Repercussions. Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave. Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients that there is "something else that we have to do," we often see it open up a ...

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Noticing. If you think about it, that's really a lot of what we do a lot of the time. As clinicians, we are trained as observers to notice, to use our eyes, our ears, our hands. To notice. We notice that our patients seem different today. More tired. A little pale. Notice a change in their gait. Notice they are in pain. We notice swelling in their legs, a new heart murmur, a ...

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Wouldn't it be cool if ... ? Wouldn't it be better if ... ? Wouldn't it be much easier when we see patients if ... ? How come we can't ... ? It seems like every day, someone in our practice comes up with an idea for a way to do something better:

  • From our front desk staff who check patients in, and have to deal with a multitude of electronic systems for registration, ...

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Actual conversation heard in the hallway outside an exam room earlier this week: Doctor: "So, we're going try this medicine for your blood pressure; you keep checking it at home as we discussed. If the numbers remain high, we can increase the dose or add another medicine." Patient: "Well, what do we do if the pressure stays high; if this medicine doesn't work?" My partner told me later that she had explained the ...

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Where is everybody? It's a Wednesday morning, and after 8 o'clock grand rounds I headed back from the medical college auditorium to our practice, and as I walked back into the office our med-tech told me that my first two patients were already in their exam rooms. So I dove right in, starting with a husband and wife there for their annual physical exams, and I set about getting to my morning ...

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Just sign here. How many times a day are we asked to do this? "Just sign here." "Just put down your license number." "We need a stamp with your doctor's info on it." "Give us your NPI." "Initial here, here, and here." If we took the time to read all the things we're signing, we wouldn't have time to do any doctoring. The other day I was asked to hand-write the date on ...

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It all started out with Malaysian methimazole, and didn't end until two highly trained medical professionals sat on opposite ends of a telephone call, scratching their heads and wondering how two digits being transposed could lead to so many problems. Those two transposed digits caused a thyroid uptake scan to become a bone marrow scan (whatever that is). But look at all it took to get there. Mystery illness, mystery medicine It started ...

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I need your help. I'm trying to figure out how to get rid of something that's terribly broken in our process of taking care of patients, and I can't do it alone. It's time to kill the referrals process, get rid of them altogether. Every day, a huge proportion of the messages we receive through the electronic health record are requests for us to "put in a referral." Patient has low back pain, has ...

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It's 10 p.m. on Wednesday night, and I'm finishing up my notes for my patient visits from this morning while I do my bowel prep for my colonoscopy tomorrow. Now, I know we can argue the biomechanical challenges of doing both of these tasks at the same time, and this certainly may be TMI, but it struck me as I was sitting there trying to do both of these things how ...

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Last week I made a patient's chart perfect. Not bragging, but ultimately it ended up being pretty easy, and I'll explain how and why in a little bit. This was a patient I had not seen in several years, with a number of chronic medical problems, for which he had been taking less than optimal care of himself since I had seen him last. Here for a "checkup," we talked about his health ...

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