I know. I know. Medicare is the insurance that all of us love to hate. But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons:
1. Medicare’s fee schedule. It’s bad, but not that bad. Sure, Medicare’s fee schedule has only increased 3.1% over the past 12 years, while …
10 reasons why I love Medicare as a physician
Should doctors ask patients if they own guns? Currently, ObamaCare bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics …
Why doctors should not ask patients about guns: A conservative case
Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.
When there is bad air in the mine, the canary’s sensitive lungs will cause …
Doctors are the canaries in the coal mine of medicine
Medical knowledge, technology and rapid clinical advances in related scientific fields are expanding in an almost exponential manner. It is thus impossible for any individual or any medical specialty to absorb and implement these strides. Consequentially we physicians and other caregivers not only tend to specialize in medicine today, we are essentially ordained to subspecialize as a result of this knowledge explosion.
The …
The creative destruction of the American family physician
Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston’s South End. I consult my iPhone one more time to confirm that I’m in the right place and knock on the vehicle’s glass-paned door. Ritchie, with his oversized Las Vegas baseball cap and faint smell of cigarettes, ushers me inside and I settle in across from him on …
Needle exchanges: When the perfect is the enemy of the good
A version of this column was published on January 13, 2013 in USA Today.
Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.
I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an …
A virtual office visit for your cold is not a good idea
For as long as I can remember I have tended to develop a bad cough nearly every time I get sick in the cold and flu season. I’m not sure if I have a minor tendency to bronchospasm or if my years of passive smoke exposure as a child somehow damaged my lungs. Who knows, but I seem to have the tendency for every URI become a lingering bronchitic cough.
In …
Why I hold off on antibiotics for my cough
I have come to terms with making difficult decisions. I accept the possibility of committing a mistake that will cost a life. But I never signed on to bankrupting my patients. Never!
I had been up all night tossing and turning. The stat CT scan was deemed unnecessary by the insurance company. My patient called crying saying he couldn’t afford the thousands of dollars in charges. Never …
I didn’t become a doctor to bankrupt my patients
Lots of people are using complementary and alternative medicine (CAM) these days—things like vitamins, homeopathic or herbal medicine, chiropractors, acupuncture or massage therapy. But they don’t always tell their doctors about it.
In a study in the journal Pediatrics, researchers in Canada found that among kids with chronic health problems, 64.5 percent of them were using some form of CAM—but more than a third didn’t tell their …
Let doctors know if you’re using alternative medicine
For practicing physicians, there’s a tricky balance in believing that the Internet can help save lives.
I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the Internet. Many clinics block video-streaming sites and don’t allow for traditional email …
Dr. Google: Tips for patients who diagnose online
For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.
Yet somehow 43 percent of newly-licensed RNs can’t find jobs within …
The nursing shortage: Why it isn’t a good time to become a nurse
I saw 17 patients in my primary care practice yesterday. Six of them were coughing.
One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …
How to know whether your cough is serious
The American Journal of Surgery had a nice little (38 patient cohort) study from the VA database that tried to determine the process by which patients make informed decisions on elective surgery. The results were rather surprising, at first glance.
Sixty-nine percent of patients decided to have surgery before meeting their surgeon, and 47% stated that the surgeon did not influence their decision. Although the surgeon was an important source of …
The days of the primary care gatekeeper are coming to an end
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One of the true joys of being a primary care doctor is partnering and educating patients to make the best decision for themselves and their families. Though they may not always agree with what I have to say, at least I know I’ve done my best to give them the information they need to be informed. What follows are common conversations I …
Answers to common vaccine questions from patients
When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …
Reform medical education to fix the primary care shortage
The health care scene is evolving. Rapidly. We all know that. Thanks to legislation, changing patient expectations and physician shortages, we are all in for a roller coaster of changes over the next few years.
But what does this mean for physicians? Plenty. Most importantly, it means physician’s roles in the health care system will change. Drastically. And that means the traits and skills you’ll need to be successful will change, too.
Some traits …
The successful physician of 2015: 5 essential traits
For the past month I’ve been trying to formulate a blog that could capture my thoughts about mental illness and the prevention of violence. At this point my ideas are still not crystallized, but perhaps writing this will help. A few days before Christmas I received a phone call from a former patient’s mother. She called while I was at the mall with my family doing some last minute shopping—I …
Will improved mental healthcare be enough to curb gun violence?
A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch.
And I agree. Comparing guns and cars is fair, after all they kill about …
We can learn a lot by comparing guns to cars
Recently both President Obama and the AMA have called for physicians to talk with their patients about gun ownership, especially if they sense mental health issues. This request sounds innocuous enough, but let’s explore the implications and the reality here.
First I need to issue a disclaimer. I am neither a member of the NRA nor do I necessarily feel that more gun laws and bans will reduce the recent tragedies …
Should doctors be required to ask patients about guns?
An excerpt from Pet Goats and Pap Smears.
After two decades of formal education, today I’m finally set loose with real patients. It’the actual moment I’ve been waiting for my entire life.
We’re each assigned to a family doc for the month. I scroll down the list of third-year medical students, place my right index finger beside my name, slide …
Learning about human relationships and the art of medical practice
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