Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge conversations that aren’t about sports, Wall Street, or ObamaCare. Consultants hate being asked clinical questions out of context; they know that they may give incorrect advice if the [...]
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The Patient Will Rate You Now
These days, I’d never consider trying a new restaurant or hotel without reading the on-line ratings on TripAdvisor or Yelp. I seldom even bother with professional restaurant or travel critics. Until recently, there was little patient-generated information about doctors, practices or hospitals to help inform patient decisions. But that is rapidly changing, and the results [...]
A Pay Within a Play: The Awkward World of Private Insurance in the UK
I remember reading an article that observed that systems of universal insurance – which need to put their energy into providing a “decent minimum” for the masses – must also offer a “safety valve for the wealthy disaffected.” Canada bans private insurance for basic hospital and medical care services. So, when affluent Canadians want “the [...]
“I’m the Main Breadwinner”: The British Primary Care System and Its Lessons for America
I’ve heard a lot of shocking things since arriving in England five months ago on my sabbatical. But nothing has had me more gobsmacked than when, earlier this month, I was chatting with James Morrow, a Cambridge-area general practitioner. We were talking about physicians’ salaries in the UK and he casually mentioned that he was [...]
Summer in London: First Impressions
First of all, let’s get the important stuff out of the way. Mom, I’m fine. Thanks for your concern. Really. I’ve now been in London for about 6 weeks on my sabbatical. The recent riots here are all folks are talking about and the trauma is real. One wonders whether the inevitability of budget cuts, [...]
Letter From London
I’ve just returned from a few days in London, scoping things out for a planned sabbatical next fall. In what may be a pale echo of the late Alistair Cooke’s always fascinating “Letters From America,” here are a few of my initial observations: The dominant issue, of course, is the Cameron government’s new austerity program, [...]
“If There’s a Doctor on Board, Please Ring Your Call Button”
Well, it happened again. Last Thursday evening, I was somewhere over Saskatchewan, returning from a lovely Mediterranean cruise, in that uncomfortable semi-conscious state that passes for sleep when you’re flying coach, when the airplane’s PA system rang out: “If there’s a doctor on board, please ring your call button!” If you’re old enough to remember [...]
Atul Gawande and the Art of Medical Writing
Don’t read this. That is, if you have a limited amount of time for reading today, I’d rather you read Atul Gawande’s essay on end-of-life care in this month’s New Yorker than this blog. But if you can spare a little time, I’ll be focusing on some of the techniques Gawande uses to make his [...]
The Times Hits the Right Notes on Hospitalists
You probably saw yesterday’s hospitalist piece in the New York Times, arguably the best lay article on the movement to date. It hit all the right notes, and did so with uncommon grace and fairness. The piece, written by the Times’ Jane Gross, profiled Dr. Subha Airan-Javia, a young hospitalist at the Hospital of the [...]
Verb-alizing
One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called [...]
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