The art of Alzheimer’s disease

Physician
November 30, 2011

Physicians are not trained to interpret paintings, and most patients do not have a lifetime of artwork to analyze. However, a rare opportunity for both to occur is at the Museum of Modern Art’s exhibition de Kooning: A Retrospective.

Wilem de Kooning, regarded as one of the most prolific American artists of the twentieth century, grounded himself in the Abstract Expression movement. The AbEx movement is widely associated and recognized with …

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The art of Alzheimer’s disease

Problems with the Multiple-Mini Interview for medical school

Medical Education
November 28, 2011

Some medical schools have altered their admissions process by replacing the traditional applicant interview with the Multiple-Mini Interview (MMI). MMI resembles speed-dating: applicants rotate through numerous interview stations, where they act out scenarios and solve puzzles, sometimes alone and sometimes in groups. A July New York Times article presented a good overview of MMI, as implemented by Virginia Tech Carillon.

As you might expect, schools that have adopted MMI (UCLA and …

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Problems with the Multiple-Mini Interview for medical school

I will never be the physician that my father was

Physician
November 25, 2011

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Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.

My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private …

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I will never be the physician that my father was

Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety

Physician
November 17, 2011

No matter how quickly you tried to switch the television channel lately, you probably couldn’t escape the trial of Dr. Conrad Murray or avoid hearing about propofol, an anesthesia drug that can be fatally easy to use.

What you may not have heard is that the American people just dodged a serious threat to their anesthesia care, and most don’t know how near a miss it was.

The Centers for Medicare and …

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Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety

Simple tips to improve your blood pressure checks

Conditions and Diseases
November 13, 2011

A recent study confirmed that the doctor’s office may be one of the worst places to determine if your blood pressure is under control. The automatic rise in tension many people experience when they are being scrutinized contributes to artificially high blood pressure readings. Although many times the only way improve one’s blood pressure is through treatment (such as medication, a low salt diet, and weight loss), other times …

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Simple tips to improve your blood pressure checks

Billing an established patient visit as a consultation

Physician
November 13, 2011

Until recently, there was a financial difference between performing a “consultation” and a “new patient visit” for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).

In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all.  Let’s just use this understanding as the brief background for what I’m about to say.

I …

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Billing an established patient visit as a consultation

Why do non-profit hospitals compete with each other?

Health Policy
November 13, 2011

While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.

But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …

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Why do non-profit hospitals compete with each other?

The new definition for a medical emergency

Health Policy
November 9, 2011

The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed.  Some 21 states use a variation of the old definition …

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The new definition for a medical emergency

Let’s stop degree creep in health care

Physician
November 8, 2011

How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name?

Now unless the pharmacist has PharmD after their name they can’t be a pharmacist.  And for the nurse, unless they have RN, BSN or RN, MSN after their name …

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Let’s stop degree creep in health care

Treating Adele’s vocal cord hemorrhage

Conditions and Diseases
November 6, 2011

Before going any further, the title to a Los Angeles Times story was “Adele to have surgery to treat vocal cord hemorrhage. What is it?”

I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason …

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Treating Adele’s vocal cord hemorrhage

Neuropsychologists in the evaluation of ADHD

Conditions and Diseases
November 6, 2011

Recently, the media has reported that the American Academy of Pediatrics (AAP) has broadened its 2000-2001 guidelines for the diagnosis of and treatment of ADHD. While the prior guidelines focused on children from ages 6 to 12, the new guidelines cover ages 4 to 18. The story is being covered by the media with lead-ins such as saying that AAP is “expanding the age range for diagnosis and treatment.”

This is …

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Neuropsychologists in the evaluation of ADHD

What happened to the art of medicine?

Physician
November 2, 2011

During our medical training we are taught to use evidence based medicine.  This means using the most up to date scientific research data that has been analyzed and accepted as fact.  But does this mean every patient we see fits into the evidence based medicine algorithm that we have been taught to use?

I hope not.  For this would mean we would only be following half of medicine.  The art of …

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What happened to the art of medicine?

Doctors are reluctant to have end of life conversations

Physician
November 2, 2011

My 64-year-old patient with terminal cancer and less than six months to live wanted to go to Oregon. He was contemplating assisted suicide, which is legal there. “My life has been long and good,” he said. “I believe it is my right. I want the ability to say it’s too much, I can’t do it anymore. A person should have a dignified quality of life.”

Another one of my patients, an …

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Doctors are reluctant to have end of life conversations