I enjoy talking to random people about their experiences with health care. As somebody who regularly travels all over the country, for both work and pleasure (I far prefer the latter), whenever I meet people in situations where you end up talking -- be it on airplanes, a guided city tour, or at a social function -- as soon as I say I’m a physician, the conversation invariably ends up ...

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I was recently seeing a rather complicated medical patient in the hospital. We were treating both a heart and kidney condition, and things were not going so well. To spare anyone non-medical who is reading this the scientific details of the bodily processes involved, we were essentially balancing hydrating, with the need to get rid of excess fluid. After seeing the patient, I spoke with the nurse, went over the ...

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The health care experience is so much more than a buzzword to be talked about in administrative circles. Some physicians I encounter (a minority, but still enough) really scoff when they hear this term. Responses I’ve heard from doctors include: “Hospitals are not hotels!” or “If that means giving our patients as much Dilaudid as they want, then count me out!” Aside from these sweeping statements being entirely silly, they are ...

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Shock. Horror. Did you just read the title correctly, or are you seeing things? Well, after you recover from the shock of reading a line you probably never thought you could possibly see in writing -- let me tell you this: Physicians and politicians are probably as opposite as you can imagine in terms of their daily work life, guiding principles, and yes, level of respect shown to them by ...

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On November 6th voters in Massachusetts are facing a very important health care-related question. In addition to voting for political parties in the midterms, they also face three ballot questions. The first of these is whether there should be mandatory state enforced nurse-to-patient ratios. For a general medical or surgical floor, this will be no more than four patients for every registered nurse. For other types of adult floors and the ...

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The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20 percent for Medicare patients (higher for certain patients, with up to a third of these occurring in the first 7 days), there is an ...

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A physician recently recalled to me a situation he found himself in on the last National Doctors’ Day. Those of you reading who work in health care, will already be aware that this is on March 30th every year. I have seen this day celebrated in every hospital I’ve worked in since I first came to the United States over a decade ago. I actually think it’s a nice gesture, and ...

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A few weeks ago, I was giving a day-long seminar in California on improving communication skills, optimizing the patient experience, and how this is all ultimately linked to better proven outcomes. Part of the day involved doing role plays, playing the part of doctors and patients in various difficult hypothetical scenarios. My experience of this type of group exercise is that all clinicians usually really enjoy it, when it’s done in ...

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Physicians everywhere are having to deal with ever-shrinking time slots with their patients. Every doctor (or nurse) would love to have more time if possible, and it’s probably one the biggest frontline frustrations for any clinician who wants to do a good job. Time to go over the history in more detail, examine the patient thoroughly, and then spend adequate time discussing everything afterwards. Wouldn’t that be nice? The reality though ...

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When I’m working in a hospital setting as a physician, part of my everyday job duties involves going over consent forms with patients. I am of course a medical physician, rather than a surgeon, so generally don’t have to go over them as often. But I do have to take consent regularly for certain interventions including blood transfusions and minor procedures. The process of getting consent is something everybody is ...

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In June, a story circulated online about how Brigham and Women’s Hospital in Boston, one of the most famous academic medical centers in the United States, and a major Harvard Medical School-affiliated institution, decided that it would take down physician portraits that were hanging in a popular and historic lecture theater. The reason? Well, it was felt that the portraits were predominantly of white male physicians, who had been esteemed teachers ...

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A natural part of life is emotionally growing (hopefully) with experience. If I was to look back at my own journey, when I was in medical school and just graduating, I would say that without doubt, one of the biggest things I would tell my younger self, would be to not take things too personally. This would be particularly true in professional situations. I look back at how personally I used to ...

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Following one of my recent articles on how physicians can improve their communication skills and ultimately help attain better patient outcomes, I received an interesting comment from a physician. It went something like this: “Sorry, but I’m not an actor.” This response typifies a small (but not insignificant) subset of responses I get when I’m discussing and promoting techniques that any doctor can utilize to better their skills in this area ...

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Fake news is a term that’s become notorious over the last couple of years. For notorious reasons perhaps. But there’s actually another serious arena where there is inadvertently an awful lot of “fake news” on a daily basis. And that is, well you guessed it: in health care throughout our nation’s hospitals and offices! Let me explain, and I suspect anyone who works in health care will be familiar with the scenario. ...

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As physicians, we are used to asking our patients lots and lots of questions. It’s our job to elicit information, listen, and then come up with a management plan. There’s a standard script every doctor goes through, based on the science of medicine, and we usually have this memorized to a tee. And that’s all very well and good. However, as with many things in life -- especially those that ...

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I was recently doing some home shopping in Target. It was peak time and fairly busy. After I was done, I walked towards the front of the store and approached the counter area to pay. But alas, there appeared to be hardly any manned registers. Lots of people were strolling up and down, trying to do the same as me: find a real person to help us check out. We ...

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When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for ...

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The doctor-patient interaction is the absolute core of clinical medicine. Maybe I’ll go much further: it’s the core of health care in general. I always try to remember, whenever I’m ever feeling frustrated with the system, the crazy bureaucracy -- and of course, the debacle of our clunky electronic medical records and their data entry requirements -- to separate myself from all of that when I’m face-to-face with my patient ...

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There are so many theories out there about what we should or shouldn’t be doing with our complex and fragmented health care system. We are facing a perfect storm of factors: an aging population, a huge increase in chronic disease, new and expensive treatments, and rising expectations of what care we should be receiving. All of this is sending costs spiraling out of control. As a nation, we spend almost ...

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I am a frequent traveler and spend a lot of time in a number of different cities. The one I’ve currently been spending the most time in is a place, quite frankly, I’m crazy about: New York City! Anyone who writes a lot is usually also by default, a keen observer of people, and there’s no place better to do this than a busy, crowded city. There’s an interesting habit that ...

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