Terry is a particularly difficult patient. She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff. No there real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult …
Taking care of other physicians and their families
Sorry for not posting for a while. It’s not that things have been quiet; they definitely haven’t been.
Here’s the update:
The only way to accomplish big things is to do the little things
I recently heard from an aging and respected physician the old adage that “what is good for the doctor is good for the patient.” The room full of physicians of all ages and specialties nodded their heads in agreement. This saddened me, as it represents a physician-centric system that oftentimes leaves the patient’s needs and desires completely out of the equation.
An area of emerging importance in medicine, whose impact should …
Patients need to be involved in quality metrics
“He’s dead, Jim.”
So here’s my beef. At the recent Forbes Healthcare Summit there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held; personal genomics, where data from your own genome is cheap and easy to get and can be integrated with clinical knowledge to produce better care; targeted therapies for various diseases, …
Let’s solve our most pressing healthcare problems first
Two weeks before the Newtown, Conn, shooting I was at my doctor’s office for an annual physical exam answering questions on an intake survey. Questions like “Do you smoke? How much?” and ” Do you wear the seat beat?”
And then one question stuck out: “Do you have any firearms in the house? Are they stored in a locked area?” What business …
Firearms violence is a public health safety issue
A recent editorial in the New York Times about non-physician health care providers or NPPs, has drawn more than 260 comments. Who are these NPPs and why do so many people care about them?
Historically, nurses have a long history of stepping in when there are gaps. For example, in the early 1900s anesthesia was given by med students and interns, and …
Why your nurse practitioner is your friend
You need a doctor, and I love what I do. But this work just isn’t sustainable.
In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a …
Don’t make me leave primary care
Assembling the right medical team is important to keeping you healthy and saving money. Besides you, one of the most important people on this team is your regular doctor. For many people, this is their primary care physician (PCP) or primary medical doctor (PMD). A highly trained and well-qualified primary care doctor can advise you on what preventive tests and treatments are truly necessary to stay healthy.
If you view your …
An excellent primary care doctor is your trusted health care advisor
Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.
These stresses, if unmanaged or poorly managed, can …
Dealing with psychological stress of being a doctor
Here are the sad the financial facts. You have heard them before:
Anyone who discounts that fact that we women physicians are discounted …
6 ways to close the gender pay gap in medicine
The ultimate cure to the perversions inherent in U.S. health system economics is cracking the risk code – optimizing the financial risk allocation for any given disease across payer, health system, physician and patient. After years of payer and more recently health system effort, the heat is increasing on doctors and patients.
Despite vigorous effort on wellness and prevention, it’s fair to say the industry has so far missed the mark …
Patients need pay for performance too
The blogosphere is alive with the sound of Silver — Nate Silver, that is, the head of what should be called the FiveThirtyEight Modeling Agency. Silver constructs statistical models to calculate the probability of electoral outcomes. Though he hasn’t shared his model yet, the results fit his model very well.
Is that the point? Statistical models can be constructed to serve various …
Would Nate Silver make a good doctor?
Wrinkles are bad.
So are small breasts.
Also crow’s feet and age spots.
Jiggly arms and muffin tops.
Don’t forget untrimmed pubic hair.
This tirade isn’t limited to women.
Guys, are your muscles ripped?
Chest gleamingly hair-free?
Male member sufficiently enhanced?
On a regular basis, I see 9 to 11 year-old girls who tell me that they’re cutting back on what they eat because they’re “fat.” While I’m examining them, …
We need to change the definition of beauty
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I pick up a Glock semiautomatic, the model used in the Virginia Tech massacre. I need to hold it, to feel it, to rub my finger across the trigger.
I don’t fear death. Raised in a morgue, I worked with my dad, the city medical examiner. As a kid, I watched autopsies and talked to dead people and made up heroic stories …
It’s easier to get an assault weapon than a doctor
Happy New Year! It’s 2013! Time for us to embark on ambitious health and fitness resolutions we have no intention of keeping past March!
Here to assist us with our resolutions are a collection of fitness devices and apps that will help track our heart rate, sleep cycles, calories burned, steps walked, mood and much more. Data from these devices can …
Patients who self track their data: Curb your enthusiasm
When someone is arguing that our health system needs an overhaul, one of the most common reasons they cite is because it is “built on a flawed foundation of fee for service.” Of course we blame fee-for-service reimbursement for the rampant overtesting, overtreating, and fragmentation (among other things) in our health system, but this doesn’t mean that it is inherently bad, and here’s why.
First, a little contextualization will help. Fee …
Is our system built upon a flawed foundation of fee for service?
We physicians like to think that we are really different from other workers. We physicians, perhaps thinking back to that medical school application essay we all wrote, really believe that we went into this career to simply help others. We physicians truly believe that we always put our patients first.
Because we sincerely believe all of the above, we are shocked when someone like Uwe Reinhardt points out that collectively we …
Are physicians really that special?
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Two years ago, my practice became a patient-centered medical home (PCMH), or more accurately, my practice began the transition towards delivering patient care under this new model. While that process is far from complete at this point, it’s been a positive experience. This month, I’d like to share …
ACP: What I’ve learned from my medical home
”Email is the killer app of patient portals.”
I heard a variation of that quote when interviewing people for the patient-provider communication chapter of the book I’ve been co-editing and writing for HIMSS with Jan Oldenburg, Brad Tritle and Kate Christensen. For the organizations who’ve pushed patient portals the furthest into their patient base, email is always the place where things started. In other words, email is the gateway drug for …
How secure messaging and email benefit patients and improve outcomes
I should be encouraged. I was asked to talk on public radio last week about my new practice, then I was on a panel of “experts” in Washington DC on Monday. Everywhere I talk about what I am doing I get positive reactions. I get very positive reactions, actually. I was approached by someone wanting to work with me “when I get …
Can winning the war of words help my patients?
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