Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and …
As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.
Most people …
We are all familiar with the statistics. Chronic conditions like obesity, hypertension, and diabetes are present in our population at unacceptably high and costly levels. More than 78 million American adults are obese, and more than 1 in 20 is extremely obese. About 70 million U.S. adults have hypertension with only 52 percent having the condition under control. Just over 29 million Americans have diabetes and an additional 86 million …
How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.
Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind …
Once upon a time, there was a man who was a very good cook. He was just an ordinary man, but he had real culinary talents. He could create the perfect meal for anyone who came to see him in his modest café.
His maître d’ and waiting staff were warm and well trained, and the menu was designed specifically for the clientele of his eatery. He gave each person his …
In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?”
“Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming.
“You students are …
I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:
A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again …
A guest column by the American College of Physicians, exclusive to KevinMD.com.
If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around.
When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify …
If you are a doctor, everywhere you hear or read about all that is wrong in medicine. Please do not get me wrong, the medical profession is under assault. Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients. For many of us in the profession, we feel helpless. We feel …
Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …
No, customer service in the U.S. is terrible when it comes to health care. No, the customer service in the U.S. health care system is horrendous. No, health care has the worst customer service of any industry in the U.S.
There. That seems about right.
What makes me utter such a bold statement? Experience. I regularly hear the following from people when they come to my practice:
Back in my first year of blogging, I wrote a post, titled “A Day Without a Diagnosis,” about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school.
That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring.
My first patient of the day was …
Physicians today are increasingly viewed and treated as skilled workers instead of professionals. The difference is fundamental and lies at the root of today’s epidemic of physician burnout.
Historically, there have been three learned professions: law, medicine, and theology. These were occupations associated with extensive learning, regulation by associations of their peers, and adherence to strong ethical principles, providing objective counsel and service for others.
Learned professionals have, over many centuries, worked …
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Hope is a tricky thing. On the one hand, false hope can lead patients to opt for painful, futile treatments at the end of life. On the other, unnecessarily bleak outlooks can lead to depression and inaction. When health is at stake, presenting information with the right amount of hope can guide patients away from both suffering needlessly and/or succumbing to treatable disease.
I was reading a sad story about a …
Sometimes, it’s difficult to recall that single defining moment or person that sends you on the path you’re meant to take in life. I was fortunate in that I found that experience halfway through my undergraduate career at the University of California, Davis. I had recently lost my grandmother; although I’d wanted to help, all I’d been able to do at the hospital was translate for her. That overwhelming sense …
A guest column by the American College of Physicians, exclusive to KevinMD.com.
More than ever before, patients are receiving laboratory test results, with some of their numbers in bold or with “H”s or “L”s next to them. In some cases they’re getting them straight from the lab, in accordance with federal regulations. If not from …
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No matter how early I rise with the intention of getting my workout done before my children wake up, I’m rarely able to do it alone. Most days my 3-year-old daughter climbs out of bed and comes straight down to our home gym and watches me do my workout.
Often times she’ll sit quietly in the corner, but sometimes she’ll join in and follow the trainer on my workout DVD and …
Step 1: Greet patient.
Step 2: While chatting, check all boxes in electronic medical record for a complete review of systems and physical exam. Copy and paste parts of previous chart note while looking at patient every once in a while. Smile if possible.
Step 3: Tell patient to do yoga.
Step 4: Bill insurance company for complete physical exam.
Welcome to big box assembly line medicine.
Ever wonder what …
I quit medicine. I was five months out of residency, and I was leaving medicine. I had dedicated my heart, soul, several years of my life along with weekends, holidays, special events, and my children’s first words to this honorable profession. Medicine was never suppose to “just be” my job. It was suppose to be my calling, and it had betrayed me.
I was finally a full fledged physician, and I …
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Fifty years ago, it was very uncommon to find doctors married to other doctors. Why? To answer that question, we need to explore the sociology of the time. Fewer women went to college, which meant fewer female doctors. Many couples married early, right out of high school or right after college. If the wife had career aspirations herself, these were often put aside in order to help her husband get …
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