Dr. Melos is a gastroenterologist in solo practice in a medium-sized Midwestern city. One day she hears a knock on her door. When she answers, she finds two representatives of Athenian Health System, who request a few minutes of her time. She invites them to take a seat in her office.
After exchanging pleasantries, the visitors get down to business. They extend Dr. Melos an …
What happens when moral physicians stand up to power
Like two ships passing in the night, we sidled up to each other at the nursing station on the hospital telemetry ward. I had already been home, ate with the kids, and returned, while he hadn’t left floors all day. We typed away at our computer stations, and chatted from time to time.
After we exchanged common pleasantries, we jumped into local politics. …
When doctors win, patients are the ones that sometimes lose
“We have an admission.”
The dreaded four words for most interns on a day you are swamped with discharges while trying to get your post rounds orders in.
“Hypertensive emergency and possible osteomyelitis of the foot,” my senior informed me with a few other details as we made our way to the emergency department. Mr. Rodriguez was a very pleasant middle-aged gentleman, with graying hair and a goatee. I introduced myself, explained …
What happens when the best medicine has to offer can’t be offered to everyone?
Eleven billion dollars.
Sounds like a lot of money, doesn’t it?
It is. But, I’ll give you even more perspective, Tony Robbins style.
Eleven seconds ago you started reading this page. A few blinks of an eye. But, eleven million seconds? That was a few months back. 127 days to be exact. Can you remember what you were doing then? Eleven million seconds have passed since you did it.
But, when you jump to billions, you’ll …
Those in charge of EHRs are uninterested in cooperation. How sad.
What does a millennial physician look like? And, importantly for physicians’ groups, hospitals, and health systems, how do you effectively recruit them to come work for you when they are in such high demand?
Much has been written about this generation of overeducated and underemployed young people — all full of entitlement and purpose — who have been transforming values and expectations in …
How to hire a great millennial physician
Recently I have been reading articles regarding the patient experience that I find both stimulating as well as challenging. As the chief experience officer at Massachusetts General Hospital (MGH), you might imagine just how many times these articles are forwarded to my inbox when they are published.
In “The Problem with Satisfied Patients” by Alexandra Robbins in April’s edition of The …
There’s a difference between happy and satisfied patients
So, there I was yesterday, working frantically to keep myself above the water level of the rapidly rising swamp of patients. Navigating, haltingly, the onerous and demonic EMR. So I thought I ordered three nebulizers, but it was only one. The respiratory tech approached me and informed me that she would put them in, but only this time. That I’d have to …
Why should physicians have to enter orders in the computer?
I met my newly admitted patient in the quiet of his private room. He was frail, elderly, and coughing up gobs of green phlegm. His nasal cannula had stepped its way across his cheek during his paroxysms and was pointed at his right eye. Although the room was uncomfortably warm, he was shivering and asking for more blankets. I could hear his …
Listen to patients rather than rely on tests
For all the talk about patient-centered care and a new health care paradigm — which is, of course, the right way forward — the doctor-patient relationship will always remain relatively one-sided because of the nature of the profession itself. Essentially, patients come to doctors for help, and the knowledge transfer, advice, and guidance flows in one main direction.
But that doesn’t mean that …
Patients can teach doctors these 5 things
My young patient was dying as a blood clot under the cover of her brain accumulated and began compressing the fragile tissue within her skull. She needed surgery to remove the clot that would save her life. As the team pushed her from CT scanner to the operating room, it was soon realized labs were missing and were needed before opening her …
Young physicians must take a leadership role. Here’s why.
In the late 19th century, Dr. William Halsted, a pioneer of modern surgical techniques, performed ultra-radical mastectomies for women with breast cancer. The procedure, soon named after him, involved the surgeon removing not only the breast itself but also surrounding musculature and the associated lymphatic system.
Halsted believed, and taught generations of medical students, that the more radical the procedure, the higher the …
Why doctors overtreat patients. And how to fix it.
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
During my third-year internal medicine rotation, I was introduced to and helped care for a patient named Casey (name changed to protect privacy). I identified with Casey because we were the same age, and I felt empathetic toward her situation.
Casey was very sick, a direct result of her risky behavior. She was admitted for infective endocarditis secondary to intravenous opioid abuse. She …
The dilemma of treating patients, based on their contributions to society
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It’s often said that we learn from our mistakes. Indeed, many a business course in leadership offers that premise as a given. I’ve glibly repeated this often in my classes, speeches, and advisory work.
“You don’t learn from your successes,” I point out, “but rather from your errors.” But do we really learn from our mistakes as a matter of course?
My friend and colleague …
How to protect physicians from themselves
People can wear what they want in America. Whether you want to debut the latest vogue or your midriff rife with adiposity, you are free to do so. But just because you can, doesn’t mean you should. In the span of one week, I found two people — on two separate occasions — wearing white coats, each …
Doctors shouldn’t wear their white coats in public. But some still do.
Consider, for a moment, that you are a new physician. A patient, who is a lifelong smoker, comes to your clinic complaining of shortness of breath, and after conducting several tests you diagnose him with chronic obstructive pulmonary disease (COPD). Relying on your training, you prescribe medications, arrange for follow-up visits and describe activities that can help him better manage his breathing …
Here’s a hospital taking patient engagement one step further
Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision-making in the ICU in a large survey published in JAMA Internal Medicine.
About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1 to 7 scale. Doctors and nurses considered the largest barriers to end-of-life …
Doctors and nurses need to be better trained in palliative care
In the past, physicians were responsible for both the business and practice of medicine. While administrative personnel played an important and complementary role in practice and hospital management, physicians were the cornerstone. In comparison, today the leadership structure in medicine is now an entirely foreign landscape. Administrators dominate medical practices today and, according to the New York Times, …
Rise of the administrators: Hasta la vista, docs
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?
Imagine an institution where the occupants are routinely left immobile, deprived of sleep and fed a diet that is tasteless and nutritionally marginal. Imagine further that they experience the indignity of losing any semblance of privacy and get stuck multiple times a day with needles.
Sounds like a brutal prison, right? Yet the same description could apply to a typical U.S. hospital.
As …
How hospitals can kill. Here’s what we can do about it.
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