Every so often you have a patient in your practice that you sort of know, but really don’t. You’ve seen the name somewhere, but your mind draws a blank when asked about him. You may even have a vague idea of what he looks like, but if he were to bump into you on the street, you won’t even recognize him, despite the fact that you’ve been inside his heart …
The long, tragic odyssey of a HMO patient
A friend of mine, a diabetic who has been pretty passive about his medical care, suddenly learned the importance of patient engagement a few weeks ago when a matter affecting his pocketbook grabbed his attention. A bill arrived from Express Scripts, the pharmacy benefit manager (PBM) for Emblem Health, a Medigap plan offered to former New York City employees.
For years my friend had been taking the drug gemfibrozil that diabetics …
The rise of generic drug prices: It’s tragic for patients
He had called the other day to update me up on his condition. He did not sound upset, but resolute. “They offered me peritoneal dialysis,” he said, “but I decided against it and figured I’d just let nature take its course. The hospice people are so wonderful — I’ve got things all set here at home, but I have two questions. What should I do about my warfarin? You know, …
The last visit: Turning off the defibrillator
The ALS wave has finished sweeping the nation, resulting in a flood of over $100 million raised to fight a devastating disease which is actually quite rare. Now that gallons of ice water have drenched American’s bikinis and trunks, we should be asking ourselves two questions. First, does everyone really understand more about the disease now that the challenge is over? Second, and more importantly, what lessons can we learn …
Apply the lessons learned from the ice bucket challenge
Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks.
Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ …
Medical reversals: When wonder drugs become harmful
The dark underbelly of health care is becoming all too visible now.
Fresh faces in neatly pressed white coats are in the halls. Eager. Enthusiastic. Clearly very bright. All hoping for a moment, an experience, an encounter that makes all their hard work worth it. Surely they’ll have one, but not before the thousands of keyboard clicks, the mandatory lectures, rounds and lots of lengthy, lonely call nights.
He was a doctor …
Doctors have to learn to play the game of numbers
Searching for health and fitness apps on the iTunes app store turns up approximately 2,200 results. There are calorie counters, activity trackers, heart rate monitors, virtual fitness coaches and every other conceivable permutation.
The quantity should grow even larger thanks to Apple’s latest product release, the Apple Watch, a wrist wearable computer that tracks health and fitness information. One question, though: Are the users of these apps any healthier as a …
Why health apps fall short and how to fix them
As a recently retired physician, I still maintain an interest in medical research, though I have to ask myself: Why? Surely not just from the point of view of a potential future patient. But not from the point of view of a practicing physician either. Perhaps I keep up just from a lifetime of habit? Or is there something I miss about my old job?
These thoughts came to mind as …
What does this retired doctor miss about medicine?
After you’ve written on a blog for a long time, you begin to ask yourself why. Oh sure, there are the great opportunities for a single person to make a point, to act as a tiny tugboat trying to push a corporate mothership in a slightly different direction, but you begin to realize that there are very few times that actually …
“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be ‘too active.’ Later he would tell me that it would have been “like putting a pillow over your father’s head.”
These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her …
Deactivating a pacemaker: Is it euthanasia?
“Doctor, what do you think of alternative medicine?” a patient with chronic fatigue syndrome asked me the other day. She was interested in doing something more for her severe fatigue. “Would acupuncture help me?”
I paused and, as I have done many times before, answered that my training and most of my clinical experience has been in Western, allopathic medicine. (Ironically, the word “allopathic” was first used as a derogatory term …
Alternative medicine: There should only be one standard
An excerpt from Doctored: The Disillusionment of an American Physician.
After the blowup with Rajiv, I committed myself to changing my standoffish ways. Rajiv had been urging me for some time to meet socially with his physician friends in a relaxed atmosphere away from the hospital, and so there I was a few weeks later at a doctors’ party in Manhasset, a tony …
If a doctor doesn’t do excess testing, he isn’t going to be able to live
As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, “Where to teach?”
I do not mean to imply a geographic sense to the word “where” (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a “level.” What level do I teach our residents …
The desire to spoon-feed medical residents today
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My brother and I, both optometrists, had a heart-to-heart discussion about the loss of one of our patients. We discovered he was not taking his medications as prescribed, which was leading to vision loss. When pressed, the patient said he had a choice of eating, supporting his family, or purchasing his medication.
He was under the impression that the $150 price for his generic Lipitor was “about the same” at any …
Price shop your prescriptions to dramatically reduce costs
MedPage Today recently tackled a very controversial issue in medical practice. The piece explored the ongoing battle between dermatologists and allied health professionals (AHPs) over the performance of dermatologic procedures. As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice.
According to the Read more…
The health care turf battles: It’s time to work together
He left a little early to stop by the cath lab to see his patient before her procedure. Cordial “hellos,” “good mornings,” and “any last questions?” were mentioned before she signed her consent. The team was working feverishly to prepare her for her procedure. “Have you met the anesthesiologist yet?” was next, and almost on cue, the anesthesiologist arrived and took over for a bit.
He hurried upstairs to the conference …
This is what lifelong learning in medicine should look like
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs.
On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal …
MKSAP: 21-year-old man with a heart murmur
“Dad, you have the nicest patients!”
She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what’s important in medicine. In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives.
It had been over ten years since I had my first “bring your daughter to work” experience. Her first time …
Bring your daughter to work: A reminder of what’s important in medicine
“Daddy, I think we have a flat tire.”
I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting.
How could she possibly know what a flat tire sounds like? Now? Right now? She’s …
Chest pain and what we can learn from changing flat tires
No medical resident looks forward to working night float. The initial glamour of doing chest compressions in the rising light comes up against a litany of administrative tasks. As the glamour wanes, the gulf between the objective curriculum and actual practice widens. On paper, residents learn how to manage acute emergencies and learn deeper clinical reasoning. Actual practice, or the “hidden curriculum” of training, can be a different experience, involving …
Learning from the lessons of night float
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