We have come a long way in medicine, treating serious illnesses and preventing life-threatening diseases. As a hospital-based physician, I treat various severe diseases every day throughout the ICU, medical, and surgical floors. On a normal day, I roll at a fast pace — admitting, treating and, discharging patients has become fairly routine for me. On any given day, we have an …
You may not remember me, but when I asked how you were, you said, “alive.”
A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that we’d see you again soon. Then you coded on the table. I’ve never met someone who was grateful for life the way you expressed to me that day.
You may not remember …
You may not remember me, but you changed me
Hospital transport arrives to take my daughter just after 9am. We’d been told her ultrasound and x-ray were scheduled for 10am, an hour away. Jess and I exchange a look. She’s just about to take another swig of the laxative drink she’s been drinking since 8:30.
“I’ll go with you,” I say.
“We’ll make sure there’s a bathroom nearby.”
Strike one for the Golden Cocoon.
We get to the ultrasound department, and are left …
The gratitude of a terrified parent when kindness is shown
“I don’t want a tube down my nose. I’ve been through it before and I don’t want it again.” Charlie turned his head away from the team and crossed his arms in defiance. “I’d rather be sick.”
I looked at the intern, who looked at the resident, who just said, “Well, think about it. We’ll be back in the afternoon.”
“I’m also hungry and haven’t eaten in days,” Charlie added.
“Maybe some food …
Each patient is still human and deserves to be treated as such
The importance of sleep is perhaps most realized when we become sick. When we are hospitalized and most in need of every ounce of health, though, hospital care practically guarantees that we won’t get good sleep. Fortunately, two approaches hold promise to improve sleep for patients: one organizational, and the other a common trick of the trade among those of us working in behavioral economics.
Recently I was all-too-miserably reminded of …
Hospital care practically guarantees that we won’t get good sleep
“Got a new admission for you. 93-year-old male with end stage kidney disease on dialysis, coronary artery disease, hypertension, diabetes, peripheral vascular disease here after being found unresponsive. Oh by the way, I think he’s DNR/DNI.”
It’s like music to the ears of any medicine resident. I’m still not entirely sure why this phrase brings such relief, but I’m in my last year of residency and still exhale a little bit …
Reflecting on DNR/DNI after being a code team leader
I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing with delight once I’m gone, thinking, “I really pulled one over on that rube!”
And so it has come as somewhat of a shock to me that medical care has become …
Turning health care into a giant used car lot
Unplanned readmissions to the hospital have been the focus of much attention in recent years for obvious reasons. First, they are relatively easy to measure using administrative claims data. Second, like all inpatient hospitalizations, they cost a lot of money–and are therefore a target for reducing spending. Third, they are a proxy for quality of care, as at least some portion of them are likely avoidable if the hospital does …
Is the hospital readmission rate a measure of quality?
Nearly every hospital leader in America will tell you their hospital is all about patient-centered care. Of course, we know this isn’t true in many cases, especially when it comes to hospital capacity management. Though many institutions will deny to its last dying breath that they have any priorities that supercede patient care, nearly all do.
They usually go like this: first priority is high margin surgical cases; second priority is …
Is your hospital leader committed to patient-centered care?
A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society. One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years. This is more along the …
How should the workplace accommodate women physicians?
Here’s a thought experiment presented a recent conference on healthcare consumer advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but not all, of the cost. How do you choose which hospital to go to?
At the moment, there is very little information for you to make such a decision. Many people will choose …
Choosing a hospital: What is most important to you?
I recently completed my last day as chair of the ABIM, and ended my eight-year tenure on the Board. In this blog – a bookend to the one I wrote at the start of the year, which went near-viral – I’ll describe some of our accomplishments this year and a few of the challenges that I leave my talented successors to grapple with.
I had two very tangible tasks to …
Dr. Wachter reflects after completing his term at the ABIM
In October of 2011, I left my job of 17 years, which I loved, mostly, and started a 2 year sabbatical. Since sabbatical implies that there is one year of rest every 7 years, I have built up at least 2 years since finishing medical school in 1986. Nobody in my office or medical community did sabbaticals, but we discussed that it would be a great idea when we first …
Why doctors should take sabbaticals
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Patient safety and hospital quality is a scary topic. I’ll go easy. I’m just a doctor. I don’t know much.
Entire departments, filled with cubicles, computers and well-meaning people, now exist to keep hospitals tightly regulated and running perfectly. There is data to analyze, regulations to read, and oh so many meetings to attend. This place of healing will be safe—and perfect.
The …
Does alarm fatigue really kill?
Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.
Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …
4 complaints of physician employees and 1 solution to fix them
I have been spending time at an academic medical center lately and I’m noticing some obvious flaws in our method of shaping the doctors of the future.
When I went to medical school I was trained by physicians who were eminent in their areas of specialty and also did some research. They taught in classrooms and as attending physicians when we were working on the wards as doctors in training. I …
How should we be training the next generation of doctors?
If I had to choose the way I could die, I would probably like to go peacefully in my sleep. It seems that Nelson Mandela no longer has that option. He may have had, and perhaps even been on that trajectory when he was rushed to hospital in the middle of the night more than two weeks ago. It would not have …
Nelson Mandela: His doctors and nurses also need our thoughts
It’s not exactly Dr. Jekyll and Mr. Hyde, but everybody knows my level of patience varies from time to time. So I was surprised to find myself happily telling the emergency room that I would assess the patient shortly. The kids were horsing around on the playground, and I knew I would have to call my wife and ask her to come home. It would be my second 45 minute trip to the hospital on …
Medical students: Embrace the joy now before it’s too late
Getting your appendix out can cost between $2,000 and $180,000. Hip replacements run from $10,000 to more than $100,000. Hospitals, we have also learned, frequently mark up the price of cotton swabs and routine X-rays by 300 or 400 percent, with most patients oblivious to the reason their health care bills are so large.
As a response to the hidden variability in health care prices, an increasing number of states have …
Will health care price transparency help reduce costs?
For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale.
Many years ago, as I was growing my cardiology practice, it became evident that diagnostic services for my specialty, like stress tests and echocardiograms, were done less efficiently and cost more at the local hospital, than in the office. This stimulated many groups in the …
A cautionary tale of employing doctors
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