“I see you haven’t had your flu shot this year, Mrs. Adams. Would you like to get it now?” “Nice try!” she replied playfully, her warm smile conveying a serene confidence forged by seven long, difficult decades on this earth. “But you know I never get the flu shot.” “I know,” I said, still hopeful I could change her mind, “but influenza can be very dangerous, particularly in patients over the age ...

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Speaking only for myself (but guessing I'm not alone), I can say when a patient develops post-op problems, there's a strong tendency to deny it: not to deny there's something wrong; not to dismiss the patient's concerns or symptoms. Just to grasp first at the less dire set of possible explanations. Maybe it's just the flu, constipation, drug reaction. That sort of thing. It's not about blowing it off -- ...

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Have you ever thought of an x-ray technologist as a key player in promoting high-value, cost-conscious care? Recently, an x-ray tech saved one of my patients from unnecessary imaging.  Here is the story. Last fall we had set up a 6 month follow-up ultrasound to check on a patient’s abdominal aortic aneurysm, an aneurysm that was too small to require surgery, but too large to ignore. The day before the ultrasound ...

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As physicians, we’re all pressed for time, with patient demands, family conflicts, and personal moments of stress. Many of us were acculturated in medical school to ignore our own stress and burnout and instead to devote ourselves to our patients. That tactic may have worked in an earlier world, but with a more complicated and demanding practice environment, it’s no longer tenable today. Two activities help me maintain my personal health ...

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You were supposed to die of cardiac arrest as you circled toward home plate. Or of a brain aneurysm in the summer during one of your countless hikes through the mountains. You weren't supposed to die here. Not in a hospital bed, inhabiting this fragile new body, with an oxygen tube in your nose and tumors in your lungs. Two days before you left us, I traveled home to visit you. I'd ...

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I have often spoken of the doctor-patient relationship as a covenant. Our patients bear their bodies and souls in exchange for a thoughtful, engaged, respectful partner in navigating health and disease. This dyad, this trusted space, allows for the breaking of cultural norms and full disclosure.  Proper healing is an agreement, it is a relationship. Although often not spoken of, any successful flourishing health care system also requires another ...

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Another backboarded body rolls in. I slip from my perch at the computer and greet the emergency medical technician. “Seizure. Lasted a few minutes, done by the time we got there. Fell and cut his face.  Vitals stable. Sugar fine. Oriented but postictal.  Didn’t take his meds.” Approximately my age, the backboarded man’s chin bears a ribbon of red laces. “Dammit,” he says. A glance at the cardiorespiratory monitor shows me suitable hemodynamics, ...

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Here’s a central difficulty of the Affordable Care Act: If everyone has access to health insurance, then everyone has access to all the medical care they need. Curing sickness and preventing death costs a lot, and society can go broke providing costly medical care to everyone. Society saves money and lives when everyone sees a primary care doctor who works to keep people well. But we don’t and won’t have enough ...

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It’s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction, burnout and even suicide. In fact, some believe that up to a third of the US physician work force is planning to leave the profession in the next 3 years -- an alarming statistic. Direct primary care practices are touted as the best way to restore patient and provider ...

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Three months ago, Anne finished chemotherapy.  She is tired, overweight, anxious and her feet burn.  Anne sleeps poorly, cannot concentrate at work and her relationship with her husband is distant, let alone intimate.  In my office for a “survivor’s” visit, Anne asked the glaring question. “Will I recover?  Will I ever be the same?”  After a moment of thought I answer, “I hope not.” Okay, I was not really that cold.  ...

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