shutterstock_252136366 Popular TV doctor, Gregory House’s favorite adage about patients is: “Everybody lies.” I used to believe that this was a cynical and inaccurate statement, but I had to revisit it recently when faced with a patient whose signs and symptoms were consistent with a diagnosis that she vehemently denied. A young woman was admitted to my rehab unit with brain damage of ...

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As a traveling physician, I’m often asked if I have a favorite place to work. Since I have licenses in 14 states, I have an unusual vantage point from which to compare hospitals. I know that people who ask this question presume that my answer will be heavily influenced by the town where the job is located, and all the associated extra-curriculars, environmental peculiarities (ocean, mountains, desert), and potential amenities. ...

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Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient ...

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Medicaid A physician friend of mine posted a copy of her Medicaid reimbursement on Facebook. Take a look at the charges compared to the actual reimbursement. She is paid between $6.82 and $17.54 for an hour of her time (i.e., on average, she makes less than minimum wage when treating a patient on Medicaid). The enthusiasm for expanding Medicaid coverage to the previously uninsured ...

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In my last blog post I discussed how harmful physician “thought leaders” can be when they are dismissive of the value of other specialists’ care. I must have touched a nerve because a passionate discussion followed in the comments section. It seems that physicians (who spend most of their time engaged in clinical work) are growing tired of the leadership decisions of those who engage in little to no patient care. ...

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shutterstock_245379106 It’s no secret that medicine has become a highly specialized business. While generalists used to be in charge of most patient care 50 years ago, we have now splintered into extraordinarily granular specialties. Each organ system has its own specialty (e.g., gastroenterology, cardiology), and now parts of systems have their own experts (hepatologists, cardiac electrophysiologists)  Even ophthalmologists have subspecialized into groups ...

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I once wrote about the communication difficulties caused by electronic medical records systems. The response on Twitter ranged from sentiments including everything from “right on, sister” to “greedy doctors are only complaining about EMRs because of their price tag.” The disconnect between policy wonk’s (and EMR vendor’s) belief in the transformative power of EMRs and exasperated clinician users of these products is jaw-dropping. Physicians are often labeled as obstinate dinosaurs, blocking progress, while policy wonks ...

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shutterstock_168773126 Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or ...

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shutterstock_151601138 Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. ...

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I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal handoff process at shift change resulted in a 30 percent ...

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