People like to think the worst about doctors: We don’t listen, we don’t care, we only want your money. But, the truth is we do care, and that is why most of us answered the calling to become doctors. That is why the burnout rate for doctors is so high.
Patients hate to wait in the waiting room for too long. But, truth is, I sometimes need to take a break …
The doctor inside never truly rests
Today I had a followup appointment with a young adult male with severe intellectual disabilities. He is barely verbal. Several weeks ago his caregiver told me that this young man often pointed to his chest and would say “hurt” or “heart,” they weren’t sure which. He also seemed to have gotten pickier about his food, and would literally pick at the food on his plate as if examining it. His …
When patients can’t tell you their symptoms
Seven years ago, I officially became a doctor. After years of hard work, sacrifice and insecurity, I finished my residency and passed my board certification exam in internal medicine. I was a fourth generation internist in my family and was so eager to begin my career in a new city with my fiancé. My first job out of residency seemed perfect. I had a set outpatient schedule, administrative support, and …
A new physician experiences the opioid crisis
An excerpt from How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers (Second Edition). Copyright 2018 by Toni Bernhard. Excerpted with permission from Wisdom Publications.
The fifth way I cultivate compassion for myself is to consciously work on opening my heart to the intense emotions …
Open your heart to your suffering
I am recalling a workshop on unconscious bias from last year, the moderator hands outpatient prototype profiles to each table of participants. Ours is a glossy paper with a color photo of our patient, Jane, and a clear outline of her type of employment, hobbies, interests, family members, religious beliefs, and how she prefers to receive information. This strikes me as very clear and succinct, calling attention to many of …
Thorough documentation can be weak representation of patients
Value remains one of the most widely invoked and variably interpreted concept in American health care delivery. Beyond patients, stakeholder groups across the health care ecosystem are undertaking value-based initiatives, including payers (e.g., value-based insurance design and payments), provider organizations (e.g., value-based care redesign), pharmaceutical companies and pharmacy benefits managers (e.g., value-based pricing and formularies), and private companies (e.g., value-based technology assessment).
This trend highlights a critical point: Discussions about value …
Lessons from the meeting of different value-based concepts
In academic medicine, promotion depends on the weight of our curricula vitae, measured primarily by the number of papers we publish in peer-reviewed journals. Physicians strive to jump through the hoops of publishing their work in “top” journals ranked by the “impact factor” (yearly average number of citations for a given journal). Yet the “impact factor” of these journals — even those considered most prestigious and most impactful — is …
Why academic medicine needs to value physician contributions to online platforms
To paraphrase Bill Gates: “The purpose of humanity is not just to sit behind a counter and do things. More free time is not a terrible thing.”
I have innovated. I developed a mutation assay. I discovered that vacuum ultraviolet light from excimer lasers is safe to use on human tissue. I invented an imaging device to detect burn wound depth and discovered the best laser to debride burn wounds. I …
EHRs are killing medical innovation
First of all, many osteopathic medical schools are located in underserved areas — or as underserved as possible while still having enough of a medical community to make training possible. My school, LMU-DCOM is located in the middle of Appalachia, for example. Osteopathic medical schools generally encourage students to specialize in primary care, at least as much as they can, considering that our health care system is not …
Explaining what osteopathic medicine is
The medicine I practiced between 1974 to 1992 is gone. Evidence is the coin of the realm in the courts of modern medicine. The rule “first, do no harm” demands a corollary — be paranoid.
We receive extensive training and licensure to “touch” patients. Any person who is not a physician who cuts into another person commits a very serious crime. The same is true for merely talking with a person, …
Care but don’t touch: Being wise in the modern era
Recently, a generally healthy friend of mine had two small, unrelated surgeries over the course of a few months. For the first, a small operation on his hand, he received a prescription for 30 oxycodone pills. He used one the night after surgery, to make sure pain wouldn’t wake him. Over the next few days he used a few over the counter acetaminophen tablets for his modest discomfort, and then …
Take a close look at the number of opioid pills you’re prescribing
Non-clinicians skip over some of the most necessary underpinnings of doctoring and speak too much about housekeeping issues: blood pressure targets, aspirin use, mass screenings, immunization rates and so on.
People without medical degrees could do those things. But there are steps that must be taken before we worry about the measurables. These are the essence of being a physician, what people ask for when they come to see us. Most …
Primary care does what Google can’t
Some days in medicine seem like an epic saga in which the world seems to be playing whack-the-doctor. It is easy to vilify doctors and cast much blame at them. And true, we bring some of this onto ourselves.
Today was one of those days, and by the end, I was just all too ready to run out of the office and go home. And then the last patient came and …
Simple words can sometimes make a big impact on physicians
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There has been a recent surge in discussion about men’s fear to work alone with female colleagues in medicine. This reluctance puts both men and women at a disadvantage. Women are being excluded from career opportunities and men are missing out on the benefits of collaboration. As a victim of sexual misconduct during my own medical training, I find the recent increase of acceptance of reporting to be a step …
How to ease men’s fear of mentoring in medicine
Imagine yourself as a patient burdened with a chronic disease that necessitated daily medication adherence to function. Now imagine that medication has become so stigmatized by society that you feel judged and ashamed every time that you use it. That’s the world that individuals with opioid use disorder are forced to live in when they’re prescribed methadone or buprenorphine to get through the day. Without these medications, Read more…
Stop stigmatizing medication-assisted treatment
An excerpt from Let Go of Emotional Overeating and Love Your Food: A Five-Point Plan for Success. Copyright © 2018 by Arlene B. Englander. Published by Rowman & Littlefield. All rights reserved.
Anyone who has ever tried to lose weight or keep weight off realizes that evening can be …
Evening eating: Are you a “light” eater?
A contract is an agreement stipulating the rights and obligations of the signatories. In most cases, a contract is consulted when a dispute arises. When all is proceeding swimmingly, the contract remains dormant in a file drawer or in a digital file. In general, decent people resolve differences in the old-fashioned way utilizing the twin arcane legal techniques of reasonableness and compromise. Remember them? Yes, it is possible to settle …
Do opioid contracts harm the doctor-patient relationship?
Everybody is a stakeholder these days in what we broadly call medicine, or health care. But there is little agreement on what medicine is and what the priorities of the health care “industry” should be.
I propose this breakdown of medicine into three separate phenomena.
1. Micromedicine
2. Macromedicine
3. Metamedicine
Let me explain:
Micromedicine: one on one, real doctoring
Doctors from antiquity have served their patients one on one, as individuals. Osler, the father of modern …
Medicine is a word with 3 meanings
We should consider a new position in our primary care teams — that of the scrum master. “Scrum” is a rugby term that comes from agile, a work methodology for software development that now is being applied to industry and health care.
In rugby, a scrum is a huddle where the teams come together with interlocked arms to regroup and start play again. In agile, scrum masters facilitate team huddles and …
A scrum master for primary care
It’s hard for me to believe that a few years ago, I completely turned my back on an acting career I had spent almost two decades building and instead decided to forge into an unknown world of medicine. Even now, with nearly seven years of experience in the medical field and currently in my fourth year of medical school, I sometimes feel lost for an identity.
At the time of my …
I learned how to be a good doctor in theater school
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