Doctors, not Tradesmen

How can the drive towards standardization in healthcare delivery avoid reducing a profession to a trade?

I spent yesterday afternoon at the University Hospital as a patient undergoing a preoperative evaluation for elective orthopedic surgery next week. A fit and healthy 51-year old, my risks should be low, yet like any other patient, I worry a bit. I appreciated the systematic manner that the ~ 30-year old internist used in his discussion, examination, and laboratory evaluations.

I anticipate the same when I see the surgeon in a few days, and then undergo anesthesia and the procedure. A checklist can be comforting, the presence of failsafe measures and backup contingencies reassuring.

Every physician applauds advances that reduce errors knowing it better protects our patients and spares us the costs of our fallibility. The growth in standardization whether it be computerized reminders, checklists or algorithms should allow us to reach more patients at lower cost and with improved outcomes.

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Exploring Alternative Careers in Medicine

An edited version of previous material on this website in preparation for a new section titled ‘Answers to Physicians’ Career Questions’.

Having the Self-Confidence to Begin

What’s often construed as confidence today is more the sophomoric behavior of some braggart than the real thing. We see examples in our own profession, our political leaders, and some captains of industry. It’s a false confidence as easily punctured as a balloon and as useless thereafter. Quiet unassuming confidence is the real deal. It allows one come up short, err, or experience doubt. It allows one say; “I’ve got to think through this.”

We doctors may shrug off success and accomplishment as if we are just meeting our own and others’ expectations, while simultaneously being overly bruised by vicissitude. It’s tough for us to fail, it’s very tough for us to admit mistakes, we struggle to admit doubt. Would the humility to admit to career doubts end up strengthening our self-confidence (perhaps a paradox to some) rather than undermining it? Humility about our limitations may make us more mentally flexible, more willing to listen well, to be seen by individuals helping us as more receptive.

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Colorectal cancer screenings…

… who gets them and who doesn’t is the subject of new research out from a combined institute at UNC-Chapel Hill and the RTP-based research company RTI.

Talked to RTI’s Debra Holden who lead the study, and she says there are folks who tend not to get screened. They’re:

-low income

-less educated

-have no insurance



-recent immigrants (less than 15 years in the US), and therefore unfamiliar with the US healthcare system

-have limited access to care, like in rural parts of NC

None of these is particularly surprising.

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What do we need to know about flu deaths – redux

A few years ago, during the H1N1 flu pandemic, I noticed something – when someone died in North Carolina, health officials told the public next to nothing about the person or the circumstances around their deaths. Long conversations ensued with health officials about this… finally, I produced this story.

While reporting the story, I queried the listserv for the Association of Health Care Journalists (AHCJ), of which I’m a member. Universities also play their roles, and I learned that standards for death reporting by public officials varies widely. In places like Kansas, health officials practically give out addresses, while in NC, health officials say “someone” died in the state.

I questioned the need for such draconian standards of privacy protection. The rationale from state health officials was 1) compliance with HIPAA and 2) the desire to protect the feelings of families that may have recently lost a loved one. The implication was that journalists would be insensitive enough to ‘camp out’ in front of the homes of families where someone had died of flu and make things more difficult for grieving families.

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