Popular TV doctor, Gregory House’s favorite adage about patients is: “Everybody lies.” I used to believe that this was a cynical and inaccurate statement, but I had to revisit it recently when faced with a patient whose signs and symptoms were consistent with a diagnosis that she vehemently denied.
A young woman was admitted to my rehab unit with brain damage of …
Why patients lie to physicians
As a traveling physician, I’m often asked if I have a favorite place to work. Since I have licenses in 14 states, I have an unusual vantage point from which to compare hospitals. I know that people who ask this question presume that my answer will be heavily influenced by the town where the job is located, and all the associated extra-curriculars, environmental peculiarities (ocean, mountains, desert), and potential amenities. …
Do not underestimate the importance of liking your peers
Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient …
It’s time to think about how we’re affecting patient morale
A physician friend of mine posted a copy of her Medicaid reimbursement on Facebook. Take a look at the charges compared to the actual reimbursement. She is paid between $6.82 and $17.54 for an hour of her time (i.e., on average, she makes less than minimum wage when treating a patient on Medicaid).
The enthusiasm for expanding Medicaid coverage to the previously uninsured …
Treating Medicaid patients is charity work. This bill proves it.
In my last blog post I discussed how harmful physician “thought leaders” can be when they are dismissive of the value of other specialists’ care. I must have touched a nerve because a passionate discussion followed in the comments section. It seems that physicians (who spend most of their time engaged in clinical work) are growing tired of the leadership decisions of those who engage in little to no patient care. …
It is time to stop specialty prejudice
It’s no secret that medicine has become a highly specialized business. While generalists used to be in charge of most patient care 50 years ago, we have now splintered into extraordinarily granular specialties. Each organ system has its own specialty (e.g., gastroenterology, cardiology), and now parts of systems have their own experts (hepatologists, cardiac electrophysiologists) Even ophthalmologists have subspecialized into groups …
Friendly fire from physician thought leaders
I once wrote about the communication difficulties caused by electronic medical records systems. The response on Twitter ranged from sentiments including everything from “right on, sister” to “greedy doctors are only complaining about EMRs because of their price tag.” The disconnect between policy wonk’s (and EMR vendor’s) belief in the transformative power of EMRs and exasperated clinician users of these products is jaw-dropping. Physicians are often labeled as obstinate dinosaurs, blocking progress, while policy wonks …
What happens to medical notes today’s EMRs
Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or …
5 ways how doctors can round with nurses
Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. …
Physician goes first: A way to not interrupt patients
I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal handoff process at shift change resulted in a 30 percent …
Disciplined physician communication saves lives
I recently treated a patient who was hospitalized with paraplegia. During some routine lab testing I noticed that his liver function tests were elevated, and so I began looking for a cause. I discussed the patient’s drinking habits (he rarely drank alcohol), risks for viral hepatitis (no IV drug use or exposure to those with known hepatitis), and general medical history (nothing relevant to liver disease). I reviewed his current …
A surprising cause for acute hepatitis in the rehab unit
Judging from recent articles, surveys, and blog posts, the medical profession is remarkably demoralized. Typical complaints range from “feeling like a beaten dog” to “living in humiliating servitude,” to being forced to practice “treadmill medicine.” Interestingly, the public response to these complaints is largely indifferent. The prevailing attitude (if the comments sections of online articles and blog posts are representative) seems …
Patient appreciation: Why I still love being a doctor
As a physician who openly despises many aspects of current EMRs (see “How An EMR Gave My Patient Syphilis” or “The Medical Chart: Ground Zero For The Deterioration Of Patient Care” ) I recognize that they are here to stay. And so, since we’re all stuck with these digital middlemen, I have some suggestions (based on popular social media platform functionality) …
5 things EMRs should learn from social media
Health screening is part of good preventive care, though over-screening can lead to increased costs, and potential patient harm. Health care professional societies have recently developed excellent public service announcements describing the dangers of over-testing, and new research suggests that though additional medical interventions are associated with increased patient satisfaction, they also lead (ironically) to higher mortality rates.
And so, in a system attempting to shift to a “less is more” …
A physician is now biased towards over-testing. Here’s why.
I am a regular reader of patient blogs, and I find myself frequently gasping at the mistreatment they experience at the hands of my peers. I recently had the “pleasure” of being a patient myself, and found that my professional ties did not protect me from outrageously poor bedside manners. I suppose I’m writing this partly to vent, but also to remind health care professionals what not to do …
Dealing with physicians who have lost empathy and compassion
Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness.
When you ask patients what quality is most important in a …
What is the most important trait in a doctor?
If you (or a loved one) have been admitted to a hospital recently, you were probably surprised by the number of times you were asked the same questions. At first you might assume that the staff are being diligent in double-checking your information, but after the fifth healthcare provider asks you to explain why you’re there, you start to feel as if interacting with “the system” is like talking to …
Excessive turnover in inpatient care can wreak havoc
In an effort to promote transparency in healthcare, the Association of Health Care Journalists (AHCJ) has published a database of recent hospital deficiencies discovered by Medicare and Medicaid inspectors. They then highlighted 168 reports containing the phrase “immediate jeopardy.” This, of course, piqued my interest as I presumed that hospitals who were putting putting patients in “immediate jeopardy” must be some pretty bad actors.
After sifting through the hospital names, I …
True patient safety cannot be regulated
In an effort to save on human resources costs, some hospitals have decided to make locum tenens* doctors and nurses line items in a supply list. Next to IV tubing, liquid nutritional supplements and anti-bacterial wipes you’ll find slots for nurses, surgeons, and hospitalist positions.
This depressing commoditization of professional staffing is a new trend in health care promoted by software companies promising to solve staffing shortages with vendor management systems (VMS). In …
The problem with vendor management systems to solve staffing shortages
As I travel the country providing coverage for inpatient rehab units, I have been struck by the generally high quality of nursing care. Excellent nurses are the glue that holds a hospital unit together. They sound the first alarm when a patient’s health is at risk, they double-check orders and keep an eye out for medical errors. Nurses spend more time with patients than any other hospital staff, and they are therefore …
Optimize nurse partnerships to improve patient care
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