Last month, my family was involved in a scary traffic accident en route to the Family Medicine Education Consortium‘s North East Region meeting. I was in the left-hand eastbound lane of the Massachusetts Turnpike when a westbound tractor trailer collided with a truck, causing the truck to cross over the grass median a few cars ahead of us. I hit the brakes and swerved to avoid the truck, but its momentum carried it forward into the left side of our car. Strapped into child safety seats in the back, both of my children were struck by shards of window glass. My five year-old son, who had been sitting behind me, eventually required twelve stitches to close a scalp laceration. Miraculously, none of the occupants of the other six damaged vehicles, including the truck driver, sustained any injuries.
Family physicians like me, and physicians in general, like to believe that the interventions we provide patients make a big difference in their eventual health outcomes. In a few cases, they do. But for most people, events largely outside of the scope of medical practice determine one’s quality and length of life, and Read more »
*This blog post was originally published at Common Sense Family Doctor*
I had a patient with non-valvular atrial flutter denied dabigatran (Pradaxa®) by their insurer recently. The patient had diabetes, hypertension and has had a heck of a time maintaining therapeutic blood thinning levels (prothrombin times).
But those are the rules, you see. Only patients with non-rheumatic atrial fibrillation can get dabigatran, I was told. Dabigatran was never approved for atrial flutter, only atrial fibrillation. Never mind the stroke risk in non-rheumatic atrial flutter, like atrial fibrillation, has been found to be significant.
For my patient, dabigatran would have been the perfect solution.
But increasingly I’m finding the patient is not mine, they’re Read more »
*This blog post was originally published at Dr. Wes*
The Role of Physicians in Controlling Medical Care Costs and Reducing Waste by the RAND Corporation and David Geffen, University of California Los Angeles School of Medicine, Santa Monica was just published in the Journal of the American Medical Association (JAMA). I do not think the JAMA should have published this article.
1.Why would the JAMA publish such an article?
2. Why are physicians blamed for all the waste in the system?
3. Why is it the physicians’ responsibility to eliminate waste when they are not the cause of the greatest percentage of the waste?
“The amount of money spent on medical care is increasing faster than the gross domestic product (GDP), and the federal deficit is increasing.”
The initial statement assumes that the government deficit is increasing because physicians control government spending for healthcare.
This is only partly correct. Read more »
*This blog post was originally published at Repairing the Healthcare System*
Have you ever stopped bothering to care about a patient? A doctor sent me his own personal account of the smoking Mr Jones:
Dear Happy. I read your article on bounce backs with great interest, and was astonished by some of the vitriol it elicited. I remember having one COPDer bounce back to me three times within a month at the VA when I was a medicine resident. He would leave, smoke and drink, and then come back and be readmitted to my service with exactly the same course each time. It was like Groundhog Day.
Finally I had a little talk with him and said: “Mr. Jones, each time you come in, you’re on death’s door. So I come down to the ER, stay up with you all night and save your life. But you know, I’m really getting tired of having you come in after drinking and smoking and then working like a dog to save your life. So let me tell you, if you don’t quit smoking, the next time you do this there’s a good chance that I’m not going to bother. Why should I? It doesn’t seem to be doing either of us any good.”
To my complete astonishment, he actually quit smoking and stayed quit for about a year. Then he fell off the wagon, deteriorated too far before getting to the hospital and died. I was frankly proud of him for the effort, but somehow suspect that I’d be shot in a drive-by if I ever told that story in public. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
When a patient decides they are leaving against medical advice what responsibility does the physician have to their care? When I was a resident in training, and even early on in my position as a hospitalist, I would get a call from the nurse that Mrs Smith was demanding to leave the hospital against medical advice. I would tell the nurse “Fine. Let her go. I’m not her father.” I would tell the nurse to discharge Mrs Smith with no medications and leave it up to them to find follow up.
I would suspect this is a prevalent attitude for many hospital and emergency based physicians. I’ve seen it over and over again. And I still see it today. Many doctors and nurses feel obliged to let grown men and women make poor decisions. However, being a grown man or woman able to make poor decisions is apparently not enough to keep a doctor for being sued and losing that lawsuit because a patient chose to make poor decisions. Read more »
*This blog post was originally published at A Happy Hospitalist*