In my last blog post I discussed how harmful physician “thought leaders” can be when they are dismissive of the value of other specialists’ care. I must have touched a nerve because a passionate discussion followed in the comments section. It seems that physicians (who spend most of their time engaged in clinical work) are growing tired of the leadership decisions of those who engage in little to no patient care. …
It is time to stop specialty prejudice
It is an oft-recited paradox that Americans like the men or women representing them in Congress while hating Congress as a whole. In fact, respect for Congress is near all-time lows. In what has to be seen as a bad sign for the medical profession, people’s attitudes towards physicians are beginning to look downright Congressional.
Most Americans like their doctors, with surveys …
Patients don’t like their doctors. Why is that?
The quality-measurement enterprise in U.S. health care is troubled. Physicians, hospitals, and health plans view measurement as burdensome, expensive, inaccurate, and indifferent to the complexity of care delivery. Patients and their caregivers believe that performance reporting misses what matters most to them and fails to deliver the information they need to make good decisions.
Thus begins a recent editorial in the New England Journal of Medicine. It was accompanied by …
Quality measures are going through growing pains
It seems everywhere you look in health care today; some consultant is telling you that “less” is actually “more.” Less care leads to more quality. Less expense brings better outcomes. Nurse practitioners with less training are more cost effective. Fewer work hours for residents builds a safer hospital environment.
Never in our entire history have we gotten so much for so little.
Arshya …
Pay for a doctor and get a plumber instead
Meaningful. Having a serious, important, or useful quality.
You know this word because you want it to define your life. Nearly all of us, at some point, will seek a more meaningful existence. Most wish our jobs were that way too.
Meaningless. Having no purpose or reason. Ouch. We don’t want anything to do with that. Meaningless makes us question what in the …
The sad, tragic road to meaningful use
Many physicians I know are struggling to make ends meet while making several hundred thousand dollars per year. Despite growing incomes, their savings rates remain extremely low due to ever increasing expenses. What they do manage to save, they turn over to professional money managers.
How does this happen? Why are some of the smartest, hardest-working and most responsible members of our society unable to create real wealth? The answer is …
Most doctors are financially illiterate
An excerpt from The Freedom Formula for Physicians.
Get the last copy of your pay stub. What is your year-to-date compensation? What is your annualized compensation?
Hint: Take your current compensation and multiple it by 12, divided by the number of months already compensated. For example, using an end-of-the-month May check, multiply the amount by 12 divided by 5.
Get the last copy of …
Physicians: How to gain insight into your tax situation
There is a scene in the movie, The Matrix, in which the main character Neo is offered a choice between the red pill and the blue pill.
This is your last chance. After this, there is no turning back. You take the blue pill — the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill — you stay in Wonderland, and I …
Learning from physician burnout: Which pill will you choose?
A medical student asked to speak to me about a month ago at the Philadelphia College of Osteopathic Medicine, where I am an instructor of family medicine. He has been very active in our school’s Primary Care Scholars program and community health outreach activities. “Dr. Chan,” he said, “I am so torn. I really love primary care, but I am so …
Want to practice primary care and be debt free? Here’s how.
Her heart was failing; her ejection fraction was unmeasurable. Her hip was broken, and she developed a pulmonary embolism post-operatively. She was painfully close to death. Yet at some point, the hospital finished and spit her out at the nursing home.
She was confused.
I tried to take the best history that I could. Her answers where usually no more than a single word. Her physical exam revealed a desperately weak woman, …
Doctors who attack other physicians
Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that?
Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren …
A house call is worth a dozen tests. And then some.
This isn’t a debate about vaccines.
The fight here has nothing to do with that. For the record, I strongly support the concept of vaccination. Public health is better in the 21st century because of it. Measles? Mumps? Oh, I can find you in the United States, but we aren’t living our lives every day petrified of an outbreak. Smallpox? Polio? Where did you go? Not here, that’s for sure. And, …
Forget the ivory tower: We need more Disney in medicine
In a recent article posted on this site, the author (a radiologist) waxed rhapsodic about a young medical student that was convinced to pursue primary care. When the author asked the student about the economic downsides to primary care, he responded by saying, “I’m not in it for the money … What matters to me isn’t the money — it’s making a difference in my patients’ lives.”
Well, good for him. Time …
Money matters, despite what medical students say
ADVERTISEMENT
1. Before anything, advertise yourself as a protector of the public against incompetent physicians.
2. Design the examinations for each specialty with a “one size fits all” approach. You can achieve this by disregarding the fact that many physicians prune their practices over time to accommodate to the demographics of their communities and their availability of specialty care. This has particular significance for internal medicine and family medicine.
Also, by including a large …
How to start your own board certification organization
We’ve almost made it.
Long gone are the purgatory stints of library study, slaving to solve esoteric problems relating to planks and pulleys. Innumerable several-day exams have been conquered and tucked far away in our memories, hopefully never to haunt us again. The last of our forced smiles and faux-eager nods have been displayed toward ambivalent instructors and medical teams during the throes of our student rotations.
Post-graduate training is also nearing …
Reflecting on the end of residency training
Times change, and, as with Darwinian natural selection, those who adjust survive and those who don’t perish. Henry Ford’s assembly line greatly ramped up the production of automobiles but put many people out of work. The elevator operators of my childhood are long gone. Those who have embraced new technology have usually thrived; those who have fought it or failed to understand it have suffered. Witness the success of Amazon versus …
The medical testing industry needs to become extinct
I’m a family doctor working in underserved medicine. My friend Pierre Wolfe was one of Denver’s top restaurateurs for decades. When we get together I often think of the parallels between our industries.
A postcard of Pierre’s Quorum Restaurant from the 1960s shows Pierre at the front door of his restaurant, holding a menu, and says “Pierre Wolfe himself greets you at …
To remember who is the customer and who is the servant
As we enter year two of the Affordable Care Act, we have seen many issues arise during implementation. Through both executive order and executive memorandum, President Obama has unilaterally changed the law more than 100 times in order to advance his political agenda.
When it became important to publicize enrollment and increased coverage of the uninsured, the president, and the ACA provided for an increased payment scale for patients with Medicaid. …
The Affordable Care Act’s Medicaid bait and switch
A new revelation has added to the ongoing controversy over the health risks of e-cigarettes. Some commentators have viewed the use of this electronic delivery system for nicotine as a way for smokers to cut down on tobacco cigarettes or quit the habit altogether. Others have contended that e-cigarettes can be a “gateway” to smoking and may actually increase …
The time to regulate e-cigarettes is now
Ever wonder what your doctor is thinking while taking your history? If we’re doing it right, we’re looking at you instead of a computer. We’re making appropriate eye contact while displaying welcoming body language. And we’re letting you tell your story with as few interruptions as possible. Clearly we are listening intently, but did you ever wonder what’s going through our minds while you’re speaking?
I’ve been thinking about this lately …
What are doctors thinking when you’re talking in the exam room?
Get free updates delivered free to your inbox.
