As many of you know, if you’ve read my columns regularly, once a year the whole family escapes from the city, and we travel up to New Hampshire to stay at the lake house that’s been in my wife’s family for over 100 years.
A modest wooden house perched out over the water, situated just right for sunset viewing, for a few …
20 minutes isn’t long enough for an office visit
Last year the American Association of Nurse Practitioners announced a $2 million campaign to further expand independent practice, which they already have in 22 states. The relatively new doctorate of nursing (DNP) has led to a confusing scenario where nurses are indeed doctors, just not the kind you think of when you see a white coat. The profession (well, its money-making institutions) has fought hard to keep people confused.
Doctors are …
Do physicians really need such extensive training?
I was in a discussion with a group of patients about how difficult it is for patients to get access to their own medical records. It was initiated after one of my patients was refused copies of her recent hospitalization. There is much confusion out there about who actually owns the record and how it is allowed to be accessed. Most people are aware of HIPAA, the regulation set into …
Who actually owns your medical records?
About once or twice a day, everyone on our hospital’s computer network gets an emergency message that scrolls across the bottom of our screens, highlighted in the colors of danger and warning.
They include things like a notification that a particular data system is down and that a backup on paper will have to be used for documentation, or the hospital …
How pneumatic tubes symbolizes our health system
The storage capacity of the human mind is amazing. One estimate of the size of the brain’s “RAM” is as high as 2.5 petabytes (a million gigabytes). The number is based on the total number of neurons in the brain and the total number of possible connections per neuron. I suspect it is an overestimate, given the vagaries and innate inefficiency of biological systems. Nevertheless, the true figure …
It’s OK if doctors can’t memorize everything
An excerpt from Dottoressa: An American Doctor in Rome.
When I migrated from the banks of the East River to the Tiber shores the path was strewn with bureaucratic boulders, land-mines, and pitfalls. I offer the tale of my odyssey as an object lesson to would-be fellow cosmopolites in that …
Several weeks ago, I began my studies for a master’s degree in journalism. I’m continuing to work as a physician, but for the next two years, I’ll also be gaining knowledge in an important field: health communication.
I recall being a medical student and observing the different ways in which my supervising doctors spoke with their patients. Some doctors communicated clearly and were easily understood. Others used words that I had …
The language of medicine can be complicated. Does it need to be this way?
More than 200 health organizations have now implemented OpenNotes. Many more are piloting, are soon to implement — or have implemented, and we don’t know it! For more than three years I’ve been fortunate to represent OpenNotes to potential implementers, and I’m confident I’ve heard almost every clinician concern or anxiety regarding what might happen when patients read their own notes.
Here are the five most common concerns I’ve heard — …
5 clinician concerns about OpenNotes
It’s 10 p.m.
Seven days before Christmas.
I’m sitting at work “finishing” up some charts.
I am suddenly overcome with anger.
What am I doing here right now at this minute? I am helping no one.
This work I’m typing away at — trying so hard not to scream — it’s hoops. Fucki*g hoops … for insurance companies. So I can beg them to pay me. Pay me pennies for the hard, good, compassionate, humanitarian …
As we’ve seen, the lives of those working in the health care system has become overwhelmingly challenging, burdened by all of the excess nonmedical stuff that has been added into our lives as we try to take care of patients.
From prior authorizations, to clicking in the electronic medical record, to endless streams of regulatory requirements, to the continuous onslaught created by …
How can we address retention in the era of physician burnout?
Touch is a sensitive thing. No pun is intended here, but whether and how we touch our patients deserves our careful thought and deliberation.
So much interpersonal contact these days is virtual, with emojis, abbreviations and whole words thrown around as substitutes for human contact. Think XOXO and, “hugs and kisses.” And when people do touch in our health care environment, it is often with gloves, even for simple fingerstick blood …
The sensitive topic of physical contact during exams
I just did my first telemedicine video visit.
The concept seems so strange, the idea of carrying out an “office visit” without the patient actually being in the office.
Right now we have it structured so that when a patient calls up requesting to see me on a day when I am already fully booked (or, as is usually the case, overbooked), …
A physician’s first telemedicine video visit
I made my 10:20 a.m. patient wait while I told my support staff about my day off.
“I was getting an ice cream when I saw a car accident. By the time I got there, it was clear that there were no serious injuries and all I did was to distract the passenger so she wouldn’t panic while we waited for EMS. Her husband hit a tree with their van, and …
Asking patients the right questions isn’t as easy as you think
According to a recent Harvard report, physician burnout is “a public health crisis that urgently demands action.”
Half of all doctors report troubling symptoms: depression, exhaustion, dissatisfaction, and a sense of failure. These physicians are twice as likely to commit a serious medical error, research finds. Experts predict that if left unaddressed, burnout will further erode the mental health of doctors and radically undermine …
Clinical performance data: a physician’s friend or foe?
Every year, there’s this rite of passage, the passing of the baton, as our graduating senior residents move on to fellowships, or into spots as hospitalists, or to practice jobs here in New York City or other cities, and a fresh new group of newly-minted physicians arrives ready to take up the gauntlet of training as Internal Medicine doctors under our …
New doctors are prioritizing the wrong things
So, who doesn’t want a better health care system?
We are barraged with stories in the medical literature and in the public press about the terrible state of our health care system, what poor outcomes we have, the inefficiencies in care, complaints about the electronic medical record, inflated costs, lives ruined by medical bankruptcy, and massive social inequities in terms of access …
Stop nickel and diming doctors
It wasn’t even nine o’clock when the screen on my laptop suddenly froze. From that moment until my last patient left the building, my clinic had no internet.
For my part, the day went pretty smoothly, mostly because of some of my own work habits. It also helped that it was a warm, sunny day, and my schedule was on the light side. Others have frowned at my old-fashioned work habits, …
A doctor survived a day without a computer. Here’s how he did it.
I’m a doctor. And, like most medical professionals, I’m a bad patient.
Two years after my last appointment, I got a CTJ, “Come to Jesus” from my doctor.
I called his office for a form. I needed proof that I don’t have tertiary syphilis. For my Thai visa.
Why tertiary syphilis, as opposed to HIV, cholera, lepers or bubonic plague? I don’t know. That’s the power of bureaucracies. They don’t have to make sense. …
Falling through the cracks, when it comes to health care, is a bad thing, but the way things are going, it’s getting harder and harder to avoid.
Providers in every setting are bombarded on all sides with data, results, messages, and things crying out — screaming — for our attention. Take, for instance, the conundrum that appears when a patient is …
How to prevent patients from falling through the cracks
As Wei Wei Lee sat with her doctor to discuss starting a family, she felt a “distance” between them. The physician was busy on the computer and focused on the screen.
“It just didn’t feel very personal,” Lee said. “I didn’t feel heard.”
It seemed as though keeping a record of the conversation was more important to the doctor than making a connection with Lee.
It wasn’t the experience she wanted, but she …
When physicians focus more on screens than patients
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