Our job — though many of us actually see it more as a calling than a job — is to care for patients.
Documentation is a process whose primary purpose is to support the patient care process. Coding, billing, population management, meaningful use and many other processes may be important to an institution but are of little or no use (and provide …
The absurd barriers to good patient care
Being related to a famous person is somewhere between a cruel joke and a minor distraction. My father was immensely talented and worked very hard at his writing, but the degree of his success was a fantastically unlikely bit of luck. There are lots of talented, hard-working artists who don’t make it.
The important thing in overcoming mental illness, whether or not …
A doctor shares his story about overcoming mental illness
Recently I was asked to talk to a special group: the doctors and staff who teach new doctors. I reached out to my community and the suggestions that came pouring in of how to improve physician burnout were amazing.
What I learned is that a key element of guiding young doctors and avoiding burnout is to stop for a minute.
Can you believe …
This is the key to avoiding physician burnout
If I had groused two years ago that we were getting doctored to death, you would’ve thought me obtuse. When I claim today, though, that every head bump doesn’t need an MRI, you get it.
There’s a growing buzz about Americans receiving too much health care. In fact, overtesting and overtreatment are the main source of health care’s amazing expense. You can …
Doctors are short on curiosity. Here’s why.
Smoking is a major cause of heart attacks, strokes, emphysema, and lung cancer. Smoking rates have steadily declined in the U.S. in the last 50 years, but about a fifth of U.S. adults still smoke. Helping them quit would make a major contribution to their health.
A study in the New England Journal of Medicine (NEJM) studied the effectiveness of different …
Paying people to quit smoking. Does it work?
As a little kid, I used to love the bedtime story about Humpty Dumpty and his fall from the wall. “Humpty Dumpty sat on a wall. Humpty Dumpty had a great fall. All the king’s horses and all the king’s men couldn’t put Humpty together again.” Until recently, I never thought about this story as a logical and sad analogy to …
Stop the Humpty Dumpty approach to health care
Momentum remains in favor the flow of physicians to employed positions. Is this wisest path for physicians? That is unknown and likely depends upon the particular circumstance. Either way, independent physicians are an increasingly shrinking, yet curiously heterogeneous group. Independent practices vary in size, composition and philosophy. The impact of size (from solo to very large) and composition (primary or specialty care, single or multispecialty and physician demographics) is relatively …
Complete independence for a small practice today is unwise
When I was growing up, I thought that doctors had it made. About three months into med school I realized how wrong I was.
Question: “Hi professor, what part of the chapter do I focus on?”
Answer: “Everything.”
My text books would be out of date by the time I finished them. Just as I learned where they kept supplies in the hospital it …
The survival strategy of a new doctor
I am going to make a bold statement here. Are you ready for it? There is nothing wrong with health care providers thinking like businessmen.
I know what you’re thinking, but I feel the word “business” gets a bad reputation in medicine. We immediately associate the term with profit-hungry, egocentric individuals, a preconceived notion probably rooted in their unfair depiction in popular …
4 reasons why business and medicine go together
“Knowledge is power.” The words of Sir Francis Bacon still ring true almost 400 years later. For the most part, knowledge can provide the power to change lives, change communities and change the world. People born in adverse conditions can potentially improve their circumstances with a degree from higher education, and it is why the first college degree in a family …
For physicians, medical knowledge can be both a blessing and a curse
The annual American Telemedicine Association just wrapped up their national conference in Los Angeles recently. Physician-dignitaries such as Dr. Sanjay Gupta and Dr. Patrick Soon-Shiong gave keynote addresses, the exhibit hall was laden with telemedicine industry advocates, and the Twitter hashtag #ATA2015 was trending with great vigor. The four-day event was well-attended and comfortably demonstrated telemedicine’s emerging popularity.
Telemedicine is not new. …
The $30 billion telemedicine industry: What’s missing?
I have been exposed to many patient interactions during my first year of medical school. However, my first real patient interaction was when I accompanied my attending to a homeless shelter in downtown Phoenix. I can clearly remember being very excited the day before the visit to the homeless shelter; this was to be the first time I would actually interact with real patients. …
To a patient: Stay strong. Don’t lose hope.
I’m thankful that my first rotation was family medicine out in Youngstown, Ohio. Youngstown is a small town halfway between Cleveland and Pittsburgh. Everything moves a little slower out there compared to what I’m used to in Brooklyn and Manhattan. Similarly, my family medicine rotation as a whole was slower and calmer compared to my other rotations. I didn’t see any emergency conditions or an excessive number of rare pathologies …
Doctors: Now is the time to develop your style with patients
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If it weren’t for social media, I would not know that internal medicine physicians are challenging the ABMS Maintenance of Certification (MOC) requirements and the ABIM. I became encouraged by their efforts and fascinated with details of the ABIM’s finances. If you’ve been a board-certified physician for at least three years, you should know about MOC. According to the American …
It’s time for family physicians to challenge MOC
In a recent Forbes editorial, conservative commentator John Goodman argues that the Texas Medical Board is sending the state back to “the middle ages” because they are trying to limit the practice of medicine in the absence of a face-to-face, doctor-patient relationship. He believes that telemedicine should have an unfettered role in health care — diagnosis and treatment should be available to anyone who wishes to share their …
Can we expand physicians’ reach without eroding the patient relationship?
Out-of-context quote of the day: “We have no malls and no Walmart. Recruitment is nearly impossible.”
These astonishing statements were made by Elizabeth Nelson, a nurse practitioner in Nebraska. She was not talking about teenage summer jobs. She was not talking about professional Walmart greeters, addicts of cheap stuff made in China who want an employee discount, or people who really like Cinnabon. …
Go fund a physician rather than fight nurse practitioners
Did you know that you are a “telemedicine provider”? No? I can’t blame you for not knowing, but you are, and always have been. Well, maybe not always, but certainly since Alexander Graham Bell invented the telephone. Better yet, you provide free telemedicine services. Here is an idea: on the home page of your practice website, you should add a big …
You’re already a telemedicine provider. You just don’t know it yet.
When I began the practice of medicine, I used to think of the entranceway to the exam room in mystical terms. How else could I explain my patient’s willingness to suspend all social rules and norms upon passing through those magical doors? They would sit down in front of their baby faced-doctor and talk about things. Private things. Scary things.
Conversations occurred that would be unthinkable if two strangers were to …
The sanctity of the exam room doesn’t define this physician
“I want to tell you my story now,” a patient recently told me, a woman who suffers from many physical and emotional ailments. She had the diagnosis of PTSD on her problem list, along with hospitalizations for “stress,” but I never asked beyond that.
“OK,” I answered, not knowing what to expect. “Tell me your story.”
She paused for about 30 seconds, but I …
If my patients know I am human, they don’t ask for me to be superhuman
Who can argue against evidence-based medicine? Who can argue with using evidence to develop guidelines? The key to practicing great medicine must involve using the best evidence to guide our protocols.
My son, while in college, was an English major. I remember reading his papers. He often used the phrase “on further reflection.” I often recall that phrase when considering these complex issues.
Frederick Nietzsche wrote, “There are not data, only interpretations.” …
Why guidelines should only be a framework. They should not be rules.
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