Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth.
Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family.
Doctors delay childbearing and starting their own families so they can care for your family.
Doctors miss their own kids’ ballet recitals and baseball games …
Why you should love your doctor
An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.
You’ve told your story. Your doctor gets it. He has completed the physical exam. He formulates a plan to get you better. The next skill you should master may be as important as being a great storyteller. Your doctor has told you the …
A simple trick to remember your doctor’s recommendations
Whenever I talk with groups of medical professionals about job frustration and burnout, there’s a theme that shows up that’s hard to ignore. I call it “the pain of perfection.”
Most of us pursued careers in medicine to help others. And if we’re honest, we must admit that we have type A tendencies infused in our bloodstream.
Can I see a show of hands, please?
That part of us, the one that strives …
Perfection fuels physician burnout
My general internal medicine practice is equidistant from the three academic institutions and a Veterans Administration facility, and thus I have patients who receive primary, secondary and tertiary care at each of these institutions.
The notes I receive back from one of these organizations are hands down the best of the four institutions. These notes are personal, concise, precise and clear. If …
Replacing transcriptionists with physicians is a fool’s bargain
It is a trade secret among patients of many practices: If you’d like to be seen by your personal physician with no waiting and without an appointment, just ask for a free blood pressure check and then mention to the medical assistant that you are not feeling well at all. They can’t send you home without being seen and they don’t have enough to go on to call an ambulance; …
Always start your diagnostic search from the beginning
How do you really know if your doctor, surgeon or hospital is good, bad or somewhere in between?
I frequently speak with large audiences, ranging from CEOs to Stanford business school students.
I often start by asking participants to raise their hands if they receive excellent health care. Each time I ask, about 90% of the hands in the room shoot up. But all the hands come down when I ask, “How do …
It’s very difficult to assess a doctor’s true skill or performance
The world is asunder. Iraq is sinking into a sectarian abyss. ISIS, a terrorist group, now controls a larger territory than many actual countries. Russia has swallowed Crimea and has her paw prints all over eastern Ukraine. China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines. The Israeli-Palestinian peace process is in another deep freeze. Terrorists in Sudan and Nigeria are kidnapping …
FiveThirtyEight had a provocative article: “Patients Can Face Grave Risks When Doctors Stick to the Rules Too Much.”
The subsequent comments have debates over the value of guidelines. Guidelines are like a box of chocolate, you never know what you are going to get. Many clinical questions yield competing guidelines. We all know the controversies over breast cancer screening and prostate cancer screening. Recently blood pressure targets and lipid management have …
Everything in medicine requires context
If you put ten physicians in a room, you will get nine different opinions. It doesn’t matter if you are discussing policy, diagnostics, or politics. Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being. We battle our fellow physicians, administrators, and insurers. You can argue the pros and cons of …
Medicine is a house divided: It is time to unite on common goals
I am responding to the article, “Frustrations of the primary care physician should be a wakeup call.” Having practiced medicine for 25 years as a primary care physician, and accountable primary care physician for the past 10, I understand the demands on PCPs’ time and the pressure to please patients, satisfy documentation/coding requirements, manage care teams, run a practice, and earn a living. However, there are some best …
How to achieve the Triple Aim plus physician satisfaction
The VA scandal over excessive waits for doctors’ appointments is an early warning of things to come. Over the last three years, the demand for primary care appointments at the VA increased by 50% while the number of providers rose by only 9%. With four hundred vacancies for primary care providers, the VA is facing a severe gap in its ability to care for its patients.
It isn’t surprising that the …
How doctors can change the way they work and care for patients
Recently I went to a physician and left pondering the question: “What is health anyway?”
This is an interesting question, especially one for a doctor to ask.
But it’s important because if we don’t know what health is, how do we know if we’ve got it? If we don’t know what health is, how do we know we’ve improved?
As a doctor and medical writer, I’m finding it more and more difficult to write about …
A critical question for doctors: What is health?
Apple announced the company is working on a new app, called Health, that allows a user to store in one place all aspects of their health data, from heart rate to blood sugar levels, cholesterol measures and calories burned. The Health app, Apple says, will enable an exercise app to determine the number of calories you consume a day — and, in turn, how hard you have to exercise to burn …
Are we relying too much on gadgetry to improve ourselves?
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I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with …
Doctors must discuss the cost of care with their patients
Over the last few years I’ve had numerous encounters with vets and vet hospitals. Domino, the dog that we had since I was in medical school, was sadly very sick. He was a Jack Russell-Corgi cross, black and white, with the loveliest sweetest nature. He lived till almost 13-years-old, bringing an immense amount of joy to our whole family. Sadly, he passed away last summer. My parents felt a huge …
5 things medicine can learn from veterinary care
Is the practice of medicine more of an art or an applied science?
It’s a debate patients may not even know is taking place. But the way your primary care physician, surgeon or hospital answers this question may determine whether you live or die.
Doctors on the far “art” side of the spectrum maintain that every patient and physician is different. Therefore, they believe there is no one right way to treat …
Doctors often choose to ignore the evidence
In recent months, there has been a lot of talk on social media and in the press about how miserable many doctors are. These conversations have also brought inspiring alternatives to the forefront. For example, Zubin Damania, MD, founder of Turntable Health, and Pamela Wible, MD, a leader in the Ideal Practice movement, have notably and smartly encouraged doctors practicing on the front lines to take matters into their own hands, creating new practice …
3 systemic changes to create more happy doctors
Back when Prozac (fluoxetine) and Zoloft (sertraline) were new, I remember the mental acrobatics doctors made to justify giving these drugs to anxious patients. The drugs were approved for treating depression, but we knew they often seemed to help anxiety. The reason, we were told, was that some anxious patients were actually depressed, deep down, and we had just failed to recognize their depression.
Now, with studies to support their use …
For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it. I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at …
When patients yell at staff, they end up hurting themselves
I have a confession to make. The purpose of a recent blog post was to set up this one. What I questioned, at that time, is whether the future of primary care will come from outside change (business, politics, or even specialist physicians and administrators) or internally, hence creative destruction versus internal combustion.
When I entered my first primary care practice in 2002, I had great doubts that the traditional …
The only way primary care can survive
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