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Physicians don’t take the time to communicate with their colleagues

Physician

October 4, 2014

I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned at a local restaurant.

The telephone rang with the caller ID identifying a call on my office work line.

“Hello this is the emergency department, please hold on for Dr. S.” …

Marijuana and motor vehicle safety: An impending public health dilemma

Abraar Karan, MD

Medications

October 4, 2014

Since 1996, 21 states have approved the legalization of marijuana for medical use. More recently, Washington and Colorado have legalized the use of recreational marijuana, with California and Oregon not far behind. The health risks associated with marijuana have been well documented in a number of studies, but these are secondary to the much greater mortality risk associated with an increased prevalence of the drug: driving under the influence.

As is …

3 ways to improve primary care access

Richard Migliori, MD and Grace Terrell, MD

Health Policy

October 4, 2014

Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits.

Unfortunately, too many Americans lack easy access to primary care. Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. …

Read more…

3 ways to improve primary care access

Apply the lessons learned from the ice bucket challenge

Uruj Kamal, MD

Physician

October 4, 2014

The ALS wave has finished sweeping the nation, resulting in a flood of over $100 million raised to fight a devastating disease which is actually quite rare. Now that gallons of ice water have drenched American’s bikinis and trunks, we should be asking ourselves two questions. First, does everyone really understand more about the disease now that the challenge is over? Second, and more importantly, what lessons can we learn …

MKSAP: 59-year-old woman with pain of the right foot

mksap

Conditions and Diseases

October 4, 2014

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

A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications …

How to improve doctor-administrator relations

Marc-David Munk, MD

Health Policy

October 3, 2014

shutterstock_110304980

A colleague at a hospital-based health system recently told me about physician alignment initiatives his employer was introducing. These included co-management deals (where doctors get per patient incentives for on-time discharges, and high quality scores) and new salary models that adjusted based on various metrics. At the same time, he noted, his hospital was laying off clerks, leaving him spending hours on clerical tasks …

Ebola: Is it time for travel restrictions?

Brian C. Joondeph, MD

Physician

October 3, 2014

Should we be worried about Ebola? That’s the question on the minds of many Americans given the first documented case on U.S. soil. And now there is a second possible case, someone having contact with Thomas Duncan, the first U.S. case of Ebola.

Thomas Frieden, director of the Centers for Disease Control and Prevention reassures us, “I have no doubt that we’ll stop this in its tracks in the U.S.” President Obama also told …

Examining the safety of outpatient surgery centers

Nina Singh-Radcliff, MD

Physician

October 3, 2014

The unexpected death of Joan Rivers at 81 years of age occurred during a routine outpatient procedure at an accredited doctor-owned surgery center. Although there are few confirmed reports of what actually occurred, what we do know is that media-fed information can resonate amongst the general public — and our patients. Concerns have been raised about the outpatient setting, patient selection, and types of surgeries that are performed.

As a result, the responsibility …

The physical exam is still useful. Here’s how.

Robert Centor, MD

Physician

October 3, 2014

Dr. Danielle Ofri has an important piece in the New York Times: “The Physical Exam as Refuge.” As an outpatient physician, she makes the case that the physical examination provides a special time for the physician to focus entirely on the patient. Is examination time the refuge for the harried physician, and the opportunity to engage the patient in extended conversation about their condition?

While I did outpatient medicine for …

Medical reversals: When wonder drugs become harmful

John Schumann, MD

Medications

October 3, 2014

Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks.

Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ …

Is there any room for individuality in medicine?

David Mann, MD

Physician

October 3, 2014

There are now so many rules and regulations in medicine that it is difficult for doctors to express any individuality. Like the burgers at McDonald’s that are constructed in such a way that they taste the same regardless of your locale, doctors are expected to behave similarly when confronted with similar circumstances. Or at least that is how the proponents of algorithmic medicine see it.

In addition, electronic health record systems create uniformity by enforcing …

7 common reasons for refusing vaccines

Claire McCarthy, MD

Medications

October 3, 2014

The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S.

We have got to get more people immunized.

Essentially all of the cases were linked to “importations,” cases brought in from other …

Read more…

7 common reasons for refusing vaccines

There’s a part of us that’s unafflictable

Kenneth D. Bishop, MD, PhD

Physician

October 2, 2014

We’re born into our bodies, and we take that for granted.

Our first job is to take a breath, something we’ll hopefully do many millions of times and never think about. That first breath changes everything: Our blood starts to flow through our heart and lungs in a different way and for the first time we taste a new world.

Before we’re born, all our needs are met via an artery and …

Young fathers can also get postpartum depression

Alix Casler, MD

Conditions and Diseases

October 2, 2014

A study published in the journal Pediatrics showed that young fathers, those who became dads at an average age of 25 years, have a 68% increase in depression symptoms within the first five years of becoming dads. This applied to young dads who lived with their children and their wives or girlfriends. Dads who lived away from their children and older fathers did not show that same increase in rates of …

Who still uses faxes? The medical industry does.

P. J. Parmar, MD

Physician

October 2, 2014

Faxes!

Who still uses faxes? The medical industry does. Here is a picture from just today: 27 faxes received and about 20 sent, and that is only counting after noon. Some days are worse, with up to 40 faxes to handle in our small medical practice.

faxes

On the left are the 27 faxes received: We use e-faxing, so they arrive as pdfs. On …

There is something very special about being a physician

Arshya Vahabzadeh, MD

Physician

October 2, 2014

Pretty much on a weekly basis I come across an article about how awful life is as a practicing physician. Articles focus on how unhappy physicians are with their jobs, with their hours, with their pay or with health care reform.

After almost a decade of practice, the fact is that I like my job.

Is it perfect? Absolutely not: quite far from it, in fact. There are certainly many times when …

VBAC is the love child of medical malpractice lawyers

Jennifer Gunter, MD

Physician

October 2, 2014

The New York Times has reported on a woman who wanted to deliver vaginally and claims she was forced to have a repeat C-section (her third C-section) against her will. I can’t comment on the veracity of her claims, however a forced C-section is never, ever acceptable. It doesn’t mater if the fetus has an agonal rhythm (is visibly dying on the monitor), as an OB your role is …

Doctors and patients deserve better than Medicaid

Peter Ubel, MD

Health Policy

October 2, 2014

I have written a couple of pieces documenting the high percentage of physicians who refuse to take Medicaid patients, and some of the reasons for their refusal. One of my pieces prompted a physician to email me with his take on this matter. I am going to quote from that email, but take out identifying information to protect his anonymity.

Here’s what he …

A family physician misses hospital rounds

H. Andrew Selinger, MD

Physician

October 1, 2014

As a family doctor, I had the privilege of sitting down at the hospital recently with Mr. M, a longstanding patient of mine, and his family. Mr. M is a college-educated engineer, struggling near the end of his life with end-stage kidney disease, dialysis, severe congestive heart failure and crippling COPD. And he was pretty down about it.

In the hospital, a critical care physician, a pulmonologist, a nephrologist, and a cardiologist …

Will direct primary care be offered by employers?

Stephen C. Schimpff, MD

Health Policy

October 1, 2014

Part of a series.

Comprehensive primary care for employees means better employee health, greater productivity, less presenteesism and lower costs for both employee and employer. That is why some companies are making health care a strategic imperative rather than just a tactic as part of human resource cost management. Some are developing full service enhanced primary care clinics on site with excellent success as described in my Read more…

Will direct primary care be offered by employers?

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