October 13th, 2009 by Toni Brayer, M.D. in Better Health Network, Opinion
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Medscape has a physician portal and they asked the question: “Where would you like to practice medicine?” The responses from physicians were varied with lots of complaining and joking like “Dubai”, but this reply from a family medicine doctor got my attention. I think he speaks for many physicians.
- I would like to work in a fantasy world.
- One where I didn’t have to worry about someones economic status. Read more »
*This blog post was originally published at EverythingHealth*
October 5th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Policy, Opinion
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When you build a house, you begin with the foundation. The same holds true for the U.S. health care system. The President and Congress are scrambling to put up a reform structure that would have a better chance to succeed if the cinderblocks and joists were in place. No health care system in our country can develop adequately unless supported by validated information, policies and procedures based upon accurate data related to its most important features, and updated continuously. While there are agencies and institutions that can answer some of our questions, a comprehensive assessment is lacking. We should learn much more – the sooner, the better. Conflicted entities cannot be relied upon for objectivity, so if the government would like to increase its role in health care, creating a method for objectifying the rationale for change is the correct place to start. Read more »
September 2nd, 2009 by Dr. Val Jones in True Stories
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This post is a “Dr. Val classic” – first published in early 2007.
***
Internship, for those of you who may not know, is the first year of residency training. It is the first time
that a doctor, fresh out of medical school, has responsibility for patient care. The intern prescribes medications, performs procedures, writes notes that are part of the medical record, and generally learns the art of medicine under the careful watch of more senior physicians.
Internship is a frightening time for all of us. We’ve studied medicine for 4 years, memorized ungodly amounts of largely irrelevant material, played “doctor” in third and fourth year clerkships, but never before have lives actually been put in our hands. We know the expression, “never get sick in July” because that’s when all the well-intentioned, but generally incompetent new interns start caring for patients. And so, we tremble as we begin the new stage in our careers – applying our medical knowledge to real life situations, and praying that we don’t kill anybody.
I’ll never forget my first day of internship. I must have drawn the short straw, because not only was I assigned to the busiest, sickest ward in my hospital (the HIV and infectious disease unit), but I was on call that day (so I’d be working for 24 hours straight) with the most hated resident in the program (he had a reputation for treating interns poorly and being arrogant to the nurses). As I reviewed my patient list, I noticed that the sign out sheet (the paper “baton” of information handed to you by the last intern who cared for the patients – meant to give you a synopsis of what they needed) was supremely unhelpful. Chicken scratch with diagnoses and little check boxes of “to do’s” for me. I was really nervous.
So I began to round on my patients – introducing myself to each of them, letting them know that I was their new doctor. I figured that even if I couldn’t completely understand the sign out notes, at least by eye-balling them I’d have an idea of whether or not they were in imminent danger of coding or some other awful thing that I figured they’d be trying to do.
My third patient (of 15) was a thin, elderly Hispanic man, Mr. Santos. He smiled at me when I came
in the door – the kind of lecherous smile that a certain type of man gives to all women of child bearing age. I ignored it and introduced myself in a professional manner and began to check his vital signs. I was listening to his heart, and I honestly couldn’t hear much of anything. There was a weird, very distant beat – something I wouldn’t expect for such a thin chest. The man himself looked awful, but I really wasn’t sure why – he just seemed really, really ill.
My pager was going off mercilessly all night. I wondered if this was how the nurses got to know the characters of their new interns – to test them by paging them for anything under the sun, tempting us to tip our hand if we had tendencies to be impatient or disrespectful. But in the midst of all the “we need you to sign this Tylenol order” pages, there came a concerning one: “Hey, Mr. Santos doesn’t look good. Better get up here.”
My heart raced as I rushed to his bedside. Yup, he sure didn’t look too good. He was breathing heavily, and had some kind of fearful expression on his face. I didn’t really know what to do, so I decided to call the resident in charge (much as I was loathe to do so, since I knew he would humiliate me for bothering
him).
The resident appeared in a froth – “Why are you paging me? What’s wrong with the patient? Why do you need me here? This better be good!”
“Um… Mr. Santos doesn’t look too good.” I said, frightened to death.
“What do you mean ‘he doesn’t look too good?’ Can you be a little bit more specific” he said, sarcasm dripping from his tongue.
“Well, I can’t hear his heart and he’s breathing hard.”
“I see,” said the resident, rolling his eyes. He marched off towards the patient’s room, certain to make an example of me and this case.
I trotted along behind him, hoping I hadn’t been wrong in paging him – trying to remember the ACLS
protocol from 2 weeks prior.
The resident drew back the curtain around the man’s bed with one grand sweep of the arm. “Mr. Santos,
how are you doing?” he shouted, as if the man were deaf.
The man was staring at the wall, taking in deep, labored breaths of air. I saw that the resident immediately realized that this was serious, and he placed his stethoscope on the man’s chest.
I approached on the other side of the bed and held his hand. “Mr. Santos, I’m back, remember me?” He smiled and looked me straight in the eye.
He replied, “Angel.” (in Spanish) Then he let out a deep breath and all was silent.
The resident shook the man, “Mr. Santos? Mr. Santos?!” There was no response.
“Should I call a code?” I asked sheepishly.
“Nope, he’s DNR,” said the resident.
I was flabbergasted.
“Yep, you just killed your first patient. Welcome to intern year.”
As I thought about his cruel accusation, I was comforted by the fact that at least, as Mr. Santos released his final breath, he thought he had seen an angel. Maybe my presence with him that night did something good… even though I was only a lowly intern.
July 29th, 2009 by DrRob in Better Health Network, True Stories
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A recent oft-cited study showed that doctors who who apologized for mistakes were less likely to be sued. My initial reaction to that is to file it under “duh.”
But then I was greeted with a note lying on my desk.
Dr. Rob:
First, I want to tell you that for the majority of the many years my family has been patients of your practice, I believe we received excellent care and you always had our best interests in mind. Further, we appreciate all that you and your staff have done for us.
However, it is with great regret that I find myself in the position of writing to you with a problem I see as pervasive in your practice…
Ugh. This is not the way to start my day.
The letter went on to describe a problem with communication of a concern the patient had about a medical problem that was very worrisome to her. It didn’t point the finger of blame at my nurse, nor any one else in the office. It wasn’t at all angry in its tone to me. It simply expressed the disappointment of a patient who felt let-down by her physician.
The letter ended with:
I look forward to speaking with you about this issue early in the week of July 20.
Thank you in advance for your attention to this matter.
I put off calling her until the end of the day. I knew she would be reasonable overall, but beyond the fact that I hate calling people on the phone at all, I hate calling when I know I have to apologize. The problem in this case was not with my staff or with confusion in the office. The problem was with a physician who simply dropped the ball and did not follow-up as promised.
I finally called:
Hi.
First let me say thank you for the letter you sent. I mean that sincerely. I would much rather hear about problems in our office than to simply having people get angry and leave. This is something I needed to hear.
Second, let me say that the blame is 100% mine. I really wasn’t worried about the problem and so I honestly just let it slip my mind. I did tell you I’d contact you and would send you to a specialist if things weren’t clear after the tests I ordered. I’m sorry about that.
I went on to discuss the situation and that I didn’t think anything was serious at all. She still wanted to go ahead with the consultant because of some stuff she had heard about the condition. I told her that I have no problem with that, as I see my job as one of giving my advice and perspective; but not as making the final decisions. The most important thing is that her worries are addressed and that she feels comfortable that everything is OK. If it takes a consultant to do that, then I have absolutely no problem with that.
I also explained that communication in a medical office is very difficult – and has gotten much harder as we have gotten busier. It is our plan to eventually have communication by e-mail, but that is not ready for prime-time. This is not an excuse, I told her, but an explanation and a promise that I do see the problem and we are doing something about it.
As expected, she was gracious about the situation and was thankful for the apology. I didn’t do it to avoid lawsuit or to protect myself. I like this family and didn’t want to lose them as patients. Beyond that, though, I owed her an apology. I had let her down. I hadn’t done what I promised I would do. She had been kind enough to send me the letter and deserved a quick resolution to the situation.
I still hated picking up the phone, though. It isn’t easy to admit fault, no matter how accepting you know the other person will be.
As obvious as it seems that apologizing will prevent lawsuit, it is a hard thing to do.
But I am glad I did.
*This blog post was originally published at Musings of a Distractible Mind*
July 13th, 2009 by DrWes in Better Health Network, Health Policy, Opinion
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It was supposed to be delayed gratification.
After all, that’s the American way: work hard, put your nose to the grindstone, get good grades, be obsessively perfectionistic, then you’ll be rewarded if you just stay with it long enough. It’s the myth that perpetuated through medical school, residency and fellowship, and our poor residents, purposefully shielded from the workload they’re about to inherit, march on.
But then they graduate and find that just as the population is aging, chronic and infectious diseases are becoming more challenging, health advances and potential are exploding. Just then, we decide to launch a full scale attack on physicians and their patients with increased documentation requirements, call hours, larger geographic coverage of their specialties, reduced ancillary workforce, and shorter patient vists.
Physicians get it – burn out and dissatisfaction are higher now than ever before. This is probably the greatest real threat to the doctor-patient relationship and health care reform discussions don’t even put it this on the table.
At the same time that we expect our doctors to be devoted, available, enthusiastic, meticulous and at the top of their game with perfect “quality” and “perfect performance,” while simultaneously cutting their pay, increasing documentation reqirements and oversight, limiting independence, questioning their professional judgment, and extending their working hours. We must become more efficient!
Deal?
*This blog post was originally published at Dr. Wes*
