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The insufferable patient: You know the one

Medical Education

March 14, 2015

He is that new patient to the clinic.

You know the one.

He is the “multiple chronic conditions” patient. Diabetes, hypertension, COPD, chronic kidney disease, congestive heart failure, arthritis — it would probably be quicker to name the conditions he doesn’t have. You let out a deep sigh before entering the room.

You know the one.

He is the “non-native English speaker.” English isn’t his first language, perhaps not even his second. You try …

Don’t fall victim to health insurance denials

Jane Arnoff Logsdon, LSW

Patient

March 14, 2015

I consider myself a pretty savvy and resourceful consumer. I know how to solve problems that come up in the day to day situations we all face. I have navigated my way through more than a few complicated and sensitive financial situations. Add to that my ability to be persistent, and you would think that I could figure out a simple denial of an insurance claim with ease, right? In …

MKSAP: 66-year-old man with a persistent rash for 6 years’ duration

mksap

Conditions and Diseases

March 14, 2015

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

A 66-year-old man is evaluated for a persistent rash for 6 years’ duration. The rash waxes and wanes in severity, and it becomes pruritic only after he becomes hot and sweating, such as when he mows the lawn or exercises. It has always been limited to his back and lower chest. He …

What does a technology optimist think about the future of health care?

Robert Wachter, MD

Health Technology

March 13, 2015

Andy McAfee is the associate director of the Center for Digital Business at MIT’s Sloan School of Management. He is also coauthor (with his MIT colleague Erik Brynjolfsson) of the 2014 book, The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, one of my favorite books on technology. While he sits squarely in the camp of “technology optimists,” he is thoughtful, appreciates the downsides of IT, and …

What would truly personalized oncology look like?

Amy Abernethy, MD, PhD

Conditions and Diseases

March 13, 2015

The concept of “personalized medicine” gets thrown around a lot these days. And as an oncologist and a palliative care doctor, who advocates for using data to get information that can provide more personalized cancer care, I believe strongly in it. But what would truly personalized oncology look like?

More than 14 million people are living with cancer in the United States, according to the National Cancer Institute — and some 1.7 …

A letter to physicians refusing to see vaccine-hesitant families

Natasha Burgert, MD

Physician

March 13, 2015

Dear doctor no longer seeing vaccine-hesitant families,

I know that creating your “no tolerance” office-wide vaccine policy was not easy or came without soul-searching. I can only imagine the heated boardroom meetings and passionate arguments throughout the weeks the policy was being drafted. I trust it is because of your support and love for the families you currently care for that you felt the need to create the policy, and it …

10 secrets to success as a female surgeon

Lauren Crawford, MD

Physician

March 13, 2015

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I bolted through the conference room door on the first day of residency orientation. The room full of interns shifted in their seats. All one dozen of the faces looking up at me were male. I got some crooked, goofy grins. So began my introduction to the world of surgery.

So, what would I tell my daughter about how to survive and …

The ABIM response to Newsweek determines how far anti-MOC sentiment will spread

Kevin Pho, MD

KevinMD

March 13, 2015

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Regular readers here are well-versed on the controversy surrounding maintenance of certification (MOC) and the American Board of Internal Medicine (ABIM).

The story recently made mainstream news, with a comprehensive recap by Newsweek senior writer Kurt Eichenwald: The Ugly Civil War in American Medicine. Go read it.

The ABIM subsequently released a strongly-worded statement. They are clearly not happy with the mainstream media spread …

3 surprising vaccine myths

Roy Benaroch, MD

Medications

March 13, 2015

Myth #1: Vaccines work by preventing disease in individuals who are vaccinated. Nope, that’s not actually true — it’s quite wrong, but in a subtle way. And a misunderstanding of this concept, I think, has led to a lot of mischief. If people understood how vaccines really work, how they can best protect us from disease, it might help overcome some skepticism.

Vaccines do indeed prevent diseases in individuals, but that’s …

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3 surprising vaccine myths

Cupcakes are being banned from school parties. And that’s not a bad idea.

Claire McCarthy, MD

Physician

March 13, 2015

When my older children were in elementary school, I sent in cupcakes for their birthdays or for class parties.

My youngest is in elementary school now, and for his birthday, I sent in pencils and temporary tattoos for classmates — because the school doesn’t allow us to send in sweets anymore.

When the change was first made, my reaction was: For real? Banning …

The phenomenon of the flipped patient

Kerri Vincenti, MD

Physician

March 12, 2015

In a recent article posted in JAMA, authors presented a viewpoint about the phenomenon of the flipped patient when describing the increasing reliance that millennial trainees place on getting to know the electronic health record (EHR) of patients rather than the patients themselves. As I read through the text, I found myself agreeing with the points made by the contributing writers that EHRs are increasingly used as the first line of …

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The phenomenon of the flipped patient

How corrosive cynicism is destroying professional relationships in medicine

Jeffrey Parks, MD

Physician

March 12, 2015

One of the obligations of a medical or surgical specialist is to communicate with the referring primary care provider. This can take many forms: a phone call, texting via smartphone, email, messages sent via EMR, and dictated letters. The format is pretty standard no matter what medium is chosen. You thank the referring doc for the consult request, you give some brief background info about the patient in question, and …

Waiting for problems to become emergencies is terribly expensive

Rob Lamberts, MD

Physician

March 12, 2015

“I’ve been getting winded lately.”

He’s a middle-aged man with diabetes. This kind of thing is a “red flag” on certain patients. He’s one of those patients.

“When does it happen?” I ask.

“Just when I do things. If I rest for a few minutes, I feel better.”

Now the red flag is waving vigorously. It sounds like it could be exertional angina. In a diabetic, the symptoms of ischemia (the heart not getting …

5 things patients say that should make doctors sit up and listen

Suneel Dhand, MD

Physician

March 12, 2015

In the busy world of hospital medicine, where doctors and nurses find themselves rushed off their feet for most of the day, time to sit down and actually listen to patients is at a premium. Every doctor knows that our primary focus has to be on the most important aspects of the history and clinical examination in order to get to …

Raising minimum wage directly impacts health

Moises Gallegos

Health Policy

March 12, 2015

I admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance of Walmart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the company’s announcement, plenty has been written about the impact that such a move will have on the company’s success and on local economies. It goes beyond that, however. What I see is …

A surgeon will always have two spouses

Robert Sewell, MD

Physician

March 12, 2015

I’m an old school general surgeon. I graduated from med school in 1974 and after a five-year surgical residency in San Antonio, Texas, I started out on my own, ready to cure the world. Boy, was I raw. Like many of my peers, I got married during medical school, and like every surgeon back in those days I told my wife, …

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A surgeon will always have two spouses

What does it take to collaborate in health care? Here are 3 ideas.

Kevin R. Campbell, MD

Medical Education

March 11, 2015

Recently, I had the honor and pleasure of introducing my book, Women and Cardiovascular Disease, in London. During the event, I was able to meet with many of my European colleagues from both the media as well as the health care space. I spoke with countless bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women. We identified many ways …

I broke my own rule when giving bad news

James C. Salwitz, MD

Physician

March 11, 2015

For 25 years, I have taught medical students how to give bad news. Step one: Be prepared. Step two: Find a safe, personal, quiet environment. Step three, and this is most important: Before you speak, ask. What do the patient and family understand? Fail to follow this vital rule and reap the whirlwind. So, therefore, you might ask, if I have such wisdom and experience in this critical area …

Ease the transition to hospital medicine

Tracy Cardin, ACNP

Physician

March 11, 2015

I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I …

When you can’t let your guard down: Cancer as a constant threat

Don S. Dizon, MD

Conditions and Diseases

March 11, 2015

Every so often I see a patient who views cancer as a constant threat to be handled. The cancer becomes so significant that she feels she can never let her guard down. I always worry about this — partly because that singular focus on fighting cancer can sometimes detract one from other aspects of life, and those facets that give …

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