During my sophomore year of college as a pre-med, I volunteered at the front desk of a free clinic, where it was typical to see patients waiting sometimes for more than two hours. At first I figured it was just because some patients took longer to examine than others. It wasn’t until I got certified as a nurse’s aide and started working in the medical department at the same clinic …
Using Google Docs to manage patients more efficiently
Today I am going to write about how the US could save up to 10% on its healthcare bill.
The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.
A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …
What if doctors worked for free?
As the weather heats up and the allure of grilling returns, it is important to consider some of the potential health risks. One of the great joys of my life is “manning” the grill – beer in hand, wafting smoke rising through the air, a delicious anticipation building. It seems worth the risk of consuming carcinogens present in the smoke …
Grilling with aluminum foil: What are the health risks?
There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber. Yes, that hole has been there about a year, and it has been on my to d0 list for the duration, daring me to show if I inherited any of the fix it genes I got from my father. Why not hire someone to come fix it? I …
The ultimate DIY project: Create your own EMR
As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.
We raced in the …
Doctors think about their patients all the time after they leave
We think the reason doctors rarely make house calls is money. Doctors can charge, but it is hard to charge enough to justify the time it takes to drive door-to-door, fill the tank and attend lengthy visits. Thus, the house call has faded into history. However, I have another theory about the end of this valuable service: perhaps it is increased emotional distance between patients and their doctors.
I watched an …
Another reason why the house call is dead
I first picked up an ultrasound transducer 17 months ago, at an emergency medicine ultrasound course at Harvard University. I had just barely heard about using ultrasound as a clinical tool and was vaguely interested. The course was 3 days long and cost a little under $700 and changed my life forever and made me a better doctor.
Emergency physicians have embraced the …
Bedside ultrasound tips for the general internist
A guest column by the American College of Physicians, exclusive to KevinMD.com.
English is the international language of medicine, according to many. Regardless of whether that is true, what is becoming increasingly clear is that English is the second language of medical documentation. For those of you who blame EHRs for this, the replacement of English by something else started …
English is the second language of medical documentation
Should doctors be able to write?
At first glance, this might seem like a question with an easy answer.
Yes, you might say, doctors receive a doctorate and are trusted with communicating to and about people at critical moments in their lives. Or you could reply, No, they are scientists and so need to be functional communicators able to write basic notes and prescriptions, and …
One of the more contentious topics on my site is the scope of practice for non-physician providers, such as nurse practitioners. This echos the debate on the national stage where leaders of physician organizations, who want to protect their scope of practice, conflict with those of nurse practitioners’, who want to perform the tasks that physicians traditionally have.
Simply Google “nurse practitioner” on this site, for instance, and you’ll see …
How I would end the war between nurse practitioners and doctors
I used to be a stickler for time. One of my first blog posts was about how it felt to go to work without my wristwatch.
I also used to be very particular about knowing the purpose of each visit, partly to help me manage my time, and partly to help me feel prepared and in control of the visit.
I often questioned why my colleagues’ patients would sometimes end up in …
What is the role of the physician in today’s health care system?
I recently blogged about the question of what the difference is between a doctor and a nurse, now that advanced practice nurses can do so many of the same things physicians do. As both a nurse and a doctor I thought maybe I could wade into that quagmire. In that post I suggested that the real difference is one of ultimate responsibility. A reader pointed out that this …
The medical model versus the nursing model: A difference in philosophy
How to effectively keep tabs on a patient’s multiple medical problems? And how to do so without losing sight of the whole person?
The first question is the one I wrote about in a recent blog post. The second was the theme of many of the responses and also LinkedIn.
I love this second question; it’s an issue that’s always been of interest to me. Plus it’s especially relevant in geriatrics, where …
How to effectively follow a patient’s multiple medical problems
I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.
1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category. While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …
5 critical elements of patient-centric care
When I came to medical school, I was certain I wanted to do primary care. Despite the forces that steer many of us off the path – how many times have we heard, “but you’re too smart to do primary care!”? – after three years of medical school, I was still committed to primary care.
But I struggled with which type of program would be best for me. I applied to both …
Why family medicine was the best choice for me
A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”.
As I read her screed against the ND who conducted a cursory history and exam before checking off $750 worth …
The ethical shortcomings of selling supplements
A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.
I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our …
How my geriatric practice works
Every one of us feels a high level of anxiety when we are made to wait. In grocery stores, we jockey back and forth to the line we perceive is moving the fastest and easily get frustrated when we choose the “wrong” line. When driving, we will swerve across multiple lanes of traffic to avoid a line at a toll booth or …
8 surprising thoughts about patient wait times
The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.
What’s the hubbub about?
Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …
The real reason to be cautious about Z-Paks and azithromycin
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Over the past several months, I have covered some controversial topics, such as electronic health records and the overuse of diagnostic testing. For this month’s column, I will address a less provocative topic: the role of non-physician providers …
Doctors and nurse practitioners: We’re failing the reality test
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