When I was growing up, RuPaul was all I knew of transgender anything. She was tall, flamboyant, charming, and I would look at her and try to see the man underneath the drag. I didn’t know the definitions of drag and trans, gender identity and intersex, ambiguous genitalia and gonadal dysgenesis.
Now that I’m a physician, I see transgendered patients on a regular basis — unfortunately, it’s usually in the setting …
Why bathroom bills are important
Despite above average intelligence and work ethic, the average physician is an absolute imbecile when it comes to the topics of personal finance, investing, and business. The lack of expertise on these critical life topics is having a dramatic effect not only on the financial lives of physicians but also their rates of burnout and thus their patient care. In past decades, by virtue of their above average income, a …
Physicians are financially illiterate and it’s time for that to change
I’ve had many opportunities to address physicians across the spectrum of health care settings, from those who run private practices, to those who work in large and small groups, to those who are hospital affiliated and employed. I often ask them the question “who controls the practice of medicine?” The answers I receive vary: government, insurance companies, hospitals, health systems, lawyers, employers and, rarely, patients. But one answer I never …
Why physician-led organizations work
“I am not on call,” Dr. Brian Stoltz said over a lot of background noise through what must have been the speakerphone in his car.
“I know,” I said. “Cityside ER said there is nobody on call for ophthalmology this weekend. I have a 54-year-old woman with intense tearing, discomfort and only 20/70 vision in her right eye.”
“And she’s not a patient of our office?”
“No, she has only had to see …
What do you do when a patient’s illness strikes an inopportune time?
“Do you know the visa process in the U.K.?” Yousef asks me nervously in the physician work room at our hospital in Florida. “I’ve spent the last two weeks looking up the different countries where I might be able to work — Canada, Australia, New Zealand, and South Africa.”
Yousef goes on to list the various visa and medical licensing procedures in each country and has clearly done his research. As …
Trump’s travel ban affects doctors too
Long ago, before our hospital changed over to a nearly complete hospitalist model, the faculty at our internal medicine practice served as the attending of record for all of our own patients, as well as the patients of the residents we supervised, when those patients were admitted to the inpatient services across the street.
When we would arrive in the morning, we would look at the admission list, note that one …
Let primary care doctors practice more outpatient medicine
I swear by Epic, by eClinicalWorks, by Allscripts, by AthenaHealth, and by all the coders and accountants, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
To hold my mouse in this art equal to my own hand; to make it right-click as well as left-click; when my ACO is in need of money to share an “at-risk” portion of …
Today’s version of the Hippocratic oath
So, how do you do it all?
It’s a Monday morning. After a flurry of activities, I am walking into the office at 8:00 a.m. I think back to the past 2 to 3 hours. I was up at 5:30 a.m., and in my workout clothes soon after. I managed to squeeze in a 20-minute workout, thanks to a video on YouTube. I then reviewed my schedule and patient charts for …
How do physician-mothers do it all?
“Too many times I feel
We are losing time once shared
And only when you’re in ecstasy
You seem to really care”
I recognize the song immediately — Chuckii Booker’s “Turned Away.” Not the regular version, but the extended one. As the words rush over me, caressing my nostalgia, a memory, a moment comes back.
I was standing behind the counter at Homer’s Ice Cream on a brilliant summer morning before the doors opened. We …
This the one thing that makes me feel like everything is OK
How do you describe the feeling when you are at a restaurant, and the waiter sees your coffee cup at less than half full (never half empty) and without asking they refill the cup or better yet, bring you a fresh cup of coffee? If you are like most customers, you have a nice feeling about the restaurant and the waiter as they have anticipated your needs. Usually, this anticipatory …
Improve the patient experience with anticipatory patient service
Recently, one of the biggest mistakes ever observed on live television occurred when Warren Beatty and Faye Dunaway, presenters of the award, announced the wrong film as winner of the Academy Award for best picture. Not since Janet Jackson’s costume malfunction has, live television caused such uproar.
How could this have happened? How could it have been prevented? Moreover, what can this error teach us about how we care for patients?
A …
What the Oscars can teach us about patient safety
Here’s a quote that readers will not readily recognize: “It is a pity that a doctor is precluded by his profession from being able sometimes to say what he really thinks.”
I’ll share the origin of the quote at the post’s conclusion. How’s that for a teaser? I’ll give you a hint below.
Physicians, by training and experience, are guarded with our words. To begin, we are never entirely sure of anything, …
Doctors: Be careful, your words matter
Too often, the practice of medicine in the United States is focused on treatment. Doctors are taught to battle disease and treat chronic illness to the bitter end. And we have amazing technologies and treatments that have been proven to save lives, but our costs and health outcomes don’t seem to match what we pour into the system.
But what if we doctors changed how we think about battling disease? What …
How to shift focus on America’s health
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Quality metrics and pay-for-performance have now been in existence long enough to start accumulating some efficacy data. And the picture does not look good. Paying doctors to improve their quality metrics does not, in general, improve those quality metrics. Like all good scientists, we can now either question the data, or discard the hypothesis.
Most payors and administrators appear to be reacting to the lack of efficacy data on …
What was the hypothesis with pay-for-performance?
“I can do that?”
During a recent morning practice session, a resident was presenting a patient who had had several episodes of syncope which culminated in a trip to the emergency room. She had a brief stay there, and on the discharge plan was written “follow-up with PCP and with cardiology.”
We went through her history and physical examination, we talked about how to further …
Are primary care doctors referring too much?
Health care guidelines are produced in ever-increasing numbers. The National Guideline Clearinghouse, a U.S.-based public website compiling summaries of “clinical practice” (health care) guidelines, has over 1,000 entries and is updated weekly. The National Institute for Health and Care Excellence in the U.K. has over 180 clinical guidelines. 
Health care guidelines cover all aspects of medicine, …
Is my doctor’s guideline for my treatment right for me?
A recent publication in JAMA Internal Medicine clearly demonstrated that female physicians were able to provide better care when compared with their male counterparts. Researchers from Harvard University studied the relationship between physician sex and 30-day mortality and readmission rates of over 1.5 million Medicare patients between the year of 2011 and 2014. What they discovered was that female physicians had lower mortality and readmission rates …
Why being a female physician matters
In August of 1991, I became a family practitioner in the United States Air Force and was sent to Clark Air Force Base in the Philippines. During my time there, I was asked to go on a medical mission. This experience struck me with the missionary bug to provide my talents and to care for others in another country. With medications that were near expiration date in USAF stock and …
What this physician learned from a medical mission
To my beloved patients and your families,
Over the years, it has been an incredible experience and honor to be allowed to enter into your world. It is a world that I know few people are privy to, and it is an intimate world where the deepest questions about life tend to arise. I know that when you are confronted with sickness that leads you into this world, it can be …
A letter from a grateful physician to his patients
The building contractor chatted pleasantly while I checked his blood pressure, waist circumference, cholesterol levels, fasting glucose and urine protein. We discussed bowel and prostate cancer screening in detail, and I gave him written information as we were out of time. As I signed his script for the blood pressure medication, he winked.
“That was easy money for you, wasn’t it?”
Thirty-seven dollars and five cents is the value the government places …
What I do for thirty seven dollars and five cents
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