nzou.com

Mr. Mac’s untimely death will perhaps serve to remind the public that pneumonia is not a benign condition.  Pneumonia can strike fast and hard and certain types of pneumonia have kill rates of 50% or more.

Mr. Mac was one of those rare comedians with a sense of obligation to decency and a desire to inspire greatness in young people.  He’ll be missed!

Dr. RW has recently addressed the patient-centered care model of medicine.

I think patient care has to be patient-centered.  I think we (physicians) are obligated to explain treatment options and present the supporting evidence.  There are very few patients who want to know or who would be able to utilize statistics like NNT and ARR or ARI.  In the end, patients want to know what is wrong, what the options are to fix it, what the risks and benefits are for those treatment options.  Even more than that, they really want a doctor who listens to them and who appears to care about their well-being.  These are totally reasonable expectations on the part of the patient.  If a patient walks out of our clinic confused, we’ve failed them.

I’m fairly new to the medical blogosphere, and would like to comment on commenting. 

First, let me say that I think comments are a wonderful way to discuss issues and to learn to look at problems from different perspectives.  That said, there are three, bothersome things that I’ve noticed in the comment sections of various medical blogs.

1.  Some comments contain personal attacks.  This is childish and totally unnecessary.

2.  Comments often contain words that are flippant and disrespectful - again, unnecessary.

3.  I realize that anonymity has it’s place and purpose, but I think that anonymity does little to promote meaningful discussion.  I find it much more beneficial and interesting to know who the the commenter is and what type of work they do. 

I’d usually describe myself as a grateful person.  But, today, I’m feeling especially grateful… probably because I’m sitting 50 feet from and spent several hours snorkeling in the pristine waters of the Caribbean.  It’s days like today that truly recharge my batteries and give me a renewed vigor for life.  As a healthcare professional, I get tired and even cynical at times.  Today I’m reminded of the importance of taking time away from work to regain a healthy perspective on life.  Regardless of the business and politics of medicine, the practice of medicine still boils down to the therapeutic interaction between patient and provider.  I feel strongly that we must not sabotage that interaction by neglecting our own mental, physical and emotional health - and no, I’m not just saying that to justify my next trip to the beach, or the next trip , or the next trip…

It seems the insurance companies are convinced that money talks.   In this little $400,000 experiment, the patients have a 1/10 chance per day to win $10, and a 1/100 chance per day to win $100, that’s about (36.5 x 10) + (100 x 3.65) gives you a minimum of $730 a year (if the stats play out) just for taking your medication as prescribed.  Not a bad deal at face value, however, there are at least two BIG problems with this simplistic approach to patient compliance.

1. This is not enforceable.  I could pop a pill in my mouth and spit it out later.  People have been doing this for years.

2. If patients were put on a medication that gave them side effects and stopped the medication, they’d likely get penalized and cry foul.  “No” you say, “the side effect would just have to be reported to the insurance company and the patient wouldn’t get penalized.”  Right… we all know that would mean another form per patient per medication for the doctor to fill out…  not gonna happen!

If Aetna needs some help figuring out how to spend $400k a little more wisely, I’m sure they have several million customers who would be happy to offer more reasonable suggestions.

“Nzou” is the Shona word for elephant.  Shona is one of the two main indigenous languages of the country of Zimbabwe (Africa).  My grandparents were life-long missionaries in the country of Zimbabwe (41 years), and adopted the name nzou as their totem or clan name.  It was their way of adapting to the culture of the people that they served.

I registered nzou.com because I thought it would be a neat way for me to celebrate my grandparents’ legacy.

Zimbabwe is a beautiful country, with beautiful people.  Unfortunately, it is on the brink of economic collapse.  The average person is starving and the general population is dying at an unbelievably high rate from HIV/AIDS.

http://www.zimbabwe911.com is an organized effort to send a container of supplies over to an orphanage for the children of AIDS victims.  Many of the orphans have HIV themselves.  I really hope that the customs agents in Zimbabwe let this container go through without pilfering it.

The ever-thoughtful Dr. Leap has posted Grand Rounds addressing one of the most fundamental questions for healthcare workers - “Why Do I Do It?”

 Enjoy!

Yes, you read it right, I want to talk about junk mail.  Junk mail is a topic worthy of discussion because physician’s offices receive so much of it.   The time that it takes you and/or your staff to sift through the junk mail actually costs you money. 

For example, if a front office staff member spends 15 min per day at $10/hr or $2.50 per day x 5 days/week x 52 weeks (junk mail comes year-round) you’ll spend $650 + taxes or approx $750 on having your mail sorted and opened. 

If you spend 15 min per day sorting mail at $300/hr or $50 per day x 5 days x 52 weeks, you’ll lose out on $13,000 of gross income per year.  That’s a chunk-o-change.  So, here are a few suggestions:

1. Use your work address for everything related to doctoring.  People who send out junk mail are trying to make a profit, so they LOVE to send it to people with money - i.e. you.  Every government office, every medical organization, every store you shop at is going to sell your soul address to some marketing firm and BOOM, your mailbox will explode with junk mail.  If you can limit the amount that gets sent to your house, you can avoid having to spend your time (after hours) sorting and shredding junk mail.

Shred every piece of mail that has your home address and references the fact that you’re a doctor or MD.  That includes pre-populated credit card offers, magazine prescription offers, e.t.c.  Someone will dig through your trash and try to steal your identity at some point during your career - don’t help them.

2.  Designate one person in your office to sort your mail and recycle junk mail.  Give that person a list of journals that you’d like to keep.  Don’t sort mail yourself - you can’t afford to use yourself as the mail sorter.

3.  If you’re so inclined, reply to junk mail from professional organizations and ask them to remove your address from their mailing lists.  Better yet, have your office staff write those letters for you.

I do it because I’m wired for it. I’m a medical doctor because I like the challenge of problem-solving and I enjoy the privilege of providing advice and comfort to patients.

During my medical school interviews, I gave the standard applicant spiel about wanting to help people. I was sincere, but I was both naive and idealistic. It was my residency training that gave me a more relistic view of the practice of medicine in America. I wrestled with cynicism. What resident doesn’t? The patient population that we serve as residents, while filled with many grateful, deserving patients, tends to have a disproportionate number of people with an unhealthy sense of entitlement. Couple that with our lack of power to set up healthy boundaries with those patients (i.e. being able to fire them for inappropriate behavior) and we all end up somewhat cynical.

What keeps me going back to work each day?  Well, there is one practical reason.  If I didn’t go to work I would default on my mountain [no exaggeration] of student debt and end up bankrupt. 

What else?  I honestly enjoy the mental challenge of family medicine.  I like preventive care.  I like the reward of finding cancer early.  I like guiding new parents through the unknown.  I enjoy being the doctor that my patients want to come talk to before they decide to follow a specialist’s advice.

Would I do it all again?  Yes, without hesitation.

If there’s one thing that gets my blood boiling and instantly ignites an internal rage within me, it’s child abuse.

There are cases that are obvious abuse like the foster parents who used government subsidy money to feed their own family while they literally starved the foster children, or the two year old girl who had obvious behavioral signs and physical findings of sexual assault. Most people who hear about or see these cases will be quick to report them to the authorities. Unfortunately, the word “most” has to be used in that sentence because there are people who will not report abuse either out of fear, willful negligence, complacency or cowardice.

I’ve had several instances in which family members tell me that they did not report unwitnessed abuse reported by a child because there was no physical evidence to prove that abuse had occured. The parent assume that it would be the child’s word against the accused adult’s, and who would believe a child?

Aaaaaaah!!!!

Abuse needs to be reported! If you’re a living, breathing human being (especially if you’re a healthcare provider) and you are confronted with a complaint of child abuse, ESPECIALLY if it’s from a child, you are REQUIRED to report it to government authorities. Take every complaint seriously! It does not matter that there is no physical evidence of abuse. The child’s protection needs to be assured.

Any person who fails to report abuse and act in the best interest of the child is really just as guilty as the abuser.