Humor

Obsessive compulsive disorder (OCD) is both familiar and common.  This week in the office, I came across a manifestation that I think warrants reporting. I call it the Spam Sign.

Quality in the EHR is a zero-sum game, involving a balancing act among three key but competing needs: scope, resources and usability.

I did my family practice residency in a Catholic hospital in the mid west. The strong presence of nuns in leadership and the quiet influence of the attached order and Catholic school lent an unmistakably religious atmosphere to the hospital. Mostly, as residents, we were too busy and too tired to either notice or care, but occasionally the interface between the hospital’s spiritual context and the world of patient care was uncomfortable. Even jarring.

We see lots of skin problems in primary care. 

Poor communication is the commonest cause of poor outcomes in medicine. Taking things for granted instead of asking questions is one form of poor communication.

Some of the things we learn during our medical training are startlingly obvious, but only after we have learned them.

My parents never yelled, let alone spanked. We always understood what was expected of us and feared failure rather than punishment. They expressed disappointment far more often than they showed anger. They often asked us to devise our own punishments. And, perhaps above all, they were masters of the object lesson.

I recently received an email from my employer, with a link and a request to fill out a short survey evaluating a new service available to our patients. I had a brief gap between patients, so I clicked and did the six questions. As I hit submit, it occurred to me that the survey seemed familiar. Hmmm. Looking back in my older emails, I found that I had received a similar request from the same group about 2 weeks earlier, with the same link. I contacted the person who had sent the second email.

Osler, often referred to as the Father of Modern Medicine famously said: "If you listen carefully to the patient, they will tell you the diagnosis.” He emphasized both the value of a careful history in medical diagnosis and the value of learning from one’s patients. Ask any practicing clinician and they will have anecdotes that illustrate how right he was. One stands out for me.

In 2004, Dr. Lawrence Huntoon wrote an editorial (in the Journal of American Physicians and Surgeons Volume 9 Number 3 Fall 2004) expressing concern about the potential abuse of ‘disruptive physician’ clauses being added to many medical staff Bylaws. Below the fold is my updated version of the poem (Memo to the Disruptive Physician) included in his editorial.

Memo to the Disruptive Physician