My blog represents my personal experiences and perspectives. This includes many anecdotes from my life and from my medical practice. I have been scrupulous to anonymize all medical anecdotes and to avoid ever belittling or making fun of patients. (I often make fun of and criticize myself, my colleagues, and the institutions where I have worked.)
Leadership can focus on making sure everyone does their job. Or leadership can focus on making it easy for everyone to do their job. The former is more common, the latter is more effective.
I recently finished reading Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together by Peter Ubel, MD. It should be required reading for all the following...
In medicine, unlike much of the world, it is the questions one doesn’t ask that lead to trouble. When taking a medical history, the biggest enemies are time and fear. Time, because there is never enough to ask all the questions, listen carefully to all the answers, and pursue all the possible clues. Fear, because the natural reluctance to ask certain questions is a trap.
I was taught that being an asymptomatic carrier of strep in the throat was not associated with either illness or risk of complications. That’s not always true. The schedule said ‘strep throat x 5 weeks and diarrhea.’ Handing me the encounter form, my nurse warned me: ‘Mom’s not a happy camper.’
Teaching to the test is controversial. It helps students pass tests and makes educational programs look successful, but everyone knows it does not guarantee improved education.
It is ironic that evidence-based medicine was introduced, not to eliminate variability, but to ensure that variability was both present and appropriate.
After reading this excellent study in the BMJ showing no benefit and some risk of harm from annual mammographic screening for breast cancer (see also this discussion in the NY Times) I suggested to a local institution that they should reconsider their Pay for Performance (P4P) initiative which penalizes their clinicians (by lowering their pay) if thei
Quality in the EHR is a zero-sum game, involving a balancing act among three key but competing needs: scope, resources and usability.
It seems I come across a pessimistic article like this at least once a week.
He had called and asked for medication for his cholesterol because he had been told by his wellness program at work that he needed to be on medication for his cholesterol to prevent a heart attack. He didn’t understand why he needed to take time off work to come in and discuss the risks, benefits, and options before I would prescribe anything. And he was irritated that his wife was making a big deal about it.