“I should be home well before nine o’clock,” I said to my wife on the phone as I steered my eight-cylinder SUV quietly down the highway at 75 mph with more than 100 miles left to go. “More like eight fifty-five,” I added. “That’s well before nine?” She sounded both weary and incredulous. I knew what she meant. I am not as obsessive about time as I used to be, but even ...

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We have a problem in our clinic. Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled. There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders. Nobody sees over thirty patients a day anymore; we’re lucky to exceed twenty. That ...

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Physicians play many roles in patients’ health care and lives in general. In one encounter we may be the only one encouraging a hesitant or discouraged person to look inside and outside themselves for the strength to move forward with a difficult decision. In the very next appointment, we may be taking charge as a patient develops chest pain and shortness of breath in front of our eyes. We sometimes find ourselves in ...

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A woman in her mid-thirties with a terrible limp and a past surgical history in the dozens became my patient two years ago. Her prosthetic left leg served her well, but her right leg was moving awkwardly because of advanced hip arthritis and a formerly shattered ankle. She was on long-acting morphine and short acting oxycodone. Her Social Security disability insurance didn’t cover the long-acting form of oxycodone. She told me several ...

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"One of the most prominent definitions describes burnout 'as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'" - Maslach, Jackson & Leiter, 1996 In 1974, the year I started medical school back in Sweden, the German-born American psychologist Herbert Freudenberger published a journal article titled “Staff Burnout." In it, he wrote about the physical and emotional symptoms of ...

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Dear health care administrator, I am writing to you in a spirit of cooperation, because the way health care works today, it is too complex a business to manage on the side while also taking care of patients. And I hope you don’t have any illusions about medicine being so simple that non-physicians like yourself can manage patients’ health care without trained professionals who understand medical science and can adapt the ...

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Back in my first year of blogging, I wrote a post, titled "A Day Without a Diagnosis," about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school. That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring. My first patient of the day was ...

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Physicians today are increasingly viewed and treated as skilled workers instead of professionals. The difference is fundamental and lies at the root of today’s epidemic of physician burnout. Historically, there have been three learned professions: law, medicine, and theology. These were occupations associated with extensive learning, regulation by associations of their peers, and adherence to strong ethical principles, providing objective counsel and service for others. Learned professionals have, over many centuries, worked ...

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77-year-old Edward Tripp had been to the emergency room with chest pain last Friday night. It was relentless, aching, and involved the upper part of his left chest. He had no cough, fever or shortness of breath. He was not sweaty or nauseous, and his blood work, EKG and chest x-ray were normal. He was distinctly tender over the part of his rib cage where bone and cartilage join each other ...

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When I started my first internship, back in Sweden in 1979, I worked under a fifty-something cardiologist who spoke slowly with a southern drawl -- yes, there is a southern drawl there, too, slightly reminiscent of Danish, spoken not far from where my supervisor grew up. He epitomized the old school of cardiology, before it became a procedural specialty. He diagnosed heart murmurs by auscultation with his stethoscope, and he even ...

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