I was talking to a colleague of mine yesterday. (At least I flatter myself that I am a colleague.  He has a writing job at a prestigious magazine while I, well, don’t.)  We were talking about the doctor-patient relationship, as is our wont, and he said something that stood out to me as the quintessential statement of patients’ expectations about doctors. It goes something like this: "I expect that when I ...

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“What brings you in today?” I asked my new patient, a healthy appearing clean cut 35-year-old married man with kids. “Check me out, doc.” (STD check? chronic disease screen?) “My brother was just diagnosed with diabetes; I want to make sure I’m OK.” (OK, easy -- sugar and cholesterol check) No prior medical problems for him. Prior surgeries? At this question, he paused. “I was shot in the leg last summer leaving work,” he said. “I lost ...

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Physicians have so many ways to communicate. Yet why are they so far apart? Communication Breakdown, It’s always the same, I’m having a nervous breakdown, Drive me insane! - Communication Breakdown, Led Zeppelin Oh why can’t we talk again? Don’t leave me hanging on the telephone! - Hanging on the Telephone, Blondie I honestly don’t know how they did it, how doctors practiced and communicated effectively in the days before our modern technology, with computers, ...

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As all kinds of information are being collected about every aspect of our lives, the data generated at this exorbitant rate can lead to advancements in research and health care.  That is the idea behind big data” and it’s disruptive benefits for the health care industry.  The term encompasses a searchable vast data collection for relative information in order to quickly identify trends.  Like all other disruptive innovations, the focus ...

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I’m a cardiologist. But if you believe the news, you will assume my entire medical specialty is shady and full of morally suspect physicians. Let me tell you why. Recently, two articles surfaced in the lay press, one published by the New York Times and the other by U.S. News & World Report. Like the ...

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Just a short observation.  Medicine is immersed in the customer service mentality.  We’re always reminded to be appropriate and understanding, especially when patients are frustrated or upset.  I get that. Right now, I’m sitting in the airport in Detroit.  We’re about 3 hours late leaving because we don’t have a flight attendant.  That’s right; it’s not the weather (as it was on one of my earlier flights this week).  And it’s ...

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shutterstock_112215167 Regular readers here are well-versed on the controversy surrounding maintenance of certification (MOC) and the American Board of Internal Medicine (ABIM). The story recently made mainstream news, with a comprehensive recap by Newsweek senior writer Kurt Eichenwald: The Ugly Civil War in American Medicine.  Go read it. The ABIM subsequently released a strongly-worded statement.  They are clearly not happy with the ...

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In a recent article posted in JAMA, authors presented a viewpoint about the phenomenon of the flipped patient when describing the increasing reliance that millennial trainees place on getting to know the electronic health record (EHR) of patients rather than the patients themselves. As I read through the text, I found myself agreeing with the points made by the contributing writers that EHRs are increasingly used as the first line of ...

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One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider.  This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters.  The format is pretty standard no matter what medium is chosen.  You thank the referring doc for the consult request, you give some brief background info about the patient in question, and ...

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"I've been getting winded lately." He's a middle-aged man with diabetes.  This kind of thing is a "red flag" on certain patients.  He's one of those patients. "When does it happen?" I ask. "Just when I do things.  If I rest for a few minutes, I feel better." Now the red flag is waving vigorously.  It sounds like it could be exertional angina.  In a diabetic, the symptoms of ischemia (the heart not getting ...

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