by Dr. Whoo, MD
Q. I just found out last week that I’ll be a new mom in November, making me an official mother in medicine! I’ve been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here’s my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?
— From a future mom and …
Medicine residency survival tips during pregnancy
by Crystal Phend
Advance planning improves end-of-life care for elderly patients and helps families cope with the loss, researchers found.
In a randomized trial, hospitalized patients over age 80 who were formally assisted with documenting their end-of-life treatment wishes and with designating a surrogate were almost three times more likely to have those wishes followed (86% versus 30% in usual care, P<0.001).
Family members of patients in the advance planning intervention reported significantly …
Advance planning helps families cope with loss
If there’s one thing everyone agrees on, it’s that preventive care is always a good thing. Well, I’m a doctor and I’m afraid of preventive medicine.
The theory behind preventive medicine is sound. It is better to treat prevent disease than to treat it. It is better to refrain from smoking and never get lung cancer than it is to treat lung cancer. It is better to refrain from alcohol abuse …
Preventive medicine may not always help patients
I want to touch on what is probably the hottest topic in psychiatry: whether psychologists should obtain prescription privileges. This is topical because Oregon just overwhelmingly passed a law authorizing prescriptive privileges for psychologists, although it is unclear whether the governor will sign the bill.
I endorse psychologists prescribing, and here’s why: it would be the single best thing that could happen to psychiatry.
Yes, I know it sounds ridiculous, but …
Psychiatry benefits when psychologists prescribe drugs
Now, as you know, I am a big fan of epidemiology. I do not believe that a randomized controlled trial is the be-all-and-end-all in evidence generation, and a well done observational study can add to our reservoir of knowledge much more efficiently. Of course, I, as many others, acknowledge certain limitations of epidemiologic design. However, many of them can be overcome with careful design and analysis.
I have to confess, though, …
Epidemiology and how confounding statistics can confuse
by Nancy Walsh
Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found.
Youngsters who had persistent behavior problems at ages seven, 11, and 16 years had more than twice the risk of widespread chronic pain at age 45 as other children (RR 2.14, 95% CI 1.43 to 3.21), according to Dong Pang, PhD, of the …
Chronic pain patients may have been disobedient children
When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’
Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically …
Patient advance directives are critical in the ICU
A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.
But her history was concerning to me, and it was concerning to …
Hospital admissions may require watching and waiting
I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I’m very happy to say that it appears to be living up to my high expectations.
The screen is gorgeous. It’s very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive — it …
iPad in the ER, a hands on physician review
While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS).
Under the legislation, CMS is now far freer to undertake a variety of pilot programs and demonstration projects designed to improve quality, safety and efficiency, and to convert the successful ones into policy. And, if that wasn’t enough for those who have long been praying …
Don Berwick to lead Medicare and Medicaid
With the explosion of social media, I am amazed at how many doctors I encounter who know little to nothing about blogs, Twitter, Facebook, Google Buzz and the like. “I’m too busy.” “Who has time for that stuff?” “I wouldn’t have time for anything else.” “How can I possibly keep up?”
And yet today, as more and more patients reach out to the web to find medical information or, more importantly, …
Twitter for doctors, a guide for health care professionals
In 1927, Francis Peabody remarked that, “The secret of the care of the patient is in caring for the patient.”
Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today’s era, perhaps the group that best personifies this central …
Social work is key to quality patient care
by John Fauber
For nearly a decade, Paula Oertel’s brain tumor was kept at bay by a drug that was not approved to treat her condition. Then Oertel did something she never imagined would jeopardize her health.
She moved — less than 30 miles — from one county in Wisconsin to another.
That move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including …
Medicare denies a brain tumor drug after a patient moves
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by Joseph Lombardi, MD
You probably remember the tragic death of actor John Ritter in 2003.
Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection.
In addition to TAD Coalition’s “Ritter Rules,” which focus on recognizing, treating and preventing the condition, the American Heart Association and American College of Cardiology also released new guidelines designed to prevent unnecessary …
Aortic dissection symptoms and current treatment options
by John Gever
As portrayed on popular television shows, physicians frequently deal with vexing ethical dilemmas — perhaps more often than occurs in real life, researchers said.
Doctors on TV also sleep around a great deal, with each other and with patients, and behave unprofessionally in a host of other ways, reported researchers at Johns Hopkins University in Baltimore who analyzed the content of a full season of “House M.D.” and “Grey’s …
Grey’s Anatomy and other TV doctors skirt bioethical issues
by Michael Kirsch, MD
First, let me state unequivocally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily opponent that can be difficult to vanquish. In recent years, physicians have been resorting to a ‘shock and awe’ strategy of using excessive force against it.
While this may be sound military …
Pain management depends too heavily on narcotics
by Nikolaos I. Kakavoulis, MD
Physicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change.
Why is this happening?
Now more than ever, physicians face an avalanche of complex rules, regulations, and administrative processes needed …
Physicians increase revenue with better appointment analysis
Obamacare faces a shaky future because of its call for an individual mandate. This mandate requires people to buy insurance or face income tax penalties, which the IRS would presumably enforce.
As I write, attorney generals in 35 states are in the process of challenging the individual mandate as unconstitutional.
The individual mandate issue is important. Kill it, and you kill Obamacare.
Why? Because the individual mandate is the political mechanism for controlling …
The individual mandate may collapse health reform
While typing words, the advertisement for yet another hospital is overheard from the TV. “Ignore it John,” I think to myself, but, it is impossible to not look up and see. The head shakes with a smirk, like my grandfather did and without words displeasure was easily conveyed.
Do people really think the graphical professionalism of a TV spot is even remotely an accurate metric of quality of medical care?
At work, …
Peer review helps doctors improve medical care
As physicians progress through medical training and acquire new knowledge and skills, something interesting happens. They also develop a new and increasing awareness of not only how much they didn’t previously know but also how much they still don’t know. This process sounds paradoxical but has been consistent with my personal experience: The more I learn, the less I think I know.
Any seasoned clinician knows that in order for one …
Physicians should be involved in health care decisions
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