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The Positive Power Of Compulsive Medicine

Most experienced physicians expect uncertainty in caring for real people with average everyday problems. Yet those inexperienced or uninitiated in medicine tend to see the practice of medicine as exact or even absolute.

I remember waiting in vain as a medical student and resident for my instructors to illuminate a path towards certitude. Instead, I was given something far more real and lasting: An acceptance of the indeterminate mixed with the drive to be compulsive on behalf of my patients.

During my internal medicine internship, I remember a more-senior resident during our daily morning report bemoaning her uncertainty by saying, “But I just don’t know what’s wrong with my patient.” Although she was visibly upset, our program director’s reaction to her comment bordered on amusement, culminating with, for me, an unforgettable response: “Well, you certainly have chosen the wrong profession.”

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One More Medical Acronym To Add To The Pile

In medicine, hardly a week passes without the introduction of some new acronym, previously unspoken in the average practice, which then grows to prominence — take HIPAA, PECOS, CPT, ICD, etc. — the list goes on and on.

I believe that after 14 years of practice I’ve earned the right to introduce an acronym of my own: CRAPP. For the last several months, my partner and I have used this term to describe the volumes of denials, pre- and prior- authorizations (is there really a difference?), and faxes that seem to grow like weeds on the fertile planting grounds of our desks.

More specifically, in our office the acronym CRAPP stands for: Continuous Restrictive And Punitive Paperwork. To put it blithely, CRAPP could represent any document you wish someone had put on your partner’s desk instead of yours.

On a more emotional level, this acronym captures the visceral response I have whenever my attention is drawn away from my patients and redirected towards some nonsensical busywork — much like someone yelling at a golfer during their backswing.

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The Primary Care Shortage: Killing The Golden Egg-Laying Goose?

This past Monday, I was drawn to an article in the Wall Street Journal: “Medical Schools Can’t Keep Up.” The article detailed the growing shortage of primary care doctors in our country and reminded me that we in the U.S. may have something called “insurance reform” now, but without physicians to translate insurance access into healthcare, the state of our healthcare system will continue to beg additional attention and reform.

Although new medical schools are opening and some schools have increased enrollment numbers, there are a limited number of residency positions in this country. The government has always funded these residency positions and our new reform law tries to address the primary care shortage with “slot redistribution,” whereby money from unused residency positions will be deferred to primary care or general surgery residency programs.  Read more »

Healthcare Reform, Direct Patient Care, And The Period Of Discovery

As the period of debate over the Healthcare Reform Bill ends with President Obama penning his signature, one moment from the “debate” at Blair House stands out in my mind. A Republican Congressman sitting behind a copy of the then-current reform bill –- a pile higher than 2,000 pages –- was mocked for using such a prop. It’s complicated to fix healthcare with the laconic response to his theatrics.

Things don’t appear to have grown any simpler as we settle in for a period of discovery to determine exactly what this new law spells out for us in terms of reform. There is no consensus on whether this law will help or hinder, and I’m worried.

I cannot read 2,600 pages written in legalese. I juggle my time now to keep up with the medical literature necessary to adequately do my job and I suspect other physicians struggle similarly. All doctors fight a daily battle with time, trying to care for each patient in the best way possible (this is why many of us walk so fast through hospitals and clinics.) I hope that healthcare reform doesn’t result in less time for direct patient care. Read more »

The Semantics of Reform

In my last post I encouraged everyone to watch the health care debate at Blair House mediated by President Obama. For this, I must apologize — I ignored the maxim that one should neither watch sausage nor laws being made. I had arranged to work from home that February 25 since I planned my next post to be a review of this much touted debate.  As the proceedings began, I felt cautiously optimistic as I watched our politicians gather to supposedly mediate their differences; yet as the sun set that day I was incognizant of any path towards meaningful reform that our elected leaders could set upon as a result of their interaction.

Webster’s online dictionary lists two meanings of the word debate, with the first being: “a variance of opinion on a matter,” which best describes my recollections of that day.  However, the other definition: “a careful weighing of the reasons for or against something,” may better explain my hopes of what would transpire because of the debate, but fails to describe what really occurred that day.  The realization of this fact only deepens my disenchantment with what Washington has created and now dubs “Healthcare Reform.” When I try to recall the actual debate, I hear within my mind lots of static and background noise yet I can recall nothing of significance.  What I hear reminds me of the voice of the schoolteacher from the Charlie Brown cartoons I watched during my childhood. Read more »

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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