Elaine Siegfried, M.D.
Elaine Siegfried, M.D., is professor of pediatrics and dermatology, Saint Louis University Health Sciences Center, St. Louis, Mo. She also is a member of the Dermatology Times Editorial Advisory board and a co-medical editor.
Finding the silver lining in ‘eFrustration’
I am spending more and more time in cyberspace. But as I approach 60, my long-term-memories of life before the Internet are becoming more vivid. Like many of our ancestors, I often marvel at the advantages of progress, but sometimes long for the good old days.
Curbside consultations have value, are free of many administrative encumbrances
My hospital requires documentation of how I spend my time, tabulated in hours per week, for one representative week every month, an exercise related to CMS funding. The time can be allotted among only three mutually exclusive categories: “Hospital Activities,” “Teaching Activities” and “Patient Care.” My university also quantifies my productivity in RVUs, clinical charges, grants submitted, grants awarded and publications.
How can we reconcile the spirit of the law with the letter of the law?
I am inherently skeptical of rules. But I also appreciate their potential value. Many rules are good and intended to ensure societal order, support justice and minimize error. I'm especially a fan of well-designed rules intended to control the strong personal gain incentive. But complex rules incorporate details that the devil loves to manipulate.
Compiling baffling medical encounters proves a great way to cope
We medical professionals are confronted with our own assortment of believe-it-or-nots and oddities on a daily basis. Unfortunately, they are often more upsetting or frustrating than astounding. I started keeping a list a few years ago, initially as a coping mechanism. But gradually, the list evolved into a collection.
Many times the impact of a unique physical feature goes more than skin deep
As a pediatric dermatologist, I often see children for evaluation of a "birthmark." High on the list of anxious parents' concerns is Aesthetics. Most want to protect their children from bullying; they echo the axiom, "Kids can be so cruel." I tell them that everyone has what I call "distinguishing features." Without them, we wouldn't be able to recognize people we know.
Resident programs, hospitalist movement can hinder patient care
A recent New York Times Sunday Magazine article inspired this column. "The Phantom Menace of Sleep-Deprived Doctors" was written by Darshak Sanghavi, M.D., chief of pediatric cardiology at the University of Massachusetts Medical School, Worcester, Mass. His article mourned the most recent in a series of misguided resident work-hour reductions, intended to enhance patient safety with what seemed to be an easy fix.
A troubled teen and the complex world of managed care
This is a true story, but the names and a few minor details have been changed in deference to HIPAA. I first met Bobby in 2002, when he was 8. His quality of life had been marred by severe eczema since infancy, but things got worse when he was diagnosed with asthma at age 6 and insulin-dependent diabetes a year later.
Treatment drawbacks can outweigh disease risks
I am challenged every day by children with skin disease that has no evidenced-based approach to evaluation or treatment. The trickiest issue is that my medical recommendations seldom have enough specific evidence to prove safety and efficacy, so I have to be very familiar with the wide range of potential risks and weigh them carefully against the potential benefit in each case.
Inexperience, deviation from standard protocol set stage for medical mistakes
The cover story on my office copy of this month's Readers Digest caught my eye. The title was "Doctors Confess Their Fatal Mistakes." The article recorded personal accounts of errors made by several healthcare providers. In the introduction, the author included a statement about being surprised that so many medical professionals were not only willing but also eager to share their stories.
Can the Hippocratic Oath counterbalance medicine's financial incentives?
All physicians are familiar with the concept of the Hippocratic Oath, a 2,500-year-old promise to uphold professional ethical standards. I have not reviewed the oath since I recited it at my graduation from medical school in 1985, but it came to mind as I faced a monthly red budget statement despite a full-capacity schedule with limited staff support, and low Press Ganey satisfaction scores about lengthy waits for appointments and service.

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