Stop talking about millennials
Had dinner last night with some medical students, and made the comment that current students really do not differ significantly from my class of 1975. A story about a physician criticizing young physicians in the doctor’s dining room stimulated the thought.
I have worked with medical students as an attending physician for 36 years. Unless I am fooling myself, I can see no difference in their attitude from when I started. But many write about how we must treat millennials differently. Am I missing something.
This wonderful article by my friend Dr. Gurpreet Dhaliwal – The Greatest Generation – com...
Source: DB's Medical Rants - April 5, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Is it time to reconsider the cholesterol hypothesis?
This post is purposely controversial. I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue. This post is hypothesis challenging. I may be right or I may be wrong. I hope we get some debate on my speculations.
The latest blow to the cholesterol hypothesis – Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart Health
“We had an agent that seemed to do all the right things,” said Dr. Stephen J. Nicholls, the study’s principal investigator and the deputy director of the South Australian Health and Medica...
Source: DB's Medical Rants - April 4, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Volume matters
Ran into a radiology colleague today. He will retire soon, and was happy to discuss the stress on radiology. I have observed more interpretation errors (or at least I think I have) over the past 5 years. We now strongly stress that the learners review all films and question radiology reads.
My friend opined that volume expectations have become “unsustainable”. We order too many imaging studies. When you ask physicians to “ramp up the volume”, they make errors. As he described volume expectations and the impact on his field, I immediately categorized his laments as the same laments we he...
Source: DB's Medical Rants - March 30, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
When did we stop talking about diagnosticians
Sitting around the philosophy table at my golf club this past week, some octogenarians started talking about physicians. They reminisced about several physicians, labeling them as great diagnosticians. I love the label, and now wonder where it went.
As a college student I remember hearing my parents friends use the term great diagnostician to describe physicians. So I asked the octogenarians about the term. They (and the younger philosophers) told me that as patients and family members of patients a correct diagnosis was their highest priority. This opinion was unanimous (and nothing is unanimous at the philosoph...
Source: DB's Medical Rants - March 23, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
The importance of a positive culture
This year marks 33 years of administrative positions in academic medicine. When I first started, I suspect I made many major mistakes. I learned through the time tested school of hard knocks. As I reflect on my own career, and those whom I have observed, I have come to believe the famous saying, “Culture eats strategy for breakfast“.
Look at ward attending physicians. The same attendings have “good teams” every time they attend. Their teams get the work done and thrive. The learners learn and progress. The same IM attendings have a greater percentage of students choose internal medicin...
Source: DB's Medical Rants - March 22, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
@LakeStreetDive – an appreciation #notmedicine
This blog usually focuses on medicine, either clinical stories/problems, or health care policy. But today I want to write something totally different.
Over the past 2 days I have become obsessed with Lake Street Dive. How I became obsessed may have some lessons.
I love music, and believe I always have. Since the 50s and 60s I have had serial and parallel music romances. I still remember the initial Beatles performances on the Ed Sullivan show – I was smitten. As I recall those days, their musical freshness captivated me. Throughout the years, I periodically get attracted to performers and groups
Some of m...
Source: DB's Medical Rants - March 19, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Why P4P can hurt patient care
For years I have railed against P4P. The concept seems so right to the wonks and politicians. The concept seems right if you have shallow thinking. If you ask practicing physicians to do a pre-mortem analysis on how P4P would fail, they would have understood.
Last week in my favorite thought provoking blog (Farnam Street), they published a wonderful piece that explains the problem well – The Distorting Power of Incentives. While I hope you read that post, I will provide the essence.
Understanding incentives comes through second-and-third-level thinking. Many incentive systems have backfired because people fa...
Source: DB's Medical Rants - March 16, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Whither the master clinicians
Yesterday’s post on our responsibilities to students and residents struck a nerve. One comment shared this wonderful post – A letter to the Master Clinician.
In my career as a student and physician-in-training, the teachers who inspired me to become an Internist and a Nephrologist were all Master Clinicians and spent a lot of time with us – showing us physical examination skills, ways to think through tough cases and how to balance family and residency life. As a community of young physicians, we would like to extend an invitation to you to return and show to us your skills and enthusiasm. We understan...
Source: DB's Medical Rants - March 10, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
What medical students and residents deserve
An anonymous medical student has this post on KevinMD – A star medical student feels like he made a terrible decision.
And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where they limit their involvement with patients: dermatology, radiology, ophthalmology, anesthesiology. It begs the question: why are these the happiest, the most high-salaried, and patient-limited specialties? They all must have a connection.
He goes on to la...
Source: DB's Medical Rants - March 9, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
The ethics of performance measurement
For years I have argued that performance measurement has significant potential for unintended consequences. But today, I read an article that crystallized my concerns in an important new light. The article is written about the ethics of studying work hours – Leaping without Looking — Duty Hours, Autonomy, and the Risks of Research and Practice. As I read the article, the implications of the ethical arguments stimulated my thoughts about performance measurement. While I hope you will read the entire article, these lines have particular relevance here:
Bioethicist and legal scholar Michelle Meyer has describ...
Source: DB's Medical Rants - February 25, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Improving patient experience – within reason
My friend, Dr. Gurpreet Dhaliwal, has a most interesting opinion piece in the Wall Street Journal today – If Only Health Care Would Focus On This One Thing
In this post he suggests that we should not worry about multiple aims (the triple aim or the quadruple aim), but rather focus health care design and delivery from a patient perspective. He writes:
In health care, our keystone habit should be taking the patient’s perspective. If we could develop the habit of always seeing health care from the perspective of the patient, we would have one guiding principle – not four – for the tough decisions and trade-offs...
Source: DB's Medical Rants - February 18, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Since when is medicine about productivity?
45 years ago I entered medical school to join the medical profession. My father, a psychologist, always expressed great admiration for the medical profession. He strived to convince psychologists that they should hold their profession to the same standards as medicine.
If he were still alive, I can only imagine his commentary about the following common topics – productivity, RVUs, performance scorecards and our inane documentation rules. Productivity has several definitions. Economists define it:
the rate at which goods and services having exchangevalue are brought forth or produced :
When did our professi...
Source: DB's Medical Rants - February 14, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
The heroin epidemic – some thoughts
As a medical student and resident, I saw many heroin addicts. We got used to managing right sided endocarditis and overdoses. That epidemic diminished greatly until recently. Susan Collins points out the likely source of the current epidemic – Susan Collins cites possible tie between hospital patient surveys, overprescription of opioids.
“In the meantime, however, we are concerned that the current evaluation system may inappropriately penalize hospitals and pressure physicians who, in the exercise of medical judgment, opt to limit opioid pain relievers to certain patients and instead reward those who prescri...
Source: DB's Medical Rants - February 10, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
A teaching secret #meded
Recently, I participated in a panel discussion. During the discussion I stressed the importance of humility in teaching. I challenged the teachers to ask their learners questions about the topic they taught the previous week. If the learners did not remember the lesson, the teacher should take responsibility. Our job is to induce learning.
We can give a brilliant talk on a subject, but if the learners do not absorb the lesson, then we have not succeeded. The purpose of teaching is helping the learners.
Too often early in my career I had pride in my ability to lecture in small groups and large groups. I misunder...
Source: DB's Medical Rants - February 7, 2016 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Source Type: blogs
One physician’s journey to direct primary care – a burnout tale
Donald Ross (an obvious pseudonym) has practiced in a medium sized town for around 20 years. I count him as a protege as we worked together during his residency. As a clinician educator, we work with many interns and residents and sometimes we develop lifelong relationships. Donald Ross and I share a love of golf, ACC basketball (although we root for rival teams), and internal medicine. We periodically communicate through Facebook.
Recently, he posted on Facebook that he was leaving his current group practice to start a retainer practice. I have visited him as a guest lecturer in the past, and we either talk or e...
Source: DB's Medical Rants - February 5, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
