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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Too much data, big and small. Every morning when I log onto our electronic health record, one group of messages are from patients with their self-recorded health information data that they've sent to me for review. Here's my home blood pressure over the past 24 hours. Here are my fingerstick glucose readings over the past 24 hours. Here's my weight over the past 24 hours. Here is my depression score over the ...

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178 measures. This is what we're up to -- the collected compilation of quality and performance metrics for our ambulatory care network, across all the different divisions. Where did these come from, who decided this is what we should measure, does anyone really have any idea if measuring these things reflects the true quality of the care our patients receive? That's a lot of questions all at once, and I'm not sure we're ...

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Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to ...

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There are a couple of times a year when there are no house staff to be found anywhere in the hospital or the outpatient practices. These include the holiday and end-of-year parties, resident retreats, and the annual house staff picnic. The house staff picnic is a particular favorite among the interns and residents, a full day away from the hospital, dressed like civilians, fun in the sun, barbecue, softball with their ...

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On the porch. It's that time of year again, when we escape from the heat of New York City summers, and head to New Hampshire, to the Central Lakes District, where my wife's family has had a house perched out over the clear waters of Newfound Lake for over 120 years. It's a small wooden house, with barely enough room for all of us squeezed in, painted bright yellow and orange, with ...

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