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Basic Health Education: Not So Basic

The past two weeks I’ve been the “dayfloat” resident on the cardiology inpatient service. With the 30-hour-shift work “restrictions” placed on medical residents, there has been a need for new systems of care to ensure the safety of newly admitted patients and cardiology dayfloat is one of them. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their patients through the end of the work day. It’s a fairly easy rotation, as they go, though because I “float” from one team to another without patients of my own, it’s also not the most satisfying.

Towards the end of my two week rotation, I was paged by a nurse because a patient’s husband wanted an update on his wife’s condition. Glancing at my “signout” — a one-page synopsis of the patient’s presenting illness and hospital course — I learned that Mrs. FN (as I will call her) was admitted to the hospital for heart failure secondary to “medical noncompliance.” It appeared that she had not had any of her medications for well over a week, which likely precipitated the shortness of breath and fluid overload that led to her admission. On top of this, the patient had a number of “dietary indiscretions” including eating Chinese food, which likely only exacerbated her condition. Read more »

*This blog post was originally published at BeyondApples.Org*

Patients Starved For Time With The Doctor

If you’re into health care consumerism, you’ll enjoy my guest blog post at CDHC Solutions magazine. CDHC Solutions focuses on consumer-driven health plans. Consumer-driven plans are a form of “high deductible” health coverage that is more popular than ever. For whatever you want to say about these plans, one thing is clear: They don’t solve the fundamental problem of patients not having enough time with their doctors.

Here’s a taste of what I wrote:

Researchers have been trying to pinpoint the impact of this time starvation on the quality of medical care, and they’re finding disturbing results. A recent study in the Annals of Internal Medicine found that because of time pressures and related factors, doctors deliver “error-free” care as rarely as 22 percent of the time. The researchers called this a “failure to individualize care,” which is a nice way of saying the doctors just weren’t paying enough attention to the needs of their patients.

Read the whole blog post here.

*This blog post was originally published at See First Blog*

When Diagnosing, Doctors Often Ignore Patients’ Social Factors

A recent study from the Annals of Internal Medicine found that doctors often discounted a patient’s social situation when making a medical diagnosis.

Lead researcher Saul Weiner “arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor.”

Evan Falchuk, commenting on the results, provides some context:

It’s hard to expect even the most gifted clinician, trying to make it through yet another week of a hundred or more patient encounters, to get these difficult decisions right. Too much of the context of a patient’s care gets lost in the endless churn of patient visits that the health care system imposes on doctors.I suspect this is enormously frustrating for doctors, although it’s worse for patients. What the researchers call a failure to “individualize care,” a patient might call “not being paid attention to.” It’s a dynamic that anyone who’s been ill has probably seen firsthand.

These findings are entirely unsurprising. Read more »

*This blog post was originally published at*

How Error-Free Is Your Doctor’s Care?

According to the Annals of Internal Medicine, doctors make the wrong medical decisions surprisingly often.

Using a “mystery patient” technique –- in which actors pretended to be patients –- researchers found that doctors made errors in complicated cases in 60 percent to 90 percent of cases. Sixty to ninety percent. In uncomplicated cases, they made errors in nearly 30 percent of cases.

As one study participant put it, “I was shocked.”

The study took place over three years, and included more than 100 doctors in six Chicago-area hospitals. The doctors had agreed to participate in a study on medical decision making, but had no idea that they might see a patient who was actually an actor. The actors recorded their conversations with the doctors. Read more »

*This blog post was originally published at See First Blog*

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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