In recent months, there has been a lot of talk on social media and in the press about how miserable many doctors are. These conversations have also brought inspiring alternatives to the forefront. For example, Zubin Damania, MD, founder of Turntable Health, and Pamela Wible, MD, a leader in the Ideal Practice movement, have notably and smartly encouraged doctors practicing on the front lines to take matters into ...

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Back when Prozac (fluoxetine) and Zoloft (sertraline) were new, I remember the mental acrobatics doctors made to justify giving these drugs to anxious patients. The drugs were approved for treating depression, but we knew they often seemed to help anxiety. The reason, we were told, was that some anxious patients were actually depressed, deep down, and we had just failed to recognize their depression. Now, with studies to support their use ...

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For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it.  I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at least once it sounded as if the receiver was ...

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I have a confession to make.  The purpose of a recent blog post was to set up this one.  What I questioned, at that time, is whether the future of primary care will come from outside change (business, politics, or even specialist physicians and administrators) or internally, hence creative destruction versus internal combustion. When I entered my first primary care practice in 2002, I had great doubts that the traditional ...

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Disruptive innovation is competitive strategy for an age seized by terror. - Jill Lepore, author of The Disruption Machine: What the Theory of Innovation Gets Wrong "What do you want me to do with all the stuff in this box?" my wife asked this weekend. I looked inside and saw my former self: one of BNC and pin connectors, wires, a notebook with sin, cos, theta, and a host of other equations -- a ...

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A stark reality of the past year has been the ever-looming ICD-10 transition, which ultimately got punted on by the federal government to October 2015. With the deadline to make the transition to ICD-10 now more than a year away instead of six months (and who knows if that will even be the case next summer), I’d still wager that many health systems are working to keep their transitions on track ...

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Earlier this year, I started teaching a course to first year pediatric residents at Stanford. In it, I challenge the trainees to identify the structural contexts in which patients and families make choices that may impact their health and well-being. Termed structural competency, the goal is to enable young physicians to understand and confront stigma and inequality as key determinants of health. We talk about ...

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Let me show you four simple steps, requiring just 15 seconds, that will turn a patient thank you into a two-way healing encounter of the highest order. It is incredibly easy for a thank you from a patient to slip by during a busy day in the office. We can get so caught up in the blizzard of clinical tasks we fail to hear what the patient is trying to communicate. We don’t ...

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Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover. One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter. The second sheet, mysteriously, contains only a single line: This page intentionally left ...

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There is a growing recognition in medical education and practice that the spiritual component of human existence must be recognized and addressed. The American College of Physicians has concluded that physicians are obligated to attend to all dimensions of suffering: the physical, psychosocial, spiritual, and existential. Similarly, the Joint Commission on Accreditation of Healthcare Organizations (JAHCO), which accredits hospitals, recognizes that spiritual concerns are often important for patients and that hospitals ...

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