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The Baltimore riots: We should look beyond stereotypes

Rhea Boyd, MD

Physician

May 2, 2015

As Baltimore erupts in fiery protest following the death of Freddie Gray, the city joins scores of others who have recently challenged the role of police in community.

With the disproportionate representation of black males in the correctional system and the videotaped deaths of those approached by police for seemingly petty infractions, the longstanding concern for a criminal justice system that differentially treats communities of color, is …

A rare case in a rural doctor’s office

Hans Duvefelt, MD

Conditions and Diseases

May 2, 2015

I see some odd things in my clinic. One recent diagnostic dilemma was a man in his late fifties with shortness of breath.

He had been born with a ventricular septal defect and had undergone surgery for this in his infancy. During his lifetime, he had seldom gone to doctors and always thought he was in fairly good health, maybe just of a weak constitution. A smoker since age 13, he …

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A rare case in a rural doctor’s office

The downsides of automating health care

Skeptical Scalpel, MD

Physician

May 2, 2015

If you are a doctor, nurse, patient, or just someone interested in patient safety, you should read a five-part story called “The Overdose: Harm in a Wired Hospital” excerpted from a book The Digital Doctor by Dr. Robert Wachter.

Dr. Wachter and the hospital are to be commended for publicizing this incident so others may learn from it. The hospital staff, the patient, and his mother, also deserve credit for allowing their …

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The downsides of automating health care

After an autism diagnosis: A new parental role

Lisa Shulman, MD

Conditions and Diseases

May 1, 2015

A variety of factors contributes to the challenge. First, even in this era, in which autism is a household word, it is not unusual for me to give the diagnosis to parents who have not considered the possibility that their child has autism. Statistically speaking, the children we see at Albert Einstein College of Medicine’s Children’s Evaluation and Rehabilitation Center for these initial evaluations are very young — on average, 24 months …

What to tell your kids about the Baltimore riots

Claire McCarthy, MD

Physician

May 1, 2015

The riots in Baltimore are all over the news. As a parent, it would seem like the best thing to say to your kids is that riots are bad, that violence isn’t the way to solve anything.

But that would be missing the point — and missing an opportunity.

Don’t get me wrong; I don’t think that riots are good or that violence is the way to solve things. But what is …

Walter Scott and a physician’s conscience

Rhea Boyd, MD

Physician

May 1, 2015

The recent killing of Walter Scott was another brutal reminder of the home African-Americans wake to daily. Their America, is one where your father might not come home at night, because his brake light went out, and that cost him his life. It’s a place where petty crimes are penalized by life sentences, doled out on the streets by the very men and women charged with their …

When is it OK to secretly record your doctor?

Jeffrey Parks, MD

Physician

May 1, 2015

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JAMA published an opinion piece about the controversial issue of patients secretly recording their physicians during encounters. We live in the era of the smartphone. Everyone has one — soccer moms, teenagers, young kids who can’t even read yet, elderly nursing home patients who can’t safely feed themselves. Everyone. And these devices have amazing powers of audiovisual capability. We all know this. …

Why it’s time to improve the social determinants of health

Ira Nash, MD

Health Policy

May 1, 2015

It has been known for a long time that “health care” — all the stuff that we do, prescribe and provide — is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care.

I …

Why are affordable drugs so expensive?

Peter Ubel, MD

Medications

May 1, 2015

In the old days, blockbuster drugs were moderately expensive pills taken by hundreds of thousands of patients. Think blood pressure, cholesterol and diabetes pills. But today, many blockbusters are designed to target much less common diseases, illnesses like multiple sclerosis and rheumatoid arthritis or even specific subcategories of cancer. These medications have become blockbusters not through the sheer volume of their sales, but as a result of their staggeringly high …

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Why are affordable drugs so expensive?

A patient this oncologist can’t forget

Don S. Dizon, MD

Physician

May 1, 2015

She was so young — only 32 when diagnosed with ovarian cancer. She had given birth to a son only four months earlier and by all rights should have been celebrating being a new mother. But, instead, she had developed acute pelvic pain, undergone emergent removal of her uterus and ovaries, and was now in my office to discuss …

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A patient this oncologist can’t forget

Fellowship training, as viewed by a physician’s spouse

Ashley Mast

Physician

May 1, 2015

As a wife and mother, I have days that are very difficult, especially since my husband is in training. I go several days in a row where I only see him right before bedtime, and some days he is unable to see our son at all. I often feel like I have no control of our schedule, and am lucky to …

Doctoring to the test. Look to education for a cautionary tale.

Shirie Leng, MD

Health Policy

April 30, 2015

A few weeks ago I wrote a piece about performance metrics in medicine. People asked me: “Well, if you don’t like the metrics, what would you use?” So I thought about this, and the best way I can think of to explain what I mean is to use an example from a different field: education.

Standardized testing has become ubiquitous in schools. …

Resistant hypertension? Or failure to take blood pressure correctly?

Janice Boughton, MD

Conditions and Diseases

April 30, 2015

I recently read a discussion by three hypertension specialists, Drs. Jan Basile, Dominic Sica and David Kountz, on how to treat resistant hypertension. Resistant hypertension is blood pressure that remains above goal despite treatment with three drugs, from different classes, one of which must be a diuretic. 10 to 15 percent of patients with high blood pressure will have resistant hypertension. These are the people who always seem to have …

End-of-life care: What I learned from a pet’s death

Abigail Schildcrout, MD

Physician

April 30, 2015

It has taken me almost two years to be able to write this. We said goodbye to our beloved dog in early May of 2013. I grieved for well over a year.

About a month-and-a-half prior to his death, we had a big medical scare with him. I wrote at that time about how dealing with a veterinary emergency can provide us with some insights and practice parallels to dealing with …

As an under-represented medical professional: Lean in

Mary Branch, MD

Medical Education

April 30, 2015

While reading the book Lean In by Sheryl Sandberg, I was mesmerized by her insight about the self-perpetuating difficulties women face during their careers; however, something was missing.

Mrs. Sandberg, the COO of Facebook, wrote an enlightening novel about the differences in mindset between the genders and how this hinders women in their career. I found that she was spot on with my experience as a woman pursuing medicine. Like Mrs. …

How mobile technology can improve clinical trials

David Lee Scher, MD

Health Technology

April 30, 2015

I recently discussed both the merits and needs for the use of mobile technologies in clinical trials. Recruiting patients via social media is now a reality and has been a topic of discussion in many forums, including mainstream medical journals. There is no question that online patient support groups serve unique purposes. There are regulatory issues involved in this arena.

However, new regulatory frameworks need to be developed in the age of digital …

The low-hanging fruit of health care costs

Tracy Cardin, ACNP

Health Policy

April 30, 2015

I just finished reading the Journal of Hospital Medicine article called “The highest utilizers of care: individualized care plans to coordinate care, improve health care service utilization, and reduce costs at an academic tertiary care center.”

Using a multidisciplinary team of volunteers including members from hospital medicine, ER, psychiatry, ambulatory care, social work, nursing and risk management, individualized care plans were developed for high utilizer patients. These patients had multiple co-morbidities, …

A geriatrics-driven health care system

Elaine Khoong, MD

Physician

April 29, 2015

We have all seen the statistics; America is an aging country. The baby boomer generation is retiring, and families are having fewer and fewer children.

In health care, we often hear about this issue in the context of an inadequate health care workforce. An aging population in conjunction with the ACA has created a quickly growing pool of patients that outpaces the slow growth in the supply of health care providers.

But …

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A geriatrics-driven health care system

I temporarily went back to paper records. And it wasn’t so bad.

Steven Reznick, MD

Health Technology

April 29, 2015

On Monday March 30, 2015 our Greenway PrimeSuite electronic health record had a system-wide failure at the level of the Edgemed Computer service center in New York State. It meant that I was back to using pencil and paper to interview patients and record the answers and physical findings.

With much trepidation, I began seeing patients with two sheets of white blank …

Burnt out physician? Creativity can help.

Starla Fitch, MD

Physician

April 29, 2015

Those of us in health care face tough decisions every day. Should we spend less time with patient A so we can have more time to tell patient B about a bad pathology report?

Should we work through lunch to see a few more patients but risk burning out our office staff at a time when morale is at an all-time low?

Should we skip our child’s piano recital to attend that …