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Change the culture of uneven power dynamics

Physician

April 14, 2015

My career is based on communication and empowerment within the medical world. I educate on the patient/family side and the medical professional side. It takes understanding and empathy from both sides of the stethoscope to optimize communication. It takes communication between both sides to bridge perceived power differentials. It takes work on both sides to change a culture of uneven power dynamics.

I read two Facebook posts within the past few days dealing with a …

Good health care leaders have these 3 traits

Suneel Dhand, MD

Physician

April 14, 2015

In my travels up and down the East coast, I’ve worked with a number of health care administrators (and even temporarily been one myself, although quickly discovered that it wasn’t quite my cup of tea). The experiences that I’ve had have been highly variable, and I’ve seen the full spectrum of administrators ranging from the brilliant to the quite dire. As someone who has read many autobiographies of famous leaders, …

As the doctor exits, what does it mean for the humanity left behind?

James C. Salwitz, MD

Health Technology

April 13, 2015

The nightmare sickens me. A small child trusts a man to protect her, take care of her, and shield her from harm. The man, for incomprehensible and useless reasons, neglects her unto death. For me, when I think of Germanwings flight 9525, I am haunted by the photo of a single tiny girl, taken in the last days of life; the obliteration of that perfect life’s potential. Waste, tragedy, evil.

In the …

Pseudodiseases, the age of misinformation, and the death of the null hypothesis

Thomas Paine, MD

Conditions and Diseases

April 13, 2015

She was lying there stretched out, her mouth open, her eyelids sealed, her fingers straight, immobile, and paler than an image made of wax. From out of her eyes came two streams of tears flowing slowly down onto the pillow …

For forty-three days, Charles did not leave her. He neglected his patients; he sat up every night, he was constantly taking her pulse, applying sinapisms, cold-water compresses. He sent Justin to …

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Pseudodiseases, the age of misinformation, and the death of the null hypothesis

Should we give patients our cell phone numbers?

Anne Katz, RN, PhD

Physician

April 13, 2015

shutterstock_160559990

I recently attended the David Stroud Adolescent and Young Adult [AYA] Symposium at Keck Medicine of University of Southern California. It was a very interesting symposium with experts in adolescent and young adult cancer presenting on many different topics important for this population. There was also a panel of young adult …

Accountable care for Medicaid. No, we need real solutions.

Shirie Leng, MD

Health Policy

April 13, 2015

New York officials are doing an “experiment” that should strike fear, anger, and outrage in the hearts of doctors who take care of Medicare patients. (New York has the highest Medicaid budget of any state.)

As any doctor who has a high volume of Medicaid patients knows, Medicaid pays practically nothing. Doctors who take Medicaid usually have to carry a bigger patient load to survive. Medicaid patients are often sicker than …

Why patients lie to physicians

Val Jones, MD

Physician

April 13, 2015

Popular TV doctor, Gregory House’s favorite adage about patients is: “Everybody lies.” I used to believe that this was a cynical and inaccurate statement, but I had to revisit it recently when faced with a patient whose signs and symptoms were consistent with a diagnosis that she vehemently denied.

A young woman was admitted to my rehab unit with brain damage of …

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Why patients lie to physicians

A psychiatrist. Undercover.

Maria Yang, MD

Physician

April 13, 2015

My husband was in the aisle seat, I was in the middle seat, and The Man was in the window seat.

The Man had one white earbud in his ear; the other one was dangling in his lap. His right thumb swiped through several screens of his smartphone in less than a second. He heaved a sigh.

“This is f*cking lame,” he muttered.

The plane was supposed to take off 15 minutes ago. …

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A psychiatrist. Undercover.

Can hospitals tell workers not to smoke at home?

Michael Kirsch, MD

Physician

April 12, 2015

I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city. They are a world class medical institution whose reputation is largely derived from its cardiovascular department. Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects. The entire campus is smoke-free, as …

After a verdict: Doctors need to be taught a lesson. Really?

Dr. Saurabh Jha

Physician

April 12, 2015

Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the president, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after …

So you want to be a surgeon? Here are 10 tips to help you.

Dr. Nikki Stamp

Physician

April 12, 2015

My interns started the term with mixed career aspirations. One wanted to do interventional radiology, the other, “not sure.” Now, in their last few weeks of our term, they’re thinking about a surgical career. Which I think is great. I’ve been lucky enough to have had some great advice over the years, and I’ve nutted a few things out myself along the …

MKSAP: 54-year-old woman with shortness of breath

mksap

Conditions and Diseases

April 12, 2015

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

A 54-year-old woman is evaluated for shortness of breath of 3 months’ duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 145/82 mm Hg, and pulse rate is 108/min. Oxygen saturation is …

Abortion: Caught between an oath and beliefs

Anonymous

Medical Education

April 11, 2015

Medicine is an area of study that is bursting with countless gut-wrenching ethical debates. Throughout our medical training, even in some medical school interviews, we are asked and tested on how we would personally navigate the delicate tightrope of right and wrong.

Trying to maintain equilibrium between our personal beliefs and those that are best for our patients can often be difficult. On one side of our acrobatic act, we are …

In the midst of child abuse, the face of an angel

Lawrence R. Ricci, MD

Physician

April 11, 2015

Angel was then, and is even now, one of the most beautiful babies I have ever seen and I have seen many in my thirty years as a child abuse pediatrician. Yet, to look at her today, asleep against her foster mother’s shoulder, one could never guess at the devastation wrought upon her.

I first met Angel, then only a few months old, in the pediatric intensive care unit just before …

How doctors and families can work together in patient care

Ravi Parikh, MD

Physician

April 11, 2015

Mr. U* came to the hospital overnight with severe heart failure. His breathing was supported by a ventilator and he was sedated. Thus, our primary means of communication was via his daughter. His daughter, distraught, stayed awake through most of the night. She appeared suspicious about her father’s care, immediately asking my credentials when I entered the room and demanding that we discuss treatment decisions with her alone. The next …

MKSAP: 28-year-old man with pain on the radial aspect of the right wrist

mksap

Conditions and Diseases

April 11, 2015

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

A 28-year-old man is evaluated for pain on the radial aspect of the right wrist that occurs with use of the thumb. The pain has been present for 2 weeks. He has never had this pain before and has not had any trauma. He works as a computer programmer and plays video …

Can I add you to my list of medications?

Jacques Balayla, MD, MPH

Physician

April 10, 2015

Medicine is filled with intricacies and subtleties about the human condition. Within these nuances, and embalmed with the science of the profession, lies the true art of medicine, a concept not hastily understood, nor easily defined. Although the practice of medicine continually changes in response to new biological understandings, novel technologies, and evolving cultural contexts, the ethical foundations of the clinical relationship between patients and physicians paradoxically remain constant. …

Alternative vaccine schedules dilute the vaccine message

Justin Morgan, MD

Conditions and Diseases

April 10, 2015

An increasing amount of parents are choosing to delay or spread out vaccines for their infants and toddlers. Dr. Allison Kempe and her colleagues at the University of Colorado School of Medicine found that in a typical month, 93 percent of pediatricians and family physicians reported that some parents of children less than 2 years of age requested to spread out their vaccines. The findings, published in the April 2015 edition …

What does it mean to be a health care leader?

James D. Grant, MD

Physician

April 10, 2015

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Clearly, physicians are the leaders of the health care team. We were educated and trained for that role.

But on the business and political sides of health care, maybe not so much.

One reason is that the word “leadership” has a lot of different meanings. A leader in one …

Does the attire determine professionalism?

Adam Bitterman, DO

Physician

April 10, 2015

I recently sat down with a well-known physician within the orthopedic community as well as among the medical socialites of social media. When I walked into his office, the first words out of his mouth were about my attire. As I was concerned about first impressions, I broke out the fancy suit, custom tailored, of course, a matching shoe and belt …

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