November 17th, 2010 by John Mandrola, M.D. in Better Health Network, News, Opinion
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The best part of doctoring is its humanness. Machines can’t do it — not even Apple products.
But that’s the worst part, too. Since humans practice medicine, there will be “medical errors.” And when doctors err, people — not spreadsheets or profits — are hurt. That’s the rub. Like any endeavor, the greater the reward the greater the risk. Those cards were put on the table in medical school.
“Don’t want mistakes? Don’t do anything. Don’t make any decisions. Don’t do any procedures. Then, there will be no errors,” the grey-haired, Swiss-born cardiac surgeon counseled me many years ago after an imperfect ablation.
The headline was about a doctor’s error. It was a doozy. But for me, the story belies the headline. A Boston Globe reporter called a surgeon’s public admission of performing a wrong operation “an unusual display of openness.” I would call it something else: Breathtaking. Unprecedented. Courageous. Read more »
*This blog post was originally published at Dr John M*
November 12th, 2010 by John Mandrola, M.D. in Better Health Network, Humor, Opinion, True Stories
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I loved my old status. Perhaps, reveled in it would be a better description. I was a crotchety, generic medicine-only doctor.** Sadly, my status changed today. Dabigatran (brand name Pradaxa) was the culprit.
It was a little nerve racking. I wrote the order, looked at it, thought it out again, talking to myself: “John, are you sure you don’t want to do it the old way? [pause to think] No, I am embracing the new.” And then, I closed the chart and handed it to the nurse.
“What’s that? Pradaxa?” asked the nurse. “Stop the Lovenox? You sure?” My face must have told the story.
Eight days had passed since dabigatran’s approval. “That’s plenty of time to mourn warfarin’s demise,” I thought. Enough studies, enough blogs — it was time for the rubber to hit the road. Read more »
*This blog post was originally published at Dr John M*
November 7th, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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I don’t consider myself a right-wing healthcare fear monger, but if I were this study would be worthy of amplification. As reported concisely in the New York Times, from the journal Demography (not previously known to me), population researchers reported that even though elderly Americans have more medical problems than their peers in Britain, older Americans live longer once they make it to 70. Why would this be?
Is it because Americans who reach 70 are “heartier” than Britons, as Columbia University PhD (but now on leave and working at HHS) Sherry Giled says. Or is better survival of the American elderly one of the benefits of the “fury of American medicine?” Read more »
*This blog post was originally published at Dr John M*
November 2nd, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, Humor, Opinion
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Have you ever thought: “What if I won an election and was put in charge of an administration?”
Halloween weekend seemed the perfect time for considering the fantasy (or some would argue the horror) of a DrJohnM administration. (Let it be known, I have some leadership experience: I lead local group rides with some success. A community organizer of sorts.) But for the sake of college-like dreaming, let’s consider government under my realm.
First off, clearly the present-day political costumes would have to change. There would be a ban on suits, ties (MRSA-spreading), and uncomfortable shoes. People think better if they are dressed in comfy clothes. It works for Google.
Of course, since I am a practicing doctor, a focus of my administration would be on healthcare reform. And like our current president, I would also have “expert” panels — only my “fix healthcare” panel would look very different. To illustrate these phenotypical differences, let’s consider some of my panel’s inclusion and exclusion criteria.
Panel exclusions:
Anyone with a 4.0 GPA. You are out. Sorry, there are plenty of other think tanks for you, in pretty cool places too, like Cambridge, Ann Arbor, and Palo Alto. A very wise retired urologist once told me that B students nearly always make better doctors, and surely those who tried other things in life (besides the classroom) will make better real-life decisions. Read more »
*This blog post was originally published at Dr John M*
October 28th, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, Opinion
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As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.
A decade or so ago when I started private practice it was obvious that referrals came to me because of my association with an established group. This association was essential, as one could have been the next Michael Jordan of electrophysiology, but referrals would still have gone along historic lines, to the favored group. It would have taken a Herculean effort, over years, to encroach upon such long-established referral patterns, etched over the bonds of rituals like Wednesday afternoon golf matches and dinner clubs.
Thus, few specialists start independently. You join an established group, do good work, form relationships and eventually, your quality becomes known. As it should be: Do good work and doctors will trust you with their patients. But yet, even the highest caliber specialists may fall prey to the easily accessible, affable (but unknown and untested) “new guy.” For enhancing referrals, availability and affability trump [actual] skills at least 90 percent of the time. Read more »
*This blog post was originally published at Dr John M*
