Posts by Tracy Cardin

Consider It Done

The VA health system recently sought senate legislation to empower nurse practitioners within the Veterans Affairs Department to practice independently, regardless of state-based limitations on their practice. This would allow all advanced-practice nurses (APNs) such as midwives, clinical nurse specialists, nurse anesthetists and nurse practitioners to practice without a supervising physician. Currently, 21 states, the District of Columbia, and the Indian Health Service allow APNs to practice independently. One of the primary motivators for this initiative was the critical deficit of access to care for veterans. Since this announcement, there has been a marshalling of forces on both side of this conversation. Physician groups, most notably the AMA, have denounced this plan as one that risks the lives and well-being of patients, stating that APNs lack the education and training to provide medical care and that there is no factual basis to establish that APNs practicing independently would deliver quality…

R-E-S-P-E-C-T

A lot has been written about physician (or provider) burnout. Some of the highest burnout rates include internists and ER doctors, both of which live in our wheelhouse, and some factors that impact the burnout rate have included too many bureaucratic tasks, insufficient income, the computerization of medicine, the ACA, (thanks Obama), insufficient income in relation to hours of work, lack of work-life balance, hyper-responsible personality types as well as a lack of individual control within an organization. But in my practice, one of the greatest negative impacts I see on provider attitude and compassion fatigue is the erosion of the respectful relationship between provider and patient. Let me demonstrate. Just last week on our hospital medicine service, we had a patient call a provider "bitch," had a patient who refused to take any medicine or comply with any phlebotomy without multiple 45-minute debates about the relative merits of each…

Balancing Act

My father died of Mantle cell lymphoma 12 years ago. He was only 60 when he succumbed, and despite being involved in the business and brouha of medicine literally since high school, I was so unprepared for his illness. It started when he came to visit me from his home in St. Louis.  He had a cold you see, and his cough after the cold was nagging and persistent.  I brought him over to my office and listened to him, looked in his ears, and gave him a course of antibiotics. A few weeks later he told me he thought his spleen was swollen and that he felt "full" after he ate. I told him to head to a doctor right away. He did, but was told he had "stress". The following weekend I came to St. Louis, made him stretch out on the sofa. Yep. Giant spleen. This was…

There Are a Million Stories in the Naked City

Hospital Allegory:  (Special thanks to Keiki Hinami). Three scientists are tromping through the wilds of a previously uncharted rain forest. They are captured by blood thirsty aborigines who scream and chant at them. The Chief approaches the first scientist as asks him, "Do you want death or do you want cheech?"  The natives whoop and holler.  The scientist, shaking in fear, has no idea what cheech is, but does not want to die, so fearfully chooses "cheech".  The aborigines yell and scream, yank out the scientist's eyeballs, slice open his abdomen, pull out his entrails until he crawls off moaning in agony into the jungle to die.  The second scientist is then approached. "Do you want death or do you want cheech?!"  The second scientist is in a state, saying convulsively over and over, "I don't want death; I don't want cheech!" The Chief demands an answer and the scientist,…

Dysfunction Isn’t Fun

I was talking with a colleague in another section today and she was noting the difference between our hospitalist group and her section.  She has somewhat intimate knowledge of our section because she did a year with us before moving on to her specialty fellowship.  She is a bit frustrated with her new home and its team members because she feels like there are a lot of "B's".  You know- b*tching, bickering and backbiting. I was asking her to tell me the reasons she thought this is occurring. Is it a top down issue, is it just a personality problem with people attracted to her specialty, is it that there is instability with the people and processes that make up that section?  What is it?  No answer was forthcoming.  In the clinical setting, when no answers are clear and forthcoming we say the problem is "multifactorial". After speaking with  her,…
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