It was a Friday morning, in the wee hours. I had come in to the hospital early to get caught up on the ever-present computer work. As I got a quick cup of tea, a young surgeon I’d seen around the operating room came in. He’d clearly been up most of the night.
We exchanged a few pleasantries. And then he cut to …
What is it about doctors that makes them think they don’t need help?
Check.
The administrator’s voice wavered as I picked up the phone. He was calling about the nursing home patient that I admitted the day before. While normally forthright, I could feel the discomfort in his tone as he danced around the issue. The patient’s insurer had called. Apparently they made an “arrangement” with the mega-ACO owned by the latest consolidation of Goliath health systems. They wanted my patient transferred to another …
Health care monopoly: How it affects the nursing home
Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm.
Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months.
A slender, middle aged man, …
When the art of medicine gets lost in the business
I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.
I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of …
What a messy house has to do with medicine today
When I started my internal medicine residency, I was pretty sure I was going to rock this primary care thing. I knew the drugs for hypertension, the guidelines for diabetes management, and depression management seemed like nothing more than an algorithm. I felt buoyed by familiarity as I looked at the problem list for my first primary care patient: basically diabetes, hypertension, and depression.
As I opened the exam room door that early July day, I …
Transforming primary care to spend extra time with patients
I have to thank my colleague @SusannahFox for alerting me to this on my Twitter stream. It was a link to a Washington Post article about a campaign to get people in Belgium to stop Googling their symptoms.
Can this ad campaign get people in Belgium to stop Googling their symptoms? …
Wake up health care: Patients Google it
I’m getting to the point where I think it might be time to stop or at least decelerate the pace of my writing on medicine. When I retired from medical practice almost a year ago there were a lot of pent up experiences that I felt a need write about. But now I have already written about almost everything that I wanted to and, as I am no longer a practicing physician, …
Can writing about medicine change medicine for the better?
Just north of Denver, Jefferson County has become a battleground in the fight over performance-based pay for teachers. The recently elected school board plans on implementing “[a] compensation system that recognizes and rewards our great teachers,” according to school board president Ken Witt. The response of the local teachers’ union was for teachers to call in sick and enlist students in protesting what they describe as a proposed “patriotic curriculum.”
The protests are a convenient …
P4P: If it works for physicians, why not for teachers?
Open a new browser tab and check your favorite weather forecast website or app. Right now.
How many days in the future does it go? Seven? Maybe even 10? Look at the current forecast for the 7th day out from today. Do you trust it to accurately predict the weather for that day? Why? Or why not?
Have you ever wondered why they can’t …
What chaos theory has to do with family medicine
One of the top students at one of the nation’s largest medical schools, Ishan Gohil has made an unusual — and to many of his colleagues — inexplicable decision. Instead of seeking to train in one of medicine’s most highly specialized and competitive fields, he says, “I elected to pursue a career in family medicine.” Many view his choice of primary …
Primary care fits some medical students. Here’s one.
It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket.
They call these messages “system notices.”
OK, maybe that’s an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic …
Communication is key between physicians and EHR programmers
Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.
– Susan Sontag, Illness as a Metaphor
Words are important. …
Pathographies: Step into our patients’ lives
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Care coordination seems to be the rage these days. It is mentioned in most discussions of new delivery and payment models such as the patient-centered medical home (PCMH) and accountable care organizations. The concept is not a new one; primary care physicians have been coordinating care …
Need better care coordination? There’s a toolkit for that.
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Most of the doctors I know went into medicine because they really truly wanted to help people. But medicine, long honored as a calling as well as a profession, is facing some tough new challenges. Many doctors are disillusioned or simply burnt out. Others have accepted their fates as interchangeable provider units.
The name of the game today is efficiency — i.e., …
Patients: Accept your fate as a hamburger
Man looks into the Abyss, and there’s nothin’ staring back at him. At that moment, man finds his character, and that’s what keeps him out of the Abyss.
– Lou Mannheim (Hal Holbrook) in the movie, Wall Street
We hear reform ideas all the time: Primary care physicians need to work at the top of license, physicians need to work in teams, health …
What primary care can learn from the financial service industry
Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …
It’s time to tell fast medicine to slow down
I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.
I have a different thought.
Although every experience …
When you can’t share experience: The power of listening
An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine.
A doctor’s self-worth can be tied up with a lot of issues.
How well can we make a diagnosis?
How elegantly can we perform the surgery?
How happy are our patients? Our staffs? Our families?
How many articles …
Fall in love with medicine again
The documentation I get from everyone is terrible. Seldom does it tell me what I actually want to know, and if there is useful information it is buried in an avalanche of yada yada. The main reason for this is that documentation is driven by our ridiculous payment system, which requires us to follow arcane rules to generate notes that justify the obscure codes we submit for money from the …
Building a better EMR. Read how one doctor is doing it.
I talk a lot with different physicians about integrating NP/PA providers into their practice. I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians. Many times a doctor will have a medical “horror story” with the NP/PA playing the villain. One bad encounter or event seems to justify a complete rejection of the many positive …
5 ways to ease the integration of NPs and PAs
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