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How doctors can improve patient interactions

Kevin

Patient

February 24, 2010

by Lockup Doc

Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.

When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about …

Atul Gawande’s The Checklist Manifesto reviewed

Robert Wachter, MD

Physician

February 24, 2010

Every now and then, I read and enjoy a book, but only later fully appreciate it as its lessons and insights slowly become apparent. Judging by the number of times I’ve said, “That reminds me of Gawande’s observations about ___” over the past month, The Checklist Manifesto is one such book.

In this short, deceptively simple volume, Atul (who I count as both friend and inspiration) discusses the …

Why being President of the United States is a health hazard

Kevin

Patient

February 24, 2010

Originally published in MedPage Today

by Liz O’Brien

Exactly whom are we honoring on Presidents (or is it President’s) Day?

A. George Washington
B. George Washington and Abraham Lincoln
C. All presidents

The answer is more complicated than you’d ever expect. Probably A is most correct, but if it were up to me, I’d pick C.

Certainly every one of these 43 men has earned the …

Is Google Android or the iPhone the future of mobile smartphones?

Kevin

Health Technology

February 23, 2010

by Felasfa Wodajo, MD

Over the last few months, a great deal of time has been expended on the “hot competition” between Apple and Google in relation to smart phones.

Much of this interest probably had to do with a partially imagined story of a once close friendship between Apple and Google, founded on their mutual enmity of Microsoft, now fractured on the rocks of competition and greed. While the truth probably …

Some hospitals tube feed patients with advanced dementia

Kevin

Physician

February 23, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Tube-feeding patients with advanced dementia — a practice whose effectiveness has been questioned by two widely cited literature reviews — is most common in larger hospitals and those run for profit, researchers said.

The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater …

How the ER is now used to triage every patient

John Schumann, MD

Physician

February 22, 2010

The ER is the portal of entry to our hospitals now, for better and for worse.

On the plus side, this means that most patients being admitted to general medical and surgical services have a workup at least started and are triaged appropriately to their destination.

A good ER evaluation should answer the following questions:

1. What’s the nature of the illness?

Are we dealing with the heart, the brain, or an abdominal organ? …

What doctors do when they don’t know the answer

Alex Lickerman, MD

Conditions and Diseases

February 22, 2010

Part two of a series. See also part one.

Previously I’d discussed how most of the time diagnoses are relatively straightforward. But what do doctors do when a diagnosis isn’t immediately clear to them?

Likely one or more of the following:

1. Revert to “novice” thinking. Which, in fact, is completely appropriate. We’re taught in medical school that approximately 90% of all diagnoses are made from the history, so if we can’t …

End-of-life decisions and making advance directive choices

Kevin

Patient

February 22, 2010

Originally published in MedPage Today

by Crystal Phend

“I do not want my life to be prolonged if, to a reasonable degree of medical certainty, my situation is hopeless.”

“I want my life to be prolonged as long as possible within the limits of generally accepted medical standards, even if this means that I might be kept alive on machines for years.”

Check …

Forcing residents to nap may not improve patient care

Kevin

Medical Education

February 21, 2010

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

More that a year after the Institute of Medicine (IOM) issued a report calling for mandatory naps for medical residents, the organization responsible for implementing — or rejecting — the IOM’s controversial recommendation has yet to make a decision.

The Accreditation Council for Graduate Medical Education (ACGME), which has …

Does your cardiologist deserve his salary?

John Mandrola, MD

Health Policy

February 20, 2010

Conflicted am I on reading of the strategy of a group of South Miami cardiologists who have written their patients complaining of the cuts to reimbursement, primarily cuts in imaging procedures. A tension emerges from within upon reading the following quote from a “healthcare expert.”

“I’m not at all sympathetic with the cardiologists,” said Robert Berenson, a doctor who was once in charge of Medicare payment policy and now is a …

Why Medicare and health care should be deregulated

Kevin

Health Policy

February 20, 2010

by David Allen, MD

Should health care be controlled or provided by the government?

I believe that years of answering ‘yes’ to this question has been at the root of most of the problems in the American health care system. Let’s explore a few of these ‘yes’ answers:

Health care for the elderly must be provided by the government. By creating Medicare, the US government has massively and deleteriously affected medicine. …

Medical marijuana has doctors asking questions

Kevin

Medications

February 19, 2010

Originally published in HCPLive.com

In January, New Jersey became the 14th state in the nation to legalize marijuana use for certain chronic illnesses. Other states where the use of medical marijuana is permitted include Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington; around a dozen more states are weighing pending bills.

The New Jersey …

Laparoscopic procedures injure the surgeons that perform them

Kevin

Physician

February 19, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the surgeons who perform them.

More than 80% of surgeons completing an online questionnaire reported pain or stiffness in the hands, neck, back, or legs after performing minimally invasive surgeries, according to Adrian Park, MD, of the …

ACP: Resident work hours – Managing a precarious balance

American College of Physicians

Medical Education

February 18, 2010

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

In December 2008 the Institute of Medicine (IOM) released its report entitled “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” in which it proposed a number of changes to the current regulations developed and enforced by the …

Texting and cell phone use are becoming more common in hospitals

Edwin Leap, MD

Physician

February 18, 2010

The cell-phone is a wonderful device. Even I, somewhat Luddite about certain technologies, find it delightfully useful for things like calling my wife when I lose the grocery list, calling my wife for directions and calling my wife to remind me of what I was supposed to be doing. I’m not really a fan of texting, though my wife and oldest son seem to communicate that way quite effectively. It’s …

Treating ADHD may not improve kids’ school grades

Kevin

Conditions and Diseases

February 18, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Adhering to guidelines when treating children with attention deficit hyperactivity disorder (ADHD) relieved symptoms but had no effect on kids’ performance in school or in their relationships with others, researchers found.

Although parents and teachers noted significant improvements in symptoms among ADHD kids (P<0.001) in a special treatment program, there …

Treating atrial fibrillation with catheter ablation on TV may not be ethical

Larry Husten, PhD

Conditions and Diseases

February 17, 2010

Mauricio Arruda performed a live atrial fibrillation ablation at University Hospitals in Cleveland on the Today Show recently.

The 6-minute segment was relentlessly upbeat. The TV producers pulled every trick in the book to overcome the inherent difficulty of portraying a hard-to-explain disease like atrial fibrillation and an even harder-to-explain procedure like catheter ablation. Instead of making any effort to truly educate their viewers, the producers took the easy …

Magnetic resonance imaging (fMRI) for persistent vegetative state

Kevin

Conditions and Diseases

February 17, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Researchers in England are reporting they have been able to establish limited communication with a man in a persistent vegetative state by using functional magnetic resonance imaging (fMRI).

The 34-year-old man was able to answer simple Yes or No questions by imagining different types of activity, which caused changes …

Don’t fall into the dementia trap when treating a developmental disability

Kevin

Conditions and Diseases

February 16, 2010

by Lockup Doc

In addition to correctional psychiatry, I spend about half of my professional time treating patients with developmental and intellectual disabilities (mental retardation). The majority of my patients have severe or profound mental retardation and are completely nonverbal.

Over the years I have observed that when many of them are admitted to the hospital for acute medical or surgical problems, because they are severely cognitively and functionally impaired, they are …

How to better notify patients of their abnormal test results

Shantanu Nundy, MD

Patient

February 16, 2010

I just returned from vacation to find email messages from three patients inquiring about their recent test results.

The first email was from a young man who had fainted and underwent Holter monitoring, a test that checks for abnormal heart rhythms. The second was from a woman I recently started on cholesterol-modifying therapy who wanted to know whether her recent blood work showed a satisfactory improvement in her cholesterol. The third …

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