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The line between comfort care and murder

Physician

February 6, 2015

“So, I told the doctor at the nursing home that I loved my father more than anything. Dad was my friend and the most wonderful man I had ever known. I wanted everything for him. But, I said, Dad was sick, weak, confused, and he never wanted to live like that. The next morning he was dead. That was OK by me.”

I once participated in a panel discussion about hospice, …

Is health insurance the new paternalism in health care?

Martine Ehrenclou, MA

Patient

February 6, 2015

If I could drop our health insurance altogether, I would. With a high deductible of $4,000 for in-network providers, my family of three has yet to reach our collective deductible over the last three years. This means we have to pay out of pocket for medical care until we reach that amount. To make matters worse, our health insurance premiums increased by 10 percent, forcing us to find a less …

A career in primary care means you are comfortable with uncertainty

Hans Duvefelt, MD

Physician

February 6, 2015

Primary care is a messy business. Nobody has just one simple problem, and no patient has all the typical symptoms for their diagnosis. Most don’t even tell us everything that’s going on. And most don’t follow their treatment plan completely. But this may be OK, since we often change our minds about what is right or wrong in the practice of medicine.

Knowing what constitutes success in front line medicine is …

Prescribing off-label: It’s gotten out of control

Allen Frances, MD

Medications

February 5, 2015

Doctors prescribe way too many medicines for patients who don’t really need them. A lot of the pressure comes from intense drug company marketing. Some comes from patients who aren’t happy leaving the office without a pill. And doctors have too little time with each patient to explain non-pill solutions to problems. Wild prescribing is not new. For thousands of years, doctors have given patients useless (and often quite harmful) …

What is a serious diagnosis?

Farokh Jamalyaria, MD

Physician

February 5, 2015

The serious diagnosis is a polite middle-aged woman with a hopeful smile sitting on the side of the bed, with her husband in the chair across from her, as you carefully tell them what it means to have ovarian cancer.

The serious diagnosis is the teenager who just found out he has lupus nephritis — without any other signs or symptoms of lupus — and that he might be on hemodialysis …

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What is a serious diagnosis?

Survival pearls for surgical interns

Rajendra Sawh-Martinez, MD

Medical Education

February 5, 2015

Living in the trenches of a surgical internship can be a gut wrenching, lonely experience for many. The journey from medical student to resident to surgical attending is a notoriously steep trek, necessitating our long 6+ years of training. Surviving intern year remains as hard as ever despite the significantly greater resources and awareness that exists among residency programs today.

These burdens are felt by all specialties and have tragically led …

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Survival pearls for surgical interns

Reflecting on an orthopedic surgery rotation

Kathryn Schlosser

Medical Education

February 5, 2015

“Katie, If you go into surgery, you’re going to miss patients.” It was three in the morning in the ED; the resident was feeling the strain of a 24-hour trauma call, and I was loving it. I had spent the past half hour with a lovely, older woman whose foot had gone through the floor of her vehicle in a crash. We chatted about where she had been traveling, and …

Precision medicine: Getting the right patient to the right doctor

Tara F. Bishop, MD, MPH

Physician

February 5, 2015

In his State of the Union address, President Obama announced a precision medicine initiative “to bring us closer to curing diseases like cancer and diabetes.” The goal of precision medicine is to more accurately identify diagnoses and treatments based on a patient’s genetic information. This information will hopefully lead to better screening, earlier diagnosis, and more personalized treatment.

But it’s hard to imagine that patients will get this kind of medical …

It is time to stop specialty prejudice

Val Jones, MD

Physician

February 5, 2015

In my last blog post I discussed how harmful physician “thought leaders” can be when they are dismissive of the value of other specialists’ care. I must have touched a nerve because a passionate discussion followed in the comments section. It seems that physicians (who spend most of their time engaged in clinical work) are growing tired of the leadership decisions of those who engage in little to no patient care. …

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It is time to stop specialty prejudice

Patients don’t like their doctors. Why is that?

Peter Ubel, MD

Physician

February 4, 2015

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It is an oft-recited paradox that Americans like the men or women representing them in Congress while hating Congress as a whole. In fact, respect for Congress is near all-time lows. In what has to be seen as a bad sign for the medical profession, people’s attitudes towards physicians are beginning to look downright Congressional.

Most Americans like their doctors, with surveys …

From a physician: God bless the night shift

Edwin Leap, MD

Physician

February 4, 2015

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I went into an all night pharmacy recently, after getting off of work at 10 p.m. I had to pick up a prescription for my endless, insomnia-inducing cough. Walking up to the counter, I was bathed in the smell of cigarette smoke, carried on the coats of patrons. Eight of us stood by the counter, outnumbering the staff by 100 percent. …

Evaluating medical students: Beware misleading first impressions

Rushil Patel

Medical Education

February 4, 2015

I showed up that morning on the inpatient service as a part of my elective. Surprisingly, I found three other medical students present: 1 third year, 2 second years.

The fourth year of medical school has many perks as I have been told by those senior to me. Once the application process gets underway, I have been advised to live every day as though it were my last. Personally, I liked …

The AMA: One medical student’s perspective

Akhilesh Pathipati, MD

Medical Education

February 4, 2015

Last year, I had the opportunity to attend the American Medical Association’s interim meeting in Dallas, one of the two annual conferences held by the organization. I went to the meeting to present at a research symposium, but I stuck around for a few extra days because I was curious about the inner workings of organized medicine. As someone interested in health care systems and the delivery of medical care, …

Today’s EHRs: No doctor left behind

Gregory Kurio, MD

Health Technology

February 4, 2015

It has been quite a year. Between 3 main hospitals, 2 major medical institutions and 3 major healthcare networks, our practice has been on 3 different echocardiographic reading platforms, 3 ECG reading platforms, and 8 different electronic health record systems including 4 instances of Epic alone. I am typically enthusiastic to a fault about new technologies and, time after time, have rushed in, often where angels feared to tread. I …

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Today’s EHRs: No doctor left behind

A doctor’s first-hand account of the flu

Mike Sevilla, MD

Conditions and Diseases

February 3, 2015

Even I am not immune to influenza. In Northeastern Ohio, there have been more hospitalizations and school closings this year from influenza. And, let me tell you, as a family physician who also sees patients in the hospital and the office, we have seen a lot more respiratory illnesses versus last year.

No, I’m not one of those Dr. Oz hypocrites who skip the influenza vaccine. …

Fighting high health costs. Because I can.

Christen McCurdy

Patient

February 3, 2015

Sometime while I was still in high school, my mom began to have trouble breathing. She had never had asthma before; an albuterol inhaler helped for a while. Still, cold season was a nightmare, and later, so was allergy season, and every year seemed to get worse.

After college, I moved back in with my parents. She fought her way through the cold season, dutifully driving 20 miles (and later 40, …

A medical student’s personal statement: Deconstructed

Fizzy, MD

Medical Education

February 3, 2015

I recently dug up a copy of the personal statement I wrote when I was applying for residency. I’ve said before that I think these personal statements aren’t worth much. But somehow, I now feel compelled to prove it by ripping apart my own personal statement.

So here we go:

It was the same situation that I had been in dozens of times.

Well, not really. I mean, I was only a third-year …

ABIM announces immediate changes to MOC program

Richard J. Baron, MD

Medical Education

February 3, 2015

Dear Internal Medicine Community:

ABIM clearly got it wrong. We launched programs that weren’t ready and we didn’t deliver an MOC program that physicians found meaningful. We want to change that.

Nearly 80 years ago, the American Medical Association and the American College of Physicians founded the American Board of Internal Medicine (ABIM). ABIM was charged with distinguishing the discipline of internal medicine from other forms of practice by creating uniform standards …

Quality measures are going through growing pains

Christopher Johnson, MD

Physician

February 3, 2015

The quality-measurement enterprise in U.S. health care is troubled. Physicians, hospitals, and health plans view measurement as burdensome, expensive, inaccurate, and indifferent to the complexity of care delivery. Patients and their caregivers believe that performance reporting misses what matters most to them and fails to deliver the information they need to make good decisions.

Thus begins a recent editorial in the New England Journal of Medicine. It was accompanied by …