A few days ago, I made a call to my neurologist’s office. The fourth call about the same issue. I needed my migraine medication and wasn’t able to get it. I was almost ready to give up and give in to having migraines on a daily basis. None of the usual preventative medications have worked for me, so I am on one of the new, hi-tech injectable medications for migraine …
Too many moving parts: Physicians can’t own it all anymore
This weekend was bliss. I went from Friday night to Monday morning without a single phone call. No nursing homes were needing to send a patient to the emergency room: no new fevers or unexpected falls. I can honestly say that it is the first time in more than a decade that I have gone a whole weekend without doing some work. The thing about my half retirement is …
After a partial retirement, what this physician misses the most
How do we change the way we think about taking care of patients, particularly when it comes to not the individual patient sitting in front of us, but a whole population of patients just like them (or somewhat like them)?
In our practice, we have been struggling with how to best do population health, trying to find the best ways to …
To do population health right, think about individuals
“Red” McDougall had terrible leg pains soon after going to bed. He did have a bad back, and some mild spinal stenosis, but I hadn’t heard much about that in the past few years. He was dealing with the ache in his legs when he was on his feet too long.
A few months ago he saw his vascular surgeon for a routine followup. He’d had a femoral-popliteal bypass to restore …
When the buck stops with primary care
So many people are suggesting that if only doctors practice self-care we could deflect burnout before it overtakes us. Yes, physicians are probably the worst professionals for taking care of ourselves. We work long hours, answer calls at all hours of the night, take little vacation, work in stressful situations, and often face hostility in the workplace. But this is not the reason we are burning out at high rates; …
Solving physician burnout requires so much more than self-care
I was having dinner with somebody not so long ago, and the conversation turned to what life is like as a physician. I always find it interesting to have these conversations with people who are not in the medical field, especially those who have got their ideas from watching medical shows on television! The person I was speaking to on this occasion, however, wasn’t about to go down that route, …
Health care professionals must always be on their A game
In the last year of medical school, all medical students are faced with important decisions about where they would like to complete their residency. For osteopathic students, one key element of this decision is to what extent do they want to be a minority within their program. I am an osteopathic physician. Osteopathy is core to my identity and pride as a physician. I am one of two osteopathic physicians …
Applying to residency as an osteopathic medical student: myths and realities
Over the course of several years, IBM’s fledgling Watson for Oncology program has received a wide range of reviews. Among them is a harsh critique published by Gizmodo. The article is filed under the keywords “AI,” “Watson,” “health,” “health care,” and “Doctor: This product is a piece of shit.” The last keyword is courtesy of a provider in Florida commenting on a highly publicized medication error.
While the …
Getting to a minimum viable product (MVP) health care app: Partner with physicians
“Pathognomonia.”
I do not believe this is a real word. That’s OK. I don’t care if it isn’t. I have wanted to write this little blurb several times over a period of a few years. My theme is related to what we physicians regard as pathognomonic — i.e., definitive proof of a particular condition based on one sign or symptom. Sometimes causing unwitting harm to our patients and families. Why haven’t …
We should not be in a hurry to label a sign or symptom pathognomonic
In the mid-1990s, I was working as the medical director for a national computer processing company that had the medical policy and utilization review contract for many Medicaid programs in the United States. Within the first few weeks of being hired, I was invited to attend an IT meeting where the computer project supervisor was going to show off a beta medical reporting program the company had developed for an …
A physician was barred from attending any future IT meetings
I have received several phone calls in the last few weeks from young adults requesting information about their last vaccinations. They are traveling to areas of the world that suggest or require certain vaccines and do not remember if they had them or not. Others are applying for positions of employment which require travel and the employer’s human resources department needs the patient’s updated vaccination records.
When we tell them that …
When consumerism and convenience goes wild for no good reason
I recently completed my internal medicine residency training. Three years, thousands of hours, thousands of patients, thousands of decisions. I certainly learned a lot from the past three years: everything from what “HFrEF” means and how to manage it, to treating recurrent C. difficile colitis, to how to share decision-making with patients about whether or not to start anticoagulation in atrial fibrillation. Despite the multitude of lessons I have learned from my co-residents, …
3 lessons this physician learned from her patients
5,177.
That’s the current number of “cc’ed charts” as of this morning in my electronic health record in-basket.
While it might sound like a lot, this is not at all an unusual accumulation, partly due to the fact that I receive a notation every time a patient at our practice gets a flu shot, and also every time one of my patients or …
Electronic health records: Separating the signal from the noise
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For the last 25 years, I have had the privilege of being a designated airman medical examiner by the Federal Aviation Administration. To earn that privilege, it required flying to FAA headquarters and taking a one-week training course followed by refresher training material every three years.
The FAA grades medical examiners annually by our judgment and decision-making. The nature of the questions we are required to ask the pilot candidates, and …
The rewards of being a designated airman medical examiner
I am a mother. A wife. A daughter. A sister. A friend. I am a doctor. I am a runner. Just like everyone, there are many pieces to my core identity. These are the traits that encompass the fixed view I hold of myself. These ring true for me, even when (at times) reality paints a different picture.
I just went for my first run in over three months. Viewed from …
We can empower patients by validating their perceptions
Three years ago, I had a massive, life-changing event. It passed with little notice; it was beyond banal and happened while eating sushi with a colleague in a landlocked state.
Here I am with a young patient at the direct primary care practice I opened in Kansas City, Kansas, after residency.
We were in our last year of residency (he in internal medicine, myself in family medicine) and had realized that we …
Why we need more physician entrepreneurs
In family medicine, there’s a minor obsession with the word “pipeline.” The term makes me want to scream. Just think about a pipeline. The “line” part is superfluous. A pipeline is actually just a pipe. Our goal is to stuff prospective mission-driven family physicians into a big pipe, confine them there and apply large amounts of pressure to push them through this pipe as quickly as possible, lest the pressure …
A minor obsession with the word, “pipeline”
When I was in medical school, I didn’t realize the potential data would have in health care. Back then I learned from 1000+ page hardcover textbooks and handwrote notes in paper medical records.
Fast forward twenty years — data and analytics are at the forefront of health care. Other doctors and I now have electronic medical records in the majority of hospitals and medical offices; there are claims data warehouses, and …
How doctors can distinguish themselves in a data-driven world
Not including residency, I have been caring for patients for five years. But was I really caring about them? We all took the oath to do no harm. We all began our journey into medicine with intentions to make a difference in patient’s lives. But sometimes our intentions erode. We become jaded. We listen to disgruntled counterparts tell us how medicine used to be.
It’s true. We missed the boat. Our …
Genuine empathy goes a long way
What I’m about to tell you is based on good insider information. But I also disclose that this is an amalgamation of a few reports of teledoc companies to me and their crony insurance companies, not a thorough analysis of the entire industry. I just assume there are other business models out there that look a little different, but I suspect the bottom line impact is about the same.
Most large …
The troubling questions surrounding telemedicine
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