In my first year in the hospital, as a third-year medical student, there was one refrain I often heard from physicians and staff alike: This is a hospital, not a hotel. It was an expression of the frustration engendered by “needy patients,” those who were upset that their breakfast was late or that the room was too hot or that they couldn’t speak with the physician just this second. Often, ...

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One day a man decided to open a pizza shop. The first week he sold pizzas and collected money from his customers; the happy customers ate hot pizza, and the man made some money. The next week many of his customers who came in had pizza insurance, and had already paid Blue Wall Insurance for their pizzas. Since so many of his customers had purchased pizza insurance, the man signed a ...

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I am a gynecologic-oncologist. I work in the high-stakes realm of cancer care. I strategize complex treatment plans involving surgery, radiation, chemotherapy and the newer biological agents to treat the myriad of disease that we call collectively “cancer.” Cure — or at least control — requires urgent and timely administration of these modalities along with various imaging or blood work to assure that the treatment prescribed is effective. I love ...

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To the patients concerned about the future of health care: We need one another now more than ever. In April last year, I started this blog to help patients and physicians connect in an increasingly disconnected health care system. Both patients and physicians feel bound and invaded from multiple directions, all interfering with the doctor-patient relationship. We all suffer for it. It occurs to me that many of you may ...

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We have believed a lie to prop up an increasingly untenable system. We have behaved as if we could safely put our emotions aside to do our jobs at no substantial cost to ourselves in the process.  We’ve all heard the admonishments. “I don’t want my surgeon crying in the operating room.  He needs to leave those emotions outside.” Or: “This is just the way medicine is now.  It has nothing to ...

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In this current era of health care, patients are increasingly being labeled as “customers” to provide a landscape suggestive of the need to provide customer satisfaction. Many health care providers grow increasingly frustrated with that terminology. It demeans the relationship that is fostered in the patient-physician encounter; belittling it to a transaction that occurs as the exchange of goods for an expected outcome. Perhaps a more appropriate corollary to the ...

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Ratings have become a national obsession.  U.S. News & World Report rates colleges, medical schools, hospitals, subspecialties, etc.  Some private firms develop physician ratings.  Many insurance companies provide physician report cards.  Intuitively most physicians understand that these ratings have serious flaws, yet they persist. Here's a quote from a Malcolm Gladwell article that I had read and forgotten: "The Order of Things: What college rankings really tell us":

A ranking ...

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It’s 5:50 a.m. and my alarm is buzzing. It’s been going off intermittently since 5:30 a.m. Even though I really don’t need to be out of bed until 6:00 a.m., I’ve lived with myself long enough to know my biggest vice is the snooze button. I roll out of bed and get ready for the day -- blue scrubs, messy bun, enough makeup to feel like I tried, freshly clean teeth ...

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Next month when our youngest child leaves for college, the biggest change may not be in his life but in ours. We are done with dropping them off at school, or giving them driving lessons, or helping them with difficult homework assignments: We will officially become “empty nesters.” My wife and I ponder sitting at the dinner table and standing by the kitchen counter, where exuberant political dialogue takes place, and common ...

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I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic. The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin. The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite ...

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