August 2017

Can doctors see beyond a patient’s weight?

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STAT_Logo My older sister, Jan, visited me in San Francisco last spring. “You look great,” I told her, noticing that her clothes were hanging loose; she’d been heavy most of her life. “I’ve lost 60 pounds,” she said, and I automatically congratulated her.

“I wasn’t trying,” she replied.

It hit me then that something was very wrong, first with her health, but also with the way I assumed that her weight loss was a sign of well-being. My own judgments and shame associated with being fat got in the way of seeing my sister. Looking closer, her face seemed strained, and despite the constant smile she turned on, she wasn’t well. She told me that she’d been in so much pain that she’d had little appetite for months.

I asked Jan if she’d seen a doctor. She had, but it hadn’t gone well. The doctor she’d known for years had converted his practice into a concierge service, and she hadn’t wanted to pay the extra $15,000 to stay with him. So she’d made an appointment with an OB-GYN a friend had recommended. Jan’s eyes welled up as she described the visit.

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Improving physician satisfaction by eliminating unnecessary practice burdens

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

In April, the American College of Physicians (ACP) released a position paper titled Putting Patients First by Reducing Administrative Tasks in Health Care, published in the Annals of Internal Medicine. The paper, part of ACP’s Patients Before Paperwork initiative, is a thoughtful look at the many administrative tasks that physicians face every day. It presents a framework for evaluating these tasks and calls on health plans, regulators, vendors, and others to consider this framework when they impose new requirements on physicians.

This position paper is not a “Hell, no!” declaration. It calls for stakeholders to work with physicians to assess the burden of each administrative task, consider less-burdensome alternatives (or eliminate tasks altogether), and for tasks that are implemented, explore ways of minimizing the negative impact on physicians and their patients.

I was particularly pleased to see that the paper mentioned the Quadruple Aim, a concept described by Drs. Christine Sinsky and Thomas Bodenheimer that adds provider satisfaction to the Triple Aim goals of improved patient experience, better population health, and lower cost. I wrote about the Quadruple Aim in an earlier KevinMD column and in a commentary in the Journal of Graduate Medical Education.

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Is the end of disparities in medicine near?

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The patient looked at me and said that he did not remember the name of the specialist, only that she was a “woman doctor.” As this was completely unhelpful, I pondered the fact that a doctor who was male is never referred to as a “man doctor.” Why is it that woman physicians need the added label, as if the norm is a doctor who is supposed to be a male? While I have nothing against my male colleagues, I think I deserve to be equal to them, especially as we are now in the 21st century.

When I have approached this subject in the past, many told me that I am simply wrong, mostly by men in the audience. However, most women who have climbed the ladder to their medical degrees can relate stories of being treated as less than our male counterparts.  To be fair, many men in our field support efforts of gender equality and they are not the ones creating this gap. Rather, it is the medical culture at large where these disparities fester.

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The vision forward for health care should be bipartisan

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Last November, we wrote an op-ed for STAT, as medical students, lamenting how politicized our future profession has become in recent years. In the aftermath of a divisive election that we argued may well have been a “referendum on the Affordable Care Act,” we implored policymakers and other stakeholders to take politics out of health care before attempting to reform it. We believe that partisanship has infected health policy in devastating ways, weakening the level of scrutiny, paralyzing the rigor of debate, and ultimately preventing much-needed progress on issues of cost, access, and quality in American health care. Over the last few months, we saw this infection run its latest course in the halls of our Congress.

As if a testament to our analysis, the partisan mechanisms by which health reform was pushed through the House failed to achieve the passage of any bill in the Senate, and here we are, eight months later, with the same, exacerbated problems we identified in November: sky-high deductibles, increasing premiums, and insurers pulling of marketplaces. Yet, even after months of political teamsmanship yielded nothing for the American people, the first impulse of some has been to retreat back into partisan corners. Conservatives on the right, like Rand Paul and Mark Meadows, are pushing for a total repeal of the ACA, while liberals on the left, like Bernie Sanders and Elizabeth Warren, are fighting for a transition to a single-payer system.

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10 things that weren’t advertised to me before I started medical school

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Last month, thousands of medical students donned their white coats as they took their first steps into hospitals nationwide to begin clinical rotations. This marks an important transition from the classroom into an actual inpatient setting to demonstrate the knowledge they’ve accumulated over the past two years. For most students, this means pretending to hear and correctly identify heart and breath sounds while agreeing with whatever the attending says. During my brief time on the floors, I’ve not only learned a great deal of medically relevant information, but also things that weren’t advertised to me when I was a student.

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Traditional private practice needs to change

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Owning a business is not some pie in the sky deal where you take a phone call when you make the turn at the country club every day. The public at large, however, thinks that is exactly what business owners do.

Owners are the people that collect money while others work right? They are rich people that just happened to be rich, so they bought a business for other people to make them more money. How spoiled!

In reality, business ownership is one of the toughest jobs there is. You are ultimately responsible for not only the financial well-being of your family but all of the employees that work for you. Your decisions shape the lives of everyone. There aren’t many jobs with that kind of pressure.

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This doctor sings to her patients. And the results are beautiful.

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I am an interventional pain physician. I spend most of my days doing spine injections with a fair amount of kyphoplasties and spinal cord stimulators thrown in as well. It seems to me that these are minor procedures that shouldn’t evoke anxiety in patients, but they do. Patients get nervous. They get anxious.

I am also a singer. I had the privilege of being classically trained through my college years. Like so many other passions, singing was put on the back burner in my pursuit of medicine. Music is a blessing that I hold dear to my heart, and it has pained me to not have an outlet for this gift.

When I got out of fellowship and started in private practice, I began to occasionally hum some tunes as I was doing injections. That hum naturally turned into singing. Over a short amount of time, I found myself singing during each and every procedure all day long. I sing hymns usually with some Italian opera and show tunes thrown in. Most of my patients are over 65, and they seem to enjoy those genres. For my younger patients, I add some Adele and even some Disturbed as indicated.

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A medical student confronts life outside the hospital

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There is a feeling that you get when you’re out at a dinner party standing and smiling at strangers as they walk by you — a temptation to rest on the “wow” factor of your medical training. Partly because peacocking is inherent to social events such as these, but partly because you fear that you’re inherently boring to people outside your field. The surest way, you think, is to announce that you’re in medicine and bask in the raised eye-brows and approving nods that previously alluded you in smaller talk.

“Oh, what kind?” The inevitable next question, and soon you own the conversation that was minutes before centered around local spin classes. Now, you think, your relevance and worth is known.

It’s a terrible feeling to have to do this. Countless articles have already been written about the isolating feeling the medical profession has on their staff and care givers. Very few people outside of medicine understand the rigors and small accomplishments that make this line of work more than just a nine-to-five. To the other people at this event, it’s just another evening out with friends, but for you, it’s the rare social event; the one you’ve rearranged call schedule for, the first time you’ve worn clothes that aren’t clinic appropriate. This is your one night off in nearly two weeks.

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Why a pediatrician does what he does: Lessons from Caleb

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A tired but beaming mom greeted me as I entered the room. In her lap was a content appearing, slightly chubby, cherubic faced baby.

“This is Caleb … isn’t he beautiful” mom gushed. “He is named after his dad …” but then added in a softer voice, “but I’m not sure how much he plans to be involved.” Mom’s smile waned for a moment but quickly came back. “Looking forward to coming here often,” she said as she gave me a tight bear hug that literally took my breath away.

Mom ended up being prophetic on both accounts. Dad Caleb indeed ended up falling away while our Caleb would soon become one of our most frequent clinic visitors. At first, it was for the routine visits of the first few years of life. Mom, as many of our parents, was haunted by the demons of mental health problems (anxiety in her case), poor housing, smoking (“helps my anxiety” said mom) and poverty. This, in part, with time led to an ever increasing proportion of Caleb’s visits focusing on asthma, obesity and behavioral concerns. These visits were partly medical in nature but mostly social, with lots of discussions and hand holding, focusing on mom’s anxiety, her anxieties about Caleb, her need to quit smoking, and trying to find help for her economic situation.

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