Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine. Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless.
But people ask me all the time, so, as a little experiment, I …
Last week, I took a 6-day vacation. Two days before and two days after, I put in a total of 32 unpaid hours of work which was cut short by a call from my daughter asking me why I am working during my time off. While away with my family, I ran into people of different walks of life and noted …
Recently, when my parents came for a visit, our conversations led me to realize something important: I have been a doctor for more than 20 years, and yet my parents have no idea what my daily life is like. It then occurred to me that if they have no idea, then surely my patients have no idea either.
So, if you’re a …
Dear patient:
I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care.
I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just …
Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth.
Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family.
Doctors delay childbearing and starting their own families so they can care for your family.
Doctors miss their own kids’ ballet recitals and baseball games …
I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with …
For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it. I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at …
Nearly all physicians are now subject to patient satisfaction ratings. In my case, and many thousands of my colleagues across the country, it is via the survey tool sold to health care facilities by the Press Ganey Company. There are also many, many online sources that rate physicians.
The idea is a good one: Physicians should be subject to feedback from patients about patient perceptions of how good a job the doctors …
As a medical student I was in awe when a professor looked at a patient’s hands or nail beds and described their medical condition without taking a history. I was also enthralled by a TED talk by the best selling author, Abraham Verghese, where he described a lesson that Arthur Conan Doyle, author of Sherlock Holmes, learned as a medical student at the medical school in Edinburgh, Scotland from the famous physician …
When I first met Ralph, he was 82-years-old. He suffered from shortness of breath which started when his wife of 56 years was diagnosed with a rare bone cancer. Upon further investigation, I diagnosed him with a weak heart and a very tight aortic valve which required immediate surgery. Ralph made it; his wife died. Today, twelve years later, he brings me treasures from his metal detecting hobby on the …
Patient noncompliance.
I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time.
We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often …
Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there …
When one hears the words “language barrier,” it usually brings up images of a person who is in another country of which the national language is not his own. If you have visited a foreign country without fully knowing the primary language, you can start to feel out of place fairly quickly. Despite one’s best efforts to navigate the country, a part of the cultural experience is lost without knowing …
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Next in a series.
How many patients can a primary care physician (PCP) reasonably care for? I have been interviewing PCPs: Here are some of their thoughts when asked this question.
Responses were widely divergent ranging from about 300 to 3,000 or even more. Yet many are clearly conflicted. Some say they can manage about 2,000 with little difficulty — but then observe elsewhere in the conversation that they have no …
An obstetrician is found dead in his bathtub. Gunshot wound to the head. An anesthesiologist dies of an overdose in a hospital closet. A family doctor is hit by a train. He’s decapitated. An internist at a medical conference jumps from his hotel balcony to his death. All true stories.
What are patients to do?
When they call for appointments, patients are …
Round and round and round we go yet again. The system is broken. Do something. Health care reform!
“Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means — and that everyone else agrees with them. Wrong.
Quality is very much in the eye of the beholder, and …
Next in a series.
Good question. You call for an appointment and are told it will be about 20 days. You arrive on time only to sit in the apt named waiting room for 40 minutes. Finally you get to see your primary care doctor (PCP). You begin to explain why you came in but are interrupted within about 23 seconds even though it would have only taken you about …
Nobody stands up to argue against quality and value in health care. You might as well argue against motherhood, or puppies. Yet many physicians are inherently skeptical of definitions of “quality” that are imposed from above, whether by outside evaluators like The Joint Commission, or (worse) by the government.
There’s good reason for skepticism. Some of the “evidence” behind “evidence-based medicine” has turned out to be flawed, tainted by financial conflict …
Whenever new physician salary data is released, reporters and policy experts often compare doctor salaries in the United States to those of other countries: most notably, France.
And on cue, Vox’s Sarah Kliff — normally an excellent health care writer, by the way — is uncharacteristically lazy in framing physician salaries through a biased lens.
After presenting the data, …
“Doctor, can I record this conversation?”
It’s happened to me a couple of times already. But the question above was never asked. Rather I was informed later on that my conversation with a patient or family was recorded without my knowledge. Smartphones have made it all too easy for patients to secretly record conversations with their health care providers. Simply hit a button, lay it innocently down by your side in …
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