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The Physician Exodus: When Doctors Leave Hospitals Behind

My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films after 5PM on weekdays.

Still, I continue to scratch my head about why only three of seven community pediatricians take call, such that family physicians have to admit their patients. I was bumfuzzled that our neurologists were previously going to require us to use telemedicine for stroke evaluation when their offices were close by the hospital. (In the same year they were called in roughly three times per neurologist for urgent stroke evaluation.) That problem was resolved, thank goodness.

Now, I find that the problem has returned and grown. We will, very soon, have no ophthalmologist on call, despite the fact that we have three in the community and that they are contacted with remarkable rarity to deal with on-call emergencies. Soon, we will have no neurologist on the weekend. And the pediatric problem remains.

Of course, I’m using my local experience to highlight something that isn’t a local problem at all. It’s a national problem. All over America, specialists are relinquishing their hospital priveleges and staying in the office. Proceduralists are opening surgery centers that are free from the burdens of indigent care. Primary care physicians are allowing hospitalists to do all of their admissions.

In the process, not only are patients losing out, but referral centers are being absolutely overwhelmed. The cities and counties that lie around teaching hospitals are sending steady streams of patients, since they have fewer and fewer specialists. Those referral and teaching centers want patients, but they can’t take all of the non-paying patients, all of the complicated, or even all of the mundane patients with no local coverage. Those facilities, for all their shiny billboards and “center of excellence” marketing, will collapse. Read more »

*This blog post was originally published at*

Christmas Gifts For My Medical Colleagues

This is my column in December’s Emergency Medicine News:

I like to think back on favorite Christmas gifts I have received down the years. I don’t think I can do any better than the children of mine who were born around Christmas. Three of the four came within one month of Christmas day. One came on December 23rd. What wonderful presents!

Going farther back, I recall sitting by the Christmas tree at my childhood home, or the homes of my grandparents. I found toy soldiers, toy horses, Matchbox cars, pocket knives and many other little-boy wonders. I remember the beautiful wooden stock and golden trigger of my first shotgun, and how it pulled me irresistably into a sense of impending manhood to know that my father and mother trusted me enough to give such a gift.

I have been thrilled to give gifts to my wife and children down the years. I smile when I consider stuffed animals, American Girl dolls, Polly Pockets, toy knights, castles, iPods, bicycles, books, a small harp, and a shiny sword. I admit that I love putting their packages under the tree.

I enjoy hearing about the things my loved ones love. It is my delight to know their hearts and to go and find the perfect thing that, when opened, will make their eyes light up and give them delight.

But there are people other than my family, and there are many kinds of gifts. I can’t help but think that if I were giving the perfect gift to my patients, some would love to open a gold-embossed Oxycontin prescription with the “infinity” emblem under “number of refills.” And others would be speechless to dump out their stocking and find their disability paperwork completed. The tears of joy would flow! Read more »

*This blog post was originally published at*

Thanksgiving And Your Priorities

Here is my column in [the November 21st] Greenville News:

This Thanksgiving we will have 32 guests at the table. Rather, at the tables we scatter about the dining room…and living room…and kitchen. At our house, food is practically a sacrament. And obviously Thanksgiving is the high holiday of American eating. So we will be honoring the tradition by feeding everyone as much as we can.

Because the guests are all beloved to us, we will also have a variety of foods, in a variety of presentations. For instance, there will be fresh cranberries for organic purists, as well as a maroon gelatinous mass of cranberries for those who feel that cranberries indeed spring from aluminum. The turkeys will be divided perfectly among dark and light meat lovers. And for the carb-loving, there will be sweet potatoes, mashed potatoes, and potatoes soft, but cut into chunks. (In deference to the texture-challenged.)

We will have assorted dressings, casseroles and vegetables. And more types of sweets than any of us really need. All of it because we love one another, friends, family, young and old. And we want everyone to have something that they love. The sheer pleasure of eating is one (but not the only) reason that we love the holiday so much.

I think we also love it for a few other reasons. For instance, we (and I mean all Americans) love it because it slows us down, just a bit, before the Christmas madness sets in. Yes, the day after Thanksgiving it’s “game on.” But on Turkey Thursday we stop, if only because we are too full to move. So much of our lives involve rushing, hurrying, competing. Thanksgiving is a food-stuffed, sleep-inducing speed bump in the frantic activity of the season.

We also love it because it is tangible. Today so much is virtual. So much of our lives are borne on the airwaves, across cell-towers or satellites. Our pleasures are so often intangible, insubstantial — distant sounds and images on movies, television shows, or the Internet. Even our work is often virtual. Thanksgiving is a time when we can touch and taste, listen and embrace. Read more »

*This blog post was originally published at*

What Kind Of Physicians Does The Government Want To See?

Here’s my [recent] commentary at KevinMD.  Let me know what you think. What kind of physicians DO we want for the future?

I was talking with a pre-med student recently. He had completed his very first medical school interview and was, understandably, excited. But he told me the interviewer had asked him what he thought would be the outcome of the current healthcare reform measures.

I laughed to myself. After 17 years in practice, even I don’t know the outcome, though I have my suspicions. It seemed a loaded, almost unfair question. After miring students in biology, physics, chemistry and every known application-padding activity, after expecting volunteerism and activism, I’m not sure why they would expect this young man to have any earthly idea about the reform measures from his current position in the medical biosphere.

But I wondered, since I’m not a medical educator, was there a right answer? And I wondered even more, what do we want in our future physicians? Read more »

*This blog post was originally published at*

A Tribute To Hospital Volunteers

Here is a talk I gave last week to our hospital auxiliary association, mostly made up of retired volunteers. They give us so much, and this is my tribute to them.

Capacity, utility and volunteers

Thank you for letting me speak to you tonight. It is an honor. I have today been at two different ends of the medical world . Today at lunch, I spoke to a Christian Medical Student’s association at USC in Columbia, SC. And now, I am honored to speak to you, who do so much to keep the hospital functioning by your gift of volunteerism.

Tonight I want to talk about capacity and functionality. About utility and usefulness. In preparing to do so, I began to think about how I became the way I am, and my mind wandered to ancestry. I suppose that ancestry has much to do with who we are, though I doubt it is the sole determinant. Read more »

*This blog post was originally published at*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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