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Sick or not sick? Handling the reality of inpatient medicine.

Medical Education

November 28, 2014

“So, is this the sickest list you’ve ever had?” the resident asked me at 2 AM, after I finally finished checking off all my boxes for the night. I nodded. I agreed.

I was also shaking.

I had been covering nine patients that night. Almost none were stable. In the span of one shift, we called three rapid responses. One person went into cardiogenic shock right in front of me was transferred to …

Improve the lives of primary care doctors. Here’s how.

Davis Liu, MD

Physician

November 28, 2014

Making primary care better for doctors currently in practice and attractive to medical students and residents is critical given the needs of our health care system. It also has been a major focus of the health care organization where I work. A few colleagues and I noticed that many primary care doctors still stayed later than others despite lowering patient panel responsibilities and the implementation of the nation’s most robust …

Having children during medical residency: 6 tips to survive

Jasmine Almeida

Physician

November 27, 2014

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We had our first child during the fourth year of my husband’s ophthalmology residency, and our second son joined us during the first year of a surgical retina fellowship. Juggling long hours, multiple medical commitments and the needs of two small children can be exhausting but every day is complete with fulfillment and laughter — and who can ask for anything …

Autism’s cause: How much genetic? How much environmental?

Christopher Johnson, MD

Conditions and Diseases

November 27, 2014

Autism was first reported in the medical literature 70 years ago. In 1943 a child psychologist named Leo Kanner described a child with social difficulties and repetitive, stereotypic movements; the following year Hans Asperger described four such children. Since then we have gradually learned more about what we now call autism spectrum disorders (ASD), although we still do not know what causes it. From early on it was apparent that the …

EMRs remove the soul of the medical record. So, what’s next?

Margalit Gur-Arie

Health Technology

November 26, 2014

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By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacities, but there will be no one charting on paper. The term “charting” itself may become obsolete, like yonder or popinjay. The term EHR, which is what replaces the paper chart, won’t last either because it doesn’t …

What medicine can learn from the Secret Service failure

Ira Nash, MD

Physician

November 26, 2014

I was listening to the news on my way to work recently, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the …

We waste a lot of dollars on unnecessary medical care

Peter Ubel, MD

Health Policy

November 26, 2014

It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care.

But which medical care is wasteful and how much is such care costing us? A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz, a graduate student …

What is it about doctors that makes them think they don’t need help?

Starla Fitch, MD

Physician

November 26, 2014

It was a Friday morning, in the wee hours. I had come in to the hospital early to get caught up on the ever-present computer work. As I got a quick cup of tea, a young surgeon I’d seen around the operating room came in. He’d clearly been up most of the night.

We exchanged a few pleasantries. And then he cut to …

Health care monopoly: How it affects the nursing home

Jordan Grumet, MD

Physician

November 26, 2014

Check.

The administrator’s voice wavered as I picked up the phone. He was calling about the nursing home patient that I admitted the day before. While normally forthright, I could feel the discomfort in his tone as he danced around the issue. The patient’s insurer had called. Apparently they made an “arrangement” with the mega-ACO owned by the latest consolidation of Goliath health systems. They wanted my patient transferred to another …

Even if no life was saved, an ER physician makes a difference

BirdStrike, MD

Physician

November 26, 2014

I walk out of the patient room. My eyes stare at the computer screen. I’m behind, way behind. I roll my head on my neck. My neck feels tense, and I have a headache. It’s been a long week. I need a vacation. Hurry up, click-click-click this computer, I think to myself. Dammit, is this EMR really freezing up again?

I look …

Silicon Valley breakups: Are there lessons for health care?

Robert Pearl, MD

Health Technology

November 25, 2014

In recent months, Silicon Valley has surpassed Hollywood as America’s home for high-profile split ups.

Last month, computer security giant Symantec announced its intentions to split in two. And three days before that, HP announced plans to divide up into parts. In September, eBay announced its intention to spin off PayPal.

With enough twists and turns to fill a screenplay, the tech industry’s recent split-up saga raises a …

Physician goes first: A way to not interrupt patients

Val Jones, MD

Physician

November 25, 2014

Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. …

We need to start skin cancer prevention with our children

J. Leonard Lichtenfeld, MD

Conditions and Diseases

November 25, 2014

The numbers about skin cancer incidence and costs in the United States are worse than anyone expected.

That’s the message that comes from a report published recently in the American Journal of Preventive Medicine on research from the Centers For Disease Control and Prevention, the Agency for Healthcare Research and Quality and the National Cancer Institute.

The researchers took a look at the number of skin cancers …

When the art of medicine gets lost in the business

Hans Duvefelt, MD

Physician

November 25, 2014

Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm.

Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months.

A slender, middle aged man, …

Reporting physician quality: The dangerous game the government plays

Arvind Cavale, MD

Health Policy

November 25, 2014

We have heard ad nauseum that the data collection mandated by Medicare and Medicaid is to improve quality of care. Significant taxpayer dollars have been expended as bonuses in the name of PQRS (Physician Quality Reporting System). With all this investment and mandating, one would assume that the PQRS must be highly indicative of better quality of patient care, right? Not so fast.

Two recent reports demonstrate how ineffective this program is and how much physicians hate …

What a messy house has to do with medicine today

Abigail Schildcrout, MD

Physician

November 25, 2014

I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.

I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of …

Ezekiel Emanuel’s wrong ethical view of aging

Jim deMaine, MD

Physician

November 24, 2014

Ezekiel Emanuel wrote an article for the Atlantic on “Why I Hope to Die at 75: An argument that society and families — and you — will be better off if nature takes its course swiftly and promptly.” As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest — and that …

When physicians need backup during a routine procedure

Michael Kirsch, MD

Physician

November 24, 2014

A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system …

The rational ignorance of Jonathan Gruber

Dr. Saurabh Jha

Health Policy

November 24, 2014

I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks.

Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero.

Stupidity, though, was …

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