Nearly every physician regards himself as an ethical practitioner. Nearly none of us are, at least not fully. There is no bright line that separates ethical from improper behavior. Indeed, it is because the boundary is fuzzy that ethicists and the rest of us wrestle with contentious controversies. It is, therefore, expected that ethicists are divided on many issues, much as the U.S. Supreme Court is often split in its ...
A few weeks ago I was an expert witness in a malpractice trial. In this post I will use generalities and specifically not reveal any details of the patient or the court case. I first became involved in this process several years ago. My involvement included a deposition, reviewing medical records, reviewing other expert depositions, discussing the patient’s most unfortunate story with lawyers for two different defendants, and finally testifying. ...
“Sometimes my leg hurts.”
“Why does it hurt?”
“Uh, that’s a tough question. Does it hurt a lot?”
“No, just every once in a while.”
“OK, and where does it hurt.”
He gives an expression of disbelief at the stupidity of the question. ”My leg!”
“Where on your leg?”
“I don’t know,” patience now growing thin. ”I just want to know what’s causing it.”
“Well, Jonathan, it doesn’t work that way. My main job is to make ...
In a recent blog post, I discussed the harms of a new epidemic: too much medical care. We also don’t want the opposite. In fact, much of the driving force leading to overdiagnosis and overtreatment is this fear of rationing.
So what can you do to ensure that you obtain just the right amount of care?
It isn’t easy -- if it were, if there an algorithm that would give ...
What is patient engagement?
Everyone agrees that it’s a good thing, and that we healthcare providers should be fostering it.
How to do so, however, depends on just what you believe patient engagement means.
As Dan Munro recently pointed out, the term “patient engagement” is a hot buzz phrase, and -- in the best tradition of such phrases -- it’s amorphous enough and appealing enough to mean just about anything.
Provided that it ...
I received a very intriguing question the other day.
“What happens when someone despicable, someone who has committed some horrible act or made some terrible decision, comes in for evaluation or treatment and you have to see them?”
I have been asked to see child molesters of the worst kind, men (usually) who have done things so vile to children that it would make your stomach turn to hear about them. Having ...
Another tragedy, another tragic series of errors, another avalanche of debriefings and politicization, and in Washington, DC, there are 12 more dead. What can we say about this? It seems that the standard commentary fails. Aaron Alexis was not an angry white man, nor a conservative. He carried no assault rifle and he had a secret security clearance. He doesn’t seem to have been motivated by race. He was a ...
In today’s health care environment, we are all driven to see more patients in less time and do more with less support. Obviously most of this is financially motivated -- the delivery of medical care had unfortunately become more of a business than an art. As more physician groups are now owned by hospital systems, the “bean counters” and administrators are now ...
Recently I met the husband of a patient with a diagnosis of advanced lung cancer. Even though she was young and had been healthy, the disease spread to her bones. I outlined treatment for this incurable illness: choices, goals and side effects. This was a very tough meeting, because by the end we had to discuss time as measured by dollars.
The particular challenge was that this family had health insurance ...
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):