Follow-up appointments at my continuity clinic have given me the opportunity to look at my clinical judgment in snapshots.  Unlike on my inpatient rotations, where I see the same patients every day,  I have to wait for a month or two to see if a medication is working, or if a patient is satisfied with their progress in physical therapy.  Sometimes I have a crisp memory of my clinical decision-making ...

Read more...

A response to Unpaid, stressed, and confused: Patients are the health care system's free labor. Dear Sarah, I am genuinely sorry about your chronic foot injury.  Thank you for your insightful article and feedback.  You are correct the system is fragmented and places “considerable burden” on patients to “coordinate their own care.”  You (the patient) and me (a physician) are now in the same boat, headed the same direction with the ...

Read more...

"We experienced an iatrogenic event that produced an untoward sequela, and while it is now quiescent, it may still recrudesce." No one likes to be given bad news, especially of disease.  But first, you have to understand what it means.  When it comes to communication of medical information, the way the message is delivered is often just as important as the information itself.  Indeed, good communication is the backbone of every patient-provider relationship. The ...

Read more...

To the American Board of Pediatrics: I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date. The first hurdle was the exam application and the second was the testing day experience, which was one of the most humiliating of my ...

Read more...

One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as ...

Read more...

The time has come. The time has come for patients to know how dangerous the state of health care has become and to finally do something about it. I’m ticked off. So ticked off that I’m writing this in between office patients, and I really try very hard to prevent my patients from waiting. Apparently insurance companies feel practicing medicine is as easy as checking off boxes, like hanging chads ...

Read more...

“I love you,” she said as she was leaving the room. “I, I um …” “Not you. Your computer.” She cast my computer, still warm and glowing with its brilliantly colored logout screen, a glance of longing and desire, and left the exam room. “Oh, I thought …” The slamming of the exam room door clipped off whatever the end of that sentence might have been. I sat down and rolled my chair over to ...

Read more...

A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling ...

Read more...

The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice. Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any ...

Read more...

I have a love-hate relationship with the no-show patient.  Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my ...

Read more...

Most Popular