A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary emboli. Emboli occur most often when a blood clot in the veins of the legs breaks off, travels through the right side of the heart, and gets stuck …
More information does not equal better care
Mitt Romney’s “let them eat cake” comments on 60 Minutes serves to illustrate how badly both sides of a political debate can confuse an issue. In 2010 he criticized emergency room care as a potential loophole used by people to get “entirely free care” while avoiding having to pay for health insurance and in his book No Apology, the Governor outlined the idea behind Massachusetts health care …
ER utilization shouldn’t be a measuring stick for health care reform
When I was a resident physician, I had the coolest classmates ever. We worked together, laughed together, learned together and many of us stay in touch to this day. Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush-pilot/fishing guide and one an amateur mountaineer.
But one of the things that united us, one …
Emergency physicians who love their guns
Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad.
I’d be interested to know how customer satisfaction played out in my home. “Kids, now you’ve had a week of school-work. Please fill out the attached survey …
Is customer satisfaction in healthcare a gateway to corruption?
Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with …
Preparing for your doctor’s visit: 10 things to always bring
Faith. A simple word with complicated meaning. It is a seed buried deep within our spiritual cores, ready to be nourished and blossom with the sprinklings of tragedy. It is a belief that things will work out, despite our lack of vision for fate’s secretive reasons of the bumpy journey we must endure. It is an inherent hope that has either sustained us or has failed us miserably. Yes, to …
I have seen faith present its various faces many times
Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave. This was one of those cases.
One hectic morning before my shift, my wife and I rushed around the house trying to get our kids ready for school. On this day, my daughter was to go on a field trip where the teachers would walk the kids through the city to the local …
My worst nightmare was not coming true, someone else’s was
Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are. Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
– Johnathan Blaze
It is generally agreed upon that the more one values a good or service, the …
To the patients who resent greedy doctors
Emergency Physicians Monthly has an important debate between ACEP President David Seaberg and EP Monthly founder Mark Plaster about the “Choosing Wisely” program.
Choosing Wisely is being pushed by the ABIM Foundation as a way to get specialty societies to label certain tests as “unnecessary” or of questionable benefit.
I side with Dr. Seaberg in this argument.
I disagree with the concept some people advance …
Reduce health waste through deregulation and free market principles
As emergency physicians who are trained in acute resuscitation and thrive in high-stress situations, we tend to roll our eyes at the less acute complaints our patients come in with. “Back pain for three months? Headache for a week? Why are they here now?”
Patients, too, complain about this. “Can’t they see it’s not a real emergency and go see their primary care doctor? This must be costing our healthcare system …
My flirtation with the ER has made me more sympathetic to patients
1. A 40-year-old female sees her family physician for burning chest pain after she eats hot peppers. She had it only once while exercising. Her family physician sends her to the emergency department and she gets admitted for chest pain. Rather than going home with treatment for her GERD, she ends up dead. This never should have happened, but the family never learns what really killed her.
2. A 33-year-old father of …
Cause of death: Defensive medicine
I am guilty of neglect.
I’ll admit it. I’ll own it. I’ll embrace it.
When I am doing a consult now for one of many hospital emergency rooms, I am sent a pretty standard package of history, nurses notes, doctor’s assessment, physical exam report, lab results and other information that I review prior to actually seeing the patient on the screen and doing my own assessment. Now, on a day like today, …
When patient histories start to blur
I remember a short lecture I received in my medical officer’s course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their service. The topic was appropriate documentation in the medical record.
Among the notable examples of what not to do was this gem, written by a medical officer about another officer’s wife: …
Speak the truth, document the truth: To do otherwise is malpractice
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An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections.
On the surface, it kind of makes sense – one should be punished for making a …
Why punishing medical mistakes won’t make patients safer
I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills …
Doctors are practicing irrational medicine at the end of life
It turns out that the practice of medicine is just common sense. If someone has fallen and their hip hurts, it is probably related. If someone does not have an infection, do not give an antibiotic. Exercise and good food are, well, good for you. If it is not broken, do not fix it.
Usually, patients understand this basic idea. The best chance of becoming and staying healthy is the simplest …
When patients stray from the common sense approach to health care
As an emergency physician, I tend to work on the other side of preventive care services. I see what happens when women don’t know about safer sex and birth control, and end up with complications from sexually transmitted infections. I see what happens when women do not get routine screening for cervical cancer and struggle with life-threatening cancer. I see what happens with out-of-control hypertension and diabetes, and the heart attacks and strokes that …
The well woman visit: An easy way to obtain preventive services
Imagine this scenario. A young child is playing in the yard when her pet dog bites her face. Bleeding, the child is rushed to the ER and the doctor offers to suture up the child’s face.
A parent will probably ask for a plastic surgeon to suture the face instead of the emergency room doctor.
As such, the plastic surgeon is called in and sutures up the face beautifully.
The child and family …
After the ER visit, the financial nightmare begins
While the typical physician is now accepting of the IT changes that are intruding into their work environment, he often does not understand the reasons or the strategic underpinnings for the push for the digitalization of health care. Being a typical modern consumer, he understands smartphones, online shopping, and email, but doesn’t understand concepts such as clinical data repositories, data warehouses, decision support and business intelligence. Analogies can help, but …
What health care can learn from the military
The names of things often greatly affect our perception. In end of life lexicon, there is a movement underway to change the name of the medical order DNR (do not resuscitate) to AND (allow natural death). No change in the medical reality of what occurs, but a radical change in our emotional reaction to the each term.
DNR: “They withholding a medical intervention” (evoking negative feelings).
AND: “They are giving care that …
Artificial death extension: It means that I actually care
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