A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Mission must have always been in my blood, but it took me a while to discover it. I considered going on a mission trip to Bungoma, Kenya, in 2009, but the timing coincided with one of the major conferences at the New York State Society of …
A mission trip to Kenya: Challenge, success and heartbreak
Medicine has always had it regulatory fiefdoms, but in 2002 they were greatly expanded. At that time, a charter on “medical professionalism” was published by the American Board of Internal Medicine, the American College of Physicians, and the European Society of Internal Medicine in the Annals of Internal Medicine that touted three fundamental principles:
The first set of professional responsibilities for physicians was a …
Physician regulators get paid so much more than front line doctors
Medical scribes are a burgeoning field with many institutions and practices exploring their use while the many commercial enterprises who lease out scribes are pushing for their widespread acceptance. There is no accepted definition of what scribes do or what their background or training should be. There is no mechanism for licensure of them in any state. They are poorly defined medical assistants. The field is in its infancy and …
Do medical scribes threaten patient privacy?
If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, “the entire education sector, including college and mid-career training, represents nearly 9 …
Testing doctors is big business
I have been a way from blogging for a a bit and tried to clear my head a bit with a vacation skiing. I left the computer at home, disconnected (as best I could), and had the luxury of feeling the knees working less fluidly than they had before, but still had some fun for a brief 3 day stint. It was nice to notice that there’s a whole world …
Physician time means nothing to programmers and policy makers
I truly enjoy the practice of medicine. The challenge, the complexity, and the constant evolution, combined with the opportunity to continually, positively, and substantially affect people’s lives should lead to an exciting career.
However, the economics of medicine as a business have sapped much of this enjoyment for everyone involved.
As the government strives to save health care dollars, the hospitals and insurance companies gear up their high priced lobbyists to guide …
Why doctors would make good plumbers
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days’ duration. He is otherwise healthy except for the recent finding of pancytopenia. Family history is noncontributory. His only medication is a daily multivitamin. Following a physical exam and lab results, what test is most likely to establish …
MKSAP: 43-year-old man with severe abdominal pain
Remembering why we got into medicine in the first place can often soften the edges of long, difficult days.
My story unfolded on a circuitous route to medical school. I started with a master’s degree in sociology, and my first job after I graduated was working for the Virginia Center on Aging. I administered hour-long assessment surveys to the elderly population of the state. I would drive my old Volkswagen to …
Remember why you got into medicine in the first place
As an internist (yes, I am a specialist, just not a subspecialist), I do no procedures. Patients pay me (albeit mostly indirectly) for my cognitive skills. But we live in a culture that seemingly rewards procedures more that pure cognition. Now I understand that procedures are not mindless. Physicians doing procedures must think prior to the procedure, during the procedure and after the procedure. But cognition without procedures seems undervalued.
The …
Solving the physician income disparity
It saddens me to proclaim that the American Medical Association (AMA), the once-venerable organization that has advocated for the interests of physicians and patients alike since its founding in 1847, is on the precipice of irrelevancy. Membership has dwindled such that only 1/4 of physicians now belong to its ranks.
The attendant decrease in social and political influence that accompanies this decrease in membership arguably compromises the ability of the AMA …
Address the primary care shortage and make the AMA more relevant
Most of us would agree that health care costs are too high in America. They must be controlled or else we won’t have a sustainable health care system here. And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts. But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums …
The New York Times takes a cheap shot at specialists
I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …
To put patients’ interests first, we have to put our own aside
There’s an elephant in the room, one that’s preventing patients from getting the most out of their visits to the doctor — and the name of that elephant is embarrassment.
It’s not unusual to feel uncomfortable about some of the more intimate aspects of your health, but too often this discomfort turns into outright embarrassment. This embarrassment can lead to omissions, which in turn make it impossible for your doctor to …
3 tips to overcome embarrassment in the doctor-patient relationship
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Everyone agrees that the US healthcare system is too costly. The challenge of public policy is deliver higher value by improving quality while reducing costs by eliminating waste and increasing efficiency. Historically physician compensation has been tied to productivity, which encourages procedures and over-utilization.
How can we motivate physicians to provide preventive, cost effective and quality care without incentive programs? Alfie Kohn in 1993 published ”Incentive Plans Cannot Work.” Clearly, poorly …
Financial incentives are the wrong way to compensate physicians
Doctors are burned out and they don’t enjoy their job as much as they used to. But looking broadly, physicians are still spared the economic difficulties and loss of autonomy that are present in most other sectors where people are still lucky enough to be employed. There are issues that doctors rarely face: unemployment, inability to pay their rent and food with their paycheck, and lack of health insurance.
These …
What we value as a society is reflected in how doctors are paid
Norman Rockwell never imagined a world where visiting a doctor could be compared to a trip through a Starbucks drive-thru. The days of shooting the breeze with patients and family members have been relegated to the “Good ole’ days” museum right next to Rockwell’s paintings portraying the doctor as more than just a healer, but a trusted friend. What happened to those days? With challenges like increased patient volumes and …
3 simple ways to improve our patient relationships
He looked ahead, seeing his feet on the hearth. There was smoke rising from one of the three logs, and he marveled at the small flicker of flame that stretched up and ignited the smoke that swirled above the log, dancing briefly somewhat joyously, then gone again, smoke returning.
“You can’t say you weren’t warned,” she said.
He sat, reflecting on her words. So much years of work, so much effort, breadwinner, …
After a lifetime in medicine, where did the time go?
I realize that my blog has been littered with depressing musings on healthcare lately, and so I thought I’d offer up one very positive and “actionable” suggestion for all you patients out there. In the midst of a broken system where your doctor is being pressured to spend more time with a computer than listening and examining you, where health insurance rates and co-pays are sky-rocketing, and where 1 in 5 patients have the wrong …
The one little question that could save your life
Recently I read an interesting article on leadership published at Inc.com. Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in medicine. In this article, author Curt Hanke writes about the inspiration and leadership positives found in the three simple words: “I don’t know.”
On first blush, we may think that a leader speaking these words may no longer …
Admit when you fall short: The power of “I don’t know”
Recommendations. Specialists are full of recommendations. Sometimes they’re helpful, even lifesaving. Other times, not so much. I try to make a point of calling ahead and letting them know about special circumstances, but it’s tough getting past their nurses. Then again, even when I do get through to them, I’m never sure I’m getting through to them, if you know what I mean.
Specialist’s recommendation (ortho, seen for fracture):
Frequent falls resulting …
Nonsensical recommendations from specialist physicians
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