You’re in your 30s. You work hard. You strive to master your craft. You support your extended family. You are liked by both your co-workers and boss.Problem: You unexpectedly become unhealthy–you find out your kidneys are failing.Solution: Regular kidney dialysis can keep you alive, by filtering toxins out of your blood.Problem: Dialysis is time consuming (>3 hours/session, 3 sessions/week) and leaves you feeling tired and weak.Solution: Your brother, who is ...
John Schumann, MD
Young doctors don’t see value in primary care careers
In my new role as one of the directors of an internal medicine training program, I help select new interns out of medical school for the three year training stint of residency.At the end of residency, many graduates go on to subspecialty fellowships, another two to four year period of intensive training in fields like cardiology, nephrology, critical care etc.For those that don’t choose a subspecialty, one choice remains: traditional ...
What doctors can learn from the orthodontist’s office
I took my daughter to the orthodontist last week to get braces.There's a lot about the process that seems better than when I was a kid. Mostly, it's that instead of having to slide brackets around each of your teeth (yishk!) the orthodontist just paints a special glue on the enamel and places the brace on the front of each tooth. Kids get to pick the color of their braces ...
Telemedicine to augment the patient encounter
When I use the term "telemedicine," what does it mean to you?In current parlance, it usually refers to radiologists looking at digital images of x-rays and other scans from locations remote from the site of acquisition. Think "outsourcing" where the radiologist could even be as far away as India.But according to a recent conference I attended, telemedicine could mean so much more. It can range from synchronous video chat ...
The effect of the RUC overvalues procedural skill
An interesting legal case brewing in the medical world that's worth sharing.A group of six physician plaintiffs from Georgia are suing the government (the Secretary of Health and Human Services) in a federal district court claiming damages from the fact that Medicare, the massive program that covers the elderly and disabled, fails to execute due diligence by rubber-stamping a reimbursement structure that overvalues procedural medicine over cognitive services.Huh?Some background ...
Before getting a CT scan, ask your doctor if its really needed
How and when do new medical technologies become the standard of care?A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.
Looks a bit like a medieval torture doughnut.
The only thing that surprises me about this is that it’s not more.Way more.I remember the first time I actually ordered a CT scan on a patient all by ... Medical ethics at hospitals and medical schools in China
One of the topics I went to China to discuss was our medical school’s approach to teaching medical ethics.At Wuhan University they have a first-year course, but I was told by both the school administrators and some of the students that the material is dry and not seen of immediate importance, so students often skip the class.Here’s how ...
Palliative care can lead to higher quality of live and longer survival
Every once in awhile amidst the weekly deluge of medical articles comes a show-stopper that has the potential to change the way we practice.Rarer yet is the article that not only changes how we practice, but calls into question why we do what we do.This recent article from the New England Journal of Medicine is just such an article. Before you bolt, let me simplify it for you.
Here’s the ...
Working at the student care center in college
For five years I worked at GlassHospital’s Student Care Center.I don't get no respect, neither.One of the great things about GlassHospital is that it sits on the campus of a well-known and fairly well-respected former Big Ten university.Like all colleges and universities, our place acts in loco parentis to the students that grace its campus. This means responsibility for our students’ health and well-being.I loved working at the Student Care ...
Watchful waiting is underutilized for most men with prostate cancer
NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”Very telling.The thrust of the article and the ...
Leading a hospital team of foreign trained doctors
Recently, I had the opportunity to decamp from the the friendly confines of GlassHospital and trek a few miles to the north.GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of Blessed Proximity.Our Lady has a residency training program, just like ours, with the major difference being that nearly all of the doctors come from foreign lands.Something you should know about medicine in ...
Empathy is needed for better relationships with patients
Most people enter the healing arts with a genuine desire to serve others.The long educational journey and the realities of both the workaday world and the various business models of health care often strain our abilities to act in an empathic manner.We have to pay the bills, after all.“No money, no mission,” is a refrain I’ve often heard in the non-profit corners of the health care world, justifying business decisions ...
Customer service needs to be a priority in health care
What do Enterprise Rent-a-Car, KeyBank, and the Cleveland Clinic have in common?They all make customer (patient) satisfaction a top priority.They accomplish this in industry-specific ways, but together their emphasis on service as a passion shares common themes:1. Buy-in for a service culture comes straight from the top, and permeates the entire organization. 2. Copious resources are delegated to building a service culture, starting with hiring. 3. Employees are “hired for fit.” If ...
Why patients file medical malpractice lawsuits
Time to turn our attention to an unpleasant topic: Lawsuits.Who files them?Why? And what actually happens?There have been oceans of ink spilled about medical malpractice. An oversimplification of the various positions on malpractice and malpractice reform goes something like this:
- (+) Malpractice suits are good. They keep healthcare professionals and hospitals on their toes; if the threat of a big payout improves safety and quality, then lawsuits provide an important regulatory ...
Blood tests in hospitals may be unnecessary
I’ve just finished a month “on-service” as a teaching attending for a general medicine team here at GlassHospital. This means I served as the physician of record for every patient admitted to the team.You might find it interesting to know that patients admitted to the hospital’s general medicine service get assigned to their teams by random assortment. Since there are five teams, one team takes call every fifth day. ...
Undocumented individuals make hospital discharge difficult
Working in the hospital this month, my team has been caring for Mr. M. He was here when we started on service at the beginning of the month, and unless his planned transfer to another facility goes through, he’ll be here when we sign off to the next team at the end of the month.Mr. M is in his fifties. He speaks Spanish. He is an undocumented immigrant from Central ...
Can house calls be revived under health reform?
Beginning in the 1970s, the house call began a slow death. As the medical-industrial complex (MIC) burgeoned, with bigger hospitals and a surfeit of technology, it became incumbent on patients to come see us rather than us going to see you.Yet there are pockets of house calls still left in the U.S.For the geriatric age group, there has been growth in the care-at-home sector, especially for homebound elders. They can ...
Death in a hospital is not always comfortable
In America, too many people die in the hospital.I don’t mean that they die due to medical error or incompetence, though that’s always a hot topic of discussion amongst doctors, researchers, administrators, and regulators.What I mean is that if you ask most people, they say they’d rather die at home, surrounded by their loved ones, drifting off to sleep painlessly after having had last rites administered (feel free to plug ...
Helping organ donation with donor advocate teams
One of the joys of practicing at an academic center is that I get to do many different things in my job.The foundation of my work is seeing my own patients in a large group (more than thirty doctors!) primary care practice.Two months a year, I take my turn rotating on the hospital inpatient services, supervising teams of residents and students who are the primary caregivers for patients with illnesses ...
Becoming vegetarian can help fight high cholesterol
I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian.I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a ...
