I saw 17 patients in my primary care practice yesterday. Six of them were coughing.
One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …
How to know whether your cough is serious
A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch.
And I agree. Comparing guns and cars is fair, after all they kill about …
We can learn a lot by comparing guns to cars
You need a doctor, and I love what I do. But this work just isn’t sustainable.
In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a …
Don’t make me leave primary care
Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.
These stresses, if unmanaged or poorly managed, can …
Dealing with psychological stress of being a doctor
The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …
Your doctor has sold his practice: 6 tips for patients
Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …
Physicians can be better doctors by being patients
The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …
Common criticisms of concierge medicine that deserve to be answered
As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …
Primary care doctors may no longer be needed
She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …
What doctors can learn from working at Starbucks
Along with about 8.4% of the US population, I have asthma. To promote good doctor-patient communication, I can’t sit too far away from you. To perform a high-quality physical examination, I must enter into your personal space. Several minutes of inhaling that strong scent, however, can cause me to have trouble breathing.
I’ve never been brave enough to bring this up before, …
Please don’t wear perfume to the doctor’s office
Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …
It’s amazing what I’ve learned from patients
In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery. She hadn’t lost weight and clearly was feeling discouraged about practically everything. She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.
As her anesthesiologist, …
Mean doctors and nice nurses: It’s time to change our brand
Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.
Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.
But sometimes, medical lingo has …
As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping. The medical record is vital to the care of the patient. It tells the story of each patient’s journey through the medical system. The idea of centralizing all pertinent medical information is, in theory, a step in the right direction. In utopia, there would be one medical record …
What are the biggest issues with EMR today?
Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.
Honest fact: The morale of doctors in the real world is low–and sinking lower.
I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”
Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:
Because …
The growing culture of hostile dependency towards doctors
The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”
The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.
The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.
Let …
Reasons why doctors overtreat and overtest
Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing. But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care …
The micro level of health reform cannot be ignored
It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?
In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to …
Why doctors shouldn’t treat their family and friends
Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …
Why doctors don’t like to go to doctors
With all of its frustrations and challenges, I love my job. In fact, the very things that make primary care so difficult and often times exhausting are also what make it in my opinion the most awesome field in medicine.
When I was in grade school, I wanted to be a physician. My parents would take me to the pediatrician for routine check-ups or when I wasn’t feeling so great and I remember …
It is both a privilege and an honor to be a primary care physician
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