Doctor-Patient Interactions, not Transactions

Borrowing from business parlance to describe the diverse elements involved in optimum healthcare provision is fraught with peril. We need our own lexicon.

I’ve spent much of March traveling, accounting for my sporadic writing as my hypothalamus shut down after an excess of traversing oceans and continents.

A month sleeping at home and grinding my own coffee beans in the morning has appeal, but there’ll be particular satisfaction in avoiding the misery of airline travel which some time ago passed beyond the ‘benign decay’ part of the deterioration curve and now officially qualifies as truly abysmal.

Returning from California two days ago, we were offered the opportunity of paying a supplemental $136 for 5 extra inches of legroom on a flight from LAX to Detroit. I passed, not even caring to know whether it was $136 each (probably), rather laughing at the absurdity of my 61-inch tall missus needing the extra space anyway. Are we going to be strap-hanging in midair next?

Besides, it was obscure to me how 5 more inches of legroom was going to compensate for the foul air, the hardness of the seat, and lavatories that are surely too small for 30% of the American populace.

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Helping Physicians Balance Life at Home & Work

Being told to balance my life at home and at work better smacks of one more platitude. How exactly do I set about doing this? Suggesting to a physician that they examine their balance of responsibilities at home and work is like telling a patient with a bad head cold to take a cup of hot non-caffeinated tea and get a good nights sleep. You get a “you mean that’s it” look, and realize you’ve been dismissed as an amateur. I refer to it as the “remembering things your mother told you” solution.

You’ve never met my rock-of-sense almost 84-year old mother, but I’ve certainly tried hard in recent years to reflect on her lessons rather than those of my hyper-competitive and workaholic physician father dead now these 16 years. If I were to ask my mother to help you balance your professional responsibilities as a physician with your personal life this is pretty much what she’d say.

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Changing Doctor’s Attitude

Wistful reminiscences of life in medicine years ago are recollections of what was best and easiest well pruned of all the shortcomings.

None of us like to be told we need to fix our attitude. With me it’s like hearing a nail on a blackboard – all my defenses are instantly brought to bear; I want to grimace and put my hands over my ears to ward the effect off. We feel undervalued, unappreciated, misunderstood. It takes a pliable ego to stand one’s ground, hear out the criticism or complaint and give it a fair appraisal.

Much that ails the medical profession these days is about how we choose to perceive the world about us. We’ve never had it better in terms of the number of clinical, technological and scientific advances that allow us improve the lives of our patients. We’ve never had easier access to information whether that be tapping into new knowledge, or reaching colleagues who may advise you on a clinical dilemma. We can communicate more easily with our patients who are also better informed.

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Healer or Technocrat

A focus on technical and scientific advances in patient care takes us ever farther from our role as healers.

Mary was my first ever patient. I’m calling her Mary, though in truth I don’t remember her name. She was 70 if a day, I barely 21, in the first month of my clinical clerkships, proud of myself in my still clean new white coat. She snoozed, an early afternoon snooze, in a sunny corner bed by a window in Dr. Barnaville’s female ward.

A decade or so earlier Mary had undergone an alcohol injection into her gasserian ganglion to alleviate trigeminal neuralgia, a procedure that left her with some facial anesthesia and eventual return of her pain. Significant worsening of this pain had led to a hospitalization to try some different medications. The resident told me to examine her cranial nerves.

Prior to entering the ward I sat on a hard wooden bench in the corridor carefully reading how to examine the cranial nerves in the pocket version of McLeod’s “Clinical Examination”. As bushy-tailed as my white coat was bright, I moved from Olfactory through to Hypoglossal, felt confident, and entered the door.

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Of Pharmacists and Passive-Aggressive Blogs

Do a simple google search with the search terms pharmacy and blog and you will find that the top results feature sites such as The Angry Pharmacist and Your Pharmacist May Hate You. The fact that these blogs are listed so prominently has much to do with their popularity. Having followed these blogs for I while, I suspect that their authors’ rants and raves strike a chord with many pharmacists who can identify with their experiences and viewpoints. Being unequivocally controversial probably doesn’t hurt their popularity either.

On further searching I came upon another site, this one ranking the top 50 pharmacy blogs in the blogosphere. If you take a glance at this list you will notice one interesting pattern in the blog titles. I already alluded to this above, but to clarify many of these blogs have the word Pharmacy or Pharmacist in the title combined with some colorful adjectives.

Some examples include angry, angriest, frantic, slave, pissed, soul-sucking, and politically incorrect. I wish many of my naive peers in pharmacy school would take a look of some of these blogs to get an idea of what they are potentially getting into as pharmacists. In all seriousness, these bloggers make pharmacy seem like a profession heading downhill hell.

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Doctors, not Tradesmen

How can the drive towards standardization in healthcare delivery avoid reducing a profession to a trade?

I spent yesterday afternoon at the University Hospital as a patient undergoing a preoperative evaluation for elective orthopedic surgery next week. A fit and healthy 51-year old, my risks should be low, yet like any other patient, I worry a bit. I appreciated the systematic manner that the ~ 30-year old internist used in his discussion, examination, and laboratory evaluations.

I anticipate the same when I see the surgeon in a few days, and then undergo anesthesia and the procedure. A checklist can be comforting, the presence of failsafe measures and backup contingencies reassuring.

Every physician applauds advances that reduce errors knowing it better protects our patients and spares us the costs of our fallibility. The growth in standardization whether it be computerized reminders, checklists or algorithms should allow us to reach more patients at lower cost and with improved outcomes.

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Exploring Alternative Careers in Medicine

An edited version of previous material on this website in preparation for a new section titled ‘Answers to Physicians’ Career Questions’.

Having the Self-Confidence to Begin

What’s often construed as confidence today is more the sophomoric behavior of some braggart than the real thing. We see examples in our own profession, our political leaders, and some captains of industry. It’s a false confidence as easily punctured as a balloon and as useless thereafter. Quiet unassuming confidence is the real deal. It allows one come up short, err, or experience doubt. It allows one say; “I’ve got to think through this.”

We doctors may shrug off success and accomplishment as if we are just meeting our own and others’ expectations, while simultaneously being overly bruised by vicissitude. It’s tough for us to fail, it’s very tough for us to admit mistakes, we struggle to admit doubt. Would the humility to admit to career doubts end up strengthening our self-confidence (perhaps a paradox to some) rather than undermining it? Humility about our limitations may make us more mentally flexible, more willing to listen well, to be seen by individuals helping us as more receptive.

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Colorectal cancer screenings…

… who gets them and who doesn’t is the subject of new research out from a combined institute at UNC-Chapel Hill and the RTP-based research company RTI.

Talked to RTI’s Debra Holden who lead the study, and she says there are folks who tend not to get screened. They’re:

-low income

-less educated

-have no insurance

-Asian

-Latino

-recent immigrants (less than 15 years in the US), and therefore unfamiliar with the US healthcare system

-have limited access to care, like in rural parts of NC

None of these is particularly surprising.

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What do we need to know about flu deaths – redux

A few years ago, during the H1N1 flu pandemic, I noticed something – when someone died in North Carolina, health officials told the public next to nothing about the person or the circumstances around their deaths. Long conversations ensued with health officials about this… finally, I produced this story.

While reporting the story, I queried the listserv for the Association of Health Care Journalists (AHCJ), of which I’m a member. Universities also play their roles, and I learned that standards for death reporting by public officials varies widely. In places like Kansas, health officials practically give out addresses, while in NC, health officials say “someone” died in the state.

I questioned the need for such draconian standards of privacy protection. The rationale from state health officials was 1) compliance with HIPAA and 2) the desire to protect the feelings of families that may have recently lost a loved one. The implication was that journalists would be insensitive enough to ‘camp out’ in front of the homes of families where someone had died of flu and make things more difficult for grieving families.

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