End the human rights abuse of medical students and doctors

Physician
December 2, 2014
YouTube video

This courageous physician blows a whistle on the human rights abuse in hospitals. Doctors forced to work 8 consecutive days. No sleep. No access to food. Doctor forced to work in ICU after having seizure. Is this the care you want in American hospitals?

Full transcript:

The hospital administration and the national hospitalist company that I worked for made this agreement that the shifts would be 24 hours. And they would …

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End the human rights abuse of medical students and doctors

Two patient result letters: Which one did this physician send?

Physician
December 2, 2014

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Middle-aged lady, twenty pounds overweight.

Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.

Yada, yada, yada.

Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …

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Two patient result letters: Which one did this physician send?

Hotspotting: The power of storytelling cannot be underestimated

Medical Education
December 2, 2014

“There was one time when I wasn’t here for seven months in a row,” ”Pam” told me.

I sat with Pam in her third floor hospital room — the floor on which she always stays when admitted to the inpatient medicine service — as nurses, doctors, and janitors poked their heads in the door to say friendly hellos and “Nice to see you again, Pam!” A dining facility staff member entered …

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Hotspotting: The power of storytelling cannot be underestimated

Medicare’s perverse incentive to keep patients on dialysis

Health Policy
December 2, 2014

One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.

I began to understand this paradox clearly when I listened to my friend’s anguish.

She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …

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Medicare’s perverse incentive to keep patients on dialysis

Medicare will pay for care coordination. Should doctors take the money?

Health Policy
December 1, 2014

CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients.  When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …

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Medicare will pay for care coordination. Should doctors take the money?

Regulations are changing the very heart of medicine

Physician
December 1, 2014

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You treat a disease: you win, you lose. You treat a person, I guarantee you win – no matter the outcome.
– Patch Adams

Health care reform sounds like a great idea, in theory. Get more people the access they need. Improve the quality of health care provided. Get doctors on electronic health records so they can more easily coordinate care between specialists. …

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Regulations are changing the very heart of medicine

3 ways to make health IT work better for nurses

Health Technology
December 1, 2014

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The job of a nurse has changed dramatically over the last couple of decades. I’ve witnessed these changes at close quarters and heard feedback from nurses in several different hospitals. The biggest change undoubtedly is the interaction with information technology and the move away from paper charting.

The theory behind this push, which is part of the federal government’s meaningful use policy, …

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3 ways to make health IT work better for nurses

The surgeon general in limbo: It’s time that he be freed

Health Policy
December 1, 2014

If a foreign government took the United States surgeon general hostage, I’m confident we’d be pretty upset. I think we would be working on reprisals, and maybe even prepping a SEAL team.

I don’t know if it’s better or worse that we need no help from a foreign power to take our surgeon general hostage. Our own political system manages, all on its own.

Admittedly, it’s not quite the surgeon general who …

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The surgeon general in limbo: It’s time that he be freed

Consider the lipstick sign in your next physical exam

Conditions and Diseases
December 1, 2014

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The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.

Fine motor skills and concentration can be correlated with a positive …

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Consider the lipstick sign in your next physical exam

The sterilization deaths in India: It’s worse than you think

Physician
November 30, 2014

The reports from India read more like the review of a horror movie rather than a detailing of a government funded surgical program: 83 women receiving a surgical sterilization leaving 11 dead and another 50 hospitalized, 20 of whom (as of this posting) are seriously ill. And all of this happened in six hours with one surgeon at a government sponsored sterilization camp.

As an OB/GYN I want to tell you how bad this actually is.

The …

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The sterilization deaths in India: It’s worse than you think

Trivializing the significance of losing one’s hair during cancer treatment

Physician
November 30, 2014

asco-logo Even after so many years, I take the process of starting someone on anticancer treatment very seriously. The drugs we use can cause damage, and that damage can persist long after the end of the last planned treatment. Platinum salts can cause neuro- and nephrotoxicity. Taxanes can cause neuropathy. Angiogenesis inhibitors can result in hypertension. The lists of potential …

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Trivializing the significance of losing one’s hair during cancer treatment

$2.6 million: Is the cost of becoming a doctor worth it?

Medical Education
November 30, 2014

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Each year, over 20,000 U.S. students begin medical school.  They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000.  That’s a lot of money.  But for some who pursue careers in medicine, the financial cost has been considerably greater.  Melissa Chen, 35, a final-year radiology resident at the …

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$2.6 million: Is the cost of becoming a doctor worth it?

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When joining a medical practice: The importance of autonomy

Physician
November 30, 2014

Not too long ago before I was unexpectedly dismissed by my organization, I had the audacity to complain and request change for the betterment of my patients.   Forgoing the traditional route of a solo practice, I wanted to join a large organization which supposedly provides a worry free investment that normally comes attached with starting an independent medical practice.  I agreed to the terms and conditions of any large …

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When joining a medical practice: The importance of autonomy

Should hospitals manage hospitalist programs?

Physician
November 29, 2014

I am presently doing locum tenens shifts in a lovely community in Oregon as a hospitalist. I have been to this hospital before and was glad to return when they needed some help. I like this place and noticed on my first go around that patients got good care and that physicians and nurses all seemed to get along pretty well together.


When I first worked here, 2 years ago, they …

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Should hospitals manage hospitalist programs?

ACOs: Another layer of oversight for physicians?

Physician
November 29, 2014

A sleeping dragon awakes.

At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO.

The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then “attribute” their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and …

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ACOs: Another layer of oversight for physicians?

MKSAP: 67-year-old man with type 2 diabetes mellitus

Conditions and Diseases
November 29, 2014

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

A 67-year-old man is evaluated following a recent diagnosis of type 2 diabetes mellitus.

On physical examination, blood pressure is 134/84 mm Hg; other vital signs are normal. BMI is 30. The remainder of the examination is unremarkable.

Laboratory studies show an HbA1c of 7.8%, blood urea nitrogen 15 mg/dL (5.4 mmol/L), and serum …

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MKSAP: 67-year-old man with type 2 diabetes mellitus

After the 2014 elections: Is Obamacare safe?

Health Policy
November 28, 2014

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By decisively taking control of the U.S. Senate and increasing their majority in the House of Representatives, the Republicans now have a chance to force some modest changes in the Affordable Care Act, but they will not be able to repeal or reverse it.  But Republican gains in state legislatures and governorships may put the brakes on Medicaid expansion, leaving millions without coverage.

First, let’s start …

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After the 2014 elections: Is Obamacare safe?

How to choose a good hospital? Hint: Don’t listen to the ads.

Health Policy
November 28, 2014

good hospital

Nearly every day a press release from a health care provider or health care technology vendor shows up in my inbox urging me to look at what they offer and to write about it. Most of the time I don’t find their news worth passing along, but occasionally a pitch sparks a column idea. That’s the case with the press …

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How to choose a good hospital? Hint: Don’t listen to the ads.

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