As an Air Force family physician and faculty at a family medicine residency, it was my job periodically to lead an inpatient team of young family medicine residents and medical students. That particular morning seemed like any other — half a dozen new admissions, total census of a dozen or so, and a few new consults. And it was my habit to …
Every patient has an unexpected and special story
I take a deep breath as I get ready to go see Mrs. H. I can predict after sign-out from the ER doc where this is likely to go. Mrs. H. is an 87-year-old woman who comes to the emergency room with weakness. She stumbled and fell to the floor but could not get up to reach the phone to call …
Please, can this patient be just a little more sick?
We have all seen the statistics; America is an aging country. The baby boomer generation is retiring, and families are having fewer and fewer children.
In health care, we often hear about this issue in the context of an inadequate health care workforce. An aging population in conjunction with the ACA has created a quickly growing pool of patients that outpaces the slow growth in the supply of health care providers.
But …
A geriatrics-driven health care system
I’m walking very slowly with my dad down the produce aisle at the local supermarket, past the colorful waxed apples, Mexican mangoes and Rainier cherries, and imagining my life’s blood trickling onto the floor from an invisible wound.
As I pass by the misting system spraying the bins of green, red, yellow and orange peppers, past the lady reaching for carrots, past the stock guy balancing the heirloom tomatoes into a …
I inwardly watch my life’s blood flow away. And no one notices.
I was a first-year medical student, starting my first afternoon at an outpatient clinic as part of an introductory course in clinical medicine. My white coat was freshly washed; I had a rainbow of pens in one coat pocket, and my shiny name tag dangled from the other. I only hoped that I was as prepared as I looked.
I entered Mrs. Carr’s room. A fifty-five-year-old woman, she sat gingerly at …
Sometimes, the very best medicine is a listening ear
Loss is something all humans face in their everyday lives. As a physician, the effects are often magnified. People die, they move away, they graduate from your services, or occasionally they pursue care elsewhere. Parting can sometimes bring relief, and others a deep sense of failure. But with Clara, I’m not sure we actually parted. Mostly, I was left with confusion.
Clara came to me by way of the nursing home. …
I lost a patient, but gained a friend
Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that?
Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren …
A house call is worth a dozen tests. And then some.
It was a rather unlikely place to begin my clinical career.
Shortly after starting medical school, I signed up to volunteer in the hospice unit of my academic medical center. The first few visits I relegated myself to fairly banal activities. I shredded old medical records, or I might do a load of laundry for a family member who had been waiting tentatively by their loved one’s side and was …
Remembering the humble profession of taking care of each other
Home health care is in many ways a fantastic service, especially for those Medicare beneficiaries who are essentially homebound due to frailty or illness.
But it often feels surprisingly hard to synergize with home health care.
The main problem, as I see it, is that home health care agencies have set themselves up to provide only administratively required communication with the ordering doc. (There are rules governing home health care, you know!)
Now, …
The problem with home health care communication
Check.
The administrator’s voice wavered as I picked up the phone. He was calling about the nursing home patient that I admitted the day before. While normally forthright, I could feel the discomfort in his tone as he danced around the issue. The patient’s insurer had called. Apparently they made an “arrangement” with the mega-ACO owned by the latest consolidation of Goliath health systems. They wanted my patient transferred to another …
Health care monopoly: How it affects the nursing home
Ruth was problematic. Well into her seventies, her body may have dulled but her tongue was sharper than ever. And she used it to lash me with complaint after complaint. If it wasn’t her knees, it was her ankles. If it wasn’t her ankles, it was her hips. I battled the impossible month after month, year after year. Our interactions left a bitter taste in my mouth. Nothing makes a …
The lack of joy at the doctor’s office, and a reason why
I had a recent conversation with an old friend about her elderly father that encapsulates a lot of what is both great and terribly wrong with health care in America today.
Here are the basic facts: the man is in his mid-80s, retired from teaching school, and is active and vigorous, living in the community; he is cognitively intact. He has a …
A case that illustrates the good, the bad and the ugly of American medicine
All health care professionals must be skilled at effectively communicating with patients who have dementia. Some professionals may erroneously assume that only those employed in long-term care, assisted living facility, and other similar places need these skills. However, patients with dementia visit medical practices, acute care hospitals and other health care centers. This article will provide a framework to effectively interact with patients who have dementia.
Go along to get along
This …
How to communicate with patients who have dementia
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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
More than 75 percent of operations in the U.S. occur in an outpatient setting. Outpatient, or ambulatory care, can take place in a number of different settings, including physician offices, outpatient surgery centers, or hospital or non-hospital-based outpatient clinics. With more and more elderly patients undergoing outpatient …
Outpatient anesthesia in elderly patients: What to watch for
American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers: government or private. It turns out this medical marketplace game is not all that new. It’s just become wilier, as I have shared in a couple of posts over the summer.
An obituary last week for Dr. Rashi Fein, an influential economist with a …
Question why your relative needs to be at a rehab facility
She was sick. Not sick like a high fever, body aches and a runny nose. Sick like she had spent the last half a decade in nursing homes as most of her internal organs failed. There was oxygen, and dialysis, and a colostomy. She propelled herself vigorously through the crowded halls in the custodial wing of the nursing home, her wheelchair a natural extension of her body thoroughly unhampered by …
What personal responsibility means to a physician
She was nearing the end of a long and interesting life. Her birth was announced on the party line in her rural community’s first telephone system. Her death, which would come soon, would be shared on Facebook and via cell phone. She had graduated with a degree in home economics from the University of Minnesota in 1938 and had worked for a meat packing company during and after World War …
A question you can never prepare for
Mrs. D was my last patient. I retired several months ago, and for some time prior I informed my patients so as to give them time to decide where they would like their follow-up care.
Mrs. D was an elderly lady who I first met in the ER several years prior after a fall resulting in a displaced ankle fracture. She was pleasant and alert, understanding everything I was explaining after …
A physician’s last patient before retirement
We were intimate.
As intimate as a doctor and patient can become. He had long outlived his wife and there were no children, no family, just friends. When he first came to me he was lively and active, but the years took their toll. Our visits became more regular. Every six months. Then every three.
His memory started to slip. Occasionally he would look at me suspiciously when something went wrong. His …
Sometimes doctoring reveals my failings as a human being
As every physician already knows full well, health care services delivered to the home rather than in an institutional setting are increasing, a trend destined to expand even faster in the decades ahead.
This shift is inevitable, thanks to our rapidly growing elderly population and the corresponding prevalence of chronic illness, along with the nationwide push for higher quality care at lower cost and dramatic advances in medical technology such as …
6 major myths about health care at home debunked
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