Time was baffling. It seemed like just yesterday; I sat in a posh auditorium in Chicago as an enthusiastic young adult during my first day of medical school orientation at Northwestern in 1995. Eighteen years later I was a forty-three-year-old burned out physician, practicing in Boise, Idaho, doing Google searches on the most effective way to end my life. During my time …
The story of how one physician recovered from burnout
In the past few years there has been tremendous criticism of the American Board of Internal Medicine’s (ABIM’s) maintenance of certification (MOC) program. The MOC program was significantly expanded in 2014 and required doctors to get 100 MOC points every 5 years and do at least one MOC activity every 2 years. These requirements also came with increased fees for the MOC program and increased failure rates for the recertification …
The real cost of MOC is stunning
Part of a series.
There is a crisis in the provision of primary care in the United States. If you are a patient, a primary care doctor, an insurer, an employer or a policy maker, this crisis is exceptionally important to you. The crisis means that Americans do not get the level or quality of health care that they deserve and need. This crisis is the major reason that …
Is solving the primary care crisis easier than we think?
I recently attended (and spoke at) the Concierge Medicine Assembly in Atlanta. My role was to give the perspective of a “successful” direct primary care (DPC) practice. This being the second such conference in three weeks, I’ve learned that my panel of 600+ patients and survival for two and a half years puts me in the higher ranks of solo DPC practices. The Atlanta conference was actually a combination conference, catering to …
This is what a successful direct primary care practice looks like
Dr. Google wants you to think he is your best friend. He is there for you day and night, no waiting rooms or office hours needed. He promises answers, and he gives them now. No testing, no lab draws. Dr. Google provides diagnoses after a few clicks on a keyboard and delivers the news in minutes, if not seconds. Dr. Google will …
Dr. Google should be sued for malpractice. Here’s why.
It was only afterwords that I wondered if I had been condescending. The words had come out so naturally. We were sitting across from each other in the nursing home. It didn’t take a doctor to recognize that his leg was visibly less swollen. I had seen him walking down the hallway with the physical therapist. His face a mix of pain, …
Let patients know when you’re proud of them
I’m not actually on TV, but there are days I feel like I’ve accidentally stumbled onto the set of a sitcom. When neighbors have never seen your husband in the light of day and friends joke that he is make-believe, then you might be married to a … well, you know the joke.
Being married to a busy physician can leave you playing …
I’m not a single mom. I just play one on TV.
I’m a physician entrepreneur. In 1998, I opened my first clinic. My malpractice: $500 per year. Then I tried life as an employed physician. Hated it. So in 2005, I opened my ideal clinic. Best. Job. Ever. My malpractice: $1,230 per year. Want low premiums? Here’s how I did it.
A quick tutorial. New malpractice policies mature over five years. So the first …
How I got 86% off my malpractice insurance. Now, you can too!
The drug test came back abnormal. There was THC present. I walked back to Mrs. Johnson and raised my eyebrows.
“What’s wrong?” she asked, not used to whatever kind of look I was giving her.
“Uh, you forgot to mention to me that you smoke weed.”
She blushed and then smirked. “Well, yes, I guess I forgot to put that down on the sheet. I don’t …
A patient fails a drug test, but stays in this doctor’s practice. Here’s why.
Recently I read an article in the New York Times by Elisabeth Rosenthal. She’s the same author of the enlightening article, “My doctor charged me $117,000 and all I got was this lousy hospital gown.” That may not have been the exact title of the article.
Following that article she wrote a follow-up about the long and difficult ordeal …
There’s a good reason why doctors don’t send test results
“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.”
– Dr. Martin H. Fischer, German-American Physician and Author
“A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”
– Principles of Medical Ethics, American Medical Association
“I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of …
The physician is the ultimate patient advocate
It’s been a very slow week in my office. Today we almost pitched a no-hitter, having only one patient come in toward the end of the day. Overall, we’ve been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages.
What’s wrong?
That was a trick question. This is exactly what should be happening when things are going …
A quiet day in the doctor’s office: And that’s the way it’s supposed to be
Patient-doctor communication often has many facets, wrinkles, and twists. Medical school prepares a doctor minimally for the ups and downs of these patient interactions. There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient. On the job training is sine qua non.
During and after medical school, it took …
Poker face: The complex psychology of the patient-doctor interaction
My patient had suffered a terrible, crushing injury to his chest leaving many ribs and his sternum fractured, his lungs and heart badly bruised and his body on the edge between life and death. He was on a ventilator, the tube through his mouth into his windpipe pushed air into lungs that couldn’t draw for themselves. He was on constant medications for pain and to sedate him while we used …
An inappropriate use of medical jargon: Words do matter to patients
I recently read an article written by a human physician about her personal feelings and other people’s reactions to her decision to quit practicing medicine.
The author frames the article around how her choice was made after she recognized how detrimental her career was to her own health. The irony of a doctor abandoning her profession because it was causing …
The darker side of being a doctor
I would think that when physicians decide where to set up practice, there are things that they would want to think about other than how much money they’ll make. Yet if one reads Medscape’s current list of the best and worst places to practice, it would appear that money trumps everything else (although Medscape said it also considered factors like “cultural attractions”). What Medscape apparently did not consider …
The best places for a doctor to practice: It’s more than money
Question from a reader: “What are your feelings about when a patient breaks up with you? I love love my doc, but …”
Patients “break up” with me all the time. Well, not all the time, but it’s not uncommon. There are many reasons, some of which are under the patient’s control, and some which are not. Moving across the country is …
So you want to change doctors. Here’s how to do it right.
I’m a family physician in Eugene, Oregon — a sweet town where folks are pretty darn friendly. I still do house calls. Patients often surprise me with gifts. And nearly every appointment ends in a hug.
Kindness is contagious.
I like to return the favor. So every few weeks I celebrate “patient appreciation day.” I thank patients with balloons and chocolates. Why? For …
Did you forget to thank someone? It’s not too late.
Being related to a famous person is somewhere between a cruel joke and a minor distraction. My father was immensely talented and worked very hard at his writing, but the degree of his success was a fantastically unlikely bit of luck. There are lots of talented, hard-working artists who don’t make it.
The important thing in overcoming mental illness, whether or not …
A doctor shares his story about overcoming mental illness
As a little kid, I used to love the bedtime story about Humpty Dumpty and his fall from the wall. “Humpty Dumpty sat on a wall. Humpty Dumpty had a great fall. All the king’s horses and all the king’s men couldn’t put Humpty together again.” Until recently, I never thought about this story as a logical and sad analogy to …
Stop the Humpty Dumpty approach to health care
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