I’ve written previously that financial independence is plan B. Plan A, of course, is life. Your work and time are precious, and life is too short to be wading through a morass of unhappiness only to get to some endpoint or goal. While I definitely believe in front-loading the sacrifice, the cost should not have to be misery. Physicians, in particular, tend to look at their …
Every doctor should have a plan B. Here’s why.
I volunteered to work Saturdays. And to do walk-ins. And to take all comers, not just our patients.
It has been an interesting journey.
Some clinics put their newest, least experienced clinicians on the very front line of doing urgent care. Here, it’s the opposite. I’ve got 39 years under my belt, and I see everything from sore throats to people who left the emergency room in the middle of a workup …
How urgent care rejuvenates this primary care doctor
Four years ago after moving back to Iowa City, I needed to find a new primary care doctor. I went to the University’s website and scanned the list of general internists. There I noted a physician that I had known when she was a medical student during my prior stint at the University of Iowa 20 years prior. She had been an amazing medical student, very bright, hardworking, conscientious, and …
The pathologic manifestations of professionalism
How smart do we want our electronic health record to be?
Somewhere between as dumb as a piece of paper and a pen, and too smart for our own good.
Many, many years ago, before we spent the majority of our office visit staring at a flatscreen LED and typing away, our charts were simple manila folders with those bendy metal bars that allowed you to insert new pages, separated into multiple …
Love smart functions in your EMR? This doctor doesn’t.
In a matter of less than a decade, “shared decision-making” (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere. Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been …
Is there a case against shared decision making?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
It’s officially that time of year. Summer is in full-swing, and all of America is getting ready to take a much-needed holiday.
However, some Americans, particularly those who suffer from chronic pain, often dread getting away. They are afraid their chronic pain might prevent …
Tips to manage chronic pain on summer vacation
I stood in line at the grocery store waiting to pay for my items. The woman behind me, who would be categorized as obese, was eyeing some of the snacks so conveniently placed in the checkout aisle. She grabbed a meal bar and analyzed it for a few seconds, then said aloud to me: “You ever had one of these? They’re pretty good. And they’re gluten-free, that’s how you know they’re healthy.”
Healthy.
What …
When someone claims something is healthy, be skeptical
The first time I was asked to provide a bio — in this case, it was to appear on my residency’s website — I wasn’t sure what to include. It was supposed to be short, not really an autobiography or memoir and it was supposed to make our program look approachable, impressive and balanced. I gave a quick summary of my background, my education, my interests, why I picked the …
Managing your freedom after residency
I’ve always likened the job of a primary care physician to that of a chief executive officer of a small business. Family doctors manage the “business” of delivering and coordinating care for more than a thousand patients at an average cost, in the United States, of $8,500 per year: an $8 to $12 million business. Because the actions or inactions of the PCP impact the need for, and cost of, …
Both physicians and CEOs need time to think
Repercussions.
Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave.
Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients that there is “something else that we have to do,” we often see it open up a …
Why are we treating outpatients like inpatients?
Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is …
The social determinants of a physician’s path
My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound.
Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my medication-assisted treatment (MAT) patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma, and various infectious diseases.
Years ago, working in …
The satisfaction of Suboxone treatment
When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for …
Reading the body language of your patients
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Dear Doctor,
Please help me understand why so few of you have chosen to treat people with opioid addictions.
I’ve been following the topic of opioid addiction for years. It is one of the most common themes for First Opinion submissions. Authors routinely point to the importance of medication-assisted therapy, the standard of …
Why do so few doctors treat people with opioid addictions?
In the wake of Pride Month, I have been reflecting on how our health care system impacts the lives of individuals with identities across the gender spectrum. Sometimes, when sending a prescription to a pharmacy for any given patient, we will get a phone call that the date of birth on file with insurance does not match the date of birth we have on file. Typically, this is a clerical …
Pronouns matter: How we can do better in LGBTQ patient care
No news attracts attention like a physician who’s in trouble with DEA or their state medical board. So, how does it happen, what are the common issues and what can a physician do to safeguard themselves?
First, let’s look at what the numbers and the research tell us.
The Federation of State Medical Boards (FSMB) tells us that 4,091 physicians were disciplined during …
10 ways to stay out of the DEA’s crosshairs
The keto diet has recently garnered much fame for its apparent ability to improve diabetes and obesity – results so impressive the Journal of the American Medical Association recently highlighted the diet and thereby christened it as something more than a low-carb craze. However, not all the evidence supports such a positive outlook, leading the diet to straddle the increasingly blurred lines between faddist snake oil and …
A physician’s warning on the keto diet
Everybody gets nervous at the doctor’s office. Physicians ask all sorts of personal questions about what people eat, how much they drink, and how things are at home. Even questions that would seem completely harmless in another context — such as how work is going, or what hobbies a person enjoys — seem surrounded by hidden meaning and purpose. After all, who doesn’t want to “pass” their annual checkup?
Part of …
Don’t worry, medical students don’t judge
Drivers are distracted klutzes and computers could obviously do better. Self-driving cars will make all of us safer on he road.
Doctors have spotty knowledge and keep illegible records. EMRs with decision support will improve the quality of healthcare.
The parallels are obvious. And so far the outcomes are disappointing on both fronts of our new war against human error.
I remember vividly flunking my first driving test in Sweden. It was early …
How today’s EMRs are like self-driving cars
The doctor-patient interaction is the absolute core of clinical medicine. Maybe I’ll go much further: it’s the core of health care in general. I always try to remember, whenever I’m ever feeling frustrated with the system, the crazy bureaucracy — and of course, the debacle of our clunky electronic medical records and their data entry requirements — to separate myself from all of that when I’m face-to-face with my patient …
3 things patients really want from their doctors
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