While I was in full-time practice, as far as I can tell, I received one bad anonymously written online patient review. It was on one of the numerous sites that exist but allows written reviews. The star rating is not much better since here you have no idea what the complaint is. However, the weight these reviews carry will increase, so we better take heed. Plus, given the fact that ...

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An open letter to the American Board of Family Medicine (ABFM): I recently chose to sit for my sixth (and I hope final) family practice maintenance of certification (MOC) examination, having now practiced as a board certified family physician for the past 34 years and intending to work a few more years. I want to share my experience taking this examination your organization prepares, promotes and uses at a high cost ...

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It was a case that every physician dreads. I took a deep breath, mustered up some courage and walked towards my patient’s room. When I entered, I saw an apprehensive and anxious family who was patiently waiting for some answers. The mother was sitting at bedside with eyes closed, hands clung to a rosary and lips whispering a prayer. The patient’s sister was standing by the window, looking out with ...

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The nurse grabs me: "You have to check my patient now! She is screaming and bearing down.” Without letting go of my hand, she leads me into the labor room. I don’t even consider saying no, I know not to question this nurse. She has been a labor and delivery nurse nearly as long as I have been alive; she knows much more than I about everything. The room is dark, but ...

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Maintenance of certification (MOC) for something as significant as the practice of medicine seems like a harmless enough idea. But for physicians across the country who dedicate thousands of hours to study, earn licensure, achieve board certification, and practice medicine, MOC is not only unnecessary but also a resource-consuming mandate that does nothing to improve patient outcomes and quality of care. According to the American Board of Medical Specialty’s (ABMS’) own ...

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I sat in my car, anxiously watching the minutes tick by as I ruminated over and over the words, I had prepared for this crucial meeting. I had arrived much earlier than the appointed time, knowing I would need a few moments to calm my nerves before walking into a room to face a panel of eight legal, medical, and insurance professionals. I was pregnant with my sixth baby and was ...

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By now, we have all seen the cell phone footage of a doctor being dragged off a United Airlines flight. I’ve seen it on Twitter, on Facebook, on cable news and read about it in the printed press. I’ve been texted links to the various videos each from different angles but all showing the same images — a man being dragged away with a bloody face. This has prompted quite ...

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As the world digested the events that unfolded aboard United Airlines Flight 3411 at Chicago O’Hare, and watched the horrific video of Dr. David Dao being forcibly dragged off the plane that was supposed to be taking him home, social media was red with rage at United Airlines. People vowed never to fly with them, customers ripped up their loyalty cards, and United’s stock fell over a billion dollars in ...

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Doctors and nurses like facts. After all, we're evidence-based thinkers — rational scientists. Yet, we can be surprisingly superstitious. Many of us believe in a thing called "call karma," which is when certain doctors attract sick patients while working on call (these people are said to have bad call karma). Other doctors attract less sick patients, meaning they have good call karma. As a medical student, I quickly learned that I fell ...

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I had an upsetting encounter the other day with a 22-year-old woman, who mentioned (secondary to the purpose of the visit) that she was pretty sure she had breast cancer. Why did she think that? She’d found a lump in her breast. (Somewhat unusually for the specific setting, she let me do a breast exam. All I felt was a small area of lumpy breast tissue, possibly a fibroadenoma at worst. Of course, ...

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One of the most challenging and difficult parts of my professional day is trying to determine if my patients are actually taking their as prescribed. I ask my patients to bring their medications to each visit in the original pill bottles, and we count pills. I ask them to bring their medication lists as well, and we go through the time-consuming practice of reviewing each medication against the prescribing date and ...

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Recently, the online version of JAMA published an original investigation entitled "Patient Mortality During Unannounced Accreditation Surveys at US Hospitals." The purpose of this investigation was to determine the effect of heightened vigilance during unannounced accreditation surveys on safety and quality of inpatient care. The authors found that there was a significant reduction in mortality in patients admitted during the week of surveys by The Joint Commission. The change was ...

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Throughout my premed and medical training, I've been deluged with a steady stream of negative thoughts regarding medicine as a career from outspoken, burnt-out physicians. To this day, nine years since I've finished my residency in family medicine, I remain passionately opposed to this sentiment. I've seen statistics and mathematical calculations painting a dark picture of the financial, personal and professional world of today's physician, overwhelmed with debt, administrative nightmares, ...

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At the risk of vilification by my peers, I’m going to say something extremely unpopular. We physicians have it pretty good financially. Our salaries are generous, and we have a much higher standard of living than most others in America. When I read online physician complaints about student loan debt, I cringe a bit. Because of all the people in debt, we are some of the ...

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July 10 will mark my tenth year as a nurse. When I began, I was shy and naive. Now I am already an old nurse, surprised by nothing and filled with battle stories. I’ve spent the last seven years working in a medical ICU, and I’ve seen and done so much. I counseled a bewildered husband on withdrawing care on his cancer-stricken wife. I got in a fight with a ...

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I pulled on my white coat and straightened my tie before walking into the patient room with my supervising physician, Dr. H. Our patient was a teenage boy with autism, and Dr. H let me take the lead. Towards the end of the visit I asked, as I always do, “Do you have any questions for me?” He had not made eye contact with me throughout the visit, which can ...

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During my two years off from medical school, I’ve been volunteering as a court appointed special advocate for children in the foster care system. And I’ve spent a lot of time reading about how these kids’ experiences could affect the rest of their lives. The seminal research on this happened in the late 1990s using data from more 17,000 Kaiser patients. What the researchers found was that patients ...

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It is not something that is taught enough in medical school, but practicing physicians quickly realize that in this business: Communication is everything. The reality of health care is that you can be the worst physician in the world clinically (not that it’s something desirable to be), display great interpersonal skills, communicating well with your patients -- and they will do absolutely anything you say and put you up on ...

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Recently, a nurse at Children's Hospital Los Angeles noticed that comedian Jimmy Kimmel's newborn baby had a murmur and was cyanotic and brought it to the newborn intensive care unit for further evaluation. That triggered a rush of activity that led to a diagnosis of a congenital heart defect and heart valve problem and surgery to save the baby's life. Here's what the public doesn't understand: Nurses do this every day. ...

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My old strategy for getting insurance approvals for imaging tests doesn’t seem to be working anymore. I used to put my thinking in my office notes so that a reviewer at one of the imaging management companies would clearly see my rationale for ordering that CT scan or MRI my patient needed. Now I am getting more and more requests to initiate a “peer-to-peer” call instead. My heart sinks every time; each ...

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