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Discharged too early? The decision is more complicated than you think.

Physician

January 7, 2016

Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right?

First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right …

This is why patients cannot be customers

Tanya Feke, MD

Physician

January 7, 2016

The customer is always right, or so the saying goes.

If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl.

It can sometimes …

Martin Shkreli speaks an inconvenient truth

Dr. Saurabh Jha

Medications

January 6, 2016

I don’t subscribe to conspiracy theories. I never believed a second shot was fired. Nor do I believe that Bill Clinton was stalked on the grassy knoll. So I won’t speculate that Martin Shkreli’s arrest for alleged securities fraud that happened years ago is related to his raising Daraprim’s price by 5,500 percent.

Just because something isn’t suspicious doesn’t mean that it isn’t odd.

Shkreli is a perfect poster child for rapacious …

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These are the moments why we practice medicine

Tara F. Bishop, MD, MPH

Physician

January 6, 2016

When I was a new attending, an older man came to see me as a new patient. He had not seen a doctor in over thirty years and was experiencing worsening chest pain that first occurred when he walked upstairs but had progressed to pain at rest. An electrocardiogram in the office showed signs of ischemia, and I advised him that I wanted to call an ambulance to take him …

The problem with shared decision-making in appendicitis

Skeptical Scalpel, MD

Conditions and Diseases

January 6, 2016

A JAMA Surgery Viewpoint recently suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics.

The paper acknowledged my criticisms of the Finnish study that found that simple appendicitis could be treated successfully with antibiotics in almost 75 percent of patients.

I respect the authors of the JAMA Surgery article and am happy they Read more…

The problem with shared decision-making in appendicitis

A patient is remembered. He lived life the way he wanted.

Ahmad Yousaf, MD

Physician

January 5, 2016

“Donald passed away.”

We had been sitting in the chiefs’ office with a few of the attendings who had all had Donald (name changed to protect privacy) on their service at one time or another. Everybody exhaled a collective sigh, soaking in the sting of the knowledge of Don’s death; then, within a few seconds, everybody had smiles on their faces. The smiles were born out of a personal experience with him in …

Physicians aren’t burned out. They’re abused.

Pamela Wible, MD

Physician

January 5, 2016

burnout

Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.

We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f’d up so fast? Attention medical students and doctors: It’s not your fault.

Burnout is physical and mental collapse caused by overwork.

So why …

Pediatricians should listen to parents. Here’s why.

Lisa Shulman, MD

Conditions and Diseases

January 5, 2016

Recently, during a typical day as a developmental pediatrician, I walked down the hall to schedule an ophthalmology appointment for a toddler. As I spoke with the secretary, I saw a thin “new patient” chart on her desk for another patient. I recognized the name at once and was immediately transported back 25 years ago, to when I was a fellow in training at the center and learned a very …

Why it’s time for doctors to ditch their white coats

Peter Pronovost, MD, PhD

Physician

January 5, 2016

Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients?

After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily …

Doctors are not in control. Perhaps this is our greatest challenge.

James C. Salwitz, MD

Physician

January 4, 2016

There are times, as a healer, I feel helpless. These are not just the moments when cancer consumes. I understand that the dread disease has yet been conquered, and there is still terrible loss. This not when I refer a patient elsewhere; I know my limits. Rather, these are the times when I am trapped, ignored, and the result is needless suffering.

In his classic, often quoted, 1942 short story, Runaround, …

Health IT needs to be seen but not heard

Suneel Dhand, MD

Health Technology

January 4, 2016

You may be forgiven after reading some of my articles for thinking that I’m somehow “anti-health care information technology.” It’s a subject that I’ve written a lot about over the last couple of years, mainly because I feel passionately that our use of information technology at the frontlines of health care needs to drastically improve.

But let me start first by making a confession: I love information technology. I am just …

A surefire way to see pharmaceutical reps in a timely fashion

Neil Baum, MD

Physician

January 4, 2016

Today so many physicians are not able to see pharmaceutical representatives (PRs). However, PRs do serve as a great resource and finding a way to make their visits more efficient and focused is an objective we all need to strive for.

I recall requesting an interview with Lou Holtz, then the head coach at Notre Dame, and was told by his secretary the date and time that the interview would take …

It’s time to make a spiritual legacy for 2016

Kevin Haselhorst, MD

Physician

January 4, 2016

This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy. People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity.

Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is …

The truth about antidepressants and autism

Adam C. Urato, MD

Conditions and Diseases

January 3, 2016

Recently, another study was published showing that SSRI antidepressant use during pregnancy is associated with increased rates of autism in the children. By my count, this is now the tenth study on this topic — all of which found links between SSRI antidepressant use in pregnancy and autism in the offspring. Most of these studies were recently reviewed, and also concluded that SSRI antidepressant use during pregnancy is associated …

How partnering with urgent care created a dream primary care job

Rebekah Bernard, MD

Physician

January 3, 2016

I have a dream job.

I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday. I’m off Friday through Monday, and I don’t take any call. I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety.

It wasn’t always this way. Like all new doctors recently out …

10 tips to make residency more enjoyable

Jessica Deslauriers, MD

Medical Education

January 3, 2016

As a second year resident, I often do not feel like an expert in anything. Every day I learn more about medicine and realize how much more I still want to learn. In spite of the emotional, physical and mental challenges that being a young doctor entails, I have remained positive and have grown stronger throughout residency. As I reflect on the past year and a half, I appreciate the …

Physicians: Listen to voices of the past. And learn.

Jeffrey McWilliams, MD

Physician

January 3, 2016

I’ve noticed as I get older, life seems to travel full circle no matter your path or destination. I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago. “Don’t do that, you’ll fall and hurt yourself.” Or, “Try it this way and the process will be much easier.” There is that brief moment of acknowledgment often followed by scraped …

The difficult questions have to be asked in the exam room

Nazish Malik

Medical Education

January 2, 2016

As a medical scribe to physicians, I’ve entered over a thousand different exam rooms and listened to a thousand different patients give their unique histories, but the morning of October 28th was quite different.

On this chilly late October morning, I knocked and stepped into the exam room of my very first “patient.”

“Mrs. Laura Williams” was an elderly woman, old enough to be my grandmother, but slightly taller and a lot …

I’m not worried about colon cancer. I’m worried about the potential colonoscopy.

Justin Reno, MD

Physician

January 2, 2016

“Don’t forget to bring that stool card back in, OK?”

As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon. I’d hate to have colon cancer.”

At this point, I’d hate for him to have a positive occult blood card. I could really care less about colon cancer. Colon cancer isn’t going …