Whenever I have the opportunity to suggest that good medicine is based on friendship, I usually get a nod of approval mixed with a quizzical look. What’s that supposed to mean?
At a recent meeting of an editorial board on which I serve, the reaction to my suggestion was more forceful and perhaps more honest. The topic of the day concerned patient education, and how hard it can be to move patients to do things …
Good medicine is based on friendship
“How many patients do you have?”
I’m not sure what you mean. How many patients do I see on average each day? About twelve.
“No. How many patients do you have?”
Let’s see: Last week I saw about sixty patients altogether. Five of them were new patients.
“No, no. How many patients do you have on your panel?”
My panel? I don’t know what you mean by that. I don’t work as an employer in …
Why a patient panel is an outdated concept in primary care
I thoroughly enjoy my 65-year-old male with his horrendous diabetic foot ulcer. But there’s not enough insulin in the state of Tennessee to cover the two bacon, egg, and cheese biscuits he eats every morning.
And I adore my 57-year-old female with COPD. But the inhalers won’t work until she stops smoking two packs of cigarettes per day. I laugh every time I see that hilarious 32-year-old with hypertension. But the …
Society’s health should not be doctors’ responsibilities
The optimism of a Rwandan in 2015 will strike you. Take a population that has seen or been raised in the wake of more horror than the average Westerner can imagine, and bring up a problem or something negative. Too short to reach the top shelf? It’s OK, you’ll fit under doors better. Hair stands out when bright red? Easier to pick out in a crowd. Mother has had 3 …
A physician reflects on her experience in Rwanda
One of my best friends from high school is battling with leukemia. I remember days hanging out in my room, listening to music (we were both huge REO Speedwagon fans), shooting Nerf hoops and talking about life (mainly girls at that time). We were not sure of what life would bring, but we knew we were destined for big things.
Denny was always more confident than I was at the time …
Physicians need to recognize the power of vulnerability
It was several decades ago when my father, not long retired from a lifetime of denominational service as a chemistry professor, noticed pain in his abdomen. Initially attributing this to ingestion of some excessively hot tea, he ignored it for a time, hoping that, like many ailments, it would dissipate on its own. When it did not, he sought medical attention.
He ended up at the hospital where I worked, and …
The child is father of the man
With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with …
5 health questions every presidential candidate should answer
The first posting on my blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of …
Listening to the patient is the first part of the physical exam
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Recently, I rummaged through some old files to throw out things I did not need. While marveling at how we stored documents back in the 20th century (and how little of what I saved I ever used), I came across a couple of interesting items. …
With some planning and collaboration, small practices don’t have to sell to a hospital
Dear AMA and state medical boards,
The last few years have been a period of unprecedented change in the world of health care. The need to reign in costs, expand access, and ensure higher quality care — all at a time of rapid medical and technological advancements — has changed innumerable aspects of the practice of medicine.
Throughout this, one common theme has been the dedication and determination of hundreds of thousands …
Physicians are not providers: An open letter to the AMA and medical boards
He stood still. He was virtually stymied at the request she made. I, as a visiting medical student rotating on the cardiology consultation service over which this brilliant, accomplished attending cardiologist with advanced interventional training presided, myself stood befuddled when he, in essence, appeared like a deer caught in the headlights after his patient asked him one simple question: “Doctor, could you please pray with me?”
The truth is he, like …
Remember to ask about praying with patients
As I entered the exam room to meet my new patient, I initially thought of the orange-haired heroine in the animated kid movie, Brave. Although the middle-aged woman’s hair was not quite as orange as the heroine’s, it was long, expansive in breadth and wavy in texture. Her hair seemed to engulf her petite frame. As I looked at her more closely, she appeared rather slim. Her layering of clothing …
Thank you for healing a part of me that is grieving
Vox’s Julia Belluz wrote a nice article explaining why doctors overprescribe antibiotics. She essentially gives two reasons: doctors unsure of the diagnosis want to be “safe,” and patient demand.
But there’s a third reason that’s an extension of demand: patient satisfaction.
More patients have to take time off work to see their clinician, only to spend a few minutes in the exam room. Those who take that inconvenience likely won’t want a lecture …
Reduce antibiotic use through patient empowerment
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Part of a series.
Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart.
Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or …
If urgent care centers don’t innovate, how long will they last?
Recruitment season is my favorite time of year. The CVs pile into the database, and we sift through the resumes, searching for candidates that would make a great fit for our organization. Next, I get on the phone and assess their level of interest and try to sell them on everything we have to offer. We fly them out for a live interview, and the negotiations begin.
Last year was a …
Physicians looking for a new job should beware these 4 red flags
As we enter into the Thanksgiving season, the question of what we are thankful for is frequently asked. Perhaps it is a good reminder for us to take a step back and express gratitude for events that or people who have made a true impact on our lives. I think that for us as medical professionals, it is all the more important, since conditions in the hospital may make it …
This Thanksgiving, remember the importance of gratitude in medicine
Whenever you read a health care article, paper, book, blog post or even tweet, that substitutes the term consumers for patients, and the term providers for doctors, or physicians, you should inherently assume that the authors are advocating for something that will not benefit you or the people you care for, something that will most likely harm you financially and if you happen to be less than independently wealthy it …
The clear and present future of consumerized health
In his post, “The geriatrician shortage: The problem isn’t what you think,” I completely agree that the current gap in health care professionals’ skills to care well for our aging population is exceedingly complex, reaching well beyond lack of medical school training or funding. Funding for graduate medical education needs to be transformed to match the workforce needs of the nation, with special …
Why older adults need geriatricians
I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or …
Who’s in charge of the patient? It’s a question increasingly difficult to answer.
She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable …
The joy has been sucked out of medicine. Here’s why.
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