[Recently] I ate at one of my favorite Italian restaurants. I had eaten there many times before, but the experience this time was different. After ordering, I received a vacuous bread basket with precisely two pieces of bread. At the end of my meal I was offered two biscotti — and no more. Only the manager could offer an explanation: As a means of containing costs, the decision had been made to capitate bread and biscotti distribution.
I was disappointed. I had been eating here for years. When Colic Solved was released, my publication party was held here. After all those anniversaries, New Year’s celebrations, and birthdays, I’m shortchanged on cookies? It’s remarkable how a great experience can be shadowed by something so small.
Then I got to thinking: Perhaps I’m a two-biscotti physician. Like this restaurant, there are times when I don’t finish well. I may do a phenomenal job with assessment and diagnosis, only to delay a callback on biopsies or X-ray results. Perhaps I get it all right, but fail to get the detail right on the home health orders. Are there small pieces missing in my encounter that represent everything a parent remembers? I know that there are, and I know there are things I have to work on.
There’s a lot we can learn from a restaurant. I don’t want to be a two-biscotti physician.
*This blog post was originally published at 33 Charts*
Want to know the secret to successful care of ICU patients? Think back to the advice your grandmother always gave, joked American Thoracic Society conference speaker Renee Stapleton, M.D., recently:
- Wash your hands.
- You can’t sleep your life away.
- Get some exercise.
- Sit up straight.
- Take your medicine.
- If you can’t remember it, write it down.
*This blog post was originally published at ACP Hospitalist*
The recent discussion of the appropriateness of bringing patients back to the office has really gotten me thinking about my overall philosophy of practice. What are the rules that govern my time in the office with patients? What determines when I see people, what I order, and what I prescribe? What constitutes “good care” in my practice?
So I decided to make some rules that guide what I think a doctor should be doing in the exam room with the patient. They are as much for my patients as they are for me, but I believe that thinking this out will give clarity in the process.
Rule 1: It’s the Patient’s Visit
The visit is for the patient’s health, not the doctor’s income or ego. This means three things:
- All medical decisions should be made for what is in their interest, including: when they should come in, what medications they are given, what tests are ordered, and what consults are made.
- Patients who request things that are harmful to themselves should be denied. People who ask for addictive drugs or unnecessary tests should not get them. Patients who are doing harmful things to themselves should be warned, but only in a way that is helpful, not judgmental.
- All tests done on the patient should be reported to them in a way that they can understand.
Rule 2: Minimize
Many doctors and patients have a “more is better” mentality. This not only costs more money to the system, but it can cause harm to the patient. Read more »
*This blog post was originally published at Musings of a Distractible Mind*