Nothing is more delicious to the eyes of a five year old girl then the shimmering, metallic glare of a Zippo lighter. So when her Mom ran over to the neighbors to borrow some sugar, she climbed up the rickety kitchen cabinets and stood on her tip toes in order to reach the top shelf and pilfer the object of her desire.
After tripping clumsily back down, she sprinted to the …
You never know what’s behind that exam room door
“You see, Dr. Oz was right, you’re ordering way too many tests for me,” a patient told me today after seeing news reports of today’s press conference in Washington DC by the Choosing Wisely campaign. This campaign, according to news reports (WSJ, PBS, ABC, NBC, NPR, AAFP, and others), points the finger directly at doctors for ordering “worthless” and unnecessary tests (that’s why the press, like patient advocates, love this story, because …
A primary care doctor takes issue with Choosing Wisely
Have you ever said, “I’m going to be perfectly honest with you” or something to that effect? Have you ever had someone tell you that they were going to be perfectly honest with you? Have you ever thought about what statements similar to these really mean? You should.
Trust is an earned commodity and hard to get back once lost. “Doc, I’m going to be perfectly honest with you” means that, …
When it comes to medical care, honesty is essential
Impersonal and self-absorbed as Manhattan may be, it’s still embarrassing to cry on West 32nd Street. I looked for a store, any store, and ducked inside. The pace of my steps and angle of my head as I buried myself into a back corner, thumbing through pants twice my size, gave me away. A store clerk walked over and asked if I was okay. I knew I’d have to meet …
When doctors are called providers
Recently I had the privilege of travelling to Vancouver, British Columbia to attend the inaugural BC Forum of the Canadian Coalition for Global Health Research. We had a wonderful host in the Department of Global Health of Simon Fraser University (and especially from Drs. Craig Jones & Vic Neufield). It was a challenging and pivotal conference for me.
That is not what I want to share now. The conference started with …
A few months ago, I came out with a post on why I love my own doctor. Today I want to celebrate my patients, both past and present. For me, without the experience I have had over the past 14 years, I would not have enjoyed medicine quite as much as I do.
What I like the most about medicine is the ability to interact with people. That’s what clinical medicine is all …
8 reasons why I love my patients
I recently worked a shift at one of the free, student run clinics here in Palo Alto. Compared to a previous shift a while back, today was quite calm with a manageable flow of patients. In fact, the number of volunteer hands far outnumbered the number of patients so I wondered if my services were even necessary.
Should I duck out early to go work on one of the four problem …
Each moment with a patient is a privilege
I am a physician who was diagnosed with throat cancer and underwent laryngectomy four years ago. Prior to being diagnosed and treated for cancer I did not welcome or encourage my patients’ participation in their own care. Admittedly, there were instances when such input was helpful, but more often I regarded patients with data based on information obtained from the Web as a challenge to my expertise and authority. I …
I changed my perspective about patient participation in their care
“A 41 year-old woman with no documented medical history or family history of disease presents to you complaining of occasional chest pains on exertion. How many would order a stress test to rule-out cardiovascular disease?” asks Dr. Gary Bloch, to a captivated audience of resident physicians currently in training at an academic learning day – a few hands go up.
“Now how about if she were a smoker or had high …
Why doctors should screen for poverty
By 2015, according to the American Association of Medical Colleges, the U.S. health care system will be short approximately 30,000 primary care doctors. Yet, everything we read says that primary care physicians are the linchpins of the new (really rediscovered) coordinated care models being talked about by health care policy cognoscenti. What gives?
Since the mid-1990s the number of medical students pursuing a career in primary care has been on a steady, sinking decline, …
Skills primary care doctors of the future will need
Back in 2000, a group of experts convened by the Agency for Healthcare Research and Quality (AHRQ) reported that, although substantial medical error and injury was occurring in the ambulatory setting, very little research had been done to understand the reasons why.
To address what they recognized as a serious issue, this expert panel made 11 specific recommendations that were intended to stimulate research in this area.
Fast forward to the present …
Improving patient safety in ambulatory care
An article and editorial have appeared in the Annals of Internal Medicine demonstrating that primary care physicians do not understand simple statistical data presented to them regarding screening tests for cancer. The consequences, as outlined in an editorial written by a former chairperson of the much maligned Institute of Medicine, is that primary care doctors are over-using cancer screening tests because they do not understand the statistical ramifications and conclusions …
Keep statistics simple for primary care doctors
Last June the American Academy of Family Physicians (AAFP) sent a letter to the AMA’s Relative Value Scale Update Committee (RUC) demanding specific changes to the ways that the RUC conducts its business. Primary care has been severely compromised by the RUC’s recommendations, and there was an implicit threat that the nation’s largest medical society would withdraw if the demands were ignored.
I co-authored a Kaiser Health News article in …
Should family physicians leave the RUC?
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I have worked in continuing medical education for 12 years and the argument over industry support of CME has grown tired and wearisome. Truth be told, I’m sick of it. I have always been a staunch defender of industry support of CME – and still am, for the most part – but listening to the same old arguments on both sides of the issue has become akin to the Elmo …
Reducing industry support of CME has unspoken consequences
The following column was published on March 26, 2012 in CNN.
With the Supreme Court set to hear oral arguments about the constitutionality of the President Obama’s health care law, more patients than ever have been asking for my thoughts about health reform.
I practice primary care in southern New Hampshire near the Massachusetts border, which gives me a firsthand look at how health reform has impacted my neighboring state. Despite flaws …
The Affordable Care Act needs primary care to be effective
When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich).
The more I learn as a physician, the more I realize how little I know.
The …
How technologists and insurers can help doctors
Do you, or people you care about, have a chronic medical condition? There are all kinds of chronic diseases, but the ones that are most aggressively killing us—and the health care system—are heart disease, diabetes, and metabolic syndrome (a deadly combination of excess weight, high blood pressure, increased cholesterol and elevated blood sugar). These are all primarily lifestyle diseases and cancer should probably be on the list, too.
I felt sad …
Don’t give up on your patients, some will absolutely amaze you
Primary care residency numbers didn’t change much this year. Depending upon your vantage point, that’s either a good or bad thing. For those who were hoping that the numbers would continue that 2-year steady climb out of the dumps, the 1% increase in FM positions seemed to be a disappointment. But for many of us who work day to day to revitalize the primary care pipeline, we breathed a sigh …
It’s time for a primary care workforce surge
Although my team, the New England Patriots lost Super Bowl XLVI to the New York Giants in one of the most exciting and tense games in recent memory, reviewing both the pre and post game coverage provided even more learning for doctors and healthcare than my prior post. One can demand excellence and still fall short. When one fails to achieve the intended goals, the learnings can be as …
What health care can learn from a Super Bowl loss
Today and for the next few years the weather of this industry will be dominated by pervasive, discontinuous change. Structures, revenue streams, relationships of every level: All are shifting in fundamental ways. Specifically, the weather will be driven by:
i) invention and propagation of new business models;
ii) shifting risk onto both the provider and the patient, accompanied by building of new risk-based relationships, contracts and alliances;
iii) smart primary care coming to …
10 strategic questions to ask yourself about the future of health care
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