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The financial costs of treating CT-induced cancer

Matthew F. Covington, MD and Phillip H. Kuo, MD, PhD

Conditions and Diseases

January 12, 2016

Computed tomography (CT) is a powerful diagnostic tool that allows rapid diagnosis of disease. CT is widely available in the U.S. and is a mainstay of medical diagnosis. Estimates state that 85 million CT scans were performed in the U.S. in 2012. To create images, CT scanners pass ionizing radiation (x-rays) through the body thereby exposing patients to radiation. Patients who are imaged with CT have …

The mystery of false positive mammograms and cancer risk

Dr. Saurabh Jha

Conditions and Diseases

January 12, 2016

I enjoyed Agatha Christie’s Hercule Poirot. Not only did the ingenious Belgian solve the murder so artfully. But someone identifiable is killed, and someone identifiable is the killer.

Epidemiological studies are whodunits, too. Except you don’t know who has been killed, what the murder weapon is, or who the killer is. You only know that a murder may have happened.

A study found a higher incidence of breast cancer with …

The struggle of mommy-guilt in physician-mothers is real

Emily Knipper, MD

Physician

January 11, 2016

What does a 3 year old know?

If you don’t like our toddler’s opinion, just wait; she’ll change her mind in a few seconds. The ever-changing mind of a 3-year-old is what makes the fact that I decided to be a doctor at that age all the more amazing. But, that’s how old I was when my parents took me on a mission trip to Haiti, and I decided I wanted to …

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Want to help fix health care? First you have to care about costs.

Chris Trimble, MBA

Health Policy

January 11, 2016

An excerpt from How Physicians Can Fix Health Care: One Innovation at a Time.

I’ve studied lots of industries. In general, cost and quality compete on equal terms. Some companies emphasize cost, others quality, but both are always in the picture.

And then there is health care. Uniquely among industries, health care has evolved with minimal attention to cost. Forces of cost constraint have historically been so weak as …

Hospitals need a checklist for the patient experience

Anna Reisman, MD

Physician

January 11, 2016

Earlier this year, when my mother was briefly hospitalized, nobody gave her the wrong medication (her wristband was checked before each medicine was dispensed). Nobody missed a high or low blood pressure (her vital signs were taken every few hours, like clockwork). She was usually assisted to the bathroom so she wouldn’t fall (a sensor on her bed triggered an alarm if she started to get up).

Thank goodness for hospital-based …

In health care: Fix what we can fix. Accept what we cannot fix.

Stephen C. Schimpff, MD

Physician

January 11, 2016

Part of a series.

You know the serenity prayer, written by Reinhold Niebuhr in about 1940:

God, grant me the serenity to accept the things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.

I saw an elderly woman in the hallway recently with the prayer framed and done in needlepoint by her daughter. It was very beautiful, and it got me to thinking …

Prevent your baby from dying: 9 tips every parent should know

Chad Hayes, MD

Conditions and Diseases

January 10, 2016

Dead babies aren’t something anybody likes to talk about. But while it may be an uncomfortable topic, it’s also an important one — because there are things we can do to make it happen less frequently. The loss of an infant is something parents never really get over, and something that no parent should have to experience. Here’s a look at the most common causes of infant mortality and some things you …

What passes for medical advice online isn’t actually true or safe

Edwin Leap, MD

Physician

January 10, 2016

How do we know what to believe about anything? In times past we read books, we took classes, we spoke to experts. These days? These days we do the same, but we also search the Internet. And we seem to do it with special fervor when it comes to questions about our health.

I can’t throw any stones here. Even a physician has knowledge that is limited to his or her …

4 mistakes parents make in the pediatrician’s office

Claire McCarthy, MD

Physician

January 10, 2016

I love being a pediatrician; there’s nothing I would rather do. But sometimes I get frustrated by things that parents do — or don’t do.

I’m not talking about things like being late (hey, I run late, it would be unfair to complain), or getting upset with the staff about waiting (hey, I’m going as fast as I can and what if it were your kid who needed more time?), or …

What physicians experience today is feigned intimacy

Jordan Grumet, MD

Physician

January 10, 2016

Walter was far older than his chronological age. A mere thirteen years, he kept company with a much older crew. Doctors, nurses, and CNAs were his constant companions. The other kids on his floor were either too sick to interact, or came and left within a matter of days. But not Walter. His heart was too weak to allow his departure, but too strong to be first in line for …

A life-threatening condition cannot dampen the human spirit

Val Jones, MD

Physician

January 9, 2016

My patient was an elderly farmer with severe vascular disease. He had advanced leg artery narrowing, had survived multiple heart attacks, and was admitted to the hospital after a large stroke. He was incredibly cheerful, vibrant, and optimistic. He had a very large, loving family who took turns attending to him, and encouraging him with each small improvement in his leg and arm strength. They knew his neurological exam better …

This medical student went to rehab. Here’s what she learned.

Jennifer Adaeze Anyaegbunam

Medical Education

January 9, 2016

As physicians, we are trained to look for change. We look for changes in lab findings and change medications, and we ask our patients, “what has changed since I saw you last?” We are always trying to get our patients to change in one way or another. Doctors are hardwired to seek changes that produce a dopamine release in our brains. We love it when patients see an improvement in …

This doctor won’t prescribe Addyi, the “female Viagra.” Here’s why.

Jennifer Gunter, MD

Medications

January 9, 2016

Addyi (flibanserin), the drug to increase female libido had a timid entry into the market with very few prescriptions considering the “hype.” Bloomberg Business reported 227 prescriptions in the first month. That’s a pittance considering Valeant paid $1 billion for the drug.

I am unlikely to help Valeant recoup their investment, because the more I read about this drug, the worse it looks. Here’s why:

It barely works

One of the study endpoints (meaning …

MKSAP: 72-year-old man with a laceration on his left index finger

mksap

Conditions and Diseases

January 9, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old man sustains a laceration on his left index finger while preparing chicken. He immediately washes the area and applies neomycin and an occlusive bandage. He changes the bandage and reapplies the medication twice daily. Two days later, he develops itching and redness at the wound site. He has had no fever or other …

Sometimes I see my ghosts in the form of my patients

Amrapali Maitra

Medical Education

January 8, 2016

On my medicine sub-internship, I took care of an elderly man who was a retired military surgeon. When he first came into the hospital, mentally altered from an underlying infection, he was irascible and unpleasant towards many staff members, swatting their hands away as they attempted to draw blood for lab tests.

As the infection came under control, the shell of rage fell away to a quiet dissatisfaction. The bed was …

These are the reasons why health insurers have to change

Robert Pearl, MD

Health Policy

January 8, 2016

Consumers spend 16 times as long choosing a computer as they do selecting a health plan for themselves and their family. And it should not be a big surprise.

For decades, nearly all insurance companies offered similar choices of in-network physicians and hospitals. And as a result, plans differed only minimally in clinical quality, access and service. And even when clinical outcomes varied, consumers had no easy way to access comparative data.

So …

At the end of life, medicine truly becomes an art

Don S. Dizon, MD

Physician

January 8, 2016

She had been a patient for several years, and I still remember meeting her that first time: Her breast cancer was stage IV at diagnosis, already established in her bones; she was scared; she was in pain. Surgery was taken off the table, and she was referred for medical therapy. We had discussed prognosis, the incurableness of her cancer, …

From medicine intern to radiology resident: Is the grass greener?

Kerri Vincenti, MD

Medical Education

January 8, 2016

When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year — …

Shared decision-making in primary care: How can we make that happen?

Kenneth Lin, MD

Physician

January 7, 2016

One of the most notable things so many of last year’s biggest health stories have in common is that they envision an increased role for shared decision-making in primary care.

Some patients will want to receive few aggressive interventions at the end of life; others will want more. Some women will be fine with waiting until age 45 or 50 to get their first mammogram; others will still want to start at …

Are psychiatric disorders actually brain diseases?

Steven Reidbord, MD

Conditions and Diseases

January 7, 2016

Some maladies that attract psychiatric attention are unequivocally brain diseases. Huntington’s disease. Brain tumors. Lead poisoning. However, these are not psychiatric diseases. Huntington’s is a genetic abnormality diagnosed and treated by neurologists. Brain tumors are managed by neurosurgeons and oncologists. Lead toxicity is treated by internal medicine. Indeed, a long list of medical and surgical diseases include psychiatric features: stroke, anoxic brain injury, meningitis, lupus, diabetic ketoacidosis, and febrile delirium to name a few. One important …

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