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Why Physicians Should Learn to Pronounce Patient Names Properly

I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit”. Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would typically kick ass, but didn’t bother with the name part because he couldn’t pronounce it. Somehow I found that last part more insulting.

 I’ve long since outgrown the sensitivities about my name (although I still make any telemarketer pronounce it properly before talking with them). For most patients and those with whom I only occasionally associate, I go by “Dr. Ram”, which works fine by me. But perhaps those early experiences left me with an impression about how people can be affected in positive ways by getting the pronunciation of their name right, or at least trying to get it right. As well as the negative ways in which people can be affected by getting the pronunciation wrong, or by not even bothering to try.

So I would like to direct a message to those care providers out there with easy to pronounce names, because this  is something that you probably don’t  know. Getting the pronunciation of somebody’s name correctly (or at least trying to) is important. These people often wave you through that initial awkward part of an encounter, simply because they’ve given up hope that people are going to get it right. They tell you it does not matter only because they have already spent too much time in trying to get the name pronounced properly, only to have it reduced to a few letters. They wave away the mispronunciations because they’ve learned to accept that no one is going to invest the few seconds that it will take to pronounce it correctly. But they do care, and make no mistake, it is very important to them. Not taking the time to learn the pronunciation of someone’s name sends a powerful message. It says “We don’t know you, you’re a stranger here” And doing it repeatedly says “I still don’t know you, and I’m too busy to bother to try”. The subconscious message that the patient takes from these encounters is “these people don’t know who I am”. Conversely, taking the time to try to learn the proper pronunciation of a name  says “I’m listening to you” and “I want to know who you are”. Continue reading “Why Physicians Should Learn to Pronounce Patient Names Properly”

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My EHR Tells Me I’m a Bad Doctor.

I’ve written before about our EHR and all the the things that I really like about it. Add to that list the fact that we can now get incentive payments from Medicare (or Medicaid) for buying and using an EHR (we were early adopters of the technology before the current incentives came out). But in order to qualify as an electronic health record in the government’s eyes, the federal government determined that everyone’s systems must meet certain minimum functionality requirements, what they call “meaningful use”. This is where things are getting tricky. . . because my beloved EHR is telling me that my medical records are are not meaningfully useful, and in fact are meaninglessly useful, or meaningfully useless, one or the other, or perhaps both.
As if that was not enough of a slap in the face after all the love and adoration I’ve showered upon the system, there’s this bitter morsel. I’m being told that the manner in which I’ve been deficient is in the department of documentation of smoking. Can you believe that? Smoking! Me! The super-anti-smoking guy! The one who wrote this article. And then the other one. Plus, remember that other one? Seriously?
Could I truly be deficient in my smoking documentation? Refusing to believe such blasphemy, I delved into the medical records. No, see, there it is? Right there.  Under HPI, “patient has no history of smoke exposure”. And there again, in the next chart, more extensive smoking data meticulously typed into the history. I knew that I was documenting this stuff. What could the problem possibly be? Continue reading “My EHR Tells Me I’m a Bad Doctor.”

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This is What Remains of a Shattered Mental Health System in Newtown. Could it Have Helped Adam Lanza?

I wrote in a previous post  about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured grounds  crowned with stately and handsome brick buildings in a colonial architectural style.  These were the grounds of Fairfield Hills Hospital, a state run mental health facility located in Newtown, about 3 miles from Sandy Hook Elementary School. The hospital closed its doors in 1995.

To tell the tale of Fairfield Hills Hospital is to tell a tale of two nations. The first, a new economic and financial superpower, a country with an increasingly aspirational middle class toiling in a system that rewarded their hard work with a level of wealth and a standard of living never seen before in human history.  The second, a country struggling to balance the opposing pressures of a demographic bubble and crushing debt levels the likes of which have also never been seen in human history. Continue reading “This is What Remains of a Shattered Mental Health System in Newtown. Could it Have Helped Adam Lanza?”

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Hospital Names New Executive Vice President in Charge of Lobby Christmas Tree.

An Announcement from The Holy Profit Medical Center.

“Holy Profit Medical Center” is a series of fake satirical press releases and news articles from an imaginary hospital. . . 

The Holy Profit Medical Center today named Bess E. Morass to the new post of Executive Vice President in Charge of Lobby Christmas Tree.

“We are very excited to have Bess here”, said HPMC CEO Haywood Jabuzov. “Ms. Morass received her MBA from Northwestern Michigan University, which is nationally recognized as being slightly better than Southwestern Michigan University.”

“We are very excited about this years lobby Christmas tree project” said Ms. Morass. “We have a very imposing task ahead of us, and it all begins with the Strategic Christmas Vision Project, which has already formed a committee. In those meetings we have given several power point presentations on how we might go about forming subcommittees to tackle the number of challenges that we are likely to face. We have already identified a number of areas where we may acheive strategic synergy, particularly in collaboration with the Task Force on The Formation of The Christmas Tree Decoration Committee.

Also at issue this year, is the very expensive lighting and extremely bright star on the top of the tree. Last year many patients complained that the light was so bright that it was keeping them up at night. Many employees are also questioning the cost of the tree in light of the many recent cut backs at the hospital. “This is an important point. It is the very reason we are proceeding with the Strategic Christmas Vision Project, after all, when people are laid off or are sick in the hospital, it’s more improtant that ever to have Christmas spirit!” She added, “however, the decision on the star is not under my purview, and will need to go through the ESCCTS (Executive Sub-Committee on Christmas Tree Star). We expect to have a decision on that by July of next year.”

“The first issue on our agenda was the color of the tree,” said Mr. Morass ”and I am pleased to report that we have decided to go with a yellow tree this year to promote gall bladder sludge awareness.” The Lobby Christmas Tree will be on display until mid-January, after which the Committee on Lobby Christmas Tree Disassembly will be tasked with its removal.

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Bridging Anti-coagulation is Dead! Long Live Bridging Anti-coagulation!

I am interrupting my current obsession with Top 5 lists  to bring you this important announcement: Peri-operative anti-coagulation, (also known as bridging anti-coagulation) is done! Is it time to stick a fork in it?

Right now you’re probably wondering, what the heck I’m talking about, and why you should consider it important. Currently hundreds of thousands of people throughout the country are on the oral blood thinner coumadin (also known as warfarin) to prevent a blood clot. For those who are on it long term, having a procedure can be problematic, as stopping the drug can increase the risk of blood clots, while continuation of the drug increases the risk of bleeding with surgery. Thus many patients undergo a process known as “bridging” wherein the coumadin is stopped  several days before the surgery, and a short acting injectable blood thinner is substituted so that the blood thinning effect of coumadin has time to wane before the surgery. This practice has been perpetuated without very clear evidence that it decreases the risk of blood clots or bleeding, and without much certainty about which people on coumadin need to be “bridged”. Recently, researchers sought to shed some light on this question by pooling together data from several smaller studies looking at patients who underwent bridging  to determine what the various risks and benefits of bridging might be.  The study  “Periprocedural Heparin Bridging in Patients Receiving Vitamin K Antagonists” was published  in the Journal Circulation and has received much attention, as it should have as it was co-authored by my former mentor (shout out Dr. Kaatz!) but also since it is the first large scale study of its kind. Continue reading “Bridging Anti-coagulation is Dead! Long Live Bridging Anti-coagulation!”

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Top 10 Advances in Medicine (1-5)

As promised, here’s the conclusion of my list of the Top 10 advances in medicine.  As stated before, here are the ground rules: I’m not ranking surgical advances,  I’m sticking to American medical problems, and we’re not including public health initiatives like clean drinking water. No, what we have here is a rare tribute to our  much maligned pharmaceutical industry in all its capitalistic chemical glory.
So once again, without further delay or  pre-authorization, here’s the cream of the crop of the top 10 medical advances.

5. Antihypertensives. Hypertension, like diabetes is a common contributor to vascular disease which lead to, among other things, stroke and coronary artery disease. The greater control of blood pressure by these medications has undoubtedly contributed to a reduction in morbidity. In addition, medications like angiotensin converting enzyme inhibitors and beta-blockers have other beneficial effects that go beyond their blood pressure lowering effects.

4. Birth control. In olden times in this country, and in many parts of the world today, it has been financially advantageous to have children. In an agrarian world, children contribute to labor, and tend to their parents as they age. Marriage of children could also mean merging of families and greater wealth. Nowadays, it costs close to $300,000 to raise a child. In addition, fewer children has meant more women in the job force and reduced strain on people, and marriages, which make for healthier people. Fewer children also means more resources for each child, which make for healthier children.

3. Insulin and other hypoglycemic agents: Diabetes is a major contributor to disease in the world. While it only ranks as the number 7 cause of death in the U.S. it is being increasingly understood that even minor amounts of hyperglycemia can contribute to vascular disease, particularly heart disease and stroke (which rank as the first and fourth most common causes of death). Undoubtedly without these treatments the incidence of vascular disease and infection would be astronomically higher.

2. Anesthetics and Pain medication. Imagine a world in which only the most basic surgical  procedures could be performed. A world where even lancing a boil would be considered barbaric and avoided at all costs. That’s what the world was like in the dark age before anesthesia and pain medicines. So many things that we take for granted in today’s medical world, like medicines for a minor procedure or obstetrical deliveries would not be possible without anesthetic agents. And that’s before we even consider things like hip repairs, open heart surgeries, and appendectomies. No, I think I would rather not try to imagine that world.

1. Antibiotics. Ok, this was an easy one, even most kids know about the invention of the first antibiotic. I shudder to think of where we would be today without the father of modern medicine, Dr. Penicillin, whose incredible legacy is today carried on by his grandson, Dr. Vancomycin. I kid. Check out this fascinating  first-hand account of the first use of penicillin in the U.S.; a 33 year old woman at Yale, New Haven hospital. A single vial of the “black magic” was shipped from England, the physicians actually collected the patients urine to reclaim the drug and re-administer it. She lived to the age of 90. Awesome stuff.

Check out the CDC’s list of the top 10 public health achievements of the previous decade. I found the statistics on the benefits of vaccines of particular interest; “A recent economic analysis indicated that vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.”

Related Articles: Top 10 Medical Advances (6-10);   Top 5 Things No One Taught Me in Training;   Top 5 Things You Don’t Know About Your Doctor;  Top 5 OTC Meds That Would Require  Prescription if Released Today.

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Coming Soon: Get Your Implantable Defibrillator on Craigslist?

Yes, I know I’m supposed to bring you the stunning conclusion to my top ten list of medical advances. But I was so excited to talk about this article I read recently that I’m bringing you this post instead. The top ten medical advances (1-5) will be up in 2 weeks. Unless I decide to bump it again.

We live in a golden age of technology and manufacturing. An age in which we’ve been spoiled by machines, personal devices and electronics have been created to ever increasing standards. Just a few decades ago, you couldn’t buy a Chevy Nova whose bumper didn’t fall off a week after you drove it off the lot. But today’s cars are engineered so well that they easily go hundred thousand miles and beyond.  Consumers expectations are now so high, that to ensure that electronics last the expected amount of time, they‘re engineered to last much longer than that. The cell phone(s) in your closet that you forgot about when you renewed your contract probably makes calls just as well as the one you’re using now.
The same goes for medical devices, particularly crucially important medical devices like implantable cardiac defibrillators (ICD). To ensure that they last the expected amount of time and deliver their life sustaining jolts, they have to be built to last. (For the amount of money they charge for them, they had better be). Unfortunately, building something like an implantable cardiac defibrillator to such exacting standards makes them extraordinarily expensive. Think your average Mercedes Benz expensive. And that significantly raises the bar for entry, particularly for the poor both in this country and abroad. In third world countries, access to such devices is limited to the super wealthy, as private insurance plans are limited and government resources are typically directed towards more elemental aspects of health that affect the larger population. In other words, in countries like India, if you’re fortunate enough to have lived long enough to have a cardiac problem which warrants the placement of a defibrillator, you had better be rich enough to afford one. If not, you’re on your own. Continue reading “Coming Soon: Get Your Implantable Defibrillator on Craigslist?”

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Top 10 Advances in Medicine (6-10)

I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There had to be a few ground rules before putting together a list like this. I’m a medical doctor ranking medical therapies, and so surgical advances can take up space on someone else’s server. And just to be clear,  since it’s been awhile since I’ve treated malaria and cholera, I’m going to stick to western world problems and western world drugs.  I’m also not the young idealist I once was, so public policy initiatives, like seat belts, clean drinking water, and vaccinated babies are being tossed out with the bathwater. No, we’re talking about good old fashioned chemicals with long complicated names produced in soot belching factories and administered in our nations pharmacies and hospitals with epic markups to ensure future stock gains research funding.
So without further delay, and with no pre-authorization required, here is the latter half of the top 10 medical advances.

10. Psychiatric Meds. One has only to look at the CDC’s list of the top causes of mortality in America to see the logic behind this choice, as suicide rounds out the top 10 causes of death. But psychiatric problems also have a much greater impact beyond suicide. Problems like depression and anxiety often exacerbate other medical conditions, increasing the risk of complications.  They put strain on family members and cause lost productivity and income. They are one of the most common reasons for enrollment in disability. Continue reading “Top 10 Advances in Medicine (6-10)”

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I’m Tired Of. . .

It’s been a long few months. What with the recent death of a family member, the usual barrage at work, and trying to raise a family, I think I may be in the early stages of physician burnout. So I’m going to give myself liberty to do something I rarely do. . . I’m gonna complain. Oh yeah, I’m gonna gripe and whine, and cry like a little baby. Just this once. But don’t worry about me.  Because as you read this I’m sitting in a meditative cleansing trance, taking in beautiful scenery, and trust me,  it feels oh so good. So I’ll be back soon, batteries recharged, taking all the things I’m griping about here with a swing in my step and a smile on my face. Continue reading “I’m Tired Of. . .”