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Curbside Consult with Dr. Jayne 1/23/12

January 23, 2012 Dr. Jayne 5 Comments

I was inspired by Ed Marx’s post last month, Transformation Through the Written Word. He talks about doing book studies with his direct reports, which then expanded throughout the workplace. The thing that most fascinated me about Ed’s piece was his book list. Having been the victim of a boss who tortured his team with 17 Irrefutable Laws of Teamwork, I was surprised (and quite pleased) to find books on his list which didn’t scream “teamwork!” or “leadership!” or “business!”

I’m a voracious reader, although lately I’ve been reading some fairly insubstantial fluff in an attempt to reduce stress and achieve relaxation. One of my best friends keeps recommending things like The Mathematics of Life or The Omega Theory,  but I just can’t seem to get into the mode for deep thinking.

I liked the fact that Ed’s list is eclectic – it includes James and the Giant Peach and Disney psychology along with the classic management and leadership-themed works. One of my personal favorites is The Checklist Manifesto: How to Get Things Right  by Atul Gawande. This book should be required reading for everyone who does anything which remotely impacts patients or other living things. I’ve liked Atul Gawande since reading his first book, Complications: A Surgeon’s Notes on an Imperfect Science, years ago. It helped to make sense of the things I encountered during training and in understanding the psychological complexity of events physicians are exposed to.

Speaking of psychological complexity, I’m already tired of the run-up to the November elections. One of the hot topics is healthcare reform. I’m not convinced that any of the candidates is qualified to actually speak to the issues. The general public gets pulled into the rhetoric as well. I end up discussing healthcare politics with a patient at least a couple of times a day. I recently ran across a book that should be required reading for anyone who thinks they are educated regarding the delivery of healthcare in the United States.

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I don’t want to turn into Oprah, but I’m throwing it out there as the first “Dr. Jayne’s Book Club Challenge.” Some talking points from my friend Doug Farrago (of Placebo Journal fame) really sum it up:

  • Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes, and breast implants when we really should worry about smoking, drug abuse, obesity, cars, and lack of basic hygiene.
  • Somehow we have developed an expectation that our health should always be perfect.  We demand unnecessary diagnostic testing, antibiotics for our viruses, and narcotics for bruises and sprains. And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.
  • The bottom line is that most conditions are self-limited. “Our best medicines are Tincture of Time and Elixir of Neglect.”
  • There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix. A good physician needs to have the guts to stand up to people and tell them that their babies gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat.  Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

It’s available now from Amazon, although not yet in Kindle format, which I know will make some of you sad. If you’ve read it, let me know what you think. And if you know anyone in politics, feel free to leave copies on their desks.

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Currently there are "5 comments" on this Article:

  1. The real reason healthcare is so expensive is that we love being pampered, we pretend “you can’t put a price on a human life,” and we have developed a system which lets a third party bear the cost with no upper limit. Into that opportunity has entered a very comfortable business model for hospitals and caregivers.
    Come on into my ED and let me give you some cadillac care for that sprain. Watch me and my hospital spend hundreds of thousands on that 600 gram premie. Yes ma’am; we fully support your family’s right to “do everything possible” for granny on the vent. And of course that cardiologist making north of 500K/year went into medicine to “help people.”

  2. Right. A doctor, over-weight by a large number of pounds, telling someone they need to lose weight. Happened to a co-worker of mine and he told her, “Don’t do as I do, do as I say.”

  3. Dr. Jayne writes: Speaking of psychological complexity, I’m already tired of the run-up to the November elections. One of the hot topics is healthcare reform. I’m not convinced that any of the candidates is qualified to actually speak to the issues. The general public gets pulled into the rhetoric as well.

    Ignorant people, please stay home on Election Day.
    A lot of bad policies … pass by popular demand,” “In order to do the right thing, you have to know something.”

    Read more: http://www.foxnews.com/opinion/2012/01/19/ignorant-people-please-stay-home-on-election-day/?intcmp=spotlight#ixzz1kO791DXl

  4. Hooray for you Dr. Jayne! As someone who resents obese people driving up the cost of healthcare, three cheers to you if you are telling your patients that they are too fat.

  5. Dr. J
    If an MD like Ron Paulis not qualified to speak about healthcare reform, then I guess nobody is…and we should just give up.







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