For content related to the science and practice of medicine
Since I retired, I have repeatedly been asked two questions. “How do you like retirement?” and “Don’t you miss practicing medicine?”
Imagine that you want a boat. You tell someone to build or buy you a boat, and tell them to send you a bill. What would you get? A kayak? A windsurfer? A boat for waterskiing? A sailboat. A party boat? A cruise ship? A submarine? A battleship or destroyer? You probably would not get what you want. Very likely you would end up with something expensive - that you cannot use.
Before you build or buy a boat, you need a defined goal and a process:
This is a repost of something I wrote in 2012 about how I discovered that doing collaborative officie visit notes with patients transformed the process for both the patient and myself.
Nearly a year ago I embarked on an adventure that has been changing how I practice medicine. It is also changing how medicine feels.
To parallel my Ten Principles for Clinicians, I offer the following suggestions to patients:
You are about to have the honor and great pleasure of working with a group of patients I have come to know and respect over the years. While I cannot tell you how to practice medicine, I feel no reluctance to tell you what made it so worthwhile for me.
Some of the best and most unexpected moments I’ve had in medicine have involved children.
Sitting on her mother’s lap while I elicited the story of her illness, this particular three year old had seemed relaxed, social and quite articulate. Taking a cue from how attached she seemed to be to Mom and her obvious unusual maturity for age, I tried to be clever when it came time for the exam. “Do you want your Mom to help you up onto the table so I can check your ears and lungs, or are you big and strong enough to do it yourself.”
The computer generated routing slip on the exam room door said he was there because of a knee injury. That turned out to be only partly true.
When I entered the room, he was sitting comfortably on the exam table. I introduced myself, we shook hands, and as I sat down at the computer to open the EHR to his chart, I started with my usual fairly open-ended question:
Me: So, what brings you in today and how can I help?
Him: I hurt my knee this past weekend. (Note: this was a Wednesday.)
Me: Tell me about it.
I see and hear about more and more unhappy physicians, some of whom become happy former-physicians. It makes me reflect on my own circumstances.
Research suggests that the four major underlying contributors to physician dissatisfaction and burnout are
I received a memo recently from an institution, extolling the virtues of its screening programs. It was entitled:
Screening Saves Lives.
It was in large block capitals. I call bullshit on this. Screening does not save lives. FULL. STOP.
A recent article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just and her story is compelling, so I was dismayed at the pushback saying: Not so fast.