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Kind and thoughtful words from a fellow physician colleague

Physician

January 13, 2011

I was sitting on one of the hospital’s nursing units having a difficult telephone conversation. Anyone working nearby could have easily discerned the situation from my end of the call.

Patient’s family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.

Having never had to make such a decision in my own life, I am left to imagine how …

Do satisfaction scores really measure quality care?

William Sullivan, DO, JD

Physician

January 13, 2011

Does patient satisfaction matter? The answer is a resounding “yes.”

In fact, as the director of an emergency department, feedback from dissatisfied patients has provided both me and our group with an early warning about several physicians who were not performing up to our standards. Studies show a clear correlation between decreased patient satisfaction and increased medical malpractice risk, so meeting our patients’ needs is not only in their best interests, …

Optimization of the new PCMH neighborhood

Kevin

Health Policy

January 13, 2011

by Matt Adamson

There are a number of care models now being explored to improve the manner in which healthcare can be delivered. Let’s take a quick look at a few of the well known options:

Accountable Care Organization (ACO): The ACO model has the ability to provide, and manage with patients, the continuum of care across different institutional settings, including at least ambulatory (outpatient) and inpatient …

Caregiving and living with those who have mental illness

Greg Smith, MD

Patient

January 12, 2011

Your mother has been up all night.

She has Alzheimer’s Disease and now it has progressed to that inevitable stage of the dementing process where she is paranoid, agitated, and confused. She fidgets and paces and walks all day. She gets out of bed multiple times each night. She has gone out the door into the back yard and tried to escape to the street, wearing only her night clothes. Sometimes …

How much we should try to help patients who do not want our help?

a medical resident, MD

Patient

January 12, 2011

I recently completed a long stretch of night shifts in the emergency department. I have done a myriad of things – spent over twenty minutes trying to convince a patient to take a pill that she needed to treat her psychosis, sutured a facial laceration for a young gentleman who kept insisting that he wanted to leave AMA (against medical advice) and just place a …

How surgery is a team sport, and in awe of neurosurgery

Suchita Shah

Medical Education

January 12, 2011

I recently finished my 10 weeks in Internal Medicine and have moved on to 1 week each of Ophthalmology, Neurosurgery, Anesthesiology, and Otolaryngology. This week: brain surgery. (Tomorrow, the world.)

In 3rd grade, I wrote “I want to be a brain surgen [sic].” Ever since, it’s been a goal of mine to be a neurosurgeon. Well, until college … when other interests and the anticipated reality of a 7+ year residency …

Saying Goodbye: How families can find renewal through loss, an excerpt

Kevin

Patient

January 12, 2011

by Barbara Okun, PhD and Joseph Nowinski, PhD

One of the first tasks facing families upon receiving a diagnosis is to learn more about the illness or disorder that faces them. There are many ways to do this: by visiting Internet web sites; by …

Mischaracterizations by the popular media of medical conditions

Kevin

Conditions and Diseases

January 12, 2011

by Joyce Graff

Medical dramas can play powerful roles in increasing awareness of rare diseases, but it’s critical that the diseases are portrayed accurately. Mischaracterizations by the popular media of medical conditions, particularly rare ones, can be very demeaning to people afflicted with those conditions, and can affect how people look at them in the workplace or at school.

The TV show, Grey’s Anatomy recently broadcast the first …

Intubating the combative patient

Ralph Gordon, MD

Conditions and Diseases

January 11, 2011

How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.

Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” …

Read more…

Intubating the combative patient

Doctors play a role in helping people through transitions with rituals

Alex Lickerman, MD

Physician

January 11, 2011

When I was an intern in internal medicine, I admitted a patient to my service with pancreatic cancer.

Pancreatic cancer is a bad one; back then, only ten percent of patients with it would be alive within five years after being diagnosed. My patient was a farmer in the full bloom of late middle-age health when he began rapidly losing weight. An abdominal CT scan ordered by his primary care physician …

See the same doctor when the diagnosis isn’t obvious

WarmSocks

Conditions and Diseases

January 11, 2011

I’m thankful that I don’t have to research symptoms on the internet, diagnose myself, and come up with my own treatment. All I have to do is go to my doctor and describe my symptoms. My doctor can listen to my symptoms, match them up to what he knows, ask questions to pinpoint what might be going on, order appropriate tests, and recommend a treatment plan.

Odds are, when people get …

HPV test: Doctors are still not following testing guidelines

Kevin

Conditions and Diseases

January 11, 2011

by Brian Jackson, MD and Brian Shirts, MD, PhD

We’ve heard a lot of talk lately about personalized medicine (i.e., using advanced diagnostics to guide customized therapy).

A great deal of research is going into creating new molecular and genetic tests. But whether the health care system is prepared to actually generate value from these advanced diagnostics remains an open question. Our group’s research, presented in …

5 reasons doctors should love the Healthy, Hunger-Free Kids Act

dr_som, MD

Health Policy

January 11, 2011

The Healthy, Hunger-Free Kids Act provides increased funding beyond inflation for school meals for the first time in 30 years and addresses both food insecurity and obesity in children. Here are the details:

1. Growing bodies and brains need good nutrition, the best medicine for our patients. Children at or below 185% of the poverty level qualify for free or reduced cost meals. Although children compose only 25% of …

Alzheimer’s disease diagnosis criteria: A critical review

Ken Covinsky, MD

Conditions and Diseases

January 10, 2011

Generally, Alzheimer’s disease is diagnosed only after patients have progressed to major levels of cognitive impairment that results in substantial problems in daily functioning. But the brain changes that result in cognitive impairment start years, if not decades, before patients become symptomatic. So, wouldn’t it make sense to try to diagnose Alzheimer’s Disease in patients who have the brain changes, before they have clinical symptoms?

The answer would be yes if …

How patients can advocate for themselves

Erin Breedlove

Patient

January 10, 2011

Advocacy is an important and vital skill for any young adult, but young adults with cerebral palsy and other disabilities have a bit of a unique need for developing the skills. I would argue that the skills needed for self advocacy need to have the opportunity to develop in small ways when a child becomes a toddler.

For me, the roots of my advocacy were planted in the years prior to …

The safety of biosimilars and FDA regulation

Kevin

Medications

January 10, 2011

by John Horton

When the FDA was created in 1906, not even Nostradamus could have predicted the medical advances that would come to extend and improve our lives: childhood vaccines, insulin, and the use of lasers in surgery were all unimaginable a century ago.

While many future advances are beyond our imaginations’ reach, it seems certain that the advances in biologics — medicines made from living organisms — will stand out as …

A culture of fear worsens the nursing shortage and medical errors

Jeffrey I. Kreisberg, PhD

Health Policy

January 10, 2011

There has been a lot talk about changing how we reimburse providers for healthcare from one that pays for services performed, to another that reimburses providers depending on what happens to the patient.

I think we must take a couple of steps back and first tackle the public health crises we are facing that is putting our healthcare in danger, namely, medical errors and the growing nursing shortage. Despite identifying work …

Are physicians motivated by virtue or are they passive victims?

Stephen C. Schimpff, MD

Physician

January 9, 2011

An interesting article in JAMA by Drs. Jain and Cassel referred to the British economist Julian Le Grand who suggested that public policy “is grounded in a conception of humans as knights, knaves or pawns.”

Basically, are we motivated by virtue, by self interest or are we just passive victims? The authors suggest that this is a good question not only for physicians to contemplate but …

Disconnect between knowledge of STIs and behaviors to reduce risk

PalMD

Conditions and Diseases

January 9, 2011

In my opinion, people are often too embarrassed to see their doctor about sexually transmitted infections (STIs)—in my opinion.

“In my opinion” is one of the most dangerous phrases in science. But when in comes to attitudes toward STIs, the data are scarce. STI’s are very much a “behavior”-based disease, so knowing what attitudes prevail can help us design effective prevention strategies. Attitudes toward HIV have been …

Can a doctor dodging a question help the patient?

Doctor D, MD

Patient

January 8, 2011

Doctor D has dodged some questions in his career, but he has also been on the receiving end of some non-answers and can attest to their usefulness on the patient’s side of things.

How can a doctor dodging a question help the patient?

Let me tell you a story:

Doctor D’s son Little D was born with a very rare genetic condition which required he see an expert at a big university. As …