October 2017

An open apology to medical students from a resident

This post was originally published on this website

Dear medical student, I’m sorry.

You had just finished two years of didactic learning and couldn’t wait to feel like a “real” doctor. You finally were starting your clerkships, that is, ultimately working with patients and getting deep in the trenches.

You were bright-eyed as you pulled on your pristine short white coat. You got to the hospital at 5:15 a.m., 15-minutes early for the first day of your very first third-year clerkship in OB/GYN.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


The police didn’t care when this PA was verbally abused

This post was originally published on this website

I never thought I’d be in a position where I would feel scared at work, but then — it happened. I started writing this piece a long time ago, far before Utah nurse, Alex Wubbels, was assaulted on camera by a police officer. It certainly reminded me to work on this again.

A few years ago when I was very green, I was working in inpatient on a hospital service. A particular patient assigned to our service became a very memorable one: a still teenage aged young woman named Ellie with a severe form of heart failure that required her to be on a life-saving IV medication 24/7. Overlooking Ellie’s chart, I became wary as I read a nurse’s account of the patient’s boyfriend known to be physically abusing her. Several calls from her parents imploring for help to various physicians and nurses had been cataloged. It was also clear by her vitals and labs alone that she was fairly critically ill. Additionally, Ellie showed a poor understanding of her illness and was rebelling against her parents. In normal circumstances, this was annoying, but in a critically ill patient — it was very alarming.

Nevertheless, I walked into the hospital room with a will to project certainty and authority. When I emphasized to Ellie that she will need to eventually bring her not-on-our-formulary medication (a bit sternly mind you, as I felt she didn’t understand this was keeping her alive), her boyfriend began to speak up. Her boyfriend offered pointedly that there was no one who could get this medicine — that he would not be able to afford the drive.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Here’s why women doctors need time together

This post was originally published on this website

The 2nd Annual Women in Anesthesiology Conference is taking place in October. Developing this organization has been a labor of, if not love, then honoring. We are honoring a value system that works to gives women the respect, autonomy, and power they deserve.

There is an amazing power in gathering, shared experiences and decreasing isolation. Nobody has identical life experiences. But part of what informs our identity is shared experiences. As anesthesiologists, we did not all do the same residencies. But we all know what it is like to discuss a surprise difficult airway, an ejection fraction of 15 percent in a demented patient getting emergency surgery or the frustration of an IV that blows on induction. When we discuss these situations with our co-workers, we don’t start at zero — we assume an understanding of the basics of our routines and challenges. We take a deep breath and debrief with someone who already understands or empathizes with the situation without having to give a 10-minute lecture on the basics of what we do, which very few other doctors understand much less non-medical people. Sometimes, having to give that lecture before you can even talk about the experience itself makes it not worth talking about the experience.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Is the U.S. addicted to fee-for-service health care?

This post was originally published on this website

For its many users, health care’s fee-for-service reimbursement methodology is like an addiction, similar to gambling, cigarette smoking, and pain pill abuse. Doctors and hospitals in the clutches of this flawed payment model have grown dependent on providing more and more health care services, regardless of whether the additional care adds value.

I don’t use this metaphor lightly, nor wish to trivialize our nation’s growing problem with addiction. Rather, as a physician and former health care CEO, I am increasingly concerned with the impact this payment structure is having on American health. And I worry about whether providers are willing to “kick the habit” before it’s too late.

Addictive qualities

The Affordable Care Act, signed into law March 2010, included several provisions encouraging doctors to focus on increasing value (instead of simply maximizing the volume) of health care services. And yet, seven years later, between 86 percent and 95 percent of U.S. health care providers are still paid for each individual test, procedure and treatment they provide — an arrangement that continues to drive up health care costs with little to show for it. According to the latest Commonwealth Fund report, the United States spends more on health care than any other industrialized country but ranks at or near the bottom in almost every measure of comparative quality.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


The Hippocratic Oath, updated for today

This post was originally published on this website

I am not a curmudgeon, but I am worried about the current plight of health care and the attack on the Hippocratic Oath. Bigger health care is sold as better and more efficient with the premise of lowering health care costs. The promised financial outcomes and efficiencies for the physician and their patients have not materialized. Instead, while physicians struggle with non-clinical demands on their time, patients are being pushed to “workaround” solutions built upon profit and not building relationships. Are the solutions truly “doing no harm?”

Physicians are facing burnout, loss of autonomy, decreased satisfaction, rising rates of depression and are seeking ways out of medical practice. I wonder if the lack of joy once found in medicine is related to the Hippocratic Oath being under attack. Are we being hypocritical?

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Severe remorse: Does it require a specialist?

This post was originally published on this website

In her recent New Yorker article, “The Sorrow and the Shame of the Accidental Killer,” author Alice Gregory claims there are no self-help books for anyone who has accidentally killed another person.  Nor published research, therapeutic protocols, publicly listed support groups, nor therapists who specialize in their treatment.  She profiles several such tormented souls who bear their burdens largely alone.

Yet dealing with guilt, shame, and regret is a mainstay of both self-help and professional therapy.  A simple online search reveals page after page of self-help websites, therapist and clinic practices, newspaper and magazine articles, all about forgiving oneself, learning to accept one’s failures, and letting go.  In that sense, the piece misleads about the lack of help available.  Indeed, although I don’t “specialize” in the treatment of those who accidentally kill another person — as best I recall, I’ve never worked with this specifically — I join many of my colleagues in welcoming any such person into my practice.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


The patients this doctor is eternally grateful for

This post was originally published on this website

I really like Van Morrison.  If I need to be lifted up on a Friday afternoon I’ll play a greatest hits album and will quickly be smiling.  One of my favorite songs is Days Like This. You would expect when someone says “there will be days like this,” they are complaining about days when everything goes wrong and you just have to endure to the end, hoping that “the sun comes up tomorrow.”  But this song takes a different tack:

When it’s not always raining there’ll be days like this
When there’s no one complaining there’ll be days like this
When everything falls into place like the flick of a switch
Well my mama told me there’ll be days like this

When you don’t need to worry there’ll be days like this
When no one’s in a hurry there’ll be days like this
When you don’t get betrayed by that old Judas kiss
Oh my mama told me there’ll be days like this

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Do physicians deserve our mercy? #silentnomore

This post was originally published on this website

Recently, a video went viral when a woman complained about the lengthy wait time at a clinic.  On video, we see the physician asks if the patient still wants to be seen.  The patient declines to be seen, yet complains patients should be informed they will not be seen in a timely manner.

The frustrated physician replies, “Then fine … Get the hell out. Get your money and get the hell out.”  While we do not witness events leading up to the argument between doctor and patient, we do know the staff at the front desk called the police due to threats made by the patient to others.

Based on the statement released by Peter Gallogly, MD, he is a humble, thoughtful, and compassionate physician who was very concerned for the safety of his staff, which he considers “family.”  Physicians like Dr. Gallogly do their best to serve patients, ease their suffering, and avoid losing ourselves to burnout at the same time. Every human being deserves our compassion, kindness, and clemency.  Patients and physicians must accommodate each other when possible.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Why immunization rates should not be used as a quality indicator

This post was originally published on this website

As policy experts cling to pay-for-performance (P4P) as an indicator of health care quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark.  At first, glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job.  Unfortunately, the parental vaccine hesitancy trend is gaining in popularity.  Studies have shown when pediatricians are specifically trained to counsel parents on the value of immunizations, hesitancy does not change statistically.

Washington state law allows vaccine exemptions on the basis of religious, philosophical, or personal reasons; therefore, immunizations rates are considerably lower (85 percent) compared to states where exemptions rules are tighter.  Immunization rates are directly proportional to the narrow scope of state vaccine exemptions laws.  Immunization rates are used to rate the primary care physician despite the fact we have little influence on the outcome according to scientific studies.  Physicians practicing in states with a broad vaccine exemption laws is left with two choices: refuse to see children who are not immunized in accordance with the CDC recommendations or accept low-quality ratings when caring for children whose parents with beliefs that may differ from our own.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Why telemedicine is here to stay

This post was originally published on this website

Like many of my colleagues in medical education, I am a part-time clinician.  My time is split, spending less than half in my own clinical practice with the rest devoted to resident education.  This is precisely why I love my job.  The diversity of each day keeps me engaged, challenged, and excited about the work I do.

Unfortunately, this same thing that makes my job so fulfilling is often also a stumbling block for patients.  When your doctor is only in clinic part-time with appointments booked out two months down the road, it can make scheduling a visit pretty challenging. This is an understandable frustration and has required both patients and doctors to be creative with workarounds. One-such work-around is the use of telemedicine.

The potential of telemedicine is vast.  Daily, I message with patients regarding their health conditions; I send results, follow up on visits, and answer questions.  This provides a great way to connect with patients.  People’s schedules are busy (both patients and providers) and being able to communicate through a secure electronic portal allows both parties to connect when it works for them.  I have also used telemedicine, through Project ECHO, to connect with specialists and manage patients with complex disease in the primary care setting. Going further, many health care systems, including the University of Utah, are beginning to offer e-visits where a patient can connect with a provider electronically in real time to have an appointment without ever stepping foot in the office.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.