It took a 125-nanometer virus only a few weeks to move American health care from the twentieth to the twenty-first century. This had nothing to do with science or technology, and only to a small degree was it due to public interest or demand, which had both been present for decades. It happened this month for one simple reason: Medicare and Medicaid started paying for managing patient care without a face ...

Read more...

It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment. We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word. This has been the bread and butter of counselors for years. People will faithfully attend and ...

Read more...

We knew that the most powerful way to provide substance abuse treatment is in a group setting. Group members can offer support to each other and call out each other’s self-deceptions and public excuses, oftentimes more effectively than the clinicians. They share stories and insights, car rides, and job leads, and they form a community that stays connected between sessions. Participants with more experience and life skills may say things in ...

Read more...

Talking to patients on the phone can be very efficient and quite rewarding, like when I called a worried patient today and told her that her chest CT showed an improving pneumonia and almost certainly no cancer, but a repeat scan some months down the road would still be a good idea. She told me she was feeling better, but still quite weak and that her sputum was still dark ...

Read more...

If my hypertensive patient develops orthostatism and falls and breaks her hip, I fully expect the orthopedic surgeon on call to treat her. I may kick myself that this happened, but I’m not qualified to treat a broken hip. If my anticoagulated patient hits his head and suffers a subdural hematoma, I expect the local neurosurgeon to graciously treat him even though it was my decision and not his to start ...

Read more...

I ran late the other morning. My first patient, an internal transfer, was already waiting. Booting up my laptop seemed to take forever. Usually, I try to poke around at least a little in the EMR before I enter the exam room, even when I know the patient well in order to remind myself of what we are supposed to do in today’s visit. I decided to walk in cold because I ...

Read more...

Imagine if your bank handled all your online transactions for free but charged you only when you visited your local branch -- and then kept pestering you to come in, pay money and chat with them every three months or at least once a year if you wanted to keep your accounts active. Of course, that’s not how banks operate. There are small ongoing charges (or margins off the interest they ...

Read more...

Earlier this month Ross Douthat wrote a piece in The New York Times titled “The Age of American Despair” where he posed the question “Are deaths from drugs and alcohol and suicide a political, economic or spiritual crisis?” Douthat writes:

The working shorthand for this crisis is “deaths of despair,” a resonant phrase conjured by the economists Anne Case and Angus Deaton to describe the sudden rise in ...

Read more...

The Swedish word for physician is läkare, which literally means healer. That seems a lot more glamorous than the American word physician, which is derived from physic, the old fashioned laxatives that were thought to rid the body of poisons and impurities. But we are actually the healers a lot less often than we think. The more we learn about how the body works, the more we have to admit that ...

Read more...

In medicine, contrary to common belief, it is not usually enough to know the diagnosis and its best treatment or procedure. Guidelines, checklists, and protocols only go so far when you are treating real people with diverse constitutions for multiple problems under a variety of circumstances. The more you know about unusual presentations of common diseases, the more likely you are to make the correct diagnosis, I think everyone would agree. ...

Read more...

I scribbled my signature on a pharmaceutical rep’s iPad today for some samples of Jardiance, a diabetes drug that now has expanded indications, according to the Food and Drug Administration. This drug lowers blood sugar (reduces HbA1c by less than 1 point) but also reduces diabetes-related kidney damage, heart attacks, strokes and now also admission rates for heart failure (from 4.1% to 2.7% if I remember correctly – a significant ...

Read more...

So many primary care patients have several multifaceted problems these days, and the more or less unspoken expectation is that we must touch on everything in every visit. I often do the opposite. It’s not that I don’t pack a lot into each visit. I do, but I tend to go deep on one topic, instead of just a few minutes or maybe even moments each on weight, blood sugar, blood ...

Read more...

Doctors need to be true to themselves, but at the same time, they must be chameleons. A doctor fills certain roles in the lives and stories of patients. It is a two-way relationship that looks different to each person we serve throughout every workday and even in the most casual interactions we have. Some patients need us to take charge for a while because they’re exhausted; others need us to listen quietly ...

Read more...

The family doctor used to be almost the only source of medical information patients had access to. Now, few people need us to bring them the latest news. It’s there for everyone to see. There’s even too much of it. Today, our role is to help make sense of it all. In order to do that, we must possess and project authority, but we have no reason to put ourselves on ...

Read more...

In most other human activities, there are two speeds, fast and slow. Usually, one dominates. Think firefighting versus bridge design. Health care spans from one extreme to the other. Think code blue versus diabetes care. Primary care was once a place where you treated things like earaches and unexplained weight loss in appointments of different lengths with documentation of different complexity. By doing both in the same clinic over the lifespan ...

Read more...

I have advocated before for putting a visit synopsis at the beginning of each visit note. I have called that the aSOAP note. I think that works immensely better than APSO notes that only rearrange the order of the elements. The reason I say that is that in today’s EMR notes, it’s too darn hard to find the story. If a note is half a dozen pages or ...

Read more...

The answer to physician burnout is purported to be resilience training. That’s like glorifying the natural ability of frogs to tolerate gradually heating and boiling water. Unfortunately, health care today has some toxic ingredients, and physician burnout is directly related to them. Some forms of resilience training I have been exposed to are no more than mental escapes away from medicine, such as art, music, and personal relationships. Those types of activities ...

Read more...

The receptionist interrupted me in the middle of my dictation. “There’s a woman and her husband at the front desk. She’s already been seen by Dr. Kim for chest pain, but refuses to leave, and her husband seems really agitated. They’re demanding to speak with you.” I didn’t take the time to look up the woman’s chart. This could be a medical emergency, I figured. Something may have developed in just the ...

Read more...

Touch is a sensitive thing. No pun is intended here, but whether and how we touch our patients deserves our careful thought and deliberation. So much interpersonal contact these days is virtual, with emojis, abbreviations and whole words thrown around as substitutes for human contact. Think XOXO and, “hugs and kisses.” And when people do touch in our health care environment, it is often with gloves, even for simple fingerstick blood ...

Read more...

There are two versions of “the conversation” we have with men: One is for teenage boys, and it is about wet dreams, sexually transmitted disease, unwanted pregnancy and at one point also about testicular self-examinations. Those have now been edited out of the script, which makes sense to me since I have seen only three cases of that in forty years of practice, all but a couple of them diligently ...

Read more...

11 Pages

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories