Recently, I received a phone call in the late afternoon from someone very close to me. Please note that this someone is also a doctor. “Uh, I need you for a minute. I’m kind of freaking out. Can I talk to you?”
She had just gone to her local optometrist to get a new prescription for glasses. The optometrist looked in her eyes, told her that both of her optic nerves …
Communicating urgently without scaring patients
If you had to pick a single metric to a measure a hospital, which would you choose?
Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …
What is the best metric to measure a hospital?
All patients should be treated with professionalism and respect. We all want our patients leaving our care happy, healthy and satisfied, if at all possible. However, sometimes patients don’t leave an emergency department very happy or satisfied. Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the …
The focus on patient satisfaction is enough to make you sick
Consider this scenario. Your clunker is on its last legs, and it’s time to get a new car. Most likely, you’ll search product reviews to help you decide which make and model is best — best according to people who’ve driven them and kicked the tires a bit, not based on company accolades. You’ll want to know what drivers think. Amazon.com does the same thing for books (and every other …
Keep your government hands off my EHR
Recently, an ancient sculptural masterpiece has been on temporary display in the Metropolitan Museum of Art’s Greek and Roman halls. On loan from Rome’s Museo Nazionale Romano, “Boxer at Rest” depicts a battered pugilist immediately after a fight. His face bears evidence of broken nasal bones, swelling and hematoma under his right eye, and multiple lacerations and abrasions to his nose, cheeks, and forehead. One secret …
Boxer at Rest: A physician’s interpretation
I was saddened earlier this week to read, first on Facebook as posted by his son Daniel, that Michael Palmer had passed away after suffering a heart attack and then a stroke, while going through customs in New York on the way back from a trip to Africa. Many of you know Dr. Palmer as the bestselling author who wrote medical mystery thrillers like “The Sisterhood” in 1982, …
Michael Palmer: A doctor first, in the truest sense of the word
In March of last year I began and quickly ended a cycling career. In my first race of the weekend I placed second, and in a moment of hubris felt emboldened to reach for more.
In the second race, the very next day, I signed up for a higher category. The race was tougher, and I got stuck behind the pack, which slowed immensely around turns. In an effort to advance, …
The outrageous ER markup for a tetanus shot
My daughter loves her career as a probation officer. She is very good at what she does, and finds the work both challenging and rewarding. Yet her client case load includes some of the most unsavory of individuals, found guilty by the courts of child abuse, domestic violence, sexual assault or worse, many of them living with added complexities like addictions or mental health issues. She’s been insulted and screamed at by …
Physician burnout: Don’t blame the patient
Sometimes it’s difficult to practice what I preach. But I try.
A couple of weeks ago, I spent the evening in the emergency room with our youngest son (don’t worry – he’s fine). I hate going to the ER, but every once in a while circumstances necessitate it. I called doctor friends in the relevant specialty, as well as our son’s pediatrician, to confirm the need for the trip. They said to …
Handling the delicate balance as an ER patient
Our health care system is broken and in dire need of reform. We all know the statistics: the U.S. spends $2.7 trillion on healthcare, 30% of which is waste in the form of unnecessary tests and unnecessary treatments. Conflicts of interest are rampant, with 94% of doctors reporting an affiliation with a pharmaceutical or device manufacturing company, and many more insidious influences including salaries being tied to productivity. Dozens of studies have shown …
Who’s my doctor? The total transparency manifesto
Ask physicians if our messed up malpractice system causes them to practice “defensive medicine,” and most will probably say yes — hard not to be paranoid with so many lawsuits affecting so many physicians. Some experts even contend that major reforms of our malpractice system could go a long way towards controlling spiraling healthcare costs. On the other hand, if you ask physicians whether they ever order unnecessary tests …
It’s hard to get a handle on the true costs of defensive medicine
He looked ahead, seeing his feet on the hearth. There was smoke rising from one of the three logs, and he marveled at the small flicker of flame that stretched up and ignited the smoke that swirled above the log, dancing briefly somewhat joyously, then gone again, smoke returning.
“You can’t say you weren’t warned,” she said.
He sat, reflecting on her words. So much years of work, so much effort, breadwinner, …
After a lifetime in medicine, where did the time go?
Former South Carolina Senator, and current Heritage Foundation president, Jim DeMint recently angered supporters of the Affordable Care Act by stating that uninsured patients will “get better healthcare just going to the emergency room,” than they will receive through Obamacare.
That’s a sweeping assertion. However, the ACA supporters offended by Sen. DeMint need to understand the supreme irony that without America’s emergency departments and their dedicated personnel, the ACA will fall …
Emergency departments will remain a safety net for decades to come
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What ever happened to courage?
Jim came through the cholecystectomy beautifully. In fact, he did so well that in no time he was back on the basketball court. Three weeks later he was in my office with a sore, swollen leg. He thought it was from twisting his ankle the day before. And indeed, it had all the appearances of a sports injury. I examined the extremity carefully, and decided to get …
Physicians have lost their backbone
Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one …
What an old doctor taught me about palliative care
As a nursing student, I have always enjoyed the opportunity to see firsthand new procedures, treatments, wounds, and wound care on patients. Many of the patients were older and resided in the nursing homes where we conducted our clinical rotations. It was not unusual for several of us to gather around a patient while the wound care nurse or doctor cleaned, debrided, and dressed a pressure ulcer. For us students, …
Our patients are more than the sum of their parts
I have been a loyal patron of the Karma Hair Salon in New Haven, Conn. for at least the past 15 years. Whenever my hair looks good, it is thanks to Karma and owner Cheryl McMahon’s expert attention to my unruly head (the thickness of my hair — a good problem, I know! — could give a yak envy; and I have more cowlicks than several small countries). If ever my hair doesn’t look …
Medical training is a product of willful preparation
“Sticks and stones can break my bones, but words can never hurt me.” I learned this saying when I came to America, but before that, I learned a different story. A wood cutter got lost in the forest, it was getting dark and cold. He met a bear, who offered him to come to his den. The man entered and said “It stinks in here!” The next day the woodcutter …
Our words leave the most lasting impression
An excerpt from Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.
At last through the broken windows, the pulse of helicopter rotors and airboat propellers set the summer morning air throbbing with the promise of rescue. Floodwaters unleashed by Hurricane Katrina had marooned hundreds of people at the …
Life and death in a hospital ravaged by Hurricane Katrina
All people are gifted. As an emergency room physician, I see a wide variety of gifts, such as yodeling, knitting, and swearing (mostly swearing). One gift I rarely see is math. As a whole, the U.S. sucks at math. When compared with other nations, the U.S. ranks 32nd in math (though first in confidence). Despite this, we expect mathematical coherency …
Reinventing the pain scale in the emergency department
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