The key change in medicine that has caused a escalation of costs, a decline in the quality of care, and an increasing shortage of physicians is the shift toward an exclusively business contract with society at the expense of the social contract. To differentiate the business contract from the social contract I will use the following example. One afternoon I see my neighbor hard at work changing her tire. If I ...

Read more...

“Nine of 10 doctors discourage others from joining the profession,” writes Daniela Drake on the Daily Beast. And stats say that by the end of 2014, about 300 physicians will commit suicide. What is going on? A few years back, practicing medicine was named the second-most suicidal occupation. Yet, it hasn’t stopped. The level of sheer unhappiness among physicians is on the rise. Being a doctor has become a humiliating undertaking. There ...

Read more...

The last time I was in Israel, I went on some home visits with a palliative care physician in the town of Sfat near the Sea of Galilee. My colleague, a devout Jewish doctor, took me to several homes to offer advice on managing his most serious, terminally ill patients. One older Chassidic Rabbi was dealing with an advanced lung cancer, and having a difficult time accepting any kind of ...

Read more...

I’ve based a huge chunk of my career on the assumption that evidence-based information helps people make better informed health decisions, have better health conversations with their doctors and ultimately leads to better health outcomes. Evidence is my stock in trade. I have spent many years translating evidence into a form that people can understand. I’ve written thousands of evidence-based articles across many channels. I’ve written position statements, belonged to guideline ...

Read more...

Irontriangle Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn't help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by ...

Read more...

to live in this world you must be able to do three things to love what is mortal; to hold it against your bones knowing your own life depends on it; and, when the time comes to let it go, to let it go -Mary Oliver, New and Selected Poems, Vol. 1 As a parent, you are not supposed to have a favorite child, and since some of us physicians feel a strange but kindred protectiveness for our patients, likewise we ...

Read more...

Fifteen years ago I got an unexpected invitation to write a column for a dermatology newspaper aimed at practicing clinicians. Because dermatology is a concrete field that lends itself to punning, I called the column “Under My Skin.” Writing it monthly since then has given me a chance to take a humorous and sometimes cathartic look at the joys and woes of practice. It’s fun to do, and gratifying to hear ...

Read more...

Patient noncompliance. I wasn’t very familiar with this term until I started my clinical rotations. But after just the first week, I started noticing that health care providers throw this phrase around all time. We particularly like using it as an excuse. Why did this diabetic patient require a foot amputation? Why does this patient come in monthly with congestive heart failure exacerbation? Why did this patient suffer a stroke? It’s often ...

Read more...

What do we want in the last days of life?  We want no pain. We want simple dignity, the physical kind where we clean ourselves, organize our medicine and command our bowels.  As important is the complex dignity of choosing where we spend our final days, make tough decisions for ourselves and, as much as possible, live as a person, not a patient.  It occurs to me that these critical ...

Read more...

shutterstock_93685306 The Institute of Medicine in 2010 famously recommended that nurses should be encouraged to practice “to the full extent of their education and training.” Often, you’ll hear people advocate that every health care worker should “practice at the top of their license.” What this concept is supposed to mean, I think, is that anyone with clinical skills should use them effectively ...

Read more...

Most Popular