As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let …
I work for my patient because I care for my patient
Along with about 8.4% of the US population, I have asthma. To promote good doctor-patient communication, I can’t sit too far away from you. To perform a high-quality physical examination, I must enter into your personal space. Several minutes of inhaling that strong scent, however, can cause me to have trouble breathing.
I’ve never been brave enough to bring this up before, …
Please don’t wear perfume to the doctor’s office
As I was driving to work this morning, I was thinking about how I wish I had time to exercise more. It’s my 7th week as an intern, and I have only gone on a run once in that time (a 2.5 mile run last week in 25:30 — pitiful considering that two months ago I was running 8-10 miles at least once a week). I got to thinking about …
Take back some of the richness that life can offer
For the majority of physicians in the U.S., taking their skills abroad and providing care via medical missions in undeveloped countries is usually not an option. For me, that was always an option. I am an OB-GYN who works as a locum tenens, a traveling physician who temporarily fulfills the duties of another. This has provided me the flexibility to have …
Locum tenens prepared me to volunteer in undeveloped countries
Recently, “60 Minutes” (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors.
In setting up this report, the reporter commented that as much as 10% of healthcare expenditures in this country were “unnecessary.”
Actually, most health experts I have read and consulted would put that number much …
Medical homes need ready access to good data
A lot of us get health benefits through our workplace, and employers are increasingly turning to wellness programs as a means of reducing costs and improving productivity.
In the coming year, as aspects of the Affordable Care Act take effect, many employers will provide even greater incentives for participation in programs that require the employee to achieve certain wellness goals, such as smoking cessation or weight loss.
What this means for the …
Motivating employees to meet their wellness goals
Insurers will also play a pivotal role in the development and adoption of patient-focused mobile health (mHealth) technology adoption for wellness as well as for the management of chronic diseases.
1. Payers hold the purse strings. Insurers will be the ones paying for the use of mHealth for chronic disease management for the vast majority of patients. They have a vested interest …
Mobile health technology adoption depends on insurers
It’s Saturday night at an emergency department (ED) in Boston, MA, and I am faced with a medical student’s dream dilemma: which one of the many interesting cases should I observe? Should I watch trauma surgeons operate on the 17-year-old gunshot victim or work with the ED docs to assess whether a 59-year-old woman is having an acute stroke? That is exactly what I adored about emergency medicine as a …
How my ER rotation turned me into a primary care doctor
Be obscure clearly.
-E. B. White
As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation. To begin with, there is much that is still unknown and difficult to understand about psychology, physiology and anatomy. Then throw in a disease process …
I work at clarifying obscurity about the human condition daily
Doctor: What medicines do you take at home?
Patient: Something for the diabetes.
Doctor: Do you know the name of it?
Patient: “Starts with an M. Or a P. Honey, what’s the name of that pill?
Wife: Well dear, I don’t know but it’s a little blue one. You know doc, the little blue one?
Nothing will drive your health care provider more crazy than conversations …
Know which medicines you take and why you take them
When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice? Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?
For many physicians, I suspect that the answer to …
Neither political party truly represents doctors or their patients
I would like to start out by thanking all the fantastic health care workers. As a recovering person with diagnosed concurrent disorders – having both addictions and mental health issues – I have seen the challenges and abuse often faced by doctors, nurses, counselors and support staff working within the healthcare system. This article is in no way meant to hurt, …
Stop the stigma and give patients a chance
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Recently, I was invited to speak at an ACP chapter meeting on the topic of shared vision. In the talk, I used as examples Dr. Martin Luther King Jr., John F. Kennedy, and Steve Jobs, leaders whose visions inspired people and helped them to achieve great things. As I wrote the talk, it occurred to me that …
ACP: Practice transformation is more than checking off boxes
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Warning! I am a practicing doctor who sees real patients using an electronic medical record (EMR). My sole agenda is to provide the best patient care. I have no financial stake in information technology (IT). However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually …
Why IT is the core of the healthcare renaissance
Consider the following two clinical scenarios:
1. William, a 62 year-old accountant, has been feeling “depressed” since his divorce 5 years ago. His practice, he says, is “falling apart,” as he has lost several high-profile clients and he believes it’s “too late” for his business to recover. His adult son and daughter admire him greatly, but his ex-wife denigrates him and does everything she can to keep their children from seeing …
Delivering mental health care in a more rational fashion
By now you’ve probably heard of the concept of “concierge medicine.”
To me, it’s an idea that’s Win-Win-Lose:
Win: Doctors. Those in concierge practices have chosen to forgo the traditional business model in favor of charging annual fees that range from $1500 to $15,000 per patient. How much you pay depends on the market, exclusivity factors, and amenities, like comprehensive annual physicals with add-ons like a dermatology appraisal and nutrition consultation. Concierge …
Concierge medicine: Winners and losers
A flurry of coverage recently appeared about the U.S. Preventive Services Task Force’s recommendation for one-time HIV screening for all Americans, ages 15-64.
Some might wonder why this is news — um, hasn’t this been recommended now for years? — and I think I’ve figured it out.
Let me start by relaying that every ID/HIV specialists can tell some version of the following sad story, which is still repeated on a regular basis …
HIV screening and the USPSTF: Better late than never
The other day I landed on the website of 23andMe. To my surprise, I learned that if I wanted to send the company a sample of my DNA, I’d have to swear under penalty of law neither to collect my sample nor mail it from New York State. That’s because New York State requires a laboratory license and direct interaction with a physician for mail order DNA testing.
New York, it …
DTC genetic tests and the wilds of personal medical information
I recently saw a 90-year old patient in my cardiology office practice. She was demented, but cooperative with the exam. A devoted daughter, with whom she lives, accompanied her to the appointment. Her dementia was severe enough to make a cogent history from the patient impossible. However, the daughter had something on her mind, and it had nothing to do with her mother’s heart condition.
“My mother’s primary care doctor wants …
The unintended consequences of boilerplate guidelines
What is your impression of an airlines when you sit down and open the tray on the back of the seat in front of you and find food and coffee stains on the tray? You may just worry if the same attention that was given to tray tables carries over to the maintenance of the engines. Or what is your opinion …
Why doctors should have clean and organized desks
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