Dear Ms. Patient,
I hope this letter finds you well.
Let me begin by saying that it is such a privilege to care for your family. It has been a joy to watch your children grow and your family thrive. I’m sure you will agree that we have been through a lot together.
As you know, I am devoted to help in keeping your family healthy, despite the many obstacles that have arisen. …
Dear Patient, great things are happening in health care
When President Obama turned 50 last year, he made an “informed patient request” for a PSA (prostate specific antigen) test. This is the blood test routinely used to screen men over 50 for possible prostate cancer. The President received his PSA test. But under ObamaCare, you may not be able to.
Now that ObamaCare has been upheld by the Supreme Court, all of its major provisions will be in force, …
How will ObamaCare affect prostate cancer screening?
As a college health physician, I see my fair share of fainting patients, including syncopal episodes within the clinic itself, typically while they are using the toilet, or after venipuncture and vaccinations. Our staff is as proactive as possible to avoid these predictable occurrences, listening for problems in the restrooms, putting students in a recliner chair for their blood draws and observing them for awhile post-injection for lightheadedness. Despite taking …
How to recognize positional orthostatic tachycardic syndrome (POTS)
President Obama enjoyed a towering victory that I feel leaves the GOP reeling, although they are spinning the Supreme Court’s validation of Obamacare as a great gust of wind at their backs. While I would not have expected a different response from them, I fear that there is a developing wind that may blow them away in November. I offer this analysis as a tepid Romney supporter who will be voting more …
While constitutional, does the Affordable Care Act have merit?
The family medicine residency program where I serve as a faculty preceptor “went live” with their new electronic health record. They posted a sign at the front desk that read in part: “Pardon Our Progress,” as if we were starting a major construction project — which in a way, we were.
Instead of wading through stacks of unruly paper charts, my colleagues and I logged on to a sleek online portal …
What’s needed for an EHR to transform primary care
Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws …
Women in medicine: A front line perspective
On the day the U.S. Supreme Court delivered its historic decision on the Affordable Care Act (ACA), aka Obamacare, I was rounding on my hospital patients: a man on the ventilator with pneumonia who had private insurance, one elderly woman with abdominal pain going for gall bladder surgery on Medicare, and one middle aged obese woman with a skin infection without any health insurance.
On my patients’ TV screens I watched …
With the ACA, put politics aside and focus on the facts
Primary care is ever the Cinderella-esque tragedy. Ever so maligned, ever engulfed in misery and never really the belle of the ball like she rightfully deserves to be. There may be reasons galore to this. Not least of which is the way primary care work is perceived in this country.
Let me illustrate.
The primary care attending I work with recounted a story from the early 2000s. As is usually the case with visits …
The cerebral work done by a primary care physician should be valued
One single, deceptively simple idea that would vastly improve medical care in this country by immediately streamlining all medical communication.
Design a standardized form for all medical reporting.
Scope of the problem: Despite my exclusive use of an electronic medical record, I still receive dozens of medical communications on paper every day. So be it. Until we get to the utopian ideal of a nationally interactive medical record system, we’re stuck with …
Design a standardized form for all medical reporting
One magical thing I see while working in health care is the love story. Each and every child who encounters a diagnosis or illness spawns a collection of love stories around them. The stories come spontaneously from parents, siblings, friends, nurses, doctors, community, and peers. It all happens organically and sometimes it happens without notice. Babies cling to their parents when they ache; parents cling to their children when they …
Behind every illness, there is a love story
Nothing in life is free.
In the midst of all the turmoil and excitement surrounding the newly passed Affordable Care Act, I believe we should not lose sight of the bigger picture: providing better healthcare at a lower cost for more people. The idea of the Patient Centered Medical Home, although in its trial stages thus far, is what we should be focusing on as physicians and health care providers.
Much has been …
After the Affordable Care Act, don’t lose sight of the Medical Home
There’s an intersection in Boston outside one of my favorite places to eat. At the corner of two bustling streets is a white bike, chained in place, surrounded by flowers. In loving memory.
***
One evening earlier this month, I was riding the ‘T,’ Boston’s streetcar system, when our train suddenly stopped.
There were the usual sights and sounds of delayed passengers: people fiddled with cell phones, glanced at watches, tapped feet impatiently. …
The functional and professional necessity of detachment
Student loan debt is at an all-time high at a little over 1 trillion dollars, a figure that now, for the first time ever, exceeds our nation’s credit card debt. Higher education has never cost more, the rate of rise of college tuition having exceeded in recent years the rate of rise of many other services. Perhaps as a result of this, as well as of the difficulty in obtaining …
Take the time to educate yourself before forming an opinion
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Health reform includes measures to link hospital reimbursement to patient satisfaction measures. Through both public and private insurers, this trend is likely to spill over into the outpatient setting in the very near future.
Aside from creating redundancy in the market (with some very rural exceptions, patients can act as agents of their own satisfaction by voting with their feet), there are serious limits to physicians as agents of pure …
Customer service has limits in the exam room
I was recently struck by two conversations that I had with acquaintances about recent experiences that they had had with their primary care physicians. The first occurred at my local pool. A fellow swimmer asked me if I took new Medicare patients. She bemoaned that she was abandoned — her beloved physician of over 20 years had sent out a letter announcing that she would no longer accept Medicare patients. My …
Doctors see little of the money patients pay towards health insurance
Fitness maven Jeanette Jenkins recently tweeted that “to see big results you have to get comfortable with being uncomfortable.”
In other words, making change happen, inevitably leads to emotional or physical discomfort. If you are serious about change you must be willing to endure a lot of discomfort. While this is no doubt true, I would take things one or maybe two steps further and say, “Disruptive change will only happen …
You have to get comfortable with being uncomfortable to disrupt health
With many hospitals and medical providers still in the early adoption stages of EHR, objections or problems with the various systems are still just coming to light. However, one particularly growing concern is providers using the copy-paste or copy-forward function in patient records. This is a shortcut that many physicians have found to be handy after the implementation of the new system, however using it actually can violate patient confidentiality …
How copy and paste in electronic medical records affects patient care
Local hospital readmission data mirror national data in that twenty percent of hospitalized patients are readmitted within 12 days of discharge, and 30% within 30 days. Hospital reimbursement has changed to global, not fee for service payment. Hospitals and physicians need to create effective ways to prevent readmission. Readmissions also portend poorer outcomes. Therefore, it is our task as the physician community, to work collaboratively in this process.
Currently, most patients …
Why reducing readmission rates is so difficult
It seems like every day in the office I see at least one man concerned about testosterone deficiency. If you look at the symptoms of testosterone deficiency most of us have one or more of these symptoms at least some of the time. Fatigue, depression, weight gain, lack of energy, reduced sex drive, loss of physical strength, and moodiness are all described as symptoms typical of testosterone deficiency. Making the …
The decision to prescribe testosterone replacement therapy or not
“There are three kinds of men. The ones that learn by reading. The few who learn by observation. The rest of them have to pee on the electric fence for themselves.”
– Will Rogers
Learning is a universal human experience from the moment we take our first breath. It is never finished until the last breath is given up. With a lifetime of learning, eventually we should get it right.
But we don’t. …
Sometimes both physicians and patients learn the hard way
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