I was driving to work the other day, and there was a story on the radio about the Congressional reaction to the latest recommendations for breast cancer screening from the United States Preventive Services Task Force (USPSTF).
Here’s the background. USPSTF published recommendations in late 2009 for the use of screening mammography in different age groups. For women between 40 and …
This is why it’s so hard to rein in mammogram screenings
A new clinical report from the American Academy of Pediatrics is a rare beacon of coherent thought about lice and children.
Rather than humiliating children and driving them away like lepers, the AAP recommends common-sense steps to identify and treat lice. Some facts really shouldn’t be in dispute:
Common sense guidelines for children with lice
The other day, a teen patient of mine told me she is pansexual.
We were having the usual talk I have with teen patients, the one where I we talk about sex and sexuality and birth control and sexually transmitted infections. But over the past few years, that conversation often takes interesting turns when I ask about sexuality, like it did the …
Bruce Jenner is evolving the birds and the bees talk
Imagine a surgeon removing a gallbladder miles away from where he or she actually is. Imagine when you are ill, a physician has the ability to diagnose you from your living room. Telemedicine.
Telemedicine itself is not a concept that is all that new. In the 1930’s, Italy used telemedicine to communicate with ships at sea, while in the United States, NASA …
Telemedicine is medicine’s sexiest new field, but why aren’t we ready for it?
Thankfully, many medical conditions that once were never discussed in public, such as cancer, AIDS, and even infertility, have largely shed their stigma and sense of secrecy.
Miscarriage holds an unusual place in medicine in being both common and something that many in society thinks is rare. One in four pregnancies ends in miscarriage, and there are 1,000,000 miscarriages each year in the U.S. — yet miscarriage remains shrouded in privacy …
The taboo nature of miscarriage must end
Some years ago when my father underwent bypass surgery, he was anxious, depressed and in pain as he lay in the hospital bed tied to IV catheters and tubes. Each day, his surgeon, his hospitalist, and other consultant doctors whisked in and out, asking how he was feeling and then ordering a treatment plan. A few years after his full recovery, …
A nurse is an essential partner to patient care
Recently, I was back in the United Kingdom for a short trip home. It happened to be the week of the general election, and after a long campaign the country finally went to the polls on Thursday.
For those of you unfamiliar with U.K. politics, for the last five years there’s been a coalition government between David Cameron’s Conservatives and the Liberal Democrats (the first coalition government for 70 years). The …
Fixing health care really depends on the economy
I wasn’t the first simple country surgeon, you know.
When I was a resident, our training program broke us into two teams — one that served general surgery, pediatric surgery, and trauma; the other, general surgery, transplant, and oncology. Every day was an intricate dance to see all the patients (generally between 20 and 40) for the assigned team, operate all day, …
3 things that make a surgeon great
An excerpt form Baby City: An Inside Look into Labor & Delivery.
I am going to make this medical student cry.
I don’t know how I know it, but somehow I can sense it. I know it the second she walks into the resident room on labor and delivery at Cadence Hospital, her perfect blond ponytail swinging behind her. And I’m certain of it when she holds her slim …
A medical student on her obstetrics rotation: Behind the scenes
I was volunteering at one of the free clinics associated with my medical school last weekend, and while teaching a medical student how to sew a cut, he queried, “That is an interesting technique, who taught you how to suture? Are you a surgeon?”
“I am actually a radiologist,” I replied. “To answer your first question, I was actually taught this by an obstetrician during my third year of medical school.”
Puzzled, …
What this radiologist learned from his obstetrics rotation
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated for redness that developed over her right leg at the site of a mosquito bite. She is otherwise healthy and takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 120/70 mm Hg, pulse rate is 70/min, and respiration rate is 14/min. There …
MKSAP: 25-year-old woman is evaluated for redness at mosquito bite
Hepatitis C is one of the most common chronic infectious illnesses in the U.S. today and affects nearly 3.2 million Americans. Complications of hepatitis C infection include liver cancer as well as cirrhosis. Many patients with chronic hepatitis ultimately develop liver failure and will die without liver transplantation. In the last year, a new drug class has entered the market and can produce cure rates in excess of 90 percent.
These …
How hepatitis C treatment is a glimpse of health care’s future
Practicing physicians like me rely on up scientific medical journals to keep us current on medical developments. We learn about new treatments for old diseases. New diagnostic tests are presented as alternatives to existing methods. Established treatments, which are regarded as dogma, may be shown to be less effective or less safe than originally believed. It’s a confusing intellectual morass to sort among complex and conflicting studies some of which …
When medical journals disagree: What’s a practicing physician to do?
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We physicians have long labored under the belief that if we provide objective data about the safety and efficacy of vaccines we can change anti-vaxxers’ minds. But political scientist Brendan Nyhan, Ph.D. has shown that directly addressing patients’ concerns about vaccines does little to change their decision to immunize. And he’s probably right. Other research examining the effects of education …
How to win patients and vaccinate people
Let’s take a moment to consider what makes a terrific nurse.
First, by way of gathering information, let’s consider the health care industry’s present views on excellence in nursing. Let’s think about how this conception of excellence in nursing aligns with our own perspectives.
In a recent Atlantic article, titled “The Problem with Satisfied Patients,” Alexandra Robbins writes about the economic …
Let’s celebrate nurses by reining in patient satisfaction
A response to “You’re a medical student. And it’s so obvious why.”
We don’t even have to ask, and we can tell by the bags under your eyes.
It’s so obvious that you are a medical student.
References in every pocket of your short white coat, pulling down on your shoulders until you hunch over. You force yourself to stand up straight …
This is how I know you’re a medical student
It was May 13th, 2012. Mother’s Day. My wife, Cyrena, was having an incredibly difficult pregnancy. She had pounding headaches, blurred vision, and searing pain throughout her body. As a matter of fact, she had been in and out of the hospital for the last two weeks. Our tiny daughter was only developed 23 weeks in gestation. Her due date was …
My wife wanted to fire our pediatrician. What can we learn from this?
Physicians are struggling to adapt to a sea change in the health care delivery system. Solo physician practices are disappearing, small group practices are merging to become larger, and large group practices are being acquired by hospitals and integrated delivery systems. All of this is occurring in a milieu of decreased fee-for-service reimbursement from government and private insurers, bundled payments and pay for performance, increased levels of student loan debt, …
3 changes that can improve maintenance of certification
Following the recession, the Obama administration sought shovel-ready projects.
One unlikely shovel-wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 percent of the stimulus towards digitizing medical records.
Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between …
The Digital Doctor: A reasoned look at the state of health IT
During my family medicine rotation, my very first clinical clerkship of medical school, I was assigned to make a home visit to one of my preceptor’s patients—a man I will call Mr. Jones.
Mr. Jones had congestive heart failure, COPD, and a barrage of other chronic health problems. He was a pleasant gentleman but had a low level of health literacy and had been doing a poor job of taking his …
Educating community health conscious physicians
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