I have not worn a white coat since I opened my own practice more than twenty years ago.
Not that I had anything against white coats in principle. I wore my short white one in med school with pride, and the longer one in residency too; their pockets filled to bursting with the 4 x 6 inch six-ring binder emblazoned with my name in gold, courtesy of Burroughs-Wellcome, the long-defunct pharma giant, which had presented one to each medical student in the US for many years, as well as assorted pens, note cards, alcohol wipes, hemoccult cards, and so forth. I even had a tiny teddy bear pinned to my lapel, my own way of personalizing the impersonal.
When I went out on my own, though, I made the conscious decision not to wear one. I confess that all these years later, I don’t completely recall my thought processes on the subject. It seemed Read more »
*This blog post was originally published at Musings of a Dinosaur*
There is excitement in the air about how mobile phones are the breakthrough technology for changing health behavior. Last Saturday, I was convinced this must be true. In two short hours, I:
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
Last week I wrote a simple post on eating yogurt with fresh fruit for lunch. It wasn’t until later that I realized why it’s a medical lesson.
It happens that yesterday morning I was up and out early. I saw a former colleague walking along the street. He’d gained weight, and walked slowly. I thought about how hard he works, and what a good doctor I know him to be. And yet any citizen or patient might size him up as heavy, maybe even unhealthy.
The problem is not that he’s uneducated or can’t afford nutritious foods. He knows fully about the health benefits of losing weight and exercise. The problem is the stress and long hours of a busy, conscientious physician’s lifestyle.
When I worked as a practicing doctor and researcher at the hospital, I rarely ate a nutritious breakfast or lunch. My morning meal, too often, consisted of Read more »
*This blog post was originally published at Medical Lessons*
All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining.
We now have a fast medicine option available to us. Across the country, there are over 1000 ‘minute-clinics’ that are being set up in pharmacies, supermarkets and other retail store chains. These clinics are staffed by nurse practitioners who have prescribing authority, under the loose oversight of a physician who is likely off sight. These nurses will see patients with simple medical issues and will adhere to strict guidelines so they will not treat beyond their medical knowledge. For example, if a man comes in clutching his chest and gasping, the nurse will know not to just give him some Rolaids and wish him well. At least, that’s the plan.
Primary care physicians are concerned over the metastases of ‘minute-clinics’ nationwide. Of course, they argue from a patient safety standpoint, but there are powerful parochial issues worrying physicians. They are losing business. They have a point that Read more »
*This blog post was originally published at MD Whistleblower*
A physician asked me a question regarding what should be the role of hospitalists in carrying out discharge orders written by other physicians.
I have been following your blog since I was a resident and recommend it to a lot of people. Thank you so much for enlightening me on so many day to day hospital issues. I wanted to know your opinion about something that puzzles me. When a specialist changes a medication or requires a lab to be done as outpatient after a discharge order is written (for example you write: okay to D/C if okay with cardiology, and they change a dose or request stress test out-pt) who is required to write the new scripts and arrange that test? Is it the hospitalist’s responsibility to do it? Or is the specialist who changed the dose after you rounded required to handle it? It was easier during residency due to abundance of residents/fellows and the fact it was electronic RX access. What are your thoughts? As so far I always return back and make the adjustments needed for the patient welfare, and the fact I don’t know whether I should take stance and request that physician to do their job.
Dear physician, there is nothing puzzling here. It’s black and white. Read more »
*This blog post was originally published at The Happy Hospitalist*