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What does meaningful use stage 3 mean to you?

Health Technology

April 10, 2015

On March 20, 2015 the stars aligned to produce four simultaneous events that will never again coincide during the life of human civilization. The first three, the vernal equinox, a total solar eclipse and a new supermoon, were brought to us by the stars themselves, and the fourth one was thrown out there by the government. The regulations for meaningful use stage 3 were finally published. Meaningful use of electronic health …

Obamacare re-enrollment: What can patients do?

Kevin R. Campbell, MD

Health Policy

April 9, 2015

As the Obamacare machine continues to grind forward, many patients have re-enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd), others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care. Prevention was one of …

5 tips to maintain work-life balance as a medical intern

Joyce Ho, MD

Physician

April 9, 2015

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I was asked by one of my readers recently to write a post on how I maintain work-life balance during the all-consuming intern year of medical training. I love this idea because keeping myself sane while spending 80 percent of my time in the hospital has proven to be a constantly challenging task, and I’ve come up with a few ways …

Feeding tubes and the culture of patient safety

Michael Kirsch, MD

Physician

April 9, 2015

“Safety first” is a mantra of today’s hovering parents. It’s the default explanation that a parent invokes when an edict has been issued that cannot be challenged or reversed.

“Mommy, can I please have a water pistol?”

“I’m sorry, honey. You know how Daddy and I feel about guns. This is a safety issue. Now go and practice your violin and afterwards help yourself to some kale chips.”

The safety concept has crept …

Disease can humble any doctor

Jordan Grumet, MD

Physician

April 9, 2015

I remember being more confident that most of my peers. The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me. Maybe it was on account of my lifelong pursuit of medicine. I felt nothing but elation at the newly branded “M” and “D” that came after my name on the hospital badge. I was no longer a volunteer, no longer a …

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Disease can humble any doctor

The old school physician is who we should aspire to be

Suneel Dhand, MD

Physician

April 9, 2015

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A couple of weeks ago I was on-call and had to go down to the emergency room to see a patient. Before I entered the room, I was told that the patient was accompanied by her long-time physician who was a bit “crazy and old school.”

“Hmm … that’s strange … why would her physician be in the room with her?” I …

To my patients: An apology and a thank you

Abraar Karan, MD

Medical Education

April 9, 2015

As a third-year medical student, I realized one particular morning on rounds that I had let the demands of the job overtake the joys of why I went into medicine at all. I found myself running behind my team, barely even able to say goodbye to the last patient we had seen. The human interaction had become an afterthought in the …

The Uber lessons for medicine

Regina Druz, MD

Health Technology

April 8, 2015

As the rugged beauty of the Pacific Coast unfolded in all of its splendor, I was in awe of the entirely different experience: the one created by our Uber driver, Calvin (name changed to protect anonymity).

My friend and I, attending our annual cardiology meeting in sunny San Diego, carved out a few hours of rest and relaxation. We were heading to La Jolla, a scenic seaside community about 20 minutes …

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The Uber lessons for medicine

A global perspective can change how you diagnose patients

Vincent DeGennaro, Jr., MD, MPH

Physician

April 8, 2015

“Doctor, I have trouble breathing when I walk up stairs, and I cannot lie flat in bed, so I have to sleep sitting in a chair. I feel much worse than before I got pregnant.” I recognized the diagnosis at that point, but I continued the appointment to confirm my suspicions and to revel in the art of medicine.

I listened to the young woman’s lungs, full of crackles from fluid backup, …

I inwardly watch my life’s blood flow away. And no one notices.

Maureen Hirthler, MD

Physician

April 8, 2015

I’m walking very slowly with my dad down the produce aisle at the local supermarket, past the colorful waxed apples, Mexican mangoes and Rainier cherries, and imagining my life’s blood trickling onto the floor from an invisible wound.

As I pass by the misting system spraying the bins of green, red, yellow and orange peppers, past the lady reaching for carrots, past the stock guy balancing the heirloom tomatoes into a …

Available without a prescription does not mean there are no consequences

Abigail Schildcrout, MD

Conditions and Diseases

April 8, 2015

Spring is here. The days are getting longer. The temperature is slowly getting warmer. Green stuff will start poking through the ground and popping out on trees. We’ll see more of our neighbors, since they won’t be trying to get from their cars into their houses (and vice versa) as quickly as possible before they freeze.

Pollen allergies will start up again. And grass allergies.

So many people suffer from the watery, itchy eyes, itchy, …

No unnecessary screening tests. Even at the cost of my online reputation.

Lucy Hornstein, MD

Physician

April 8, 2015

I’ve just finished sitting through a wonderfully aptly named lecture: Probability and Statistics, in which, among other things, we learned (again) that the utility of various clinical tests depends at least as much and generally more on the patient and condition involved than on the specific test itself. From stress tests to mammograms to PSAs, the relationships of true and false positive and negatives, positive and negative predictive values all …

The Match 2015: A grim prognosis for international medical graduates

Skeptical Scalpel, MD

Medical Education

April 7, 2015

There were a lot of happy faces on March 20th as depicted in this brief video of the excitement on the campus of the University of Rochester School of Medicine. Similar scenes took place at every U.S. medical school because 93.9 percent of the 18,025 graduates of U.S. allopathic medical schools matched in a specialty.

But for the 1,093 (6.1 percent) U.S. graduates who didn’t match things were not so bright. …

Angelina Jolie’s story is one of true courage and grit

Miranda Fielding, MD

Physician

April 7, 2015

I have always been one of Angelina Jolie’s biggest fans. The Academy of Motion Picture Arts and Sciences saw fit to reward her 1999 performance in Girl Interrupted with an Oscar, but I wasn’t well and truly smitten until the second Lara Croft Tomb Raider movie was released in 2003. In that film, Jolie, who performs her own stunts, is seen …

From an ER physician: Write your own admitting orders

Edwin Leap, MD

Physician

April 7, 2015

While working at small rural hospital I was once again faced with the emergency physician’s dilemma. Admitting a patient and being told to write holding orders. In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system. All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble …

Solving bullying: We must begin with ourselves

Ahmad Bailony, MD

Conditions and Diseases

April 7, 2015

“I want to hurt myself.”

That was the only thing written on an otherwise blank page. The other day, the mother of a bright second grader, showed me that alarming note. Apparently the boy wrote it at his school. She went on to tearfully explain that her child has constantly been bullied ever since joining the institution. Sadly, it is not uncommon to encounter such stories when your profession is …

Shift the focus from patient satisfaction to employee satisfaction

Thomas Paine, MD

Physician

April 7, 2015

By now, everyone in health care is accustomed to the idea of patient satisfaction data and the multi-million dollar industry ($61 million in annual revenue for Press Ganey alone) which exists thanks to the health care leaders and policy makers who embrace it. Most physicians believe it is absurd to use it as a marker of quality care, but have accepted …

Projection. From an unlikely source.

Ilana Yurkiewicz

Medical Education

April 7, 2015

The patient was hacking sputum into a tissue when the resident and I entered his room.

“How long have you had that cough?”

“Oh this? As long as I can remember.”

“But it’s been worse lately?”

“Yeah.”

“Worse how?”

“More stuff coming out each time. See?”

He opens the tissue.

“How much sputum is there?”

“Sputum?”

“The stuff you cough up.”

“I don’t look that close.”

“More than two spoonfuls?”

“Oh yes. Definitely.”

“And the color?”

“White-ish.”

“Ever see any streaks of blood?”

“Never.”

“And how long have …

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Projection. From an unlikely source.

With the EMR, you have to work backwards from the superbill

Hans Duvefelt, MD

Health Technology

April 6, 2015

Sometimes, after crafting an important or complex plan of care with a patient, I say: “Let me type all this into the computer so that, in case I run into that big bull moose up on Vaillancourt Hill on my way home tonight, the next doctor who sees you will know what we were thinking today.”

Patients sometimes squirm or laugh nervously at that, but then they usually indicate understanding and …