Imagine if your bank handled all your online transactions for free but charged you only when you visited your local branch — and then kept pestering you to come in, pay money and chat with them every three months or at least once a year if you wanted to keep your accounts active.
Of course, that’s not how banks operate. There are small ongoing charges (or margins off the interest they …
Most medical offices are hopelessly old fashioned
“I don’t know.”
That is an answer patients hate to hear. It is also an answer doctors hate to utter, and in truth, many of us fail to say those words when it would be proper to say them. Doctors spent long hours over many years of training, sacrificing personal time and family life. Most of us are perfectionists, and not knowing a medical diagnosis often feels like failure. Perhaps, the …
Stand up and be heard. But don’t hate your doctor.
I have been fortunate in that I have not had to hospitalize any patients in the past four weeks. This means I have an extra 60 minutes or more to prepare for the workday in my office. The streak ended this weekend when my associate, taking his rotation of being on call, hospitalized one of my patients with pneumonia.
In many cases, pneumonia is treated as an outpatient. You receive an …
Why this primary care physician still rounds at the hospital
There’s so much negativity out there when it comes to health care, it must be a concern to any young person thinking about entering the field. I certainly spend a lot of time writing about all the challenges we face, and have to hold my hands up to (occasionally) spreading some of that negativity as well! Guilty as charged. That’s why it’s important for anyone outside of health care (or …
This doctor has no regrets to becoming a physician. Here are 3 reasons why.
I’ve noticed a theme in my clinic since I started practicing medicine: when a patient understands what is being said about their care, treatment, and services, they’re more likely to fulfill critical health care responsibilities. No one should be surprised by this, but as our nation and hospitals increase in diversity, the issue of health care equality for LEP (limited English proficiency) patients is becoming more pronounced.
Today, this population of …
Let’s do better for patients with limited English proficiency
There was a time, before treatment algorithms, when physicians would rely on the detailed bedside and/or office observations of their patients in conjunction with the most recent published peer-reviewed studies.
Time spent with each patient was considered essential and appropriate to reach a proper diagnosis and treatment plan. Now, due to corporate mandates to produce higher RVUs, time is regarded as an unnecessary luxury, to be controlled and curtailed. Yet recent …
Experienced-based medicine has value
Stock photos of “health care workers” who attend patients — physicians are no longer distinguishable — usually feature a stethoscope draped around the neck.
But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”
The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence and the rubber tubes by sophisticated …
The stethoscope is not just a prop
When I graduated from residency, I was too worried about killing my first few patients to examine the meaning of being an attending physician. An early patient, a 97-year-old retired doc, brought it to my attention.
“Being an attending physician means you attend. When you attend me, all I want you to do is show up. You do not have to do anything. Keep the people with needles, knives, and nonsense away from …
The key to being an attending physician
It’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era. I remember in the United Kingdom, where I went to medical school, Google only became a thing perhaps midway through university. Since then, of course, the internet has exploded and penetrated every facet of our lives. And …
Don’t judge patients for researching their health issues
One of my favorite scenes in the recent Apollo 11 IMAX film was a dramatic panning shot of mission control moments before lift-off. Row after row of mission specialists, engineers, astronauts, communications technicians — all looking ahead in silent, unbreakable focus. All 100 percent dedicated to the three men about to lift-off into history. It was a truly mesmerizing portrait of teamwork.
While astronaut safety is the focus of every individual …
From a neurosurgeon: You need a family doctor
Research shows that as many as 50 percent of physicians report some level of burnout that manifests as depression, dissociation, indifference, and even substance use disorders. Medicine has become focused on monetary gains by large corporations, major hospitals, and insurance companies. As much as doctors want to focus on quality patient care, they are forced to focus on electronic medical records that are cumbersome, seeing multiple patients with quick assessments …
What rushed patient encounters are doing to patients and physicians
A guest column by the American College of Physicians, exclusive to KevinMD.com.
The administrative burden associated with caring for patients in today’s health care system has emerged as a primary driver of the loss of joy in the practice of medicine and the epidemic of burnout among physicians.
No medical specialty is immune from the upward …
How the administrative burden contributes to physician burnout
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Of all medical specialties, perhaps the most difficult to understand is internal medicine.
While the name suggests that those who practice internal medicine focus primarily on non-dermatologic diseases of “Internal” organ systems (which in many ways is true), unlike other medical fields whose names …
How internal medicine got its name
Flu vaccination prevents millions of flu-related illnesses and deaths annually, but vaccination rates are low for many reasons.
During the 2018-2019 flu season, the Centers for Disease Control and Prevention reported that about 45% of U.S. adults received the flu vaccine. While this is an increase of 8% from 2017-2018, it falls way below the national goal of 70% of American adults …
Why the flu shot cannot give you the flu (and why you should get one now)
At a certain point, we’ve all got to go home.
Whether it’s the end of the shift when the factory whistle blows and the assembly line stops rolling for a brief period while new people take our place, or late in the day after the last patient has been seen and our notes are all written and our portal messages have …
Can answers to after hours calls be automated?
“Fashion Is Moving Too Fast, and It’s Killing Creativity,” by Veronique Hyland, talks about burnout in the fashion industry. As a former Fashion Designer turn physician, my curiosity was piqued. If you substituted the word “medicine” for “fashion,” the title would be just as relevant to the medical industry, as it is to the fashion industry. Yes, medicine is moving too fast, and it’s killing creativity and our doctors. Burnout in the fashion industry stems from the need to …
Burnout in fashion and medicine: A fashion designer turned physician compares notes
My first transgender patient was a teenager who said although he was born female, he’d protested his gender from the time he could talk. He told a story of being asked, “Well, if you are a boy, where is your penis?” and he pointed to his umbilicus (which was an “outie”). OK, no problem, we have a gender clinic I can refer you to.
When he came back and asked for …
A physician is worried about gender transition in pediatrics
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?
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