Those of us in health care face tough decisions every day. Should we spend less time with patient A so we can have more time to tell patient B about a bad pathology report?
Should we work through lunch to see a few more patients but risk burning out our office staff at a time when morale is at an all-time low?
Should we skip our child’s piano recital to attend that …
Burnt out physician? Creativity can help.
For my entire life as a physician, from medical school, through residency and now until this 22nd year in practice, I have subscribed to the idea that I should have a chaperone when performing breast, pelvic or rectal exams on women. I was taught to do this from the beginning, and I still do it.
Why is this? On some level, the …
We’re going to need more medical chaperones. Here’s why.
When I was a resident at the University of Virginia, my wisest mentors gave me one piece of advice that far exceeded all the scientific and statistical jargon that others expected me to swallow. Consider this: When patients walk into your room and sit down, shut up and look into their eyes. When they are done talking, have a conversation. The key word is conversation. The visit should not include a lecture or statistics …
What value do primary care doctors offer to our health care crisis?
Have a little faith in me.
– John Hiatt
Spring ushers in major holidays in many faiths and religions. The rites of spring and the vernal equinox, new life and rebirth are springtime themes and touchstones across many cultures. Faith is important to many people and across many cultures and religions. I would assert faith is even important to atheists and agnostics, and those without a formal religious tradition.
Faith is important …
Trust and faith are essential to physician-patient relationship
I never thought it would go on for so long — seeing Donald Wyatt, I mean. I certainly didn’t plan it this way.
More than six years ago, I retired at age sixty-six from my social work job at a mental-health agency. Donald had been my client there for about eight years.
As I was cleaning out my office, his mother called. She explained how Donald’s father had left when Donald was …
How will I know that you’re not dead?
This is important to you. Trust me.
If you’re young at heart, it matters because it’s your tax dollars this April. If you’re wiser in years, it directly affects your health and the system you’ve been pumping money into for decades. This is the same medical system that you thought would take care of you later in life. Again, this is about your money and your health, so read on.
Government-funded health insurance in the United States is administered …
Why CMS should get out of measuring health quality
According to OECD data, Americans see doctors less frequently than people in any developed nation. We are hospitalized less frequently, and we stay in the hospital less time than citizens of other nations. The vast majority of Americans, more than any other nation, describe themselves as healthy, and America has the largest percentage of young people in its population. So why is health care in America so much more expensive …
Tomatoes, ketchup, and direct primary care
A couple of months ago I finally joined the swelling ranks of Uber customers. Several friends had been trying to persuade me for some time to start using the service, but me being generally skeptical of new technology (what they call a “late adopter”), it took an extreme situation to get me to finally download the app.
It was a freezing February …
What Uber drivers can teach health care
Everything eventually expires.
I looked down at the bottle of natural spring water in astonishment. It had an expiration date. Scanning the empty hospital cafeteria on an early Sunday morning, I wondered what on earth about spring water could go bad? It had no living parts, Nothing that serves as nourishment for wayward bacteria or fungus. The container was sealed. Pristine.
I figured it was another fiscal hoax, perpetrated on unsuspecting consumers. …
Our time on this earth is finite
Who is a PCP? (And does that second “P” stand for “physician” or “provider”?)
Who gets to say? Does it matter?
Perhaps we should start with some basic qualifications: The degree of MD or DO, the satisfactory completion of an accredited residency in family medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those.
How …
Who gets to call themselves family physicians?
Earnest Tipp was very overdue for his blood pressure follow-up. Almost a year and a half overdue, as a matter of fact. The last few times I had refilled his medications, I had added “needs follow-up” to the signum on his scripts.
The other day I finally saw him in my schedule. I thought about him all morning. A tall, muscular 90-year …
Stay away from doctors: From a patient who listens
I am not an economist.
This is how I start my high-value care session during the internal medicine clerkship orientation day at the Medical College of Wisconsin (MCW), and it is absolutely true. It doesn’t take an economist, though, to realize that health care is too expensive. Health care spending as a percentage of GDP has increased from around 7 percent in 1970 to almost 18 percent in 2010. An …
There are limitless opportunities to practice high-value, cost-conscious care
“Nobody does this …” Dr. D said as a greeting as he walked in holding the 700-word letter I had sent him some weeks before my periodic physical examination.
Half the letter addressed six issues that had arisen during the year and a half since my last physical. I thought, nearing age 62, that it’d be both efficient and prudent to provide my GP an update on my health experiences. Half …
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As a patient, I would like a primary care visit that is pleasant, comprehensive, convenient, and efficient. As a future practitioner, I hope for a visit that is unhurried, educational, efficient, and holistic. We may have through all these years grown accustomed to the status quo — on both ends — that is, we have come to expect the 45-minute wait in the atrium prior to our beckoning by the …
A vision for a more efficient, more elegant health care visit
The tragic deaths of Oscar Grant, Michael Brown, Eric Garner, Tamir Rice, Walter Scott, and untold others, deeply grieve our national conscience. But more black men die in America from heart disease than from police brutality, and we never mention those parallel realities in the same breath, let alone collectively mourn those dead.
Why is that?
Because it’s not just that African-Americans have higher rates of heart disease and its related risk …
The arc of injustice: How racism kills
A guest column by the American College of Physicians, exclusive to KevinMD.com.
So far, 2015 has been a busy year for reflecting on the use of electronic health records (EHRs). CMS just released its proposed rules for meaningful use stage 3. One might say that “MU 3” supports the belief that the sequel is never …
Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much.
For people who don’t like taking pills, what would a trade-off look like? If you were given the option of living X months fewer, but in return you wouldn’t have you doctor twisting your arm to take pills every …
The trade-offs of statins: How much benefit is needed for you to take a pill?
I assumed she asked because besides being a hospice volunteer, I was a medical student and wouldn’t get spooked by a dead body. She probably didn’t realize that it was my first week of classes, and I hadn’t experienced much yet.
She walked into the room with her head slightly bowed forward. She was physically and emotionally exhausted. Because of a scheduling …
My first experience with a dead body
I have been blogging now for about three years, posting once or twice a week and accumulating 240 posts. I have my little flock of loyal readers and have managed to contribute a few drops in the ocean of the health care policy debate. But just this month two pieces made some bigger waves, one ending up briefly fluttering about Twitter, …
Why the chasm between doctors and patients? It’s all about money.
Doctors and patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine.
Delivering bad news is, unfortunately, an unpleasant part of a physician’s job. Honesty, empathy, and clear communication are essential to delivering news to patients and their families — even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, …
Doctors sometimes don’t inform patients of bad news. Why?
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