I was working in the ER this weekend when one of my nurses asked me a simple question: “How would you fix the health care system?” Obviously, this is a complex problem requiring complex solutions, but in an environment where at any minute a heart attack or a stroke could disrupt a conversation I prepared a sound bite for an answer.
“Do …
Fix our health system: Be like Switzerland
“There’s no passion to be found playing small, in settling for a life that is less than the one you are capable of living.”
-Nelson Mandela
Amidst the chaos of our noisy world, it’s hard to know where to begin a new career as a healthcare professional who’s about to inherit an American disaster called healthcare. And it’s likely that in a few …
My advice to a new generation of doctors
Veteran analyst Vince Kuraitis recently reviewed a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect:
The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In …
Most ACOs are accountable in name only
I can truly say logging on to the National Commission on Certification of Physician Assistants website and seeing I’ve passed the boards was one of the happiest moments of my life. All of the hours invested learning to take great care of patients was worth that feeling. Like an entire generation of young new MD/DO/PA/NP graduates looking to make a positive …
We have inherited a health system that is broken beyond repair
Each of us wears many different “hats” throughout the course of the day. We are an employee, a wife, a father, a club member, a consumer and so on. It comes as no surprise that our thinking, what we say, and how we say it at any particular time coincides with the hat we are wearing at that moment. The thing about these “hats” or roles is that they come …
When patients are socialized into the sick role
I can always count on Mr. Wonderful to come up with a timely subject for my blog. Today’s quotable is, “Dear G-d, I have a problem. My problem is me!”
Some days it feels like I spend half my time trying to convince patients that they need to change their ways in order to get healthy. I often spend the other half of my time treating the effects of their bad …
I have a problem and my problem is me
As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …
Primary care doctors may no longer be needed
Many years ago, I wrote this essay in which I wondered why I receive so few gifts from my patients in the holiday season. I was prompted to write the essay by the memory of my father, an orthopedic surgeon in solo practice, whose patients showered him every December with foil-wrapped bottles of booze, tins of cookies, and all manner of goodies, including a “World’s Greatest Doctor Figurine.”
I speculated …
One doctor’s holiday wish list
In this article I will show you a push button shortcut you can use to quickly create more work-life balance, no matter how busy your practice and your life feels at the moment.
When it comes to creating balance between your medical career and your life, there is a simple rule in play. The strongest structure wins. When we are talking about …
Improve your work life balance: A schedule hack for doctors
She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …
What doctors can learn from working at Starbucks
I recently attended Primary Care Progress’s Gregg Stracks Leadership Summit. The summit brought together chapter leaders from around the country to get coaching in how to lead our chapters to accomplish our individual goals.
I went to the summit knowing that PCP values teams – the team-based model of organizing to improve the primary care profession and the team-based model of primary care delivery. In both cases, there would be a …
The deep professional rift between nursing and medicine
Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health care system; the effect on academic medical centers and teaching hospitals will be significant.
The political conscience is still being driven by …
Predicting the next 4 years of health reform
Dear Patient(s),
Thank you for educating me.
Thank you for letting me shine bright lights into your eyes and place Q-tips up your nose. Thank you for not shooting me a dirty look when I ask you to lift up your pendulous breast so I can listen to your heart. Thank you for letting me ogle at your protuberant belly—whether it contains a baby, a liver tumor, or liters of fluid inside. …
Dear patients: Thank you for teaching me
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Four years ago, as I was making rounds on the oncology floor, one of my patients with leukemia asked, out of the blue, “Hey, Doc, who you gonna vote for?” He had an Obama T-shirt by his bedside.
Chuckling politely, I asked him why he wanted to know. “I’m curious, Doc,” he said. “It tells me your worldview.” He said that if we agreed on who should be the next president, …
The problem with discussing politics in the exam room
Suppose 20 children and 6 adults died at a school in a very short time period. And suppose there were clusters of similar deaths, many of young healthy people, around the country: at a movie theater, a shopping mall, a high school, a house of worship. Would you expect the Center for Disease Control to get involved in trying to figure out why these people died and how to prevent …
Did any doctor ask Nancy Lanza about guns?
American Medical News featured an article with the disturbing title, “Massive health job losses expected if Medicare sequester prevails.”
I wasn’t entirely sure what a “sequester” was, since I thought it was a verb. Sequestration, I thought, was the noun. (I hear a loud knock. It must be the grammar police.) The story, as I understand it, is that when our government decided to pull together and raise the debt ceiling, …
Why across the board Medicare cuts are a bad idea
What will health insurance cost in 2014?
Will the new health insurance exchanges be ready on time or will the law have to be delayed?
There will be sticker shock
First, get ready for some startling rate increases in the individual and small group health insurance marketplace due to the changes the law dictates.
In a November 2009 report, the CBO estimated that premiums in the individual market would increase 10% to 13% …
The cost of health insurance in 2014: Get ready for sticker shock
Winter is officially here and we are in the cold and flu season. This is the time that patients get sick with viral illnesses and primary care doctors get even more frustrated as they try to do the right thing for patients. What is the right thing?
First of all we want to relieve suffering. But we also want to do that …
Antibiotics for your viral cold: Why it’s hard to do the right thing
I haven’t give much thought about gun control, but since the horrific unspeakable tragedy which occurred in Sandy Hook, Connecticut where 20 children and 6 adults were killed, I like many others are. Increasingly, crime scenes are now including movie theaters, malls, and schools, places where people escape reality, find gifts, goods or services for themselves, loved ones, or friends, and …
Mental illness and gun violence are a doctor’s responsibility
My fourth grade teacher labeled me “most inquisitive,” and I’d like to believe that superlative still rings true. But I challenge you to stop and think about it for a second – how do you set the “bar” of expectations in your own life? With your patients? With your family? With your commitments?
Are you the kind of person to place the …
How to set a realistic bar in family medicine
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