Is Dr. X a good doctor?
Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, “oh yes, Dr. X is a great doctor,” or “oh no, Dr. X is not a good doctor,” making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on …
Clinical competence, and whether a doctor is good, or not
According to Wikipedia, up to the beginning of the 19th century there had been only 3 occupations that were considered to be professions, Divinity, Medicine and Law.
A profession is considered a trade or occupation that transforms itself through “the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit, discipline members, and enforce adherence to an ethical code of practice.”
Professionals are …
The professional status of physicians is at risk
Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.
She lived for him. She was always telling me of his pain, …
Death is inevitable, but it is almost always seen as tragic
To do nothing is sometimes a good remedy.
-Hippocrates
Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence.
Edna has been my …
Sometimes the treatment is worse than the disease
It may not be rabbit season or duck season but it definitely seems to be doctor season.
Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. …
Reasons why your doctor is running late
The American Medical Association recently released its membership numbers, and they’re declining.
According to MedPage Today, the AMA “saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.”
It’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%. But it seems many physicians have little …
Why the AMA is in decline, and should doctors care?
Though there are few subjects as immediate to my experience as that described in Gardiner Harris’s article in The New York Times, “More Doctors Say No to Endless Workdays,” perhaps the truest indication of my opinion on the matter may be the fact that, upon first glance at the headline, I didn’t feel much need to read the rest of the article. More doctors say no …
We want our doctors to be perfect, but they’re human too
This past spring, I took the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam.
7 weeks later, I received my results. Thankfully, I passed.
This was not entirely a surprise, as the pass rate for first-time test takers was 88%. But it definitely requires some studying. It’s not a gimmie.
Considering that I last took my board exam in …
ABIM Maintenance of Certification (MOC) internal medicine exam tips
I’ve heard some physicians wonder out loud if their career has been “wasted” – either because they were on a path that wasn’t a good fit or they spent years focusing on accumulating and worrying rather than on contributing and enjoying. The question is one of personal value: Am I measuring up? And by whose metrics?
How do you measure the value of your physician career? Dollars earned? Lives saved? Honors …
What will be your legacy as a physician?
by Jeffrey L. Cohen and Albert R. Meyer
Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship.
Though they approach healthcare issues differently, there are many instances where they share care or even work together. Such “M.D./D.C.” relationships are legally complex, but often prove to be rewarding in many respects. Properly constructing the arrangements is critical, especially since government regulators and payers tend …
The legal issues of doctors and chiropractors working together
I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.” (e.g., “Hi, this is John Smith from the Family Health Center.”)
I occasionally see the residents’ patients for urgent visits. When I ask them who their regular PCP is at the office, …
Should doctors be addressed by their first name?
I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came …
Why doctors can’t screen patients for every disease
by George H. Northrup, PhD
No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.
With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress. Money has typically been a …
How managed care caused the mental health care crisis
Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers. Private practices are almost exclusively for-profit. Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments.
Hospitals can be for-profit, not-for-profit …
Pros and cons of private or hospital owned practice
Whenever I speak about social media to doctors across the country, I often get asked, “How do I deal with a negative online review?”
Here’s one way not to handle it: sue the patient writing the review.
There’s a well publicized case in Minnesota, where a resident posted a screenshot of …
Dealing with a negative online review on a physician rating site
In my forays into the history of medicine I came across these six little words by Hippocrates.
They seem strangely modern, almost like something you might find on a Hallmark-card for today’s medical school graduates. I don’t know how old the translation is and I couldn’t understand the original text if I tried – but these simple words really touched me when I …
Natural forces within us are the true healers of disease
by Benjamin P. Geisler, MD, MPH
Everybody is talking about Accountable Care Organizations or ACOs these days.
The reason being that the Centers for Medicare and Medicaid Services or CMS has released the rules for shared savings between ACOs and CMS.
The complete proposed rule is 429 pages long and they’re seeking comments on it now until early June.
What is an ACO?
ACOs will take care of …
How an ACO will affect physicians and Medicare patients
The results of the application of reductionism in modern biomedical research and practice has been nothing short of miraculous, but while wondrous for some things, reductionism alone is incomplete.
The basic premise of reductionism is that by breaking down (or “reducing”) complex biological or medical phenomena into their many parts, one is much more likely to understand a single cause and devise a cure.
Historically, the invention of the microscope, the defining …
Reductionism and daily medical practice
I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine).
First a few words about primary care as a field: I found it to be both awesome and boring.
It was awesome because I was the “doctor.” I had essentially full responsibility for my each patient. From calling him in from the …
Why this medical student found primary care awesome, and boring
Here are ways doctors can help autistic or delayed children behave and learn.
I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less likely to be fully addressed by general pediatricians and society at large.
1. Understand the ABCs of behavior. Antecedent = What happened immediately before the behavior? Behavior = A description of the …
How to help autistic or delayed children behave and learn
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