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Treating chronic pain: Regulation ignores the larger issues

Medications

December 23, 2014

Doctors have a long and illustrious history of addicting people to narcotics. In the 1800s this was largely because they didn’t know what else to do, they had no idea what was wrong with anyone, and they didn’t have any drugs that worked. Apothecaries, pharmacists, and doctors made proprietary concoctions in which opium was always the active ingredient.

And it worked, right? Morphine works for anxiety, works for pain, works for …

The rise of the employed physician: What it means to new doctors

Brian J. Secemsky, MD

Physician

December 23, 2014

As the youngest member of a family of doctors, it was not uncommon during my childhood to spend summers at my father’s private practice. I fondly remember greeting the familiar office staff as I recklessly ran amok among an endless array of rickety cabinets containing an untold amount of aging, yellowed paper charts. My dad’s patients would tousle my hair like family and his partners would always leave an insurmountable …

Primary care: No system can replace human effort and commitment

Hans Duvefelt, MD

Physician

December 23, 2014

It’s been thirty years since Dr. Pete shook my hand on graduation day and slapped my back, his gravelly voice mumbling a wisecrack that couldn’t quite hide his emotions. I was the first foreign medical school graduate in our small residency program and he had trusted me, just as I had trusted him, through three years of hard work and many challenges.

Our residency program was only a few years old, and my …

Never sleep with your baby: Has that advice backfired?

Melissa Bartick, MD

Conditions and Diseases

December 23, 2014

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Every new parent has heard the dire warning: Never sleep with your baby.

State and local health departments in Massachusetts and around the U.S. have prioritized this message. Millions of dollars have been invested in promoting it, and millions more spent on giving away cribs to poor families. It all comes from the official recommendations of the influential American Academy of Pediatrics published …

What will it take to reduce physician wait times?

Robert Pearl, MD

Physician

December 23, 2014

Everything in health care seems to take a long time.

Remember the last time you tried to schedule a routine doctor’s appointment? More than likely, the receptionist told you the doctor couldn’t see you for another week or even another month.

Perhaps you’ve had the experience of a loved one being hospitalized on a Friday night for a major (but not life-threatening) problem, …

Fix the problem of expert testimony

Allen Frances, MD

Physician

December 22, 2014

Dostoevsky’s Brother’s Karamazov cleverly spoofs the careless inexpertness of what often passes for expert legal testimony.

Three medical experts are called to testify whether Dmitri Karamazov was sane or insane when committing the alleged murder of his father. Naturally, the experts all disagree, with each completely convinced of the incontrovertible truth of his own opinion. Expert 1 finds Dmitri insane because he looked to the left as he entered the courtroom. Expert …

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Fix the problem of expert testimony

Physician burnout: Medicine fails us

Starla Fitch, MD

Physician

December 22, 2014

We are often our own worst critics.

Whenever doctors feel down, or burned out in our roles as health care providers and healers, we look inward. We wonder what is wrong with us. What could we do differently? We wonder why other doctors don’t have this problem.

The truth is, we do. We all do.

And yes, sometimes the problem is within us.

But other times, the problem is outside of us. Sometimes, it’s …

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Physician burnout: Medicine fails us

Is there any benefit of duty hour reforms?

Tara F. Bishop, MD, MPH

Medical Education

December 22, 2014

Almost every practicing doctor remembers the grueling hours and intense workload of residency. I recall overnight calls when I ran around from floor to floor, my beeper never stopping. I would collapse at home the next morning exhausted, drained and a little depressed. I would never want to relive residency, but I do look back at it with a sense of accomplishment. In some ways, it is a badge of …

Should ACLS certification be mandatory?

Deep Ramachandran, MD

Physician

December 22, 2014

I can recall, though it seems quite long ago, my first basic life support (BLS) course as a first-year medical student. The instructor dutifully demonstrated on a mannequin to eager young medical students what to do if someone is found unresponsive. Shaking the unmoving mannequin she said loudly, “Sir, are you OK?” Then hearing no response she showed us how to …

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Should ACLS certification be mandatory?

Confessions of a burnt-out physician

Anonymous

Physician

December 22, 2014

I’ve wanted to be a physician for as long as I can remember. As a teen, the choice to become a doctor seemed to perfectly meld my affinity for science, academics and helping others. Better yet, pediatrics offered the ability to work with families and children of all ages and developmental abilities.

For fifteen years, I lived, breathed, and worked toward my …

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Confessions of a burnt-out physician

Should radiologists discuss results with patients?

Skeptical Scalpel, MD

Physician

December 22, 2014

Radiologists discussing test results with patients, a subject that has been lurking under the radar for a while, recently came to light because of an article in the New York Times. The idea is that patient anxiety while waiting to find out a test result could be alleviated by an immediate discussion with a radiologist.

That would be very nice, but there are …

A doctor wants to leave medicine to sell Tupperware

Pamela Wible, MD

Physician

December 21, 2014

A letter received by Pamela Wible, MD.

Dear Pamela:

I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is …

Don’t pay specialists for being on call. Here’s why.

Shadowfax, MD

Physician

December 21, 2014

Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER …

Public health work is my serenity prayer

Tony Schlaff, MD, MPH

Physician

December 21, 2014

Three days after finishing my residency, I became the medical director of the community health center where I had taken my first job. It forever changed, and probably saved, my career.

The risk of burnout hit me early. While I loved patient care, I also found the stress, the lack of control of my time, and the inefficiencies of my clinic’s system hard to accept and to manage. I knew I …

Escaping the curse of experience, for just one moment

Jordan Grumet, MD

Physician

December 21, 2014

It’s a strange thing to be driving about in your car in the middle of the day. For one who has spent the majority of his professional life sheltered in dark offices and aseptic hospitals, the summer sun and fresh breeze is quite lovely. One almost begins to approach humanness. Normal. This must have been what it felt like before immersion into the tribe of medicine.

Sometimes I have trouble remembering …

Shortening medical school: Is that a good idea?

Arshya Vahabzadeh, MD

Medical Education

December 20, 2014

Why are we shortening medical degrees?

The four-year medical degree has been the mainstay of U.S. medical schools for more than a century, following the publication of the Flexner report in 1910. Prior to this, there was little standardization about what a medical degree could or should look like. Medical school education was subsequently standardized to two years of academic study, followed …

A day in the life of a hospitalist

Joshua Allen-Dicker, MD, MPH

Physician

December 20, 2014

I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second career path, I have been planning my career in hospital medicine since the beginning of my residency training.

The things that drew me …

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A day in the life of a hospitalist

When discussing cancer treatment, the approach matters

Michael Carbine

Patient

December 20, 2014

Dr. Peterson, the radiation oncologist, gets right to the point.

“The medical center’s tumor board has concluded that your cancer is inoperable, incurable and untreatable,” he says flatly. “Any chemotherapy or radiation treatments would be palliative in nature.”

He begins explaining the reasons behind the board’s verdict, but everything he’s saying washes out. My mind stopped working as soon as I heard the words “incurable” and “palliative.” I am sliding into shock.

Dr. …

MKSAP: 76-year-old woman with a headache

mksap

Conditions and Diseases

December 20, 2014

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

A 76-year-old woman is evaluated for a 1-day history of headache, left eye pain, nausea and vomiting, seeing halos around lights, and decreased visual acuity of the left eye. She has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Medications are metformin, digoxin, metoprolol, hydrochlorothiazide, and warfarin.

On physical examination, temperature is 36.8 …

What is value in cancer care? It depends.

J. Leonard Lichtenfeld, MD

Conditions and Diseases

December 19, 2014

Value.

A simple word with lots of meanings, all of which depend on the context of the moment. Value in health care — especially in cancer care — is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person’s value is clearly another person’s concern.

At the crux …

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