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Can Decision Fatigue Lead To Medical Errors?

Do you suffer from decision fatigue when you are sick or anxious or overwhelmed by bad health news?  Does your doctor make less well-reasoned decisions about the 10th patient she sees before lunch?  How about the surgeon during his second operation of the day?  How about the radiologist reading the last mammogram in a daily batch of 60?

A provocative article by John Tierney in Sunday’s NYTimes Magazine adds a new layer of complexity to the body of knowledge collecting around decision-making processes.  Considerable news reporting has focused on how cognitive biases influence our judgment and how many of us experience the abundance of choices available to us as a burden rather than a privilege.  This article adds to that understanding: Our decision-making abilities appear to be powerfully affected by the demands of repeated decision making as they interact with depleted blood glucose levels. That fatigue mounts over a day of making decisions and as blood glucose levels fall between meals. In response, we tend to either make increasingly impulsive decisions without considering the consequences or to make no decisions at all. Tierney describes a study analyzing 1,100 parole decisions by judges over the course of a year:  “Prisoners who appeared early in the morning received parole about 70 percent of the time, while those who appeared late in the day were paroled less than 10 percent of the time.”

The effects reported in the article were Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

A Taste Of Canadian Healthcare On Chicago’s South Side

This past September, a group of medical residents at my institution began seeing primary care patients at a free clinic down the street from our tertiary academic medical center (“hospital clinic”). Far from my expectations, the care we are able to provide at our free clinic is in many ways better than our hospital clinic. Somewhat paradoxically, the experience has given me a taste of what the practice of medicine is like in single-payer healthcare systems like Canada’s.

When I volunteered to start seeing patients at a nearby free clinic, I had little idea what I was signing up for. The term “free clinic” conjured up memories as a medical student in East Baltimore tending to patients at a local homeless shelter with severe frostbite or at a student-run clinic rummaging through the storage room for anti-hypertensive medications. I expected our patients to be terribly poor, the clinic to be little more than a warehouse, for supplies and medications to be few and far between, and for the care we provided to be more about putting out fires than delivering high-quality primary care.

But the place I have come to cherish working at is none of these things. A surprising number of our patients have stable lives and regular jobs — it’s just that their jobs don’t offer health insurance (including some who work in healthcare!) Patients call for appointments. When they arrive they are triaged by a nurse who takes their vitals and asks about their chief complaint before putting them in an exam room. We provide comprehensive primary care complete with routine lab tests for cholesterol and diabetes, age appropriate vaccinations, and referrals for mammograms and colon cancer screening. Read more »

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

When Puberty Ends

I heard a 23-year-old woman complain: “I must be getting old when 11:00 at night is late.” It got me thinking.

It turns out that the explanation for why teens are natural night owls has recently been elucidated. They can’t help it — they just don’t get tired until way later in the evening. Then, of course, their bodies want to stay asleep well into the next morning in order to feel sufficiently rested. Since most of them are stuck with the artificial structure of school hours, they’re screwed — and condemned to suffer constant fatigue from cumulative sleep deprivation. Old news.

Then I started wondering about the back end of this phenomenon. Even though our American “youth culture” attributes great coolness to late-night happenings, since this pubertal sleep shift is biological, there must come a point at which their pineal glands go back to releasing melatonin at a more reasonable hour. Does 10 years sound about right? I remember not being nearly as enamored of the “all-nighter” by the time medical school rolled around, as opposed to college, where staying up all night was a regular occurrence. Certainly by residency (ages 26 to 30), it was a killer. Read more »

*This blog post was originally published at Musings of a Dinosaur*

Dr. Abraham Verghese: The “Top Gun” Of American Medicine

The first-year medical students I precept were too young to see Tom Cruise’s alter ego Lieutenant Pete “Maverick” Mitchell grace the big screen in the 1986 blockbuster film “Top Gun.” Yet, the story has a relevant analogy to medicine. 

According to the film, during the Vietnam war American pilots were relying too much on technology to bring enemy fighters down. They weren’t as skilled in taking out the opposition. They fired their technologically advanced missiles to try and get the job done. They didn’t think. It didn’t work. They forgot the art of dogfighting.

The military discovered that technology alone wasn’t going to get the job done. The best fighter pilots needed the skills, insight, and wisdom on when to use technology and when not to. As a result, the Navy Fighter Weapons School, known simply as Top Gun, was created to retrain the military pilots on this vital lost skill. The goal of the program was specifically to make the best of the best even better.

Like the military, the country is discovering that the healthcare system enabled with dazzling technology isn’t getting the job done either. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Physician Burnout: Doctors And Patients Deserve Better

A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.

Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the point where they lose focus. They tend to be more depressed — perhaps one reason why doctors have a higher suicide rate than the general population.

While burnout can happen in any profession, the performance of stressed-out doctors can hurt someone else: Patients. 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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