Public health leaders must often tell people things that they don’t really want to hear. “Stop smoking.” “Eat a healthier diet.” “Exercise for at least 30 minutes each day.” To motivate people to heed these messages, leaders construct simple narratives to communicate the potential harms of undesired health behaviors and the benefits of desired ones. Who wants to spend their golden years tethered to an oxygen tank for every moment ...

Read more...

Most humans, even those who are educated, can read and write, and have studied some science, seem to have a hard time comprehending unpleasant future realities, absent personal experience. Some say that people learn most from their own mistakes. If true, that makes widespread prevention of anticipated calamities very difficult. And I am not only talking about people who are deeply into religion and superstition, and those who send politicians who proudly ...

Read more...

I recently was on vacation in Rocky Mountain National Park. Suspended on an overlook of astonishing beauty at 11,000 feet above sea level, I stared out at the tundra and bits of August snow that still clung to the highest peaks. Suddenly my attention was snapped from the massive boulders and landscapes to the ringing of my cell phone. It was a referring doctor asking me about a mutual patient ...

Read more...

Not long ago, I read an article titled, "What health care can learn from the military." As a former member of the US Army, I was intrigued.  I learned many things in the military that I use everyday in the clinic.  Before that, I employed things I learned to help me get through medical school.  My military experience gave me some fantastic skills.  None were brought up in ...

Read more...

An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections. On the surface, it kind of makes sense – one should be punished for ...

Read more...

One would think that a physician who earns his living billing patients would be conversant with the prices of his services. Not this doctor. I am queried periodically by patients asking how much I charge for a colonoscopy. Of course, every physician recognizes that this question is not phrased properly. It doesn’t matter what we charge; it’s what an insurance company determines we will be paid. I might believe that your ...

Read more...

I have been practicing medicine for 35 years and the great secret is that it just keeps getting better.  No day goes by without an important learning moment, a unique observation or just the satisfaction of making a difference.  Today I had one of those moments of revelation that will slightly change all days which follow. Stan is a 57-year-old man with curable colon cancer who requires surgery. Unfortunately, that surgery ...

Read more...

On a night flight from Boston to San Francisco a voice came over the loudspeaker. “If there’s a doctor on board, would you please identify yourself by pressing your call bell?” I reached up to hit the button, shrugging nonchalantly in response to my seat mate’s questioning look. “Duty calls,” my shrug was meant to convey. But I didn’t feel nonchalant. What I felt was approximately two parts excitement and one part ...

Read more...

One of the most difficult decisions that patients, families and physicians face involves end-of-life care. The advance directive or “living will” has become an accepted framework for patients to delineate their own preferences about what treatment they would or would not want when faced with a life-threatening disorder. But it was not always this way. In the past, physicians and families often shielded those with potentially fatal illnesses from candid conversations ...

Read more...

On a picnic blanket at Piestewa Peak in Phoenix, AZ, Rowena passed around orange honey almonds while Barbara read an Elizabeth Chase Allen poem to us. My friend Dosia pointed out the growing audience of curious squirrels hoping we would drop a few treats. The conversation turned to favorite springtime memories; our laughter cut through the quiet of the desert. Nadine brought out a layered chocolate cake for her boyfriend ...

Read more...