Category Archive: Hospital-Based Medicine

A return to the problem-oriented SOAP note

CMS is changing note requirements, among other changes.  Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.” As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction.  To me the most […]

A return to the problem-oriented SOAP note

CMS is changing note requirements, among other changes.  Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.” As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction.  To me the most […]

What is proper work attire in medicine?

I’m a creature of habit. My first activity every day is to read the New York Times. Depending on my schedule, some days I read more articles than others. This week I was away at a conference and found myself with some early morning extra time before the first meeting session, so I delved into […]

Being a commodity takes away the joy of medicine

It’s peculiar, I think, that we live in a time of physician shortage and yet some things remain abundantly clear: 1. Physicians can’t work together to fight, either for their own good or the good of their patients. 2. Like hostages, or abused spouses, they just keep going back for more of whatever bad policies […]

A physician’s mistakes as a rookie MD

July is upon us again: that New Year celebrated only by those in the medical field. A time when medical students begin as doctors, interns become residents, residents become fellows and, basically, everyone in every position is one year less experienced at it than the person who held that position the day before. This July […]

Medical students: Welcome to the wards

Dear third-year medical students, Welcome to the wards. I remember this stage — basking in the glory of completing pre-clinicals, in the excitement of finally switching heavy textbooks for living, breathing people, in the realization that medical education now lies in the hands of those I wanted to heal. I would be sleeping less, but […]

When attendings come to work rounds

Learners value efficiency.  As I recall my residency, nothing caused more angst than unnecessarily long rounds.  In the 1970s just like in the 2010s, I had much to do after rounds ended. As an attending physician, my responsibilities involve patient care and aiding learning.  I have always worked hard to do that within a time […]

Why are we treating outpatients like inpatients?

Repercussions. Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave. Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients […]

The social determinants of a physician’s path

Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to […]

Guidelines, multiple specialists, and the science versus the art of medicine

My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a […]

Older posts «

Explore the Archive