David and Goliath lessons for doctors and our health system

Physician
October 24, 2013

October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.

Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …

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What’s the best way to keep up with medical literature?

Education
October 23, 2013

As a resident, probably the most common piece of feedback one receives is, “Read more and expand your clinical knowledge base.” This critique is a standard and generic piece of feedback to encourage the younger generation to never quit in the endless pursuit of knowledge. As our erudite attendings know, medical knowledge always evolves and often reverses course. Thus, the trainee is reminded to establish the habit of keeping up …

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A new tagline for direct primary care

Physician
October 21, 2013

He seemed a bit grumpy when he came into the office.  I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to “finally get taken care of” by the doctor.  Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. …

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What an old doctor taught me about palliative care

Physician
October 19, 2013

Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one …

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Why doctors need to be more like Malcolm Gladwell

KevinMD
October 17, 2013

In case you haven’t heard, Malcolm Gladwell recently released his book, David and Goliath.  I’m just about finished reading it.

Just as interesting as the book are its reviews.  In a recent post from Slate, Gladwell himself responds to the criticism.  He freely admits that his books should not be held as pinnacles of academic rigor, but should be considered “intellectual adventures stories.”

He further elaborates on the power …

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Patient engagement is the blockbuster drug of the century

Policy
October 16, 2013

Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they  are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric.  We need a concept for removing waste and unnecessary care that could be inspired by a concept …

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Hostile dependency: The real reason for physician burnout

Physician
October 14, 2013

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say …

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Medical students may find themselves without a job

Education
October 12, 2013

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“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …

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What do we do with the extreme elderly?

Physician
October 10, 2013

A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …

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Radiation from x-rays and living in Denver: They’re not the same

Conditions
October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

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The OR is not a good place for a prank

Social media
October 2, 2013

An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.

According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”

And if that wasn’t bad enough, a “nursing attendant” took a photograph.

The patient, who said she had to quit her job …

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4 myths and truths about milk

Conditions
October 2, 2013

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We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents.

Myth #1: Don’t give milk to a child with a fever; the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable …

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Why solutions to mental health continue to evade us

Physician
October 1, 2013

Another tragedy, another tragic series of errors, another avalanche of debriefings and politicization, and in Washington, DC, there are 12 more dead.  What can we say about this?  It seems that the standard commentary fails.  Aaron Alexis was not an angry white man, nor a conservative.  He carried no assault rifle and he had a secret security clearance. He doesn’t seem to have been motivated by race.  He was a …

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How nurses can help contain health care costs

Policy
September 30, 2013

Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, …

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Nurses are too afraid to speak up in their organizations and be vocal

Policy
September 29, 2013

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I recently saw an article about Vanderbilt University Medical Center’s nursing staff.

The administration there came up with the brilliant idea of cutting back on the housekeeping staff and making nurses do some of the cleaning, though it’s not specified how much. Nurses would be expected to take out the trash and linens, and mop up spot cleans on the floors, among other things.

They …

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