I’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout. At one point, I came close to permanently leaving my chosen profession. The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive ...
November 2011
All Stories
Pancreas cancer: Exposing the silent killer
November is Pancreas Cancer Awareness Month and with the recent passing of Patrick Swayze and Steve Jobs, now is as good a time as ever to educate ourselves about this deadly disease. Almost 40,000 people per year will die of this disease in the U.S., making it the 4th most common cancer killer. It is through education and research that we can continue to improve survival and outcome ...
Teaching clinicians the teach-back for patient education
I’m a big fan of the teach-back. To my knowledge, it is the only way to confirm that my patient understands my message. I don’t believe avoiding jargon or creating written materials at a favorable readability level can ensure understanding. So, I’m always left with uncertainty until my patient teaches it back to me.I’ve been teaching clinicians to do the teach-back for about a decade now. For the same amount ...
Expecting doctors to be perfect is a setup for dysfunction
Science seeks certainty. The problem in medicine is, the body is complex and our knowledge is incomplete. People who want certainty – physicians or patients – are kidding themselves. And if we expect docs to be perfect, it’s a setup for dysfunction.Sometimes I hear of patients who believe their physicians dissed a proposed or experimental treatment that’s not understood. (I’m not endorsing wacky treatments here – I’m only talking about uncertainty.) ...
ACP: What’s a small group practice to do?
A guest column by the American College of Physicians, exclusive to KevinMD.com.In 1998 I started a period of national service to the American College of Physicians leading to my term as President for 2010-2011. During that time I kept an almost full time private practice in Fayetteville, Tennessee. Moving between the worlds of health policy and "the trenches," I ...
Useless thought experiments during medical school and residency
I recently admitted a patient with a pulmonary embolism. Before heparin drip was started, my attending ordered a hoard of eccentric, non-indicated hypercoagulable workup in the hope of avoiding the effect of heparin on these test results, including phosphatidylserine antibody and methylenetetrahydrofolate reductase DNA. I watched in horror as the nurse drew out approximately 13 tubes of blood, since each test needs its own tube.On rounds, the attending of course ...
Choosing a doctor should be like the Amazon shopping experience
Have I told you how much I love Amazon? Its the awesome! Let’s say I need something – an external hard drive. So I go to Amazon and I type in "external hard drives." Boom. I get a list of, not surprisingly, external hard drives. Which one do I chose? Fortunately, Amazon has some great data and filtering options. I want a desktop drive, not portable, so I filter those out. ...
EHR adopters give advice to those considering electronic medical records
Our practice went live with our own EMR system in late 2008. For the most part, this was uneventful. The reason for this was mainly due to proper planning. And credit for our implementation plan goes primarily to our administrator, our IT director, and staff members of our appointed EMR committee. Although some of the physicians were an integral part of the committee, we tried our best not to micromanage ...
What happens if the Supreme Court strikes down the individual mandate?
Any ruling by the Supreme Court on the constitutionality of the Affordable Care Act's controversial individual mandate isn't likely for at least another several months, but it's worth thinking about what might happen after the case is decided. The first scenario is easy: If the Court upholds the mandate, the ACA goes forward as planned to the continued objections of many conservative Americans and politicians. The second scenario is less ...
Back to school fatigue can be caused by environmental allergies
Back to school. Kids get back into a routine, and mom gets her life back, right? Wrong. For most moms, back to school is anything but relaxing. However, for some of us, it's even more tiring.Is this the time of year when you struggle to drag yourself out of bed, despite hitting the sack as soon as you put the kids down for the night?Is your focus during the day ...
Changing the incentives in the operating room
Last year I wrote about a few strategies for decreasing costs in the operating room. Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical.In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives. If you want to understand human behavior, all you have to do is identify the incentives that drive ...
Protecting patients from medical apology programs
To deal with the aftermath of medical errors, an increasing number of providers are encouraging injured patients to participate in "medical apology programs." The idea, proponents say, is for patients to meet with facility representatives to learn what happened and why. It gives the patient a chance to ask questions and it gives providers a chance to apologize, and as appropriate, offer compensation. These programs are promoted as humanitarian, and, ...
Looking back at how primary care has changed
It is almost impossible for me to believe that my views on primary care in the United States have changed so radically in fifty years. When I graduated from medical school in 1961, I was determined to become a primary care doctor. I completed residencies in both medicine and pediatrics to prepare for a career as a general physician in rural Vermont. That dream was put on hold by an ...
It’s only through humility that we can achieve great things
My 6-year-old son is really farsighted, and I had no idea. I completely missed it.To be fair to me and my husband, the ophthalmologist (the esteemed and wonderful Dr. Hunter of Children’s Hospital Boston) said that Liam was compensating really well. And until his yearly checkup last month, he had been passing vision tests (which mostly test for nearsightedness). But in retrospect, there were signs we didn’t pay attention to. ...
Patient safety requires hospital leaders to take personal responsibility
A quality-driven MD colleague writes with frustration about two problems in his academic medical center. I often hear similar comments from nurses and doctors, and so I present the examples for your consideration.This hospital has a poor record with regard to hand hygiene (in the 30% range), and my colleague suggested at an infection control meeting suggested that the rates be publicly posted in the hospital to provide an impetus for ...
Adding 5 minutes to patient charting is a big deal
"I estimate these changes to your charting work flow will take only five minutes."Five minutes is fine if it happens for only one patient. But when it is multiplied by as many as forty patients in a day, the multiples get impressive. Five minutes x forty patients = 200 minutes (more than 1.5 hours a day).Minor five-minute changes to administrative charting requirements aren't so minor, especially when you add more ...
In Kenya, operating in our comfort zone
"Traveling makes one modest – you see what a tiny place you occupy in the world. " -Gustave FlaubertWe have come to Kenya, expecting to work outside of our "comfort zones."Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor ...
How mobile health can help child abuse victims
There has not been a more horrific scandal in the world of sports that I can remember than the child abuse scandal surrounding Pennsylvania State University.Let it be said that I am very impressed with the reaction of much of the student body which is one of shock and disdain for the administration charged with covering up alleged abuses of children by a former assistant football coach. According to the ...
Major advances in radiation therapy for cancer treatment
Radiation therapy has advanced dramatically in the past few decades and the rate of change is increasing rapidly. Innovations as a result of engineering and computer advances along with conceptual advances are making a dramatic difference.Some of the new technologies include improved computer assisted treatment planning (smarter and faster and has more capability like auto-contouring, smart segmentation and improved algorithms) , continuous imaging guidance (fluoroscopic, stereoscopic, and cone beam CT), ...
Considering cancer and heart disease in opposing ways
The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring operations, prolonged toxic irradiation and chemotherapeutic agents that may be beneficial if they do not kill you first.Response to treatment of limited incidence and duration are accepted and deemed beneficial. ...
Kevin Pho, MD
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How patient satisfaction can kill
Patient satisfaction is all the rage. Medicare is beginning to tie patient satisfaction scores with hospital reimbursement, and doctors across the country...
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How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
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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....
Physician
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The analogy between baseball hierarchy and medical systems
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but...
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Saving patients from Internet health information
Lately, I get the feeling that I’m doing something wrong. I’m supposed to form a partnership with my patients. My patients are...
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Understanding what patient centered care really means
There was nothing the professor despised more then the syrup that oozed out of his partner's lips when dealing with patients. He...
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A letter of thanks to my organ donor
I have tried to write a letter of thanks but don't know what to say or even how to begin. I don't...
Patient
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Why patient engagement is reciprocal
It is said that "turn around is fair play." So if providers (physicians, hospitals and other health care professionals) expect patients to...
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Question the price of drugs and medical procedures
Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure...
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In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
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How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
Policy
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America has a medical care system not a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We...
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Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently,...
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Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no...
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America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who...
Tech
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Why physicians don’t want patients to have their cardiac device data
There is a groundswell of discussion concerning patients demanding to have direct access to data derived from their implantable defibrillators and pacemakers....
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Impersonal communication on the Internet fuels cyberbullying
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over...
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Health IT and doctors: A framework for successful partnerships
We are on the front lines of the healthcare revolution along side our patients and our colleagues in technology. We have firsthand...
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Break out of the prison of the American health care delivery system
Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost...
Social Media
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Why doctors should embrace Google+
Lots of pressure out there for you to be on Facebook and Twitter, right? The ultimate question, though, is how are you...
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Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
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Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
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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...
