Years ago, I owned a lawn service. I ran the company.
Actually, I was the company. The only worker. Then, a buddy of mine joined up. It became our summer gig for many years.
We prided ourselves on quality. We were good at what we did. And, we were fast, too.
Jump ahead a few years. OK, more than a few.
I now work in …
What running an lawn service taught me about health care today
Part of a series.
I put down my blogging pen last fall to focus on two things. One was completing a new book: Fixing the Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor. The second was preparing to move to a retirement community.
We live in a pleasant neighborhood with nice …
Moving to a retirement community: What goes into a physician’s decision
One of the ghosts in every exam room is the institution that pays many private doctors over ten million dollars, the authority that determines that you can order a BNP (brain natriuretic peptide) to look for heart failure in patients with shortness of breath but not when they have leg edema. You know who I’m talking about: Medicare.
Medicare is not only …
Are your patients uncomfortable with a scripted physical?
Recently, I wrote a piece on developing the state of connection within a medical family. In it, I highlighted the fact that everyone has a role in growing this connection and that everyone’s time, energy and effort is important. I also touched on the importance of parents presenting a unified front as the parental team. This piece focuses more specifically on developing that unified team approach.
It can be …
Tips for parenting children in a physician family
I need a new stethoscope. I have to wrap my fingers around the fissures in the tubing to make this one work.
For me, these days, listening to the patient’s chest is more a ritual than a means of diagnosis. After twenty years as a primary-care internist, I now work full-time in hospice and palliative care. I spend more time listening to …
A father’s stethoscope is a connection to his wisdom and comfort
I had the good fortune of practicing family medicine from the 70s to the early 10s. It was the Golden Age. After doing a family practice residency in a community hospital and serving a short stint as an assistant residency director, I started out in my practice that lasted almost 40 years.
Here is the story of how I got the ball …
New doctors are not kind to their predecessors. Here’s why.
Recently I read an article in the New York Times by Elisabeth Rosenthal. She’s the same author of the enlightening article, “My doctor charged me $117,000 and all I got was this lousy hospital gown.” That may not have been the exact title of the article.
Following that article she wrote a follow-up about the long and difficult ordeal …
There’s a good reason why doctors don’t send test results
The feminization of health care is fundamentally changing care delivery in the United States and it is doing so in ways that will accelerate the pursuit of improved quality and affordability.
Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” — traits such as heroism, independence, and competition. Yet it …
The feminization of health care is here. And that’s a good thing.
At 3 a.m. last Saturday, I was feverishly devouring medical journal articles on subarachnoid hemorrhages (which I now know are a type of stroke caused by bleeding into the space surrounding the brain), trying to determine just how much I needed to be panicking about the health of a loved one. With every text message update from the rural hospital he …
Thank you health care providers for being on call
“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.”
– Dr. Martin H. Fischer, German-American Physician and Author
“A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”
– Principles of Medical Ethics, American Medical Association
“I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of …
The physician is the ultimate patient advocate
As a child and family therapist and as a parent, I often see the efforts that families make to try to maintain a sense of family connection in an era of technology, increased demands and very busy schedules. Most families express a desire for more quality time together and an increased sense of connection amongst family members. The medical families that …
How physician families can spend more time together
It’s been a very slow week in my office. Today we almost pitched a no-hitter, having only one patient come in toward the end of the day. Overall, we’ve been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages.
What’s wrong?
That was a trick question. This is exactly what should be happening when things are going …
A quiet day in the doctor’s office: And that’s the way it’s supposed to be
We all have our fair share of so-called “difficult” patients. And, I would suggest that how we define “difficult” is as diverse as we are as health care providers and as individuals. Some patients come to us with that reputation — perhaps, a vague descriptor in a referral letter or …
Why this provider continues to see “difficult” patients
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Leave early.
Two words. Simple concept. But, one worth thinking about.
James Altucher explains it well, but this is the same guy who also thought he could save his business by becoming more like a Jedi Knight. Admittedly, the Jedi thing seemed to work for him, and his businesses, as well as the uncountable number of people he’s helped since then. …
A doctors lifehack: Leave early
“What’s up with the ABIM?” “I just got a note about an alternative board. Should I join it?” “Aren’t you glad to be off the Board?”
These days, I get these questions from friends and colleagues regularly. When I first joined the board of directors of the American Board of Internal Medicine (ABIM) in 2004, the organization was a …
Dr. Robert Wachter: In defense of the ABIM
Patient-doctor communication often has many facets, wrinkles, and twists. Medical school prepares a doctor minimally for the ups and downs of these patient interactions. There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient. On the job training is sine qua non.
During and after medical school, it took …
Poker face: The complex psychology of the patient-doctor interaction
My patient had suffered a terrible, crushing injury to his chest leaving many ribs and his sternum fractured, his lungs and heart badly bruised and his body on the edge between life and death. He was on a ventilator, the tube through his mouth into his windpipe pushed air into lungs that couldn’t draw for themselves. He was on constant medications for pain and to sedate him while we used …
An inappropriate use of medical jargon: Words do matter to patients
The current state of telemedicine — that is, teleconferencing with a physician over one’s smartphone — worries many critics because it assumes patients can be evaluated without a physical exam. The critics are right that those with a financial interest in “disrupting” health care typically minimize the trade-offs. Convenience and lower cost are trumpeted, while risks of misdiagnosis and mismanagement are waved off. The concerns of practicing physicians are dismissed …
Telemedicine: Why professional concern shouldn’t be dismissed
Despite rates of drug use similar to white counterparts, black men are 11.8 times as likely to be arrested for drug offenses compared to whites. African Americans constitute 14 percent of regular drug users, and yet represent 37 percent of people arrested for drug offenses, 55 percent of drug convictions, and 74 percent of people sent to prison for drug possession. One in Read more…
The intersection of illness and incarceration: How racism makes us sick
1. You don’t have to make an appointment with your doctor, or sit in a crowded waiting room for hours, to get music — you can just download it instantly from iTunes or pick up an instrument and play it.
2. Music costs far less than a medical office co-pay or out-of-pocket fee-for-service charge. And for many acute conditions, outcomes are probably pretty …
Music is better than medicine. This physician-musician gives you 10 reasons why.
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