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The Importance of Medical Judgement - Part II

Last week, I offered up an argument on why medical judgement means more than medical knowledge.  In other words, being a really, really smart doctor is not the essential qualification for practicing excellent medicine.  I ended last week’s post with some examples of medical ads that are familiar to all of us.  Here are some ads and slogans that you won’t see on highway billboards or in press advertisements. ·        Bring your back pain to our orthopedists.  They probably won’t operate on you since most back pain is not effectively treated surgically.  You don’t want unnecessary surgery, do you? ·        Wanna lose weight?  Consult with our bariatric surgeons who will refer you to one of our certified dieticians so you can endure yet another diet.  Who wants a trigger happy surgeon anyway? ·        Come to our oncology center for a second opinion.  Don’t expect any new treatments, since ‘promising’ experimental treatments are exactly that – experiments.  We’re not roll

The Importance of Medical Judgement - Part I

Would you rather that your doctor have excellent medical knowledge or medical judgment?  Answer this question before reading on. Patients are drawn to doctors and medical facilities who boast ‘cutting edge’ medical knowledge and techniques.  Medical judgement, which is much more important in my view, is barely mentioned.  Good doctors have great knowledge, but great doctors have superb judgment.  Consider the following vignette that I hope illustrates why judgement means more than knowledge. A patient is comes to the emergency room with abdominal pain.  The physician refers him to two different physicians, Dr. Knowledge and Dr. Judgment.  Which of these physicians would you rather see? Is the gallbladder the culprit here? Dr. Knowledge:  I recommend that your gallbladder be removed.  I have trained in advanced robotic surgery which leaves only one very small scar.  My complication rate is extremely low.  Our operating room team is excellent.  I am the only surgeon

Is Your Doctor Out of Date?

Years ago, I was having dinner with 2 members of The Cleveland Orchestra, one of the finest orchestras in the world.  I asked them, with my kids present, how much time they devoted to their craft.  As many parents know, getting kids to commit to practicing a musical instrument is about as easy as splitting the atom in your garage.  The musicians told us how much time they practiced, which was mind boggling, as one would expect.  Any artist, athlete, Green Beret or similar professional, has to demonstrate extraordinary commitment to maintain a superlative level of excellence and preparedness. I asked one of the musicians, the violinist, how long he could refrain from playing his instrument before he noted some professional slippage.  Guess your answer.   At the end of this post, I will relate his reply. How many hours are enough? How long can you be away from your job before your performance ebbs?For most of us, we can take weeks or longer on holiday and return back to ou

Nursing Staffing Levels Threaten Patient Care

On the day that I penned this post, I rounded at our community hospital.   My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor.   I spoke to the nurse in order to be briefed on my patient’s status.  I learned that this nurse was assigned 6 patients to care for – an absurd patient volume for a step-down unit.  “Why so many patients?” I asked.  She explained that some nurses called off work and the patients had to be spread around among the existing nurses. This occurs every day in every hospital in the country.  Nurses are routinely required to care for more patients than they should because there is a nursing shortage on a particular day.  Why do hospital administrators allow this to happen?  If any are reading this post, I invite your response.  Enlighten us.  When a nurse is overburdened, how do you think this affects quality of care and nursing morale? I suppose it saves a few bucks on payroll, but this strikes me

Why I'm Against Medical Marijuana

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio.  Once of my points in that piece is that I did not want legislators making medical decisions for us.  They can’t even do their own jobs. I am not against medical marijuana; I am for science.  The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, hope or belief. Marijuana is a Drug Enforcement Agency (DEA) Schedule 1 drug, alongside heroin, LSD and Ecstasy.  I realize this seems odd since most of us do not believe that marijuana has the health or addictive risks of the other agents on the list.  It doesn’t.  But, danger is not the only criteria used in determining which category a drug belongs in, a point often misunderstood or ignored by medical marijuana enthusiasts.  An important criterion of Schedule 1 drugs is that they are deemed to have no proven medical use. The federal government recently affirmed marijuana’s Schedule 1 status

Nursing Documentation vs Patient Care - Who's Leading?

I work with nurses every day.  Anyone who doesn’t realize how hard these professionals work, has never been in a hospital.  Their job descriptions have expanded along with their work load.  This is not your father’s hospital ward.  Hospitalized patients today are older and sicker than ever before.  It takes a seasoned nursing professional to manage the care of these complex patients.   Their work days are full simply managing the expected tasks of dispensing medications, coordinating diagnostic tests and assessing their patients.  There is no time scheduled for unexpected events, which are expected as sick people’s conditions may change at any moment.  In other words, if a nurse must attend immediately to a patient with chest pain, then his or her other more mundane tasks are delayed or shifted over to another busy nurse. I believe that the most potent barrier that is separating nurses from their patients today is the ferocious documentation mandates that nurses are required to p

Labor Day 2016

Honoring work.