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When Physicians Fail To Take Responsibility For Their Own Orders

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*

Why The Term “Patient” Is So Important In Healthcare

An online friend, col­league, and out­spoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “con­sumer,” a “cus­tomer,” or some other noun to describe a person who receives healthcare.

My vote is: PATIENT. Here’s why:

Providing medical care is or should be unlike other com­mercial trans­ac­tions. The doctor, or other person who gives medical treatment, has a special pro­fes­sional and moral oblig­ation to help the person who’s receiving his or her treatment. This respon­si­bility — to heal, hon­estly and to the best of one’s ability — over­rides any other com­mit­ments, or con­flicts, between the two. The term “patient” con­stantly reminds the doctor of the spe­cialness of the rela­tionship. If a person with illness or medical need became a con­sumer like any other, the rela­tionship — and the doctor’s oblig­ation — would be lessened.

Some might argue that the term “patient” somehow demeans the healthcare receiver. But I don’t agree: From the prac­ticing physician’s per­spective, it’s a priv­ilege to have someone trust you with their health, espe­cially if they’re seri­ously ill. In this context, the term “patient” can reflect a physician’s respect for the person’s integrity, humanity and needs.

*This blog post was originally published at Medical Lessons*

A Doctor’s Many Hats

I have taken on the task of writing 50,000 words for a novel in November (NaNoWriMo) and would have to carve time out of work or family [my posts are decreased by this new hat]. I can only wear so many hats.

But I am here, and my writing has been far more enjoyable than I expected. This is the time when it is easy to hit the wall (we get daily encouraging emails from successful writers to get us through this time), but I’m okay so far. I am writing about a doctor who encounters a very unusual patient. I am writing in the first-person, which was a good choice, as I know the first person of a physician intimately and stand no risk of getting those details wrong. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

A Doctor’s Guilt About Healthcare Costs

Times are tight and we’re all looking to save money, be it our own or someone else’s. Many will say that when it comes to the skyrocketing costs of healthcare, doctors are responsible for part of the problem.

Doctors order too many tests, either to cover ourselves in the event of a malpractice suit, or because patients pressure us, or because we genuinely believe that the tests are necessary for patient care, but in many circumstances, a cheaper option is available. We order medications that are expensive when cheaper medications are available. And psychiatrists offer care — like psychotherapy — that could be done by clinicians who are cheaper to educate and willing to work for less money. Read more »

*This blog post was originally published at Shrink Rap*

Why Primary Care Doctors Are So Busy

There’s been a lot of commentary on a recent article from the New England Journal of Medicine, detailing the undocumented tasks that a typical primary care physician performs.

For those who haven’t read the piece, entitled, What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice, it’s available free at the NEJM website. I highly recommend it.

To summarize, primary care doctors are responsible for much more than seeing patients in the exam room. In the cited practice, which has a fairly typical makeup, physicians were responsible for an average of over 23 telephone calls and 16 e-mails per day. Many practices don’t engage their patients over e-mail, so it’s conceivable that the number of telephone calls is lower than average here. 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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