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Will Slowing That Hectic Schedule Improve A Doctor’s Performance?

I had a couple of slow shifts in the emergency department recently, around Thanksgiving. And it made me think of Nomar Garciaparra, the old Red Sox shortstop.

Nomar always had to throw off-balance, while running and jumping. You can see his style on display when throwing the ceremonial first pitch at Fenway last year.

In an interview (can’t find the reference, sorry) he said he always had to throw this frenzied manner, even for an easy grounder where he’d normally have time to collect himself. If he paused too long to think about it, the throw would come off badly, he said.

I always thought this was a psychological issue — dubbed Read more »

*This blog post was originally published at Blogborygmi*

A Shrink Considers The Effectiveness Of Her Scheduling Method

I’ve been at it a long time, and one thing (of many things) that I still have not gotten down is scheduling.  I seem to have a method to my own madness, but somehow I imagine it’s not how other people do this.  I’ve heard other shrinks say, “I’m booked for the next 4 weeks” or say they aren’t taking any new patients.  Some people put a “no new patients” message on their answering machine.  Wait, so no appointments for 4 weeks?  What if a patient calls and needs to be seen very soon? Like this week?  If you can’t wait, go to the ER?  I thought the point of having a private doc was that you didn’t have to go to the ER unless something couldn’t be handled safely as an outpatient.  And if you tell the world that you don’t take new patients, then don’t people stop referring to you?  It seems to me that patients will come in and announce, “I’m doing better and want to come less often,”  “I’m moving,”  “I’m done,” or they will cancel an appointment, not call back, and not be heard from again for weeks or months.  Sometimes it all happens on very short notice and life can be very unpredictable.

In my pre-shrink days, I thought that psychiatry worked such that patients came every week (or twice a week, or whatever) and had their own slots.  Tuesday at 1, that’s me!  So a psychiatrist had every slot full with patients this way, and could be “full,” until a patient finished and stopped coming, and then another soul was let in to the Tuesday at 1 slot.  Gosh that would be nice, but it doesn’t seem to work that way. Read more »

*This blog post was originally published at Shrink Rap*

Today’s HIMSS 2010 Interview Schedule

Better Health bloggers, Val Jones, Nick Genes, and Mike Sevilla are in Atlanta to talk to interesting exhibitors at the largest health information technology (HIT) event of the year.

Monday, March 1st has a full schedule of interviewees… Please join us live on UStream to tune in for the interviews and participate on Twitter! Ask your question in real time. Drop by the UStream channel at the designated time to hear from your favorite vendor…


When No One Wants To See The Patient: The ER’s On-Call Labyrinth

The call schedule is hidden somewhere inside!

The call schedule is hidden somewhere inside!


‘The patient was seen in the emergency department by Dr. Niemans, who is the acting hospitalist on call for Dr. Whitman’s group, who usually admit for the patient’s actual primary care provider, Emily Knight, PA, who works for  Dr. Robelo, who no longer takes call, but admits his patients to the hospitalist.

Because the patient has COPD and an acute left-lower-lobe pneumonia, pulmonology was consulted.  However, no pulmonologist is available this weekend.  Pulmonary is being covered by Dr. Albertson, pulmonologist in the neighboring city.  I spoke with Dr. Albertson about this and he told me he wasn’t taking call for our patients, and why did people keep bothering him.

The patient’s cardiologist, Dr. Rease, is being covered by Dr. James.  I spoke to Edgar, PA for Dr. James who said that as of 7am, Dr. James was trading call with Dr. Housefield while Dr. James went to his son’s soccer game, but if I had any questions I should call Dr. Housefield’s Nurse Practitioner Michael, who would be rounding for Dr. Housefield, Dr. James and Dr. Josefson, at least until soccer was over or something bad happened. Read more »

*This blog post was originally published at*

Imagine That: No Charge For Surgery That Didn’t Happen

Many of the surgeries I do are elective. They can and should be scheduled to be convenient. It happens – God laughs at our plans or life interrupts or …..

Last week was such a time for one patient. She called, very apologetic, “Dr Bates, I need to reschedule my surgery. My father is having tests done. He hasn’t been feeling well.”

I quickly assure her that no apology is necessary. Her family comes first. I suggest we simply cancel the surgery for now until the “dust settles.” She can call me back when she is sure things are okay with her family. We’ll reschedule then.

She is still worried. “The surgery center called me today. Do I need to call them? Will I need to pay them or anesthesia or you for the canceled time?”

Again I reassure her, “No, I’ll call them and take care of canceling the surgery. No, we don’t charge you for surgery we don’t do. It happens. It’s okay to cancel surgery for whatever reason – another family member gets sick, an accident happens, you just get scared.”

It happens on both sides. Sometimes (as for me earlier this year when my mother had surgery) it’s the doctor who has to cancel or reschedule. Sometimes it’s the patient. I once had a patient not show up for surgery, only to find out later she had been in a motor vehicle accident the evening before her scheduled surgery. She turned out to be okay, but it really cemented how I fell about patients who call to cancel or reschedule. It’s okay. No need to apologize. Thank you for letting me know.

*This blog post was originally published at Suture for a Living*

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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