Fred N. Pelzman, MD

It's that time of year again. The start of a new academic year, marked by the arrival of a brand-new class of interns starting out in their training. Clutching their freshly-minted medical degrees, they appear so ready, so anxious, so excited, so eager to learn. Now it's our job to make sure they stay this way. (Have I written this column before? Every year ...) We need to make sure we have a world where ...

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As we all know, the time around discharge from the hospital is a tricky one. In more ways than one can imagine, patients are in a delicate state, judged by those caring for them to no longer be sick enough to need to remain in the hospital, but possibly not quite completely ready to be fully back in the community, on their own at home. Over the past few years, there have ...

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How smart do we want our electronic health record to be? Somewhere between as dumb as a piece of paper and a pen, and too smart for our own good. Many, many years ago, before we spent the majority of our office visit staring at a flatscreen LED and typing away, our charts were simple manila folders with those bendy metal bars that allowed you to insert new pages, separated into multiple ...

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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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