I am not a doctor of finance. I’m a medical doctor. So when I enter an elderly patient’s home, I’m not expecting to do a wallet biopsy. Whether they can pay me or not is of little consequence. I do think, however, about whether they will be able to afford the care I prescribe. Will they have enough to pay for that extra caregiver? Is there cash to keep a roof over …
A patient dying of financial catastrophe
As medical professionals we often see people at their worst: battered and broken, bothered and in pain, no make-up, bad hair day, naked and too ill to even care about modesty. At those critical moments, in our patients’ hour of desperation, they hand over their lives to us … and the lives of their family. All that they are — they willingly place at our mercy. At times, burnout, and …
5 ways to show empathy in medicine
My father, recently retired, spent over 40 years in private practice. After dinner, he would sift through piles of paper charts and call patients with their lab results. As a grade schooler, what impressed me the most was that he knew many of his patient’s phone numbers by heart. Of course, this was in the days before HIPAA and caller ID, so scattered charts on the dining table and calling …
The difference between care and service is significant
If one more person tells me to be sure to take care of myself, I’m going to bury my face in a pillow and scream.
“Go for a walk, take a vacation,” they advise. I know they’re trying to help, but really? Giving me one more thing to do? Oh well, they’re just doing the best they can.
I moved my folks across the country, from Florida to Washington State, and into …
The caregiver’s mantra: doing the best I can
One of the great myths amongst residents is that once they become attendings, they’ll have so much more free time. I’ll never work this much again, they think. This is the most time-intensive phase of life, and everything after residency is easy in comparison.
Unfortunately, they are usually wrong.
Statistically, working about the same number of hours in residency and as an attending is the norm. In one study, attendings work 59.2 …
Attending time: That’s just a myth
Quality of life matters.
This straightforward assertion gets complicated when we discuss the treatment of depression. Depression is common, part of a family doctor’s daily schedule; it can affect anyone, although certain groups are at higher risk. There have been many hypotheses as to why we as a species are susceptible to depression (and its frequent companion, anxiety), but in the day to day practice of medicine, those proposed etiologies end …
Treating mental illness: Quality of life matters
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Chronic pain is a silent epidemic
Chronic pain is a significant public health burden, but one that is not talked about enough. In 2011, the Institute of Medicine estimated that approximately 100 million Americans suffer from chronic pain. But chronic pain is not just …
Education as an intervention for the chronic pain epidemic
Noticing.
If you think about it, that’s really a lot of what we do a lot of the time. As clinicians, we are trained as observers to notice, to use our eyes, our ears, our hands. To notice.
We notice that our patients seem different today. More tired. A little pale. Notice a change in their gait. Notice they are in pain.
We notice swelling in their legs, a new heart murmur, a …
We need the time to apply our noticing skills to our patients
That statement from a recent patient was a summary to me of what is bad in our health care “system.” It’s a terrible summary of what is seen all over this country with people who must make the choice between financial solvency and health.
Here’s what happened: It was a new patient I saw, who is a veteran who owns two businesses. He went out on his own when he “kept …
A patient is left with a choice: financial devastation or blindness
I remember reciting a phrase during my childhood that goes something like this, “Step on a crack, break your mother’s back.” So as I would walk back and forth to school, I would make a conscious effort to avoid any and all cracks in the sidewalks for fear of bringing unwarranted harm to my mother. This was a pretty difficult task to accomplish since in my small hometown, cracks in …
Don’t let fear harm your health
Every small community has a unique but similar cast of characters. Our small Southern Utah town was no different. From a young boy’s perspective, the cops and docs were feared but cautiously idolized, the mayor was respected, the athletic coaches were immortalized, and of course, we had the homeless man in town, whom we feared. We will call ours Stu.
Stu had greasy disheveled hair and a gray beard. He wore …
A physician-father who made a lasting impression
I have written previously about the raging opioid epidemic in Ohio. Attacking and reversing this tidal wave will require many weapons, resources and time. Opioid addiction is a crafty and elusive adversary that will be difficult to vanquish. Our battle plan will have to be nimble and adjusted over time, much as military leaders must do in actual armed conflict.
Here in Ohio and elsewhere, physicians must abide by new …
Restricting opioid prescribing: Some error has to be tolerated
There are so many theories out there about what we should or shouldn’t be doing with our complex and fragmented health care system. We are facing a perfect storm of factors: an aging population, a huge increase in chronic disease, new and expensive treatments, and rising expectations of what care we should be receiving. All of this is sending costs spiraling out of control. As a nation, we spend almost …
The biggest health care fix: a relentless focus on primary care
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Since the two very sudden public suicide deaths of Kate Spade and Anthony Bourdain, society has again recognized that we never know what is under the surface of another’s façade. As physicians, these tragic occurrences emphasize that our caregiving requires seeing the entirety of an individual’s many parts.
While we acknowledge that the façade is not fake — it is but one true representation of an individual, well-curated, like pages on …
How medical training can affect the physician psyche
Generally speaking, patients and physicians are working towards good health. While many patient expectations can be unreasonable, others are practical; this article amalgamates them. Can you identify the absurd demands?
But multiply half of the listed expectations by hundreds or thousands of patients, and we begin to understand why there is such a high rate of physician burnout. Bilateral empathy lowers expectations.
Bedside manner. Don’t accept a walk-in patient and leave us waiting …
Bilateral empathy lowers patient expectations
We live in incredible times.
A time when a millennial with a YouTube account clears six-figures a year (sometimes, seven figures!) with just a computer and a webcam.
A time when a small-town girl with a love of fashion and an Instagram account can go from Nowheresville, America to front row at New York Fashion Week.
A time when the shy girl in the back of the classroom amasses a following of hundreds …
How every female physician can be a somebody
Altruism is killing us. Take a second to let that sink in. Truly think about it. Resist your conditioning to refute this claim and try to apply it to your life. Still having trouble? Let me try to explain.
In order to understand the truly destructive force of altruism on medicine, one must first define altruism. This can be difficult to do in the United States as any “good” or “charitable” …
I am frequently asked what I do at social gatherings. My response, naturally, is that I am a physician. The individual then asks what your specialty is and I respond that I am a board-certified family physician. Then, I hear, “Oh, you are a GP.” Really! After all these 35 years, I am perceived as just a GP. “Just” is the key word at social gatherings — implied or stated.
Well, …
You are never just a primary care physician
The initial doubts first surfaced mid-way through our flight bound for Montego Bay, Jamaica. In fact, we were not entirely sure that this trip was such a good idea after all. Our eldest son, 13 and in eighth grade, was already complaining about how much school he was missing and how much homework he had been assigned. Our daughter, a sixth-grader prone to procrastination, had her nose buried deep within …
Family therapy via medical missionary work
You are a child of Thanos.
“Hear me and rejoice!”
“You have had the privilege of being saved by the American College of Cardiology and the American Heart Association. (Yeah, I know we said the same thing when we prescribed low-fat diets to decrease the risk of heart disease, but you gotta give us a pass on that one.”)
“Based on our research, we have found 100,000,000 of you are ill.”
“But we can …
How our health system is like the Marvel supervillain Thanos
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