There are too many obstacles to using health insurance

Health Policy
November 2, 2014

The Affordable Care Act. Obamacare.

No matter what you call it, the law has two main goals: Insure more (all?) Americans, and in doing so, lower the aggregate costs of health care in the U.S.

After year one of the Act’s main rollout, there is no doubt about the first goal: Millions more Americans now have health insurance. Many have purchased it on the exchanges, whether they are state-run (best example might …

Read more…

There are too many obstacles to using health insurance

After a prostate cancer diagnosis: The urgency to treat

Conditions and Diseases
November 2, 2014

asco-logo

Hearing the words “you have cancer” changes everything. In my role as clinical nurse specialist in a busy prostate clinic, I see the effects of these three words on men and their families every day. The shock and disbelief, the fear and confusion as most men feel perfectly well with no symptoms at all. Many men want to do something …

Read more…

After a prostate cancer diagnosis: The urgency to treat

Keep the questions coming as you progress through medical training

Medical Education
November 2, 2014

If I had to choose one theme that has stood out in the first weeks of medical school, it would be this: questions, questions, and more questions. In the first class on our first day of medical school, our professor set the tone by laying down the requirement that we ask a minimum of ten questions before the lecture was over. Based on my experience in large undergraduate lectures, where …

Read more…

Keep the questions coming as you progress through medical training

How to talk to your kids about Ebola

Conditions and Diseases
November 2, 2014

Ebola is a scary topic; there’s no doubt about that. With the onslaught of media coverage that has no end in sight, it’s likely that older children have already heard of the Ebola outbreak or will hear about it in the near future. The question is, what can we do to help our kids work through the confusing and frightening messages they see on television?

Here are some suggestions to help …

Read more…

How to talk to your kids about Ebola

Transition of care: A letter to ACO General Hospital

Health Technology
November 2, 2014

Dear ACO General Hospital:

Thanks for contacting me about my most recent blog post.  I’m sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients.  At your request I hid even more of that information.

I know it’s kind of embarrassing to have that kind of thing made public, and I am overall …

Read more…

Transition of care: A letter to ACO General Hospital

When checklists become chokelists

Physician
November 2, 2014

Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists.

From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s …

Read more…

When checklists become chokelists

The difficult conversation everyone must have

Physician
November 1, 2014

During my first year of medical school, in the last year of my father’s life, his oncologist had a difficult discussion with him and my mother- the decision to become do-not-resuscitate (DNR). I remember my mother was taken aback, my father was relieved and I was deeply saddened.  However, when I got the call that my father may not make it out of the hospital this last time, I was …

Read more…

The difficult conversation everyone must have

Preparing for a growing caseload of endocrine emergencies

Conditions and Diseases
November 1, 2014

When an unconscious person is first brought to the emergency room, there may be little indication if the individual has diabetes or a thyroid condition.

Since millions of people have common hormone health conditions like these, emergency room clinicians and other acute care providers need to watch for cases where an endocrine disorder is causing or contributing to a medical emergency.

More than 29 million people in the United States have diabetes, …

Read more…

Preparing for a growing caseload of endocrine emergencies

What’s the right way to think about Ebola?

Physician
November 1, 2014

shutterstock_177163439

Ebola has riveted our attention: It’s a deadly disease with no known cure, and as is true of most infectious diseases, it’s easy to imagine how it could become a global pandemic and threaten us directly. For what it’s worth, though, here is what the federal Centers for Disease Control and Prevention tells us about Ebola:

1. The Ebola virus is not spread through:

What’s the right way to think about Ebola?

MKSAP: 72-year-old woman with severe COPD

Conditions and Diseases
November 1, 2014

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

A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 …

Read more…

MKSAP: 72-year-old woman with severe COPD

Medical schools should not ignore health costs

Medical Education
October 31, 2014

Medical students are brilliantly frugal. And it’s no surprise — according to the AAMC, the average U.S. medical student incurs $170,000 of debt from medical education. We are a resourceful, smart, and cost-conscious group — so why is the medical school curriculum practically silent on the cost of medicine?

During medical school, we are taught to be excellent diagnosticians. The third and fourth years of training provide 60 to 80 hours a week of …

Read more…

Medical schools should not ignore health costs

ADVERTISEMENT

Tips to repay your medical student loan

Medical Education
October 31, 2014

As of October 2013, the average medical student graduated with $169,901 of debt with nearly 80 percent of all graduates owing at least $100,000. Although these numbers are daunting, medical school educational debt is part and parcel of our profession. Truth be told, at the end of our training (which can range from three to ten years post-medical school), almost all of us will make at least $150,000 and likely be …

Read more…

Tips to repay your medical student loan

Ebola: If Nigeria can do it, so can we

Conditions and Diseases
October 31, 2014

In June, a man became very ill during a flight into Lagos, Nigeria. On the plane, he developed vomiting and diarrhea, and he collapsed in the very busy airport. Contacts on the plane and on the ground had no idea that he had Ebola — initially, he was treated for malaria — and many health care workers and bystanders on the plane and in the airport were exposed to his …

Read more…

Ebola: If Nigeria can do it, so can we

The helplessness of being a parent

Physician
October 31, 2014

Years later, I now wonder if I overstepped my boundaries.

Nancy was a pleasure to have as a patient.  A physician assistant in her early twenties, we often chatted amiably during visits.  Our conversations randomly ambled between personal and professional topics.  She recently married and was looking forward to having children.  Her gynecologic history was complicated and after a period of months of unsuccessful attempts to get pregnant, she visited a …

Read more…

The helplessness of being a parent

Ebola! But don’t forget about the flu.

Physician
October 31, 2014

Ebola virus has grabbed headlines since the epidemic started in West Africa nearly a year ago. The death toll is estimated at 4,500 people, and the epidemic continues to spread. One person infected in Liberia returned to Texas with the disease and died, infecting maybe 2 health care workers.

Ebola is a nasty virus, surely, with a case fatality rate of 80 percent. Overall health and nutrition as well as living …

Read more…

Ebola! But don’t forget about the flu.

Hospital observation status: The truth must come out

Physician
October 31, 2014

The observation status problem has continued to grow both larger and worse.

My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that we must give them the designation called observation status.  CMS recognizes observation status as outpatient care, like seeing a patient in a walk-in clinic.

We don’t decide to make a patient observation …

Read more…

Hospital observation status: The truth must come out

The problem with wedding planning when you’re a surgeon

Physician
October 30, 2014

shutterstock_149847554The other day, I got into an argument with my parents about choosing wedding décor — and I blame it on my surgical training.  My parents had borne the brunt of the work for the previous eleven months. allowing me to focus on my elective surgery rotation, flying to fellowship interviews, publishing my first article, and putting out the types of …

Read more…

The problem with wedding planning when you’re a surgeon

All online physician ratings are not created equal

Patient
October 30, 2014

Just yesterday I was searching for a local surgeon, and on one website he had 2 out of 5 stars.  Hardly anyone was recommending him.  Yet prominently featured on another site he had 4.7 out of 5 stars.  Both sites had a good number of reviews.  What’s going on?  Is one site cherry picking the reviews?  Is someone falsifying reviews on one of the sites?  Which reviews can I trust? …

Read more…

All online physician ratings are not created equal

1480
pages