Ethics (clinical and business)

Good Enough

I read with avid interest the recent  Saturday essay in the Wall Street Journal (9/6/13) where Katy Butler eloquently describes her mother's decision to forgo a valve replacement surgery, electing instead, at 83, to live with the real possibility of her death, though perhaps earlier than her cardiologist would have liked.  She chose a natural death that per her daughter Katy was one that was imperfect yes, but also "good enough."  It really made me think about the cultural sea change going on within our hospitals.  I walk by patients' rooms, I look in and often see a wasted temple, a frail and elderly patient, a skinny leg, alone and awaiting the next transition, often to rehab or a nursing home; rarely to home, to an envelope of love, comfort and care, and to the waiting arms of natural death. My own experiences with natural death have been wholly positive.  My…

A passage to bookmark

    I just finished a remarkably good book.  After concluding, a passage continued to replay in my head.  I went back to find the page, and reread it a second, and then a third time.  Not my habit, I knew the knowledge contained within needed passing on. The wisdom emanates from a 1968 conversation between Henry Kissinger, and then RAND researcher, Daniel Ellsberg.  Kissinger discussed with Ellsberg the trappings of power.  Given his experience as an Under Secretary of Defense during the Vietnam War several years before, Ellsberg had advice to give—and Kissinger got it in spades. Despite Ellsberg's association with the Pentagon Papers later on— a teensy kerfuffle you might have heard of, at the time, he had a friendship with Kissinger and guest lectured in some of his Harvard courses. While the conversation is pure realpolitik, and the advice a bromide to prepare for the political arena,…

The course seems obvious

A compelling clinical vignette always gets me. Those written for lay eyes grip me even more. The exceptional writer strips away the medical nuance and expresses the case in the starkest of terms. The stakes feel germane, the emotions conveyed hit close to home. We have been there we say and ask if a similar patient might occupy our bed tomorrow.  Alternatively and as applicable, we imagine if the profiled provider could be us. We also engage these accounts for comfort and solidarity. We take solace in sharing similar front line experiences with others, as atypical as they sometimes might be. Apiece with that spirit, I recently read an illuminating article in The Atlantic. The account profiles a physician and the difficult dilemma he faced caring for an acutely ill man with a tenuous, but hopeful prognosis. He had no advanced directives and the family, going against convention, wished to cease…

Feed Me Good!

  A story in Kaiser Health News Caught my eye this AM:                                             I could not resist citing a quote like this: Behind the scenes, UNC has installed a sous-vide cooking system, often used in fine restaurants, which cooks food in airtight plastic submerged in water baths to ensure food are cooked to the exact temperature. The system speeds delivery service since food is partly cooked and chefs can finish it on a grill after an order is placed.   Or this: "It’s been a game changer for us," said Angelo Mojica, director of food and nutrition services at UNC. He said patient satisfaction scores, which he tracks every day on a television monitor in the kitchen, have soared to 99 percentile. He parses those ratings by hospital floor and…

Trends come in threes

All things come in threes, or so they say. In my time in practice, I have cared for many undocumented adults. Usually Latino, young, and male, their issues reduce into two categories: injuries related to work (construction and food service) and uncontrolled flares of chronic conditions (diabetes and asthma). Occasionally, I also care for desperate folks in need of dialysis, transplants, or continued mechanical ventilation. Difficulty understates the latter category. (more…)
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