Skip to main content

Are Your Medical Priorities Straight?

The world is asunder.  As I write this, Iraq is sinking into a sectarian abyss.  ISIS, a terrorist group, now controls a larger territory than many actual countries.  Russia has swallowed Crimea and has her paw prints all over eastern Ukraine.  China is claiming airspace and territories in Southeast Asia increasing tensions with Japan, Vietnam and the Philippines.  The Israeli-Palestinian peace process is in another deep freeze.  Terrorists in Sudan and Nigeria are kidnapping and murdering innocents with impunity.  The Syrian regime has resulted in 160,000 deaths and has displaced over 6 million people.   The Taliban continue to destabilize and terrorize in Afghanistan and Pakistan.  Disease and hunger claim millions of lives in the developing world while other world regions have a surplus of food and medicine.  We have an immigration crisis in this country that gets worse by the day.  Several million Americans are still out of work.

Let’s not be distracted by these trifles.  A looming apocalypse exists that dwarfs the above issues and demands our overriding attention.

Should the Washington Redskins change their name?

Sometimes, folks have difficulty deciding what’s important.   

Weigh the priorities

Assigning rational priorities is an important professional and life skill.  Collectively, we all waste an incalculable amount of time, energy and resources pursuing ventures that should be left for another day.  All of us do this.   Sometimes, we do so deliberately when a lower priority activity will deliver some pleasure or entertainment.   In these instances, at least we are aware that we are dipping down on our priority list.
An important physician skill is to judge which medical issues and tests should have a priority status.  Hmmm, a patient suffering a heart attack also has athlete's foot.  Which issue do I address first? We would recognize that a patient recovering from a severe pneumonia in an intensive care unit should not undergo a mammogram or a screening colonoscopy.  Often, it is not so easy to determine the medical priorities and different physician specialists on the case may disagree on what should be the next step.

Here are a few hypothetical scenarios.

A surgeon insists that an operation is urgently required, but the cardiologist counters that stabilizing the patient’s congestive heart failure must be done first. 

A gastroenterologist advises stopping a blood thinner as the patient has a bleeding ulcer, while the pulmonologist disagrees as the patient has a new pulmonary embolus and argues that the blood thinner cannot be interrupted.

A patient comes to his internist very anxious over 3 days of rectal bleeding.  He wants a colonoscopy as soon as possible as his father had colon cancer.   The physician advises instead evaluating the patient’s recent episodes of chest tightness, which the patient dismisses as anxiety.

Knowing how to do something well is not nearly as important as knowing if and when it should be done at all.  Who wants to have his gallbladder flawlessly removed if it didn't need to come out?  You can substitute any surgery, medical procedure, diagnostic test or treatment in this example.  

Medical knowledge is important.  Technical procedural proficiency is necessary.  Communication skills are a distinguishing asset.  But, medical judgment is paramount.

Comments

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary