Sometimes things go just the way you want them to, and sometimes they don’t. Compare and contrast the case of two different patients, and how things went trying to get them the care they needed. The first patient, let’s call him Mr. Smith, called up one day last week with a brand-new symptom, which after […]
Category: primary care
When patients can’t tell you their symptoms
Today I had a followup appointment with a young adult male with severe intellectual disabilities. He is barely verbal. Several weeks ago his caregiver told me that this young man often pointed to his chest and would say “hurt” or “heart,” they weren’t sure which. He also seemed to have gotten pickier about his food, […]
A new physician experiences the opioid crisis
Seven years ago, I officially became a doctor. After years of hard work, sacrifice and insecurity, I finished my residency and passed my board certification exam in internal medicine. I was a fourth generation internist in my family and was so eager to begin my career in a new city with my fiancé. My first […]
Open your heart to your suffering
An excerpt from How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers (Second Edition). Copyright 2018 by Toni Bernhard. Excerpted with permission from Wisdom Publications. The fifth way I cultivate compassion for myself is to consciously work on opening my heart to the intense emotions — and emotional swings — that […]
Thorough documentation can be weak representation of patients
I am recalling a workshop on unconscious bias from last year, the moderator hands outpatient prototype profiles to each table of participants. Ours is a glossy paper with a color photo of our patient, Jane, and a clear outline of her type of employment, hobbies, interests, family members, religious beliefs, and how she prefers to […]
Lessons from the meeting of different value-based concepts
Value remains one of the most widely invoked and variably interpreted concept in American health care delivery. Beyond patients, stakeholder groups across the health care ecosystem are undertaking value-based initiatives, including payers (e.g., value-based insurance design and payments), provider organizations (e.g., value-based care redesign), pharmaceutical companies and pharmacy benefits managers (e.g., value-based pricing and formularies), […]
Why academic medicine needs to value physician contributions to online platforms
In academic medicine, promotion depends on the weight of our curricula vitae, measured primarily by the number of papers we publish in peer-reviewed journals. Physicians strive to jump through the hoops of publishing their work in “top” journals ranked by the “impact factor” (yearly average number of citations for a given journal). Yet the “impact […]
EHRs are killing medical innovation
To paraphrase Bill Gates: “The purpose of humanity is not just to sit behind a counter and do things. More free time is not a terrible thing.” I have innovated. I developed a mutation assay. I discovered that vacuum ultraviolet light from excimer lasers is safe to use on human tissue. I invented an imaging […]
Explaining what osteopathic medicine is
First of all, many osteopathic medical schools are located in underserved areas — or as underserved as possible while still having enough of a medical community to make training possible. My school, LMU-DCOM is located in the middle of Appalachia, for example. Osteopathic medical schools generally encourage students to specialize in primary care, at least […]