Wang Li is a 48-year old farmer from Dalian, China. After a two-day trip to the major provincial hospital, he’s heading home to his village to die. Wang has lung cancer, and even with insurance, his surgery will cost him 20,000RMB—$3,000, which is twice his annual salary. The surgery would be curative, but it doesn’t matter. “I cannot burden my family,” he said.
I am a Chinese-born, American …
Health reform: China offers a cautionary tale
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Over the past several months, I have covered some controversial topics, such as electronic health records and the overuse of diagnostic testing. For this month’s column, I will address a less provocative topic: the role of non-physician …
Doctors and nurse practitioners: We’re failing the reality test
Iinspired by the VA’s big bold step of going OpenNotes, I wrote a blog post titled OpenNotes in geriatrics: 6 awkward concerns.
It was written in the spirit of just about everything I write: to share the nitty-gritty complexities of what I find myself navigating in geriatrics, to bring attention to medical issues that older adults and PCPs struggle with, and to try to bridge …
Should OpenNotes become the standard of care?
The Oxford English Dictionary (OED) identifies the first use of the term “doctour”, as the year 1303 AD, shortened to “doctor” in the 1557 addition of the Geneva Bible. The OED first defines doctor not as a caregiver or healer, not as a science researcher or expert and not even as one with an advanced educational degree. The OED, the world’s foremost English language dictionary, defines “doctor,” 700 years ago …
The best doctors teach their patients
The progeny of the iPhone and the iPad will change the shape of your institution — and your balance sheet.
One of the more striking images, to me, out of the online spew in the last few months was from the inauguration. It was a wide view of an inaugural ball. There was the president waltzing with the first lady, and a crowd of several hundred watching them. What was striking …
Medical apps: We are approaching the tipping point
Why do you need a population health management (PHM) IT system? In our last column we discussed the fact that reimbursement tied to outcomes will demand a greater level of patient management. Greater, perhaps, than your EHR can deliver. The early focus of new pay-for-performance and bundled payment systems is on preventive care for top chronic illnesses.
The 15 most expensive health conditions account for 44% of total …
Why you need a population health management IT system
I inherited motion sickness from my father’s side of the family. I can’t sit in the back seat of a car for more than 10 minutes without becoming sick. I take meclizine before every plane flight.
I inherited asthma from my mother’s side of the family. Exposure to perfume, 90+ degree temps with 90+% humidity, or even a good laugh will all prompt me to cough.
These two maladies of mine have …
Blaming others for their health problems helps no one
The more I try to help people in this field of mine, the more I realize that it doesn’t take a village. It takes a huge industrialized city, all its wires and arteries humming with constant activity, just to try and make one woman better. In this case, one smiling woman in her 50s, ethnicity I couldn’t figure and of dubious relevance, who came to our clinic seeking advice about …
Let patients be their own people inside the system of care
A response to Dear lawmakers: This is what it’s like to be a doctor today.
With a family and financial background that eerily matches Dr. Moeller’s, please count me as one soon-to-be physician who does not share the notion that lawmakers should spend their time being overly concerned with the demands placed on physicians or physician compensation. In fact, I …
Lawmakers shouldn’t care about the personal hardships of doctors
Academic Medicine, a journal of the American Association of Medical Colleges, has sent out a recent call for articles addressing the 2013 question of the year: “What is a doctor? What is a nurse?” Thirty years ago this would have been an absurd question. Not only would it have been absurd for doctors and nurses, but for patients too. Roles were …
The only thing that truly separates doctors from nurses
We have to stop comparing ourselves to the airline industry.
Sitting on the lounge chair at the pool, I can’t believe that just hours ago I was sludging the wintry streets of Chicago, rushing to the airport. The kids clucked away happily in the back seat as the adults in front where more subdued. As grownups do, we kept running through our mental checklists even though the ship had already sailed, we …
Doctors should stop being compared to the airline industry
“Hey doctor, what do you think about this product/solution/service?”
These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it’s because I have a clinical problem I’m trying to solve. (Can any of these sleep gadgets provide data — sleep latency, nighttime awakenings, total sleep time — on my elderly patient’s sleep complaints?)
In other cases, it’s because …
Questions to ask when considering new medical technology
I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make …
Am I smart enough for family medicine?
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Once again, medical schools continue their annual fraudulent and misleading statistics in regards to primary care workforce production. The Dean’s Lie is back and rampant across the country. It only seems to get worse.
When will they learn?
USA Today: Match Day: More medical graduates enter primary care
About one-quarter (11,762) of the applicants matched to resident positions that train doctors to be on the front line …
Match Day primary care aftermath: The Dean’s Lie continues
Direct-to-consumer genetic testing is increasingly available to the general public. Reduced cost and ease of testing make this service easy and seemingly harmless. For less than $100 and without even having your blood drawn (a saliva sample is sufficient), a private company promises to provide you with information about your ancestry and your health.
However, undergoing genetic testing of any kind is not a trivial decision. It is not like having …
Be careful when ordering your own genetic tests
Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.
Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …
Clinical pearls that you don’t learn during medical training
There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so.
Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.
My focus today is more, well, literary.
I know the word “literary” often …
Where can doctors publish literary writing?
An excerpt from Pet Goats and Pap Smears.
Phoning isn’t an option. Nor is e-mail. So I write a letter to the head elder, asking that the Amish community meet with me. He agrees.
Today is the day. I accompany Steve, the hospital CEO, to an Upper Midwest town so tiny that the post office is inside the grocery store. On the third floor of a local bank, we …
The first meeting with a group of Amish patients
I am a physician who writes and I think that more of my colleagues should do so. Not because, we are such skilled wordsmiths or understand plot and characterization. We don’t. But, we confront the human condition every day. We see pain and struggle and fear and rebirth. We have much to share.
Beyond my own profession, I think everyone should write, because everyone has something important to say and to …
Why more physicians should write
The following is an exclusive excerpt adapted from #1 New York Times best selling authors Chip and Dan Heath’s new book Decisive: How to Make Better Choices in Life and Work, which was released on March 26, 2013. Click here to order.
One …
How a smart process helped Kaiser Permanente save lives
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