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Washington Post Articles Bundled payments might cut hospital costs without reducing quality of care A decade and a half ago, when I started my solo practice, I would say to my routine HIV patients, "Let's see you back in three months." I was eager to fill clinic slots; also, because of my lack of experience, I felt safer seeing my patients more often. Read More Misery Loves Company, but . . . With Swine Flu Returning, Families Can Reduce Risk of Transmission Last winter, a few months before the first outbreak of H1N1 flu, my 13-year-old became ill, first with a cough and runny nose, and then with low-grade fever and nasal congestion. It was not severe enough to have her miss school, but we had her skip indoor soccer practice. A week later her older sister, who shares her room, had the same constellation of symptoms; then my wife and my youngest son. Over a three-week period I carefully tracked the passage of the virus within the family. Read More For Doctors, Rationing Care Is Standard Practice A seasoned pulmonologist shakes his head. "Let's face it, we already ration care." And, pausing ever so slightly, he begins his story. "This family of an 80-year-old gentleman came to me a few days after he was admitted into the ICU. He had end-stage emphysema. 'We had a family conference last night,' they told me, 'and we have decided that we want our father to have a lung transplant.' " The doctor shakes his head again. "They were dead serious," he says. "I took them aside and tried to explain the situation: He is 80 years old and a smoker. He can't get a lung transplant." Read More Even 'Snake Oil' Can Help Patients Heal "Our conference was being held over lunch, but Pat, a middle-aged health-care consultant, did not touch a bite of her food. When I asked if something was wrong, she revealed her lifelong battle with Crohn's disease, an inflammation of the bowels that causes diarrhea and abdominal pain. I asked what her doctor advised. With some hesitation, she told me she was chiefly being treated by someone she called her "teacher," who helped her use her use qi gong, a Chinese system of breathing and energy exercise, to manage her illness. Read More Want to Live a Bit Longer? Speak Up. "Did you know that women live longer than men?" I asked my wife. Of course she did -- and not just because, like me, she is a physician. Anybody who walks into a nursing home can see the imbalance. Most people's grandmothers outlive their grandfathers, and 85 percent of centenarians are women. So my wife nodded, without paying much attention. Read More A Skeptic Becomes A True Believer I was skeptical when my hospital embarked several years ago on an initiative to reduce the number of hospital-acquired infections in our intensive care unit. These are infections that originate from the tubes and catheters inserted into the body -- for example, ventilator-associated pneumonia, related to a tube lodged in the windpipe to assist in breathing; urinary tract infection, related to a catheter inserted into the bladder to drain the urine; and bloodstream infection, related to a catheter threaded in the veins reaching the upper chamber of the heart.Read More Once Detected, HIV Can Be Manageable Ten years ago, an intelligent, reserved software engineer -- a woman with the complexion of Halle Berry and the physique of a marathoner -- came to my infectious-disease clinic, accompanied by her fiance. They'd been referred to me a few weeks after a rash and pneumonia prompted a clinic doctor to test the woman for HIV. The test came back positive. Her fiance, tested later, was HIV-negative. Read More Patients Can Join the Fight Against Flu Without Firing a Shot Last month at a luncheon marking International Infection Prevention Week at the National Press Club, some speakers reminded me of a shameful and frightening statistic: Almost 60 percent of American health-care workers do not receive the flu vaccine. Let me put that in context: Influenza, commonly called the flu, strikes 5 to 20 percent of Americans annually. In an average year, more than 200,000 people are hospitalized with flu complications; nearly 36,000 die, either from the flu itself or from complications such as pneumonia or a heart attack. Read More Elective Surgery Is One Thing, Elective Politics Another A few weeks ago, as I was making rounds on the oncology floor, one of my patients asked, out of the blue, "Hey, Doc, who you gonna vote for?" Equal Treatment for the Uninsured? Don't Count on It. When I walked into the hospital room of a 19-year-old woman, a foul smell all but overwhelmed me. I called a nurse to assist me and saw her, too, catch her breath.When we examined the young woman we found a chronic infection of her pelvis so painful that she resisted our slightest touch. Read More
From the patient's point of view, doctors and hospital officials can seem to be a monolithic medical power structure. But in fact, physicians and administrators often do not see eye to eye. Read More
One morning on hospital rounds, I saw a physician colleague enter the intensive care unit where a patient lay intubated and sedated. With his hands unwashed and ungloved, the physician palpated the patient's abdomen, scratched his own head and then placed his stethoscope on the patient's chest to listen to his heart. Then he walked to the nurses station, rubbed his nose and entered a note in the patient's chart. Read More
Last summer, my oldest daughter, Sapna, passed a multiple-choice driver's exam, secured a learner's permit and asked to sit in the driver's seat. This was a source of concern for me. As an epidemiologist, it is my job to look at incidence and prevalence of disease in large populations and suggest ways to keep people healthy and safe. I know that motor vehicle crashes are the leading cause of teenage death, accounting for more than a third of the fatalities in this age group. Read More Doctors Can Be Doubters My patient is an elderly man with end-stage congestive heart failure, kidney failure and now an infected dialysis line, and he is unlikely to live more than six months. The Bible lies on his bedside table next to his hospital breakfast tray and the morning newspaper. I wonder if I should pray with him. Read More A Doctor's Viewpoint Changes When the Patient Is His Father Each morning as I head for my morning rounds, I routinely hurry through the hallway alongside the cardiac catheterization lab not noticing what goes on inside. But, this morning it was different. On the table, under the x-ray beams, with a catheter tunneled into the arteries of his heart was my father. Read More
Honestly, I Could Not Help Him My patient had come for a routine doctor visit. He was a well-built, soft-spoken middle-aged man who was always polite, respectful and adhered meticulously to his HIV medication. He complained only if he was in a great deal of pain or discomfort. As usual, I asked him about his family: three adopted children. Over the years that I had known him, the children had grown to adults and had left home. One had secured a job, the second was in college, and the third had just joined the Marines. We talked about his work; he sorted packages at a warehouse. We chatted about the weather and then turned to his health. How I Learned to Treat My Bias At our hospital in Tennessee not long ago, I saw my picture on the hallway message board alongside those of other doctors in a display thanking us for our service. My Asian-Indian complexion set me apart -- it's something that I am rarely conscious about in everyday life. It got me thinking: When I walk into the room, do my patients see me as a foreigner? Then I wondered: When I walk into a room, how do I see my patients? |
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