Are We Witnessing The Death of the Modern-Day Physician?
Pamela Wible recently wrote a provocative article on KevinMD regarding physician suicide. In the seminal piece, she conducts “psychological autopsies” on 3 physicians in training who had taken their lives. She searches for answers and suggests solutions for what has become a problem of epidemic proportions. Whereas her focus on the individual is laudable and instructive, I would like to apply her technique to the profession as a whole. While some physicians are committing suicide or becoming addicted to drugs, others are leaving in less-devastating but still consequential manners: early retirement and nonclinical caree...
Source: In My Humble Opinion - December 30, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Is Less Actually More? Should Your Physician Be A Plumber Or A Violinist?
It seems everywhere you look in health care today, some consultant is telling you that "less" is actually "more". Less care leads to more quality. Less expense brings better outcomes. Nurse practitioners with less training are more cost effective. Less work hours for residents builds a safer hospital environment. Never in our entire history have we gotten so much for so little.A recent article on KevinMD by Arshya Vahabzadeh asks whether shortening medical school is a good idea. A fairly nuanced piece, a balanced viewpoint is given. I was particularly interested in the conversation ...
Source: In My Humble Opinion - December 29, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Is Maintenance Of Certification a Tipping Point? #DisagreeMOC
Physicians are docile. We are programmed to put the greater good above our own. We train mercilessly, work tirelessly, and bend faithfully at the alter of those we have vowed to heal. This is our birthright. This is the covenant we signed in our own blood when we took our healing oath. Decry us as they will, no one becomes a physician to make money. No one devotes decades of education and hardship to take advantage of the system. There are just too many easier ways to defraud. Easier ways to earn a buck.Accordingly, physicians have been far too accommodating. Rather th...
Source: In My Humble Opinion - December 23, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
To Be Noticed Immediately and Judged Subconsciously
I think I will carry two things with me from this experience.My body dropped. Almost instantaneously. One minute I was jogging next to my wife, the next my mouth and nose were hitting the pavement. I must have slipped, my foot must have caught. There was no time to anticipate the pain, not even a millisecond to reach out my arms to cushion the blow. Moments later, I felt the sting upon my upper lip and the taste of blood. I rolled back and forth on the ground trying to shake off the searing heat arising from my face. My wife dropped to the ground to comfort me. Pedestrians stopped inquis...
Source: In My Humble Opinion - December 22, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Idolatry
Julie was lost in thought.Her right pointer finger slowly traced the edges of the metallic trinket. It was tucked far enough into her pant pocket that only the longest digit could reach. Back and forth, her hand moved caressingly, pausing from time to time to inspect any irregularity, any imperfection. In such a manner Julie built a mental image of the old forgotten piece of jewelry. Her hands visually occupied a space that her eyes had long abandoned.There was not much to the frigid, sterile room A few rickety chairs. A worn carpet. Some posters placed haphazardly on the wall. The...
Source: In My Humble Opinion - December 18, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
A Year Of Concierge Medicine
A year ago, I embarked on a voyage at the leading edge of modern-day health care. I abandoned my traditional office-based practice of 2000 patients for a much smaller membership (concierge) model. My reasons were varied. They mostly focused on the dwindling time and concentration afforded by so-called “advances” in medicine, such as electronic medical records and the ever-increasing deluge of paperwork that plagues today’s physician. As I begin year 2, I would like to share a few things I have learned...Please read the rest of my post at The Medical Bag. (Source: In My Humble Opinion)
Source: In My Humble Opinion - December 17, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Attention #HCSM Meeting Planners. Would You Like Me to Speak At Your Event?
The only thing better than blogging is having the chance to tell one's stories in person. While I have been asked to speak at a number of events over the years, I have developed a new talk that I am especially itching to give to a live audience. I expect it will have all the emotion and impact of the DotMed 2013 appearance below.DetailsTopic/Running Title: The Medical Narrative, A Tie That Binds Doctors and PatientsStyle: TED style, no visuals, no notesContent: Narrative heavy, didactic lightRunning Time: 15-20 minutesRequirementsWill accept multiple offers, but will give video rights only to one.Need a few mon...
Source: In My Humble Opinion - December 10, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
A Small Island Next to a Hulking Continent; A Parable
There once was was a kind humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients. He was open and deliberate, calm and thoughtful. He himself hired every secretary and medical assistant, every nurse and biller. His staff formed a protective family who fiercely advocated for both patient and doctor.And he prospered. For a time.The winds of change were slowly gaining force in his small town. His beloved hospital joined a larger medical Goliath. His fellow practitioners abandoned thei...
Source: In My Humble Opinion - December 9, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Good Luck to the #dotMED14 Crew, @RonanTKavanagh
I don't go to healthcare social media conferences that often. There are three partial reasons for this. First, I don't have much time. Second, I'm usually too cheap to pay for it. Third, I only tend to go to those meetings that I am asked to speak at. I'll let you decide which of these three is truly the rate limiting step. The DotMed 2013 conference, however, was an exception. I was asked ( I also begged/pleaded/cajoled some people-you know who you are) to come to Dublin and speak on the topic of narrative medicine and social media. The trip was magical. Dublin was everything I co...
Source: In My Humble Opinion - December 4, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
What If Our Healthcare System Made Sense?
The conversation was almost comical, until I thought more deeply about it later. Apparently I was on "the list". Insurers make such lists for customers who are searching for a doctor who accepts their coverage. Every so often my name comes up on these lists, and I get a smattering of phone calls from perspective patients. Maybe a few times a year.This particular call came around three thirty in the afternoon. My personal assistant had already signed over the phone to me, so my office number came right to the mobile. I answered quickly expecting one of the nursing homes. The voice o...
Source: In My Humble Opinion - December 1, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Coming Up Empty. Does The Government Look Before It Leaps?
A few months ago I assessed a patient with dementia. I dutifully ordered the appropriate blood testing and MRI. As I delved further into the history, I was concerned that there may be a component of depression. Pseudodementia (memory disturbance and dementia like symptoms caused by depression) can often mimic classic Alzheimer’s disease, but resolves with proper treatment. The best way to differentiate these two syndromes is neuropsychological testing. I decided to send my patient to a colleague whom I had been working with for years. He had recently joined a large multi...
Source: In My Humble Opinion - November 24, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
The Not So Humorous Unintended Consequence of Healthcare Reform is Monopoly
CheckThe administrator's voice wavered as I picked up the phone. He was calling about the nursing home patient that I admitted the day before. While normally forthright, I could feel the discomfort in his tone as he danced around the issue. The patient's insurer had called. Apparently they made an "arrangement" with the Mega ACO owned by the latest consolidation of Goliath health systems. They wanted my patient transferred to another doctor. Apparently the insurer now required all it's patients to be seen by only medical group physicians. The administrator was almost whispering now.The t...
Source: In My Humble Opinion - November 18, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
You Are Not Your Data
A few weeks ago, @drmikesevilla (Mike Sevilla) live tweeted a slide from Eric Topol’s (@EricTopol) talk at the American Academy of Physicians' 2014 annual meeting. The slide, a picture of a young man with transparent numbers and data points outlining his face, is silhouetted by words in bold black print: YOU ARE YOUR DATA. This sentiment was a throwback to Dave deBronkart’s (e-Patient Dave’s) 2009 keynote address for the Medicine 2.0 Congress in Toronto titled “Gimme my damn data, because you guys can’t be trusted.”The idea is that a person’s ability to understand and control their medical...
Source: In My Humble Opinion - November 17, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
My First Patient Was A Mouse
I didn't think much of it at the time.Most physicians can trace back and recall their first patient. For some, it is a clinical encounter the third or fourth year of medical school. The more creative may point to their cadaver during first year anatomy and nod knowingly. My first patient was a mouse. Or shall I say a group of them?My freshman year of college, I volunteered in the lab of a prominent endocrinologist and studied a new drug to reverse the course of type 1 diabetes. We monitored genetically bred, non obese, diabetic mice. Every day we would reach into their cage and grab the...
Source: In My Humble Opinion - November 11, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Sadness On The Side
The calls came simultaneously. One from the hospital and the other from a nursing home. Two deaths separated by fractions of a second. My heart swelled. For a moment. The pile of papers on the desk softly whispered. My mobile howled jealously vying for my fragile attention. I could feel the emotion drain as I turned back to the task at hand. Unexpectedly, my mind wandered back to the wedding in California.It was a spectacle. Pre-ceremony hors d'oeuvres with sushi stations and Kabobs. An open bar long before the utterance of the first I do. The wedding ...
Source: In My Humble Opinion - November 4, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
