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Money for nothing: The dire straits of EHRs

Health Technology

November 20, 2014

I’ve previously written about my experience with poorly designed electronic health records and how it negatively impacts provider happiness and patient safety. Apparently, I’m not alone in my experiences and my sentiments about this subject.

First, we have a study that validates the concern that EHRs waste time for doctors. Imagine the impact for primary care physicians who are already crammed for time, seeing patients in short time intervals just to keep their overhead.

Then, …

Is it ever appropriate for us to choose the timing of our death?

Afshine Ash Emrani, MD

Physician

November 20, 2014

Human life is a gift. Death, too, can be a gift. Is it ever appropriate for us to choose the timing of our death?

Brittany Maynard, 29, was diagnosed with a stage 4 glioblastoma, an aggressive and uniformly fatal brain tumor. With the blessing of her family and millions of supporters around the world, she ended her life in Portland, Oregon, with a fatal dose of barbiturates prescribed by a physician. …

More resources are needed for pediatric cancer research

David A. Williams, MD

Conditions and Diseases

November 20, 2014

The fact that childhood cancer is, thankfully, a rare disease belies the fact that it is the leading cause of disease-related death in U.S. children, age 1 to 19. The fact that it is a rare disease also belies the fact the number of people with a direct stake in expanding research into pediatric cancer is quite large and extends well beyond the small number of children with cancer and …

Why cancer still evokes fear

Elizabeth Horn, MD

Conditions and Diseases

November 20, 2014

Nobody, it seems, is comfortable with death. In Haiti, where death and life are fluid concepts, where voodoo curses and ghosts are spoken of as fact rather than fiction, death is comfortably present. The dead are buried in mass graves throughout the country, victims of political crime, violence, malnourishment and infectious disease. There, life can be drained from a healthy person in a matter of hours for lack of clean …

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Why cancer still evokes fear

A factory model of health care can only go so far

Tom Peteet, MD, MPH, MEd

Physician

November 20, 2014

What we are trying to do is create a system that gets rid of the human factor.
– an internal medicine physician

I heard this statement in a patient safety seminar designed for medical residents. I paused, shuddered even, as a resident who writes poems and reads novels in my free time. To my surprise no else blinked an eye. And why should they? The concept that physicians’ humanity and empathy shape health …

What Mayor Thomas Menino taught us about cancer

James C. Salwitz, MD

Conditions and Diseases

November 20, 2014

mayor menino

Beloved and deeply respected Boston mayor Thomas M. Menino died on hospice in Brigham and Women’s Hospital recently. Menino developed advanced cancer of unknown primary (CUP) in the spring of this year, and after six months of chemotherapy, he elected to stop active treatment. Reportedly he was comfortable, and surrounded by friends and family at the time of his death. The press, the …

We owe it to our patients to put on our game faces

Starla Fitch, MD

Physician

November 19, 2014

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When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?”

When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?”

When you steel yourself …

A ritual to recover the empathy toward bodies we care for

Amrapali Maitra

Medical Education

November 19, 2014

Watching my first below-the-knee amputation on my surgery rotation, I felt a curious mix of revulsion and detachment. The woman on the operating table had a gangrenous infection that had spread across her foot. Her long history of smoking and her delay in seeking medical care meant that she had stiff, black toes by the time a surgeon first saw her. The only treatment was amputation.

In the operating room, the …

Gynecologic cancer: Being a part of these women’s stories

Sharlay Butler

Medical Education

November 19, 2014

Mrs. C was used to my quiet knock every morning at 6 a.m. She smiled as I turned on the overhead lights, but began to grimace when she realized that today was dressing-change day. The rustling packages of bandages in my overstuffed coat pockets had given it away. Mrs. C had stage four metastatic endometrial cancer; a malignancy of her uterus that was not responding well to chemotherapy and had …

Can writing about medicine change medicine for the better?

David Mann, MD

Physician

November 19, 2014

I’m getting to the point where I think it might be time to stop or at least decelerate the pace of my writing on medicine. When I retired from medical practice almost a year ago there were a lot of pent up experiences that I felt a need write about. But now I have already written about almost everything that I wanted to and, as I am no longer a practicing physician, …

What does a good death mean to you?

Don S. Dizon, MD

Physician

November 19, 2014

In July 1991, I was beginning my first year of medical school in Rochester, New York. I was filled with excitement and anxiety on beginning a journey in medicine as I started on the road to becoming a doctor.

At that time, Rochester was in the national spotlight because of the actions of one of our faculty members, Timothy Quill. …

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What does a good death mean to you?

The public’s lack of trust in science is alarming

Bob Doherty

Physician

November 19, 2014

Cynicism appears to have replaced idealism as America’s defining characteristic. So many of us just don’t trust the government, scientists, the clergy, journalists, business CEOs, labor unions, lawyers, or just about anyone for that matter, to say or do the right thing.

Two years ago, the National Journal reported that as a consequence of the Great Recession, “Americans are losing faith …

OTC birth control pills: Let’s replace politics with science

Kenneth Lin, MD

Physician

November 18, 2014

I’ve waited to address this sensitive topic until after the midterm elections, when political slogans such as the phony “war on women” and trumped-up threats to religious liberty were discarded like so many campaign posters. It was curious to see the American Congress of Obstetricians and Gynecologists (ACOG) and Planned Parenthood attacking Republican Senate candidates for supporting over-the-counter birth control pills without a prescription — a position that, if …

You always remember your first patient

Jordan Grumet, MD

Physician

November 18, 2014

I didn’t think much of it at the time.

Most physicians can trace back and recall their first patient. For some, it is a clinical encounter the third or fourth year of medical school. The more creative may point to their cadaver during first year anatomy and nod knowingly. My first patient was a mouse. Or shall I say a group of them?

My freshman year of college, I volunteered in …

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You always remember your first patient

Cholecystectomies at night: Are they safe?

Skeptical Scalpel, MD

Conditions and Diseases

November 18, 2014

A new study from surgeons at UCLA found that laparoscopic cholecystectomies done at night for acute cholecystitis have a significantly higher rate of conversion to open than those done during daylight hours.

Nighttime cholecystectomies were converted 11 percent of the time vs. only 6 percent for daytime operations, p = 0.008, but there was no difference in the rates of complications or hospital lengths of stay.

The study, published online in the …

P4P: If it works for physicians, why not for teachers?

Brian C. Joondeph, MD

Health Policy

November 18, 2014

Just north of Denver, Jefferson County has become a battleground in the fight over performance-based pay for teachers. The recently elected school board plans on implementing “[a] compensation system that recognizes and rewards our great teachers,” according to school board president Ken Witt. The response of the local teachers’ union was for teachers to call in sick and enlist students in protesting what they describe as a proposed “patriotic curriculum.”

The protests are a convenient …

What chaos theory has to do with family medicine

Ben Wilson, MD

Physician

November 18, 2014

Open a new browser tab and check your favorite weather forecast website or app. Right now.

How many days in the future does it go? Seven? Maybe even 10? Look at the current forecast for the 7th day out from today. Do you trust it to accurately predict the weather for that day? Why? Or why not?

Have you ever wondered why they can’t …

Primary care fits some medical students. Here’s one.

Richard Gunderman, MD, PhD

Physician

November 18, 2014

One of the top students at one of the nation’s largest medical schools, Ishan Gohil has made an unusual — and to many of his colleagues — inexplicable decision. Instead of seeking to train in one of medicine’s most highly specialized and competitive fields, he says, “I elected to pursue a career in family medicine.” Many view his choice of primary …

Meaningful use: The independent majority can stop the madness

Margalit Gur-Arie

Health Technology

November 17, 2014

According to the American Medical Association, there were approximately 685,000 physicians in patient care, post-residency, not employed by the federal government, in 2012. 60 percent of these physicians practiced in independent private practice, and 84 percent were working in small to medium size practices. Assuming that the trend to employment of doctors by health systems continued unabated to this day, over half of practicing physicians are still in private practice and …

Run your emergency department like a restaurant

Patsy McNeil, MD

Physician

November 17, 2014

Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any …

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