The research published about texting and driving never seem to add up to my in-real-life experience. In a typical day driving in Seattle I see countless people with their phones out, many with it wedged at the steering wheel, stuck between their right hand and the right turn signal post. Like all of us have come to observe, it’s the unusual or unexpected driving patterns that alert me to look …
Texting and driving: How to change old habits
As the Affordable Care Act (ACA) is implemented, many physicians are beginning to take stock in their own professional and personal lives. The practice of medicine is a privilege but it is also an occupation that can consume nearly all aspects of a physician’s life. In the past I have struggled with my own “work-life balance” and I have shared my thoughts on burnout in my previous blogs.
As a …
Will the Affordable Care Act worsen physician burnout?
With the implementation of health insurance exchanges in October 2013 and the beginning of the Affordable Care Act (ACA), also known as Obamacare, there is tremendous risk for the American public to be worse off. Certainly the millions of Americans who currently are uninsured because their employers do not offer insurance coverage and those with pre-existing conditions unable to purchase affordable individual coverage, will benefit. It is those with employer-based …
Obamacare: There is risk for the American public to be worse off
David Bornstein did a real nice job in his New York Times column, Medicine’s Search for Meaning. He partly captures what it is like to walk in our shoes. This is not a pity party for doctors. It is a limited look at some of the stuff that tears us up inside. He explains nicely the damage we have to absorb to get to the pinnacle …
We shouldn’t need the permission of administrators to heal ourselves
“What do you think, Doctor?”
For a novice physician, these worlds can quickly jolt a relatively straightforward conversation into a jumble of partially formed thoughts, suppositions, jargon, and (sometimes) incoherent ramblings. Even for simpler questions, the fumbling trainee does not have a convenient script that has been refined through years of recitation. Thus, many conversations that residents have with patients are truly occurring for the first time. And unfortunately, this novelty …
How do we empower patients with information while not scaring them?
Mark Twain once quipped: “Everyone talks about the weather, but nobody does anything about it.”
Is the same true of exercise? Despite a growing, multibillion dollar fitness industry, despite an increase in sales of treadmills, weights, and other home exercise equipment, despite public education campaigns like Let’s Move, eighty percent of Americans — four out of five of us–do not get the recommended amount of cardiovascular and strength training. 41 million Americans belong to …
What if exercise counseling came in prescription form?
More than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.
Let me admit that I’ve never had particularly …
I support the Affordable Care Act, but not Obamacare
The Affordable Care Act (ACA) will make insurers unable to exclude Americans with serious health problems from enrolling in insurance plans. This is among the most popular aspects of Obamacare. It is also the most likely explanation for huge premium increases in plans for individuals not on employer group policies.
Persons employed by companies with insurance plans for their employees, usually called group plans, routinely accept all eligible employees, regardless of …
Why your premium may rise under Obamacare
“Thank God you’re still here, Doc! It looks like they already laid off half the pharmacy department! The line is out the door!”
“Don’t worry, Mr. Golati! It’s just a regular day at the VA!” I replied.
October 1st at the VA Hospital was like every other day in most ways. It was still hard to find a parking space in the far-too-small lot. The hallways still bustled with white coats, smiling vets, …
A day at the VA during the shutdown
I often read advice to doctors about how to screen for domestic violence. I was that woman for many years. I was that child and I know for a fact my pediatrician knew but was afraid to report it. And then I grew up and became that woman.
Physical violence while brutal, doesn’t compare to the controlling, creeping intimate fear sustained in such relationships. My then husband came with me to some of …
A patient’s perspective on domestic violence
I recently testified before the Medical Licensing Board of Indiana regarding the pending emergency rules for physicians prescribing opioids for chronic pain. The session went on for four intense hours — ten minutes of which had been promised to me.
At my turn, I stated my name, told the Board I hailed from Indiana’s prescription ground zero, gave a brief summary of my credentials, thanked the Board, the American Academy …
Physicians are fearful of fulfilling their duty to treat pain
As the sixty-something-year-old woman and I shook hands and sat down to get acquainted during her “new patient” visit, she pulled out a small stack of papers and a thick spiral-bound notebook. I glanced at her problem list in the electronic chart: diabetes, obesity, hypertension, anxiety — the usual. She handed me the notebook and a printed Excel spreadsheet with several columns: her medications (a handful), the supplements she takes …
Trapped between two conflicting professional obligations
I recently saw a sticker on a bus shelter. It was an arrow about 10 inches long and 6 inches wide. It seemed to be pointing to the bus map. “This is Public Health,” it said. The sticker, part of a larger campaign, gave me pause. Sure, a bus stop is public health because it a marker of mass transportation; it symbolizes improved access and decreased pollution from individual cars. Looking …
Primary care has a marketing problem
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The lyrics to Janet Jackson’s song, Nasty, includes this line, “No, my first name ain’t baby, it’s Janet. Ms. Jackson if you’re nasty.” Miss Jackson doesn’t like being called, “baby,” and neither do a lot of patients.
Many healthcare professionals call patients by nicknames, such as, “honey” and “sweetie.” I believe these are terms of endearment and in most cases meant with genuine warm feelings toward patients. However, from interviewing hundreds …
A primer on addressing patients
There was nothing wrong with Sarah’s vocal cords. Her tumor had spread throughout the abdomen, but her voice was unaffected. Yet minutes after learning of the voraciousness of her metastases, she pursed her lips and began to communicate with head nods and hand gestures only.
I met her for the first time in the nursing home. I sat down quietly at her bedside on a Sunday morning. I was in the …
This is what’s so difficult about doctoring
“Daddy?”
“Yes, Jonathan?”
“Sometimes my leg hurts.”
“Yes?”
“Why does it hurt?”
“Uh, that’s a tough question. Does it hurt a lot?”
“No, just every once in a while.”
“OK, and where does it hurt.”
He gives an expression of disbelief at the stupidity of the question. ”My leg!”
“Where on your leg?”
“I don’t know,” patience now growing thin. ”I just want to know what’s causing it.”
“Well, Jonathan, it doesn’t work that way. My main job is to make …
Preventing disease is a problem for the health industry
In a recent blog post, I discussed the harms of a new epidemic: too much medical care. We also don’t want the opposite. In fact, much of the driving force leading to overdiagnosis and overtreatment is this fear of rationing.
So what can you do to ensure that you obtain just the right amount of care?
It isn’t easy — if it were, if there an algorithm that would give …
How to ensure you receive the right amount of care
What is patient engagement?
Everyone agrees that it’s a good thing, and that we healthcare providers should be fostering it.
How to do so, however, depends on just what you believe patient engagement means.
As Dan Munro recently pointed out, the term “patient engagement” is a hot buzz phrase, and — in the best tradition of such phrases — it’s amorphous enough and appealing enough to mean just about anything.
Provided …
Real patient engagement depends on defining it correctly
I recently supervised a new intern as she conducted a patient interview. Following procedure, the intern reviewed the patient’s electronic medical record (EMR) and checked his lab results. She noticed that his cholesterol was high, and he told her that he had stopped taking his atorvastatin due to a recent trip to the Dominican Republic.
“It’s no problem,” my intern replied. “We’ll get you back on the medication.” She began to …
Fighting the patient-computer attention war
Recommendations. Specialists are full of recommendations. Sometimes they’re helpful, even lifesaving. Other times, not so much. I try to make a point of calling ahead and letting them know about special circumstances, but it’s tough getting past their nurses. Then again, even when I do get through to them, I’m never sure I’m getting through to them, if you know what I mean.
Specialist’s recommendation (ortho, seen for fracture):
Frequent falls resulting …
Nonsensical recommendations from specialist physicians
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