OF ALL THE PEOPLE impacted by President Donald Trump’s executive order suspending immigration from seven Muslim-majority nations, one group is of particular importance to the U.S. health care system: foreign-born doctors and medical trainees.
About one-quarter of the physician workforce is comprised of international medical graduates—280,000 doctors in total, according to the American Medical Association (AMA). Many are here on temporary J-1 or H1-B visas, which are affected by the travel ban.
These doctors help to correct a critical shortage in primary care providers, particularly in rural parts of America. Several factors, including the relatively static number of U.S. residency slots, the expansion of insurance coverage...
DURING THIS RECENT emotional and divisive election cycle, much ink was devoted to analyzing the brave new political world we now live in, a world in which just about anyone with an audience and a platform can issue statements that are accepted as fact by millions of people, often in the face of solid evidence to the contrary.
Two major events in Western politics, the election of Donald Trump and Brexit, the U.K.’s vote to leave the European Union, have seen the elevation of personal belief to a throne once occupied by cold, hard truth, as well as the concomitant devaluation of facts to a mere subjective haziness. It used to be that only beauty was in the eye of...
The attending is chewing out the cardiology fellow, who came on duty just a half hour ago, for something that is not his fault. He—the attending—had asked the overnight fellow to place a pulmonary artery catheter in a patient, only to return in the morning to find that it has not been done.
"That's the problem with you guys these days," he complains. "Everything is just shift work for you—if you don't feel like doing something, you dump it on the people coming on after you."
This attending, though not of the House of God generation, was still old enough to have trained in the days before duty hour restrictions, before terms like "work-life balance" and "wellness" had worked their way into the...
The same day, the American Medical Association issued a press release enthusiastically endorsing Price for the position.
The next day, Dr. Andrew Gurman, the president of the AMA, came to my hospital to give grand rounds. He was shouted down by protestors in the audience, who demanded an explanation for his organization’s support of a public official committed to dismantling the Affordable Care Act and revoking the health insurance of millions of people.
IN THE YEARS since the medical community first got revved up on the idea of “value-based care”—the conceptual antithesis of the “more is better” fee-for-service model—a common target of criticism has been the “routine” physical, one of the most time-honored traditions in medicine.
The attacks come from all angles: The annual check-up isn’t cost-effective, it doesn’t lead to better outcomes, it actually might lead to worse outcomes, it’s a waste of doctors’ time, it’s a waste of patients’ time.
Such is the hostility toward the yearly physical that the Society of General Internal Medicine, as part of the Choosing Wisely campaign, recommended against routine check-ups for asymptomatic patients.
ON THE WAY to work the other day I heard a radio commercial advertising a local hospital network’s cardiac care services. In it, a patient’s daughter related her overwhelmingly positive experience with the hospital team that treated her 90-year-old father with a transcatheter aortic valve replacement (TAVR), a minimally-invasive alternative to open heart surgery.
It was a good commercial. It had all the elements: “I was worried at first, the doctors earned my trust, the surgery went well, everyone was so nice, now Dad is back at home and doing all the things he used to do, thanks to Hospital X.”
The problem with commercials like these is that they’re misleading, and they don’t really tell you anything at all about the hospi...
THINK KEEPING your life organized is hard? Try keeping your doctors organized.
In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves—a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.
How many times have you found yourself in this situation: You have a patient in front of you who is a “blank slate,” so to speak—no notes in your EMR, no labs, no imaging. The only information you have to go on is what comes out of her mouth (or, in some cases, history that the family offers). If the patien...
EVERY FEW MONTHS I see this video pop up on the social media feeds of doctor friends, mainly emergency physicians, with some approving caption along the lines of, “This is my life.” The video depicts, in overly dramatized and satiric fashion, patients presenting to the ED with various non-life-threatening conditions, among them an ingrown toenail and nasal congestion. The message: Don’t come to the emergency room if it’s not absolutely necessary.
The video is a product of the government of Queensland, Australia, and is one of several that it has released in an attempt to stem the flow of patients into its emergency departments. Each video implores patients to exercise restraint and consider alternatives to emergency care, such as...
NOW THAT the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself and our legislature will again fail to enact any meaningful reform.
Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why this is, and what can be done about it, are topics for another day.
The more morbid—but, I believe, essential—question to ask is, When a citizen is struck by a bullet from one of those sacred guns that the NRA and its allies in Congress have worked so hard to protect, what rights do we extend to that person?