming empathetic thoughts magically across time and space. No, tele-empathy is a technology. I should rather say, it’s a group of technologies recently being created to increase the empathy of health care providers. “This is rich,” you might say coming from an industry that brought us …
New technology might help us become more empathetic to others’ suffering
It is one of the most boring truisms on the planet: “Practice makes perfect.” It is also one of the most misleading. Practice merely ingrains certain patterns after deciding on the best course of action after constant criticism and problem-solving. Performance requires that the body forget the work required to ingrain the pattern and let the pattern happen. Performance requires that we drop all criticism and technical considerations. These two …
Does practice really make perfect?
Attention graduates! If you’re looking for a career with a ton of job prospects, look no further than an international classification of diseases coder. This fun and fulfilling career will take you into new worlds of diagnosis, laterality, specificity, and nitpicky-ness as you dive into thousands of columns of numbers and qualifiers. You’ll even get to call doctors and harass them anytime you want. Sign up for your free brochure …
ICD-10: No wonder why doctors are burnt out
Ladies, the moment you have all been waiting for is here! No, not affordable childcare. Not equal pay for equal work. Not gun control. Not abortion rights or paid maternity leave or a female majority in Congress or a constitutional ban on the words “chick lit.” Girls, it is so much better than all that. We got pink Viagra!
Flibanserin. Catchy name. Addyi for short. Approved by the FDA for hypoactive …
The FDA approved Addyi. But was there a hidden agenda?
Fifteen months ago, the Federal Drug Enforcement Agency, or DEA for short, began an investigation in four states: Alabama, Arkansas, Louisiana, and Mississippi. The DEA was looking for illegal drug trafficking, as they do. But they were looking for prescription drug dealers, not Columbian drug cartels. And they found them. They are doctors.
Forty-eight people were arrested, seven of them doctors. DEA …
It’s time for pain doctors to step it up
Out-of-context quote of the day: “We have no malls and no Walmart. Recruitment is nearly impossible.”
These astonishing statements were made by Elizabeth Nelson, a nurse practitioner in Nebraska. She was not talking about teenage summer jobs. She was not talking about professional Walmart greeters, addicts of cheap stuff made in China who want an employee discount, or people who really like Cinnabon. …
Go fund a physician rather than fight nurse practitioners
Humans are social creatures who naturally evaluate where they stand in relation to those around them. I have no idea how this evaluation process evolved, but at some point we noticed that some cavemen brought more food to the cave than others. The idea was born that some people are better hunters than others. We’ve been trying to decide who is “better” ever since.
The origin of the word “test” comes …
Tests in medicine and public schools: What do they really measure?
A few weeks ago I wrote a piece about performance metrics in medicine. People asked me: “Well, if you don’t like the metrics, what would you use?” So I thought about this, and the best way I can think of to explain what I mean is to use an example from a different field: education.
Standardized testing has become ubiquitous in schools. …
Doctoring to the test. Look to education for a cautionary tale.
I have been blogging now for about three years, posting once or twice a week and accumulating 240 posts. I have my little flock of loyal readers and have managed to contribute a few drops in the ocean of the health care policy debate. But just this month two pieces made some bigger waves, one ending up briefly fluttering about Twitter, …
Why the chasm between doctors and patients? It’s all about money.
New York officials are doing an “experiment” that should strike fear, anger, and outrage in the hearts of doctors who take care of Medicare patients. (New York has the highest Medicaid budget of any state.)
As any doctor who has a high volume of Medicaid patients knows, Medicaid pays practically nothing. Doctors who take Medicaid usually have to carry a bigger patient load to survive. Medicaid patients are often sicker than …
Accountable care for Medicaid. No, we need real solutions.
Medicine is obsessed with numbers. Or rather, journalists and medical administrators are. Here are two related examples of how large a grain of salt one must put on numbers.
Cardiac surgical procedures, like everything else in medicine, have quality indicators. One of these is what we doctors call “30-day mortality.” What this term means is that surgeons are evaluated in part on how many of the patients they operated on died …
The obsession with numbers in medicine: It’s time to stop
I was talking to a colleague of mine yesterday. (At least I flatter myself that I am a colleague. He has a writing job at a prestigious magazine while I, well, don’t.) We were talking about the doctor-patient relationship, as is our wont, and he said something that stood out to me as the quintessential statement of patients’ expectations about doctors.
It …
Patient expectations lead to unhealthy relationships with doctors
In order to interpret the world, we tell ourselves stories. All day long. About everything. That guy in the grocery store who clipped your heels with his cart? A jerk. The car that cut you off at that intersection? A jerk. A little old lady stopping in the middle of the aisle at the grocery store? Senile.
It is automatic, it takes no effort, and it is completely egocentric. It is …
It’s important that we get our stories right
Recently I wrote about the problems with maintenance of certification requirements. One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.” Here’s a quote from the online journal produced by Accenture, the management consulting company:
Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because …
Patients are not customers. Here are 6 reasons why.
Last week, my best friend took the recertification exam in anesthesia, the so-called MOCA exam. Like a good doobie, she paid her $2,100, paid her nanny extra so she could study, took a day off in which she missed the funeral of a friend’s husband, and took the test. Wow, she must be the most awesome, most well-read, most skilled, most …
Do you want a doctor or a demotivated test-taking machine?
When we perceive any object of a familiar kind, much of what appears subjectively to be immediately given is really derived from past experience.
– Bertrand Russell, The Analysis of Mind
I’ve learned a few more things about Stephen Pasceri, the man who murdered a cardiovascular surgeon in Boston recently. He had money troubles involving credit card debt. He declared bankruptcy at one …
When patients’ anger leads to murder
This week the local and national attention has been riveted on accusations that Bill Belichick and the Patriots football team deliberately deflated the footballs used in the division championship game. Football, remember, is a multi-billion dollar industry in which the commodity being sold is grown men throwing brown, oblong balls at each other and knocking each other down. Boston.com, a …
After a doctor’s murder: All you hear about is deflated footballs
When I was in nursing school there was always a lot of eye-rolling when it came time to discuss nursing diagnoses. This was mostly because nursing diagnoses were followed by book-length nursing care plans that we had to produce for various imaginary patients. There was also a faction, including myself, who thought a medical diagnosis was just fine, thank you, no need to reinvent the proverbial wheel.
For example, for a …
The profound wisdom of the nursing diagnosis
A front page entry in a recent issue of Anesthesiology News: “Physicians Versus CRNAs: Redefining Roles in the Changing Landscape of Health Care.” Sounds like a prize fight or a gang war: Crips vs. Bloods. I immediately got my boxing gloves on, readying myself for another bout of vitriol and dislike thinly disguised as concerns for patient safety. But the author, Michael DeCicca, a second-year anesthesia resident, surprised me.
He writes: “Logically the number …
MDs and CRNAs: Highlighting each other’s expertise
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