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The art of healing is very important in medicine. There is a difference between being a modern day physician and being a healer. All societies have healers — wise men and women, shamans, medicine men and people of other names. The “old time practitioner” was almost always a healer but many physicians today are not. It is an issue of interest, training, time and prioritization. Most …
Primary care and the art of healing
In his book The Art of Loving, Eric Fromm wrote that “the deepest need of man is to overcome his separateness, to leave the prison of his aloneness.” In the Bible, after forming Adam from the dust of the ground and breathing into his nostrils the breath of life, God declares that something is missing: “It is not good for the man to be alone.”
A number of scientific studies verify that a …
Health and well-being are holistic concepts
“Here you go, doctor.”
My patient with incredibly well-controlled type 2 diabetes hands me his fingerstick log at his regularly scheduled office visit. Despite his multiple medical problems (congestive heart failure, coronary artery disease, chronic renal insufficiency, and gout, among others) his sugars have been incredibly well-controlled over the past several years.
Page after page of scrawled numbers, tiny smears of his blood on the pages, his fingersticks range from 90 to …
When is too much data a bad thing?
Health care is but one element of what makes the biggest difference in health outcomes: Social factors play a far more significant role. Income and its distribution, education, employment, social supports, housing, nutrition, and the wider environment — what we have come to know as the social determinants of health — are the most powerful predictors of wellness and longevity. This has been understood for centuries, and empirically validated in …
Health has to go beyond health care
Thousands of health care providers now utilize Twitter and other social media as a means of communicating and staying in touch. We follow conference hashtags from afar to keep up-to-date, and to e-meet new and interesting people who share a common goal. In this way, we are able to grow our networks, foster our relevance, improve our knowledge base, and reach out to assist others.
Whether we are physicians, nurses, or physical …
Use social media to help clear health misinformation
It’s not that I was stressed out about being alone with the kids. My wife had gone out of town before. It was the darn mornings. I’m used to racing out of the house at the crack of dawn, when the rest of my family is still asleep. My most productive hours of the day are before most people even wake up. With my wife gone, the mornings with the …
Savor the moments that make a life
In a recent New Yorker article about him, Dr. Mehmet Oz was paraphrased as saying that “Marcus Welby — the kindly, accessible, but straight-talking television doctor — is dead.” If he believes that, Dr. Oz needs to get out of New York.
At 51-years-old, I’m a little too young to remember the television show Marcus Welby, M.D, that aired on ABC from 1969 to 1976. A colleague told me the show was pretty …
The country doctor is alive and well
Next in a series.
As a patient, you have probably had the experience of meeting a physician for the first time and very quickly becoming comfortable that he or she has your very best interests utmost in mind. The sense comes quickly; you become comfortable, less anxious. Unfortunately you may have had the opposite experience of encountering a well-educated, well-trained physician who, although technically an expert, left you cold.
As a …
Do you trust your primary care physician?
I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back.
Let me explain.
A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing …
The health insurance shell game reminds me of derivatives
The legislation proposals aimed at allowing physician assistants and nurse practitioners to act independently and deliver primary care services in place of physicians is a change in health care that we may face with an impending primary care physician shortage. It is an important topic for patients and physicians to discuss since ultimately those two groups will be impacted most by this change. Patients should be concerned with the quality …
The evolving models of primary care: More harm than good?
The key change in medicine that has caused a escalation of costs, a decline in the quality of care, and an increasing shortage of physicians is the shift toward an exclusively business contract with society at the expense of the social contract.
To differentiate the business contract from the social contract I will use the following example. One afternoon I see my neighbor hard at work changing her tire. If I …
The ongoing battle for the soul of health care
“Nine of 10 doctors discourage others from joining the profession,” writes Daniela Drake on the Daily Beast.
And stats say that by the end of 2014, about 300 physicians will commit suicide.
What is going on?
A few years back, practicing medicine was named the second-most suicidal occupation. Yet, it hasn’t stopped. The level of sheer unhappiness among physicians is on the rise.
Being a doctor has become a humiliating undertaking. There …
Status quo primary care: How did things get this bad?
I’ve based a huge chunk of my career on the assumption that evidence-based information helps people make better informed health decisions, have better health conversations with their doctors and ultimately leads to better health outcomes.
Evidence is my stock in trade. I have spent many years translating evidence into a form that people can understand. I’ve written thousands of evidence-based articles across many channels. I’ve written position statements, belonged to guideline …
The problem with evidence-based health is not what you think
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Patient noncompliance.
I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time.
We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often …
Physicians are noncompliant too
Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there …
Can doctors ever work together with insurance companies?
The process of becoming an excellent physician is one of mastery. The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult. The leap from decision to clinician takes decades. Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues.
The apprentice guards his knowledge closely. He bows …
Demonizing doctors won’t solve our problems
The doctor-patient relationship is under threat from state laws that try to shape what we can and can’t do for our patients. Many state legislatures are proposing laws that limit the questions doctors can ask patients in our confidential clinic visits. Do you smoke? Drink soda? Exercise? Do drugs? Is there a gun in the home?* Do you want to be pregnant? Is there fracking near your home?*
The questions followed …
State legislatures should not enter the exam room
This post deserves a caveat — health care shouldn’t be a political issue. When someone comes into my office because they have chest pain, I don’t ask them, “What’s your political leaning?” before administering care. And now after reading about the recent delay of ICD-10 in Congress, I realized that my choice in practicing direct care was the most political and least political thing I could have done.
According to Read more…
Health care shouldn’t be a political issue
When one hears the words “language barrier,” it usually brings up images of a person who is in another country of which the national language is not his own. If you have visited a foreign country without fully knowing the primary language, you can start to feel out of place fairly quickly. Despite one’s best efforts to navigate the country, a part of the cultural experience is lost without knowing …
Breaking down the language barrier in medicine
I had a silver-and-gold Passover. Hearkening back to the old Girl Scout song I learned from my mother:
Make new friends, but keep the old;
One is silver and the other’s gold.
With no space or equipment to have a seder myself, I was nevertheless the lucky recipient of not just one, but two invitations. The gold was thanks to a quarter-century-plus friendship; the silver was from a family we met the week before …
When are doctors truly accountable to their patients?
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