It’s often assumed that decision making in medicine should be done slowly. As a young trainee I was lead to believe that the doctor with slow medical thinking is more thorough. Conversely we assume the faster moving professional is cutting corners. But the time in any clinical day is fixed and our bandwidth is a zero-sum game. While respecting the risk for ... Continue Reading about Fast and Slow Medical Thinking
Doctors have clinic schedules. Based on these schedules, patients are expected to arrive at a certain time. In turn, they expect a certain amount of face time with the doctor. In my clinic, a new patient is scheduled for 30 minutes and a follow-up 15 minutes. But humans and their problems rarely fit into 15 and 30 minute blocks. So how does it work? Something ... Continue Reading about The Human Nature of Clinic Schedules
Should healthcare be inconvenient by design? And should slow medicine be the default option in some circumstances? Slow medicine is a movement calling for change in medical practice which is inspired by the slow food movement. “Like for the slow food movement, slow medicine is a call to balance over-emphasis on fast processes which reduce quality.” But real-time ... Continue Reading about Slow Medicine – Should Healthcare be Inconvenient?
Medicine is a dicipline of uncertainty. So clinicians are always looking for indicators of certainty. We’re looking for signs. Medical signs. The psoas sign indicates an inflamed retrocecal appendix. A sentinel node is a classic sign of dissemination of cancer into the chest. The Cheeto finger sign (telltale orange fingers reflecting the recent consumption ... Continue Reading about Medical Signs
Not long ago I entered an exam room and was met by a mother who immediately began talking. From the chaotic feeding to her sequence of formula roulette and the staccato of the baby’s cry, she delivered a near full history of present illness in the span of 45 seconds. And all with one breath. While I was impressed with her delivery, I couldn’t keep up. So I ... Continue Reading about Interrupting Patients for the Right Reasons
I spoke with a young pediatrician recently who complained about her late hours in the office. A lot of calling patients with questions about labs. On cursory review, she seems to do a lot of medical tests. It makes sense. Here’s the math: Two sessions per day of 10-12 children per session and everyone gets a comprehensive metabolic panel (as an example). 48 hours ... Continue Reading about Medical Tests – The More You Order, the More You Explain