The eulogy of a profession should be a relatively uncommon undertaking. And yet, the death of the physician appears to be such a fait accompli that one feels late to the wake. It has been a long and lingering death, like the proverbial frog in the pot, and but there are moments, increasing in frequency in my day-to-day clinical practice when it seems so sudden, unexpected and even surreal. This …
The self-inflicted death of the physician
“He died because he’s Black!” screamed his mother, inconsolable in the intensive care unit as her unresponsive teenage son underwent a formal neurologic examination. We had done all that we could. Mr. M had experienced a cardiac arrest for unknown reasons at home, and his mom felt the emergency medical technicians treated her son differently, possibly even withholding care, because of his race. She already knew what the result of …
A family physician changes the culture of his department
Who works for who?
How did we allow ourselves to let a system get built up around us that makes it so hard for us to take care of our patients?
Our job is to advocate for our patients, to help guide them towards their best health, to help them understand the difficult choices and to live healthy lifestyles, to give them …
How did we let insurance companies get so intimately involved with patient care?
How long does it take to diagnose guttate psoriasis versus pityriasis rosea? Swimmers ear versus a ruptured eardrum? A kidney stone? A urinary tract infection? An ankle sprain?
So why is the typical “cycle time,” the time it takes for a patient to get through a clinic such as mine for these kinds of problems, close to an hour?
Answer: Mandated screening activities that could actually be done in different ways and …
Physicians can’t do everything for everybody in every visit
I recently wrote an article giving 3 reasons why any patient may not have liked their doctor. They included the physician being visibly in a hurry, appearing to brush off concerns, or giving a general sense of not caring. While no doctor deliberately sets out to do any of these things, complaints like these are all too common, unfortunately.
The degree to which the practice of good medicine is …
3 reasons why your patients love you
A commencement speech to the graduating class of 2019, Frank H. Netter MD School of Medicine, May 10, 2019.
In less than 30 minutes, you will all finally be physicians! (cheering) And this summer you’ll be set loose on your very own patients. (laughter) How exciting is that? Maybe a little nerve-racking.
During your career (depending on specialty and work ethic) you may care …
“We are brothers and sisters in medicine. Protect and defend each other.”
In recent years, a flood of cannabis and cannabis-derived products like CBD have entered the market – often claiming to cure or treat an array of health issues and ailments.
These products are everywhere, but there is little scientific evidence to support the hype that surrounds them.
As a doctor, I’m deeply concerned at where this industry is heading – and the potential risks to patients and consumers.
I urge my peers to …
Unapproved CBD products may not be as safe as they seem
A recent New York Times piece had the catchy title, “Don’t visit your doctor in the afternoon.” It was prompted by a study published in JAMA Network Open that had the much less catchy title “Association of Primary Care Clinic Appointment Time with Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening.” The study found that the frequency of appropriate ordering of …
Why you should see your doctor in the morning
A recent New York Times article described a 77-year-old retired gardener in England who had not spoken with another human being in more than six weeks. He told the reporter through tears that he felt “very lonely, and bored.” Recent budget cuts prevented him from taking the bus to the grocery store. Younger people, including his own son, had left town for better jobs in larger cities.
I see this loneliness …
Older adults and the epidemic of loneliness
A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock.
This “system” often doesn’t work, because of the way medical specialties are divided up.
If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the …
Is primary care an unnecessary roadblock?
It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.
She and her husband were about to try to have their …
The simplest and most important question to ask in the exam room
Well, I won. Six years after I started down the very slow process to end forced MOC in my state, it happened. On December 27, 2018 Michigan governor Rick Snyder signed HB 4134 and 4135 into law. The harm BCBS caused me and my patients will never happen to another pediatrician in Michigan.
I know. Crazy. I’m still in shock. It’s taken a while to process it enough to …
The inspiring story of how a physician fought MOC against all odds
When Dr. Fleming found penicillin mold in his Petri dishes in 1928, he had no idea of the impact he — and it — would have on global health. Penicillin and the antibiotic revolution that it triggered have saved countless lives and change world history.
Less than a century later, though, antibiotics occupy a space between savior and sinner. This complicated reputation is mostly due to how …
How non-video telehealth can be a cure for overprescribing antibiotics
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Some people think that the solution to better-supported primary care is in direct primary care/salaried physician payment models. I don’t think it is the best answer. I realize money is not the only motivator explaining why people perform work. Meaningful work matters too. But meaningful work that is not respected and paid for will not sustain or be the source of burnout and resignation, not only for physicians. I think …
Fee for service is not the root of all evil
Just the other day, while I was in the middle of seeing a morning schedule full of patients, I opened one patient’s chart and was thrilled to see a whole bunch of new icons in Chart Review in the electronic health record that I had never seen before.
These apparently indicate office visits and other health care encounters with outside providers.
Sometime during …
Electronic medical record interoperability is a total mess
It was an ordinary afternoon in my outpatient internal medicine rotation. I prepared to enter a room for a congestive heart failure hospital follow-up patient. I mentally prepared myself. I was going to ask for his hospital records (particularly looking for the echocardiogram), make sure he was started on an ACE inhibitor and a beta-blocker, and ensure he had a follow up with a cardiologist in the coming weeks. “This …
The benefits of compassion always outweigh its risks
“I have the CPAP machine. I’ve had it for a year, but I don’t have electricity in my house. I stayed with my aunt who has electricity but things didn’t work out,” said the young Navajo man, his massive belly protruding out from underneath the tray table.
The old Navajo man with Parkinson’s disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal …
The systemic poverty in Navajo Nation is a national travesty
“Are you the doctor?” was the most frequently asked question I received from patients in my new practice.
The second most common question was: “Are you old enough to be a doctor?” followed by the rather blunt question “How old are you?”
I graduated from family practice (FP) residency in 2002 when I was 26-years-old — younger than most newly minted FP doctors. This warrants some explanation. I didn’t skip several years …
Why do I love being a 43-year-old physician?
When I was a kid, one of my favorite hobbies was adding to my rock collection. In the summer, I went on road trips with my family to explore the national parks, and at every gift shop, I always gravitated towards the bin of tumbled stones. To me, this was a treasure trove. I looked at all of the stones and was mesmerized by their vibrant colors — from emerald …
How rocks and crystals can be more nourishing than we know
As we go through our careers, we are given the responsibility of educating the next generation of students and residents to become proficient and competent in medicine. In telehealth, which also requires training my colleagues, is it necessary? If so, what should be part of it? Part of the equivocation with this question of creating telehealth education is at the core of the practice: since I strongly stress that telehealth …
Telehealth education: What do we actually need for our clinical practice?
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