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Medical malpractice reform won’t save money

Peter Ubel, MD

Health Policy

February 25, 2015

Two problems loom large over the American medical care system. First, we spend outrageous amounts of money on health care, with too many patients receiving too many services at too high a price. Second, our malpractice system is an international embarrassment, with too many health care providers sued by too many patients for too little reason.

Many experts have pointed out that these problems are two sides of the same coin. …

What do bridges and public health have in common?

Brian Castrucci

Health Policy

February 25, 2015

Infrastructure is never quite as interesting or exciting as innovation. The grand opening of a new building incorporating all the latest integrated technology is far more exciting than bridge repairs. In our fascination for the innovation, we often turn a blind eye to our nation’s crumbling infrastructure.

In the United States today, one quarter of our bridges are structurally deficient or functionally obsolete and more …

Medical credentialing: Explaining yourself when you’re off the grid

Edwin Leap, MD

Medical Education

February 25, 2015

The non-medical reader may wonder what I am complaining about. Of course, many of you have to be credentialed in your fields as well, whether law or accounting, law enforcement or public service, education, nursing or a trade. But those of you in medicine know how difficult it can be to become credentialed as a physician, either by a state for purposes of a license, or by a hospital in order …

The cancer metamorphosis is different for each patient

James C. Salwitz, MD

Conditions and Diseases

February 24, 2015

“I had no idea how much cancer sucks.”

My patient’s observation seems silly, basic. Of course, cancer sucks. It maims, humiliates and kills. It takes. What made the statement remarkable was its source. This is not a medically naïve person, waiting to die. Rather it was spoken by a patient in complete remission, likely cured, who is an expert in cancer care. To her amazement, it changed life forever.

I think that …

Are we prepared for the genomics revolution?

J. Leonard Lichtenfeld, MD

Conditions and Diseases

February 24, 2015

The president’s proposed Precision Medicine Initiative, as mentioned in his recent State of the Union address suggests it’s probably time to get ready for some changes in our daily routines as health professionals.

I’m not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better …

What can we learn about palliative care from Indian physicians?

Monica Williams-Murphy, MD

Physician

February 24, 2015

Early on in my career I called an Indian internist in the middle of the night to admit a patient to him.

The patient was an 88-year-old female with advanced dementia, a terminal brain disease. She had aspiration pneumonia, which is often the final common pathway of this illness. She was in respiratory failure, in septic shock and was a “full code.”

I can still recall our 4 a.m. conversation:

“Hi, Dr. …

Why the Disney measles outbreak could be a game-changer

Claire McCarthy, MD

Conditions and Diseases

February 24, 2015

Cases of measles linked to an exposure at Disneyland continue to spread, not just in California, but in several other states and in Mexico. The numbers of cases are climbing — and so are the number of exposed people who might get sick — and expose more people before they realize they are sick. Measles is extremely contagious; if someone has it, they will infect 90 percent of the people …

What doctors must learn from the anti-vaccination movement

Sayantani DasGupta, MD, MPH

Conditions and Diseases

February 24, 2015

A cartoon of an angry looking physician, a spotted boy, and some anxious parents in The New Yorker reads, “If you connect the measles, it spells out, ‘My parents are idiots’.”

A facetious article in GomerBlog announces, “Big Pharma Admits They’re Just Trying to Kill Everyone with Vaccines.”

Even television host Stephen Colbert gets in on the make-fun-of-anti-vaxxers act, recently declaring, …

Answers to your questions about the measles outbreak

Wendy Sue Swanson, MD

Conditions and Diseases

February 24, 2015

Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe”?

I hate that I can’t completely say they are …

What hospitals can learn from snow preparedness

Suneel Dhand, MD

Physician

February 23, 2015

Significant snow in New England every winter is about as certain as sun in Florida every summer. When I moved to the USA from the south of (old) England to do my medical residency in Maryland, my first few years living in the United States were relatively snow-free.

But when I started my first job as an attending physician in central Massachusetts, I was in for a big shock. I had …

Like hikers, patients also need guides

Abigail Schildcrout, MD

Physician

February 23, 2015

Our family loves to hike. Traveling the trails is a deeply happy place for us. In fact, I don’t think there’s ever been a time when one of us suggested taking a hike, and everyone didn’t unanimously and enthusiastically agree. A few weeks ago, my family took a lovely hike in a state park in Massachusetts. It was a gorgeous day: temperature in the upper 40s, blue skies, no wind. The …

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Like hikers, patients also need guides

We need fewer paternalistic physicians and more maternal ones

Elizabeth Horn, MD

Physician

February 23, 2015

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I am a physician, but I also consider myself a mother hen. When I have a census of patients, I think of them as little chicks, perhaps old roosters, clucking hens, tender capons. Some are old, some young, some have been chased out of the coop by an angry dog, caught in the wires and sent to me for care. Some …

Lessons from my first nasogastric tube

Ilana Yurkiewicz

Medical Education

February 23, 2015

I was glad she never asked if I had done this before.

My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for …

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Lessons from my first nasogastric tube

4 reasons why fecal transplants aren’t mainstream. Yet.

Alexander Khoruts, MD

Conditions and Diseases

February 23, 2015

Fecal microbiota transplantation (FMT) has emerged as an increasingly common treatment for patients with refractory Clostridium difficile infection (CDI). Unlike standard antibiotic approaches, which only exacerbate dysbiosis and may perpetuate CDI recurrence, FMT restores normal gut microbial community structure and function of the gastrointestinal tract. However, a number of challenges need to be overcome before this procedure is widely accepted in mainstream clinical practice.

Before I jump into highlighting …

Which drugs are on formulary? A little help, please.

Hans Duvefelt, MD

Medications

February 23, 2015

The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed.

Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives.

Then there are several cumbersome explanations about the appeal …

Primary care physicians: Fight for your value

Margalit Gur-Arie

Health Policy

February 22, 2015

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear to …

5 tips for travelling with your CPAP

Deep Ramachandran, MD

Conditions and Diseases

February 22, 2015

Sleep apnea is a condition that afflicts millions of people. There are two types of sleep apnea: central, and obstructive. Obstructive is by far the most common, and is usually what is referred to when people talk about sleep apnea. Obstructive sleep apnea occurs when, during sleep, the airway passages in the throat close and block the movement of air. Common symptoms are snoring, gasping during sleep, sleepiness during the day, …

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5 tips for travelling with your CPAP

What do patients really want from doctors?

Pamela Wible, MD

Physician

February 22, 2015

Ever wonder what patients really want from doctors?

Is it the fancy buildings with marble fountains?

Is it the board certifications and diplomas on the wall?

Is it the expert medical jargon and starched white coats?

Nope. None of the above.

Listen up, docs: Patients just want the real you. Ya know — you. The competent and caring you who really listens with compassion. The real you …

We have the power to prevent disease. But we’re not using it.

Brad Wright, PhD

Conditions and Diseases

February 22, 2015

We all know them. We see them on TV. We read about them in the paper. And, with the explosion of social media, you hear about it from people you know. If you have a Facebook account with a sizable enough network of friends, you’ve probably seen at least one negative comment about vaccines. On one end of the spectrum, there are the seemingly innocent people who claim that they …

Emerging health care models for innovators

James Maskell

Health Technology

February 21, 2015

As our medical system attempts to evolve to better deal with the modern epidemics of lifestyle-driven chronic disease, much time and attention is being placed on the clinical models for prevention. Rightly so, and various viable models are popping up with names like lifestyle medicine, preventative medicine, and functional medicine.

But one area that is hardly addressed is the payment structure and business model of the practices. Are there structures that …