I am not a disease.
Although when I enter your hospital, or office, or outpatient center, you may refer to me as one. You may lump me together with an odd set of symptoms, or signs. You will define me with those antiquated terms. You will pretend that you will know how I, my body, will react when placed under certain stressors. You will prescribe treatments for my disease, and yet …
I am not a disease, I am not a checklist
There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”
First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them …
Doctors who call patients hypochondriacs are committing malpractice
The New York Times recently had one of their periodic debates: When Medical Experts Disagree.
This debate actually centers on the current cholesterol guidelines, but the problem recurs often. Different experts look at the data and develop differing opinions. We see this with prostate screening, mammography, and treatment decisions.
As one reads the varying opinions in this debate, an understanding of the affect heuristic makes the debate transparent. When we like …
The cholesterol debate: Seeking truth where there is no truth
For several weeks, the bumpy rollout of the federal health insurance marketplaces has overshadowed almost all other health care topics. But after reviewing the timely Health Affairs issue dedicated to the health care work force, it is clear we must maintain our focus on building a primary care system of the highest quality and value. Within that increasingly complex system, primary care physicians are the first, most critical line of …
AAFP: The right care by the right provider is more important than ever
This wasn’t just plain terrible,
this was fancy terrible.
This was terrible with raisins in it.
-Dorothy Parker
More and more of my clinic time is devoted to evaluation and treatment of depression and anxiety rather than sore throats, coughs, UTIs and sprains/strains. An outbreak of overwhelming misery is climbing to epidemic proportions in our society.
A majority of the patients who are coming in for …
We have lost all perspective about what is truly terrible
While interviewing for medical schools last fall, I observed a strange phenomenon: every institution I encountered would underscore its student-run free clinic as a major highlight of the medical education they could offer. First- and second-year students would speak rapturously about the experience they gained from clinic. Working there, they said, reminded them of why they wanted to become doctors in the first place.
Today, the majority of all U.S. medical …
Can student run free clinics help the health care safety net?
I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …
To put patients’ interests first, we have to put our own aside
I get it. It’s not rocket science. But sometimes everyone in the field of medicine needs a bit of a refresher when it comes to keeping our patients happy.
After all, it’s a two-way street with medical providers and patients: we provide and support ways to improve and maintain the personal health of our patients while our patients provide and support the health of our careers and livelihood. We depend on …
3 tips to keep our patients happy
I recently participated in a small conference devoted to “physician alignment in the academic medical center.” The meeting was sponsored by a health care consulting firm, and drew about a dozen participants from around the country. The title refers to ways in which academic centers figure out how to work with their traditionally autonomous if not completely independent physicians to advance the institutional mission. An informal format allowed us to …
Academic medical centers: Should we continue to feed the beast?
Recently, I received a phone call in the late afternoon from someone very close to me. Please note that this someone is also a doctor. “Uh, I need you for a minute. I’m kind of freaking out. Can I talk to you?”
She had just gone to her local optometrist to get a new prescription for glasses. The optometrist looked in her eyes, told her that both of her optic nerves …
Communicating urgently without scaring patients
Remember the figure-ground drawing from psychology 101 that demonstrates (ahem) “how edge assignment designates perceptual groupings?” I always just thought it was cool how you could look at the picture of a vase and blink and — whoa, Nellie — now you saw two people face-to-face.
I’m concerned that the frantic drive toward evidence-based medicine as a strategy for quality improvement and …
Incorporating patient preferences into evidence based medicine
In my 3 years of residency, the nearly universal resident response to outpatient continuity clinic was a disturbing, guttural groan. I recognize that many aspects of primary care drag down even the most enduring physicians. But I have also found primary care — particularly with a panel of high-risk and complex patients — to be a welcome challenge. I recently spoke with one of my institution’s main advocates for academic primary …
Primary care suffers from guideline overload
The sustainable growth rate (SGR) formula was enacted into law in 1997 to tie Medicare payment for services to physicians to the overall status of the economy. Basically, if the U.S. gross domestic product (GDP) does well, doctors get more money, and if it does poorly, doctors get less money for the same service. A decade of tinkering with legislation for circumventing the application of the SGR formula, preferably a few days …
How will repealing the SGR affect your practice?
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Things are going well with the practice, but I am being wrung a bit dry. That’s the reason for my dip in writing. I am putting a lot of energy and emotion into the practice, and I don’t have a whole lot left at the end of the day. I have always been one to write out of passion and convictions — I write because I believe what I am …
In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.
Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …
Why physicians are hesitant to take Medicaid patients
Over the last couple of years, we have been witnessing the start of a seismic shift in healthcare philosophy. For far too long, the system has been totally focused on rewarding quantity: The more patients seen, tests performed, procedures completed — the higher the incentives.
Now, instead of rewarding healthcare providers for quantity in the “fee-for-service” model, we are moving towards a system that rightly focuses on the quality of care …
How can we judge the ideal health system of the future?
I was hired in 2011 by the Veterans Health Administration (VHA) to direct the Office of Patient Centered Care and Cultural Transformation and charged with ensuring that the VA transforms from physician-centered care to personalized, patient-centered care that is based on relationships, built on trust, and committed to positive results over the veteran’s lifetime.
This undertaking represents one of the most massive changes in the philosophy and process for healthcare delivery …
Our veterans drive the transformation of healthcare
I was invited to attend a private breakfast with book author, surgeon, and New Yorker contributor Dr. Atul Gawande shortly before Dr. Gawande’s talk at The New Yorker Festival. Over breakfast, Dr. Gawande spoke with IBM executive Dr. Paul Grundy on the future of health care. The event was sponsored by IBM so there was plenty of talk about how technology can and will influence the practice of medicine — …
Can technology be a change agent for health care?
In medicine, we pledge: primum non nocere. First, do no harm. But before we can do no harm as doctors, we need to be doctors. And before we can be doctors, we need to be human beings. Being a doctor is a great privilege, but it is a subordinate privilege. Being human comes first.
I distinctly recall the time in my medical education when I realized I was becoming more medical …
Doctors need to remember that they need to be human first
I have been following the news about the National Security Agency (NSA) access to our phone records with great interest. If we as a society don’t sort some of this out, we’ll see a repeat in the health sector a few years from now.
These discussions seem to pivot on issues of population-level safety vs. personal liberty, and on trust vs. suspicion re: how much of the process is driven by …
Why our personal health data will become less private
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