Mental Calculus
He would describe himself as sensitive. Not as in a lack of confidence, but more like able to tune into the feelings of the people around him. It is probably why he became a physician. A lover of math, he tripped on the mental calculus. How many wins were needed to make up for each loss? How many lives would transform a death. Even Michael Jordan missed a shot occasionally. You can't tell me that Babe Ruth didn't strike out from time to time.
He liked to daydream about powerlessness. It would be so much easier if medical science were impotent. He then could m...
Source: In My Humble Opinion - July 25, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Does Ezekiel Emanuel Think We Are Weenies?
Tilburt et al published a study in JAMA this week suggesting that physicians feel that other players (lawyers, insurance companies, hospitals, etc) are more responsible than doctors for reducing healthcare costs. Furthermore, they are hesitant to promote reforms that eliminate the current fee for service payment system.
Although I would bet the no one would be surprised by these findings, a scathing editorial by Ezekiel Emanuel and Andrew Steinmetz caught my eye. Before I get to the particulars, I would like to make a few (hopefully mostly uncontested) observations.
1)Physicians are some of ...
Source: In My Humble Opinion - July 24, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Unlikely Miracles
We were pretty damn lucky that she was young and healthy.
The surgery had been technically successful. I watched as the resident finished with the last sutures. Although the attending had already left the room, I looked on with the eagerness of a third year student. Orders were written, and the patient was transferred to recovery.
It was a routine hysterectomy. None of the pizazz and flare of a gyne onc surgery, but at such an early stage in my career, I thought I was witnessing rocket science. We left the OR and rounded for the rest of the afternoon. As I hunkered in for&nbs...
Source: In My Humble Opinion - July 20, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Should Lawyers Be The New Doctors?
Dear patients,
It has been a hard week. I wanted to take a moment to personally apologize for all that you have endured. As one who has witnessed your pains and struggles, I can only wince with each new passing hurdle you are forced to leap over. This business of disease and illness is not for the weak of heart (metaphorically, that is).
To the man stranded in the hospital with a pelvic fracture, I wanted to say I'm sorry. Contrary to what you have been told, it was not I who gave the order to make your admission an observation. In fact, I did just the opposite. I had clicked the full admission order while doing the requ...
Source: In My Humble Opinion - July 17, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Happy Birthday To Me
The guy hobbling into my office was literally a lifetime ahead of me. On the day of our visit, he was turning eighty and I forty. We shared a birthday. Things started as usual, an exchange of pleasantries and and then on to medical issues. What really concerned him that day, however, was his son. He still hadn't got married yet. Then there was his garden, his tomatoes were over watered.
We chatted easily as I finished my exam. His blood pressure was stable and his diabetes was controlled with diet only. I pushed my computer to the side and took a long look at him. He was exactly what most of us strived to be. Healthy and...
Source: In My Humble Opinion - July 12, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Are We Legislating A Primary Care Crisis?
It was the same years ago in residency. There was both a categorical and primary care residency track. Each had their own distinctive curriculum and rotation schedule. The outpatient track did more time in the clinic, the categorical more on the hospital wards. We trained side by side. We attended many of the same lectures. And our fellowship choices matched identically. In fact, most of my colleagues from the primary care group are now cardiologists, gastroenterologists, and pulmonologists. Even then, those in training changed their opinion midstream when they realized what their professional lives would entail.
It has ...
Source: In My Humble Opinion - July 8, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Doctoring Requires A Loss Of Freedom
It hit me all the sudden. The feeling of calm washed over my body as I relaxed my torso and let my legs stretch forward in the passenger's seat. My wife was driving and the kids were in the back. I had just signed out, and taken off my pager for the holiday weekend. I knew the feeling was false. The phone calls would eventually come whether I was covering or not. And they did. The nursing home was a responsibility that was mine only.
Freedom.
I can't imagine someone outside of medicine understanding this empirically. The act of doctoring requires a certain lo...
Source: In My Humble Opinion - July 6, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
What Would Osler Say?
There is a certain feeling of disenfranchisement among those of us who were present during the infancy of healthcare social media. Before the days of twitter, the players were few, the interactions meaningful, and the main mechanism of change was a quaint self publishing tool called a weblog.
We were out to rule the world. Blogs were well written and lengthy. The expectation was that the comment section would be just as lively as the post itself. There were no book deals, TED talks, or media interviews. We were a group of whipper-snappers, bucking the system, and blaz...
Source: In My Humble Opinion - June 30, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Life's Complications
I was preoccupied. My mind leaped between worrying about the success of my new practice and the deathly ill young man in the ICU. I still hadn't gotten to that blog post I had been meaning to write. I was so far into the clouds that I barely noticed them rumble. The helmeted kids were ahead of us on their bikes, pedaling away. My wife and I had just rounded the corner of our leisurely walk. We were making the trip back home.
The crash above us was getting closer. My wife turned toward the menacing clouds on the horizon, and then shouted in the direction of the kids.
...
Source: In My Humble Opinion - June 27, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Nothing Has Changed, Everything Has Changed
It was both monumental and banal at the same time.
I sat at the restaurant with the check stowed safely in my right pant pocket. The flimsy piece of paper burned through the cloth and singed the hair on my thigh. It was screaming for attention, trying to distract from the conversation and deliver me back to the worried thoughts that filled my mind over the last few weeks. Will they come, will they come?
After breakfast, the whole family got back into the car and drove towards the bank. They waited in the parking lot as I leaped towards the front door. I had already filled out...
Source: In My Humble Opinion - June 22, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Demand Apathy
Monday afternoons are always the same. I pick up the kids from their grandparents. We drive home with their backpacks and a carton of home made food. We park in the garage, and carry all the contents of the car into the house. As the kids unload, I push the recycle container to the front for street pickup the next day.
Occasionally, I stop and socialize. Yesterday, I waited at the edge of the sidewalk as a neighbor approached. A young healthy fellow, I was surprised to see his posture stooped and his head bent forward. Apparently he was under the weather. He had ...
Source: In My Humble Opinion - June 18, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Invisible Consequences, The Fall Of The Clinician/Teacher
It was just like every other email I had gotten in the past. A young student at a local university was interested in primary care, and wanted to shadow me for a month between his second and third years. I responded swiftly. I was delighted to bolster the interest in my speciality. Over the years I had helped train students, residents, nurses, and nurse practitioners. By exposing them to the office, hospital, nursing home, and hospice and palliative care, I felt I gave them a window into a nontraditional view of Internal Medicine.
He showed up on a Friday for clinic.&n...
Source: In My Humble Opinion - June 15, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Content Is The First Principal
I think we suffer from medium confusion.
Twitter, Facebook, and blogs are just a medium. They are not an end unto themselves but more a mere tool or amplifier. Our digital footprint may be littered with pictures and pithy tweets, but what separates a key opinion leader from a follower is content.
Content is the first principal. It is where intelligence, meets communication, and dances with relevance. Content is the work product of our brilliance. Without it, creation dies and curation flops about like a fish out of water.
In the new world order, communication reli...
Source: In My Humble Opinion - June 11, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
Is Social Media A Kingmaker? @drmikesevilla Take A Bow!
It's hard to believe that just seven hours earlier I had been watching Sting belt out Roxanne at Ravinia. Relegated to lawn seats, I craned my neck around the entrance of the pavilion to catch a glimpse. The large screens on either side of the stage reflected a solitary figure with guitar in hand. He was in complete control. The words came out almost effortlessly, but the sound and quality was unmistakable. The crowd swayed back and forth, jumping up and down. Thousands of hands raised, and voices sang along. After all these years, he was still at the very top.
Th...
Source: In My Humble Opinion - June 8, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
A Unified Voice
Many ask of our profession.
Are you knight or knave?
The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between. The maddening belief that the future of our healthcare system depends on this delineation is preposterous. I would more aptly characterize us as pawns.
The time for change has come.
After patiently listening to my rants and raves, my readers are starting to wonder if I have any solutions for the problems I so frequently call to attention. I have many thoughts, and&n...
Source: In My Humble Opinion - June 5, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs
