In this day and age, with excellent rehabilitation care available for nearly every injury or illness—no matter how serious—it’s hard to believe that there are millions of people who leave the acute medical system far worse off than they entered it, and aren’t routinely offered rehab. I’m talking about cancer survivors-- a group of individuals known for their tremendous advocacy abilities. It’s no surprise that these folks are really starting ...
November 2011
All Stories
The art of Alzheimer’s disease
Physicians are not trained to interpret paintings, and most patients do not have a lifetime of artwork to analyze. However, a rare opportunity for both to occur is at the Museum of Modern Art’s exhibition de Kooning: A Retrospective.Wilem de Kooning, regarded as one of the most prolific American artists of the twentieth century, grounded himself in the Abstract Expression movement. The AbEx movement is widely associated and recognized with ...
The therapeutic value of touch in medicine
My wife has two world-class oncologists who help her manage her stage 4 lung cancer. Both are excellent clinicians. Yet their skills differ in one very important way. Her radiation oncologist physically touches her a lot (in a good way of course!). There are the touches on her arm, a hand on the shoulder, hugs, and of course a thorough hands-on physician exam. Her medical oncologist not so much.We all ...
When applications ask about your psychiatric history
Sam is young man is applying for a summer program, a real resume builder. Among other things, the application asks if he has been treated for a psychiatric disorder. In fact, he's seen a therapist and he's felt anxious at times. His internist gave him some Lexapro samples and he feels better. The symptoms of his problems have been limited to his own subjective distress. His anxiety is not something ...
Is it a crime that retainer physicians make more money?
Many readers know that I co-authored an Annals of Internal Medicine article on retainer medicine. The article has received (as expected) mixed reviews, because the concept causes angst for some physicians.I believe (and I will not speak in this rant for my co-author) that retainer medicine emerged because of the current payment system. Retainer medicine is a response to burnout. Yes, many retainer physicians are making more money. Is ...
Health IT has problems, but is worth the price
I started working with computers in medicine in 1963. I was a Captain in the United States Army Medical Corps in San Francisco when a Lieutenant Colonel told me to "automate the California Tumor Tissue Registry."I said, "Yes, Sir. How would I do that?" He told me to walk across the Presidio parking lot and go into a building that had a big machine in it that is called a ...
Why doctors need to be better negotiators
Pediatrician Rahul Parikh has a great piece in Salon, Why doctors can’t say no. You should go read it.In the piece, he cites a recent study showing that, in about 10 to 25% of cases, patients come into an office visit with an agenda, or something specific they request.It can be an antibiotic, x-ray or a scan, for ...
First world healthcare expectations in a third world country
I am a third world doctor.My patients have first world expectations.Somewhere in the middle, I end up working too hard and then going home feeling cheated. For I too have expectations. I am in a tension between the reality and my aspirations.In Jamaica, health care is free. Day after day, and night after night its freeness is confirmed, tested. But the system is inanimate. It doesn't feel its own failure, ...
5 reasons why physicians will love mobile health
1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician ...
Problems with the Multiple-Mini Interview for medical school
Some medical schools have altered their admissions process by replacing the traditional applicant interview with the Multiple-Mini Interview (MMI). MMI resembles speed-dating: applicants rotate through numerous interview stations, where they act out scenarios and solve puzzles, sometimes alone and sometimes in groups. A July New York Times article presented a good overview of MMI, as implemented by Virginia Tech Carillon.As you might expect, schools that have adopted MMI (UCLA ...
Medical school is a fragmented, intimate experience
His face was four inches away from mine. I tried not to blink as he shined the ophthalmoscope’s light into my left eye and stared into my pupil as though it were the most interesting thing in the world. He frowned, placed his hand on my head, and used his thumb to pry my eyelid higher. He maneuvered for about 45 more seconds while I sat stone still, and then, suddenly, ...
10 ways doctors can lose their patients
As a neuropsychologist, I have the chance to talk to patients throughout the week in detail about their medical histories, supplemented by a comprehensive medical records review. Part of this involves discussing which provider the patient has seen and if the provider was changed, why. Sometimes, a provider is changed for a benign reason, such as a move or an insurance change but other times there are significant complaints. Granted, ...
Why this doctor moved to private practice
Chief of Medicine Evanston Hospital October 23, 2005To whom it may concern,I would like to take a moment to express my deep displeasure with one of the interactions I had with a physician in the Church Street location. I use the term "interaction" loosely since the doctor in question, Dr. Jordan, never actually saw me. Apparently he was too busy.Last Thursday I was shopping in downtown Evanston when I felt the sudden ...
Why the future of medicine is not looking too good
Question: What is the most important thing concerning residents finishing training and looking for a practice in 2011?a. Feeling of insufficient medical knowledge b. Health system reform c. Educational debt d. Availability of free time e. Dealing with patientsIf you said “d. Availability of free time,” you are either very perceptive and in tune with today’s young doctors or you read an article about this in American Medical News. According to survey ...
We are seeing more terminal patients being referred to hospice
At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient's room and give a shot of morphine. This ...
Delta Air Lines goes anti-vaccine
I have many, many patients and their families who are very active travelers. Business flights, vacation trips … some of you really rack up the miles.It is with shock and disappointment that I must report; Delta Air Lines has made a very poor choice.An ad, produced by the National Vaccine Information Center (NVIC), is currently being shown to passengers on Delta flights through the month of November. The ad encourages ...
A disconnect between medical resources and health care delivery
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the ...
I will never be the physician that my father was
Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private solo practice for most of his career. He worked ...
Grief takes no holidays
The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us. But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at the table can make already unbearable grief so much worse.No one in modern America expects a child to die. Children only die in nineteenth century novels and third-world countries, or ...
Living with chronic illness during the holiday season
In the U.S., we’re getting ready to celebrate Thanksgiving. Soon, people around the world will turn their attention to the holiday season. Chronic health problems can take a toll on relationships any time of the year. Most people have to experience unrelenting pain or illness themselves before they understand how debilitating it is, physically and mentally. Loved-ones (by whom I mean family and close friends) may be in some form ...
Kevin Pho, MD
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
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I learned the value of listening to the patient
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical...
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Repeated experiences of shaming are not good for a young child
The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly...
Patient
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
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How I became a hospice volunteer
People often ask me how I became a hospice volunteer. For the record, nobody is more surprised than I am. You know...
Policy
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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Robotics can revolutionize the delivery of medical care
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care...
Social Media
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
