It’s not often that I find myself speechless. I have heard all sorts of stories in my office — as a sexuality counselor, I am often humbled by the trust that people place in me and how much they disclose about their private lives. But one conversation I had with a patient literally made my jaw drop.
The patient is a …
Estrogen therapy and breast cancer: The pharmacist said no
There’s been a lot of controversy recently about workplace wellness programs: Do they save money for employers on health care costs? Can they produce measurable benefits for employee health? Do they unfairly punish people who are unable to participate? Are these programs just a ploy to shift medical costs to unhealthy employees?
Recently Austin Frakt and Aaron Carroll revisited these questions in a piece for the New York Times’ Upshot column, “Read more…
Workplace wellness programs: Are they really failures?
Michelle wrote in: “We trained my 3-year-old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there …
When your child doesn’t poop: Solving the constipation death spiral
I have been following the progress of bedside ultrasound (using ultrasound as a diagnostic tool during my physical exam of patients) as it gets a foothold in standard medical practice since I first started learning to do it about 3 years ago. Every so often a study comes out which warms my heart as it proves that less (radiation, expense) is more in treating patients.
An article came out in the …
Emergency room doctors can safely use bedside ultrasound
She was sick. Not sick like a high fever, body aches and a runny nose. Sick like she had spent the last half a decade in nursing homes as most of her internal organs failed. There was oxygen, and dialysis, and a colostomy. She propelled herself vigorously through the crowded halls in the custodial wing of the nursing home, her wheelchair a natural extension of her body thoroughly unhampered by …
What personal responsibility means to a physician
If you are a physician like me who performs procedures, then rarely you will cause a medical complication. This is a reality of medical life. If perforation of the colon with colonoscopy occurs at a rate of 1 in 1,500, and you do 3,000 colonoscopies each year, then you can do the math.
Remember that a complication is a blameless event, in contrast to a negligent act when the physician is …
Complications are a reality of medical life
“Mr. Jones’ chest x-ray looks normal,” the intern said to me on morning rounds.
Mr. Jones just had a transhiatal esophagectomy (THE). The esophagus is the muscular tube that connects the back of one’s throat to their stomach. It can develop cancer or become completely dysfunctional because of benign processes, and therefore need to be removed.
A THE involves cutting out the patient’s esophagus, in Mr. Jones’ case for cancer, bringing the stomach up …
To reduce health costs, everyone needs to be on the same page
Medical students are repeatedly taught the importance of the physician-patient relationship. We are told that to be a good doctor we must strive to exhibit compassion, empathy, respect, professionalism and confidence all while applying our medical knowledge to figure out a diagnosis and treatment plan. If you add in the pressure of doing this within a 15-minute visit, all while answering questions faster than an Internet search, it can get …
Vulnerability is a virtue in medicine
Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.
Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.
Within a minute, an administrative secretary came out and …
How hospitals discourage doctors: A step by step guide
The simple truth is that radiology reports can be hard to read, especially for those without a medical background. The combination of advanced medical technology and the wonderful subtle intricacies of the human body often result in a final document that more closely resembles a William Faulkner novel (translation: difficult to understand!) than Dr. Seuss. The goal is to try to …
An insider guide to reading your radiology report
The Affordable Care Act (ACA), commonly known as Obamacare, increased the availability of FDA-approved contraception to women through cost-free coverage under the contraceptive mandate. With the exception of some religiously affiliated insurance plans and employers who are legally exempt, this mandate supports women’s access to comprehensive reproductive health care, including the most effective forms of contraception. However, an integral part of family planning was left out of the legislation: contraceptive …
Why are men left out the contraceptive mandate?
1. Physician assistant (PA) growth will remain unprecedented. Demand is driving growth and PA program expansion. The educational programs are charging students higher tuition costs for these coveted PA positions. PA students now acquire unparalleled debt, according to a recent Robert Graham Center report; one in four PA students owed more than $100,000. Although high student debt may impact PA graduates ability to go into fields like primary care, it …
Physician assistants: 5 predictions in the era of health reform
Up to this point, it had only been a hypothesis: That celebrity firepower can definitively drive consumer health behavior in a certain direction. The case here concerns whether women wish to embark on a genetic hunting expedition to see if they are at high risk of developing a particular disease such as breast cancer, and the motivator in this case is Angelina Jolie.
The actress underwent genetic testing for mutations related …
Exploring the Angelina Jolie effect in breast cancer screening
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It was my first day at my new job, practicing a new specialty. Having spent fourteen years as an ICU physician — including a four-year pulmonary/critical-care fellowship in this very hospital — I had just completed a palliative care fellowship. Now I was the hospital’s palliative care consult attending.
When I set eyes on the patient in room 1407, my first thought …
A palliative care dilemma on the first day of the job
Where there is love there is life.
– Mahatma Gandhi
In this first month there is a lot I saw, learned and experienced. Love tops the list. I became an expert in arterial punctures as I did 4 to 5 of them each day in the floors. Each time I headed for an arterial puncture, many things automatically came to my mind: collect all of the required supplies, talk to and comfort …
Lessons from the first month of residency
Why do so many seemingly great technologies fail to penetrate the health care system?
I hope the following five answers shed some light on the realities of technology adoption in health care.
1. Many new technologies don’t address the real problem
Tech entrepreneurs often take a backward approach to invention. They start by discovering a nifty technology. Later, they figure out how people can use it.
This technique often teaches entrepreneurs a tough lesson: Technology …
Health care fails to adopt technology. Here are 5 reasons why.
“All your patients will die. Maybe not today, but someday. The defining fact of life is that it ends. Only a fool would dedicate their career to fighting something that can never be beaten. Therefore, a doctor’s task cannot be to fight death. A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to …
A twisted argument against end-of-life care
Over the last year I’ve written a lot about the problems with health care IT and how we need to get better. Unfortunately, unlike other aspects of our life where information technology has actually made life easier, in health care the user experience been nowhere near as smooth. IT solutions, including electronic medical records, are for the most part slow, inefficient and cumbersome. They cause a great deal of frustration …
5 examples of what health care IT should look like
If I were punched by an unknown man in an elevator there would be little doubt that my assailant would be prosecuted. If the trauma were enough to cause me to lose consciousness, meaning I suffered brain trauma, my attacker would likely be charged with aggravated assault. No one would be surprised if he received jail time. No one would think twice if he lost his job. However, if I …
Domestic violence and the NFL: We all need to change
One thousand dollars per pill?
A single treatment course for hepatitis C virus to cost $83,000?
How can those prices be justified?
The drug-discovery process is a long one, fraught with disappointments and massive investment, no matter what the outcome. Some pharmaceutical companies argue that the high prices charged for their rare “blockbuster” drugs help them recover research and development costs.
While drug pricing and drug access are contentious and controversial issues — ones …
The long road to a blockbuster drug
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