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The obsession with numbers in medicine: It’s time to stop

Physician

March 25, 2015

Medicine is obsessed with numbers. Or rather, journalists and medical administrators are. Here are two related examples of how large a grain of salt one must put on numbers.

Cardiac surgical procedures, like everything else in medicine, have quality indicators. One of these is what we doctors call “30-day mortality.” What this term means is that surgeons are evaluated in part on how many of the patients they operated on died …

Remember the psychological harms of cancer screening

Kenneth Lin, MD

Conditions and Diseases

March 25, 2015

Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force’s recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with prostate cancer screening, other than the overdiagnosis (and resulting unnecessary treatment) of clinically insignificant tumors. Since routine prostate-specific antigen screening had been going on for nearly two decades by then, we expected to …

Coping with a move: A medical marriage Q&A

Kim Blackham

Physician

March 25, 2015

Question:

My family (including two small children) and I are relocating this summer for my husband’s new job after seven years of living in the same area for residency and fellowship to a city where I know no one. I am scared about leaving our support network of friends and family nearby. Can you offer advice on starting over in a new place?

Answer:

I would guess that almost every physician family has …

Why I started a cuddling program in the NICU

Jessie Evangelista

Conditions and Diseases

March 25, 2015

When I was in kindergarten, my school bus used to drop me off at the hospital where my mother worked. My older sister and I would sit quietly in my mom’s office and do our homework while she finished up her work. Most of my friends would get stickers or McDonald’s for their good behavior, but if my sister and I were on our best behavior, my mom would reward …

Health disparities are glaring, but the solutions aren’t obvious

Robert Pearl, MD

Health Policy

March 25, 2015

The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t.

The U.S. lags behind other industrialized nations in many important health measures — partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious — but we’ll explore some …

Heal the ill but don’t hound the well

Dr. Saurabh Jha

Physician

March 25, 2015

An iconoclast must not only have abundant common sense but the gift of the gab to state the obvious. Simply stating won’t do. You must rub it in.

My favorite iconoclasts are Peter Skrabanek and Thomas Szasz. Skrabanek was a general practitioner who authored Death of Humane Medicine and Rise of Coercive Healthism. Szasz, a psychiatrist, who volunteered that he entered psychiatry to unveil its pseudoscience, is the Voldermort …

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Heal the ill but don’t hound the well

The day that I truly became a cardiology fellow

Chiduzie Madubata, MD

Physician

March 24, 2015

shutterstock_141857752

As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies.

As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is …

The last breath can be seen as a the passage into eternity

Kathryn A. Hughes, MD

Physician

March 24, 2015

Eonia I Mnimi (Eternal Memory)
– Greek Orthodox Funeral Blessing

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

***

My uncle had been declining for several years with Lewy …

Sometimes, the very best medicine is a listening ear

Sanyu Janardan

Conditions and Diseases

March 24, 2015

I was a first-year medical student, starting my first afternoon at an outpatient clinic as part of an introductory course in clinical medicine. My white coat was freshly washed; I had a rainbow of pens in one coat pocket, and my shiny name tag dangled from the other. I only hoped that I was as prepared as I looked.

I entered Mrs. Carr’s room. A fifty-five-year-old woman, she sat gingerly at …

One of the greatest rewards in health care

Maria Yang, MD

Physician

March 24, 2015

When he and I first met, he told me that he had a doctoral degree in psychology, was the CEO of the jail, and could speak 13 languages. To demonstrate, he said, “Hong tong ching chong lai tai!” He then punched the door to his cell and shouted, “GET THE F-CK OUT OF HERE, B-TCH!”

I did.

The next week, he answered my questions about the pencil drawings on his walls.

“My name …

Television ruins your sleep. Here are 5 ways how.

Deep Ramachandran, MD

Conditions and Diseases

March 24, 2015

shutterstock_50580199

As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of …

Doulas for palliative care

John Schumann, MD

Physician

March 24, 2015

Ever heard of a doula?

Doula is an ancient Greek word that translates as “woman who serves.” Specifically, it’s come to mean someone who serves as a birth attendant, a person trained in childbirth who acts in support of a birthing mother. A doula provides knowledge, comfort, and an extra pair of hands — whether it’s to provide nourishment or massage, or help a mother find a comfortable position.

As you may …

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Doulas for palliative care

Nurses are the superheroes of health care

Suneel Dhand, MD

Physician

March 23, 2015

Being a nurse is one of the most important jobs in any society. It is also one of the most respected. Public opinion polls consistently rank nurses as the most trusted profession — usually ranking well above physicians. And it’s for good reason. Patients in hospital may forget who their doctor is, but they will rarely forget their nurse. The doctor …

A therapy program for medical students

Chelsea McGuire

Medical Education

March 23, 2015

I am wearing my favorite scrubs, the teal ones a friend gave to me while I was volunteering in the aftermath of the Haitian earthquake. My first-year classmates and I are in front of the anatomy lab, waiting to see our cadaver for the first time. Our group enters, and we stand around the blue-plastic-cloaked body for a few minutes, preparing ourselves and discussing the task at hand. My anatomy …

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A therapy program for medical students

Community-centered health homes: The next iteration of quality-based care

Larry Cohen, MSW

Health Policy

March 23, 2015

In late January, government officials announced a timeline for Medicare’s shift to paying clinicians based on quality of care rather than quantity of services. As Medicare goes, so go private insurers; this makes the agency’s move toward quality-based reimbursement nothing less than a sea change. It builds momentum for a view of health and health care that is integrated and holistic, rather than comprising discrete, disjointed episodes of treatment.

This …

Are cardiac risk calculators accurate?

Kenneth Lin, MD

Conditions and Diseases

March 23, 2015

After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …

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Are cardiac risk calculators accurate?

What does it mean to live in the age of Abilify?

Steven Reidbord, MD

Medications

March 23, 2015

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill. Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill. A little more …

8 reasons why you should marry a female physician

Jamie Coleman, MD

Physician

March 23, 2015

A couple of years ago, I asked a friend of mine how she met her husband. It was at a bar, and when she asked his occupation he replied, “I work for the city.” She took that to mean he was a construction worker. They began dating and quickly fell in love. Much to her surprise about a month into their …

The physician distribution problem shouldn’t be a surprise

Lucy Hornstein, MD

Medical Education

March 22, 2015

In news to absolutely no one with an iota of common sense, the purported physician shortage isn’t actually one of numbers, but rather a problem of distribution. Per this article by in the Washington Post:

Critics of doctor shortage projections have argued for years that the problem is actually poor distribution of physicians, with too many clustered in urban and affluent areas and too few in poor and rural areas.

Doctors prefer to …

What this patient needs for a normal blood pressure

Hans Duvefelt, MD

Physician

March 22, 2015

Dwight Frost had all the risk factors, plus he had already had a stroke several years ago. His blood sugars were too high, his lipid profile was near the top of the class, he still smoked a cigar now and then, and his blood pressure hovered around 200. He also seemed a little vague about which medications he actually took and which ones he didn’t.

He spoke rapidly with a slight …

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