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Who should be receiving therapeutic hypothermia?

Peter Ubel, MD

Conditions and Diseases

September 17, 2014

Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside:

“He’s in v-fib.”

“Get me the paddles.”

The team performs urgent chest compressions for a few seconds. Then they place the metal paddles on the victim’s chest:

“Clear!” Kathump.

The patient’s heart is back to normal again, tragedy …

Abortion or ectopic pregnancy? When politicians confuse medical terms.

Jennifer Gunter, MD

Conditions and Diseases

September 17, 2014

Wendy Davis, gubernatorial candidate for Texas, has a new memoir Forgetting to Be Afraid. In it she describes terminating two pregnancies. One termination appears to have been in the second trimester for fetal indications and the other she describes as an ectopic pregnancy. She writes, “The only medical option was to have surgery to terminate the pregnancy and remove the affected fallopian tube — which …

The death certificate didn’t say enough

James C. Salwitz, MD

Physician

September 17, 2014

August 17, 2010. Maris is a 57-year-old woman in excellent health. She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law. A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge.

It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while …

Read more…

The death certificate didn’t say enough

How to choose a nursing home: Why 5-star ratings may be wrong

Trudy Lieberman

Health Policy

September 17, 2014

Just a few years ago it seemed that advocates for health care transparency had scored a big victory. The Centers for Medicare & Medicaid Services (CMS) announced that they would rate nursing homes by awarding five stars to the best and fewer stars to lower-quality facilities. Families searching for care for loved ones would have access to a familiar rating system to help them make choices. After all, star ratings for …

Why is there an influx of physician job offers in my inbox?

Jesse Irwin, MD

Physician

September 17, 2014

If you’re a 3rd- or 4th-year resident, chances are you’re no stranger to unsolicited job offers showing up in your email inbox. Maybe it’s a few a week, or maybe it’s a few a day, but they are always there. The emails find you. I’ve been out of residency for years and I’m still getting them.

The macro reason for this flood of unsolicited job offers is obvious: You’re in high …

The enterovirus outbreak: What you need to know

Wendy Sue Swanson, MD

Conditions and Diseases

September 16, 2014

Widespread news coverage has heightened concerns by many parents about a severe-symptom viral infection causing respiratory illness in children, predominately in the Midwest. Over the last month there has been a dramatic up-spike in children hospitalized with severe cold symptoms and wheezing. The virus isn’t new, but its effect on children seems to be. The Centers for Disease Control (CDC) has confirmed tests on children both in Kansas …

Health anxiety: What hypochondriasis really should be called

Lucy Hornstein, MD

Conditions and Diseases

September 16, 2014

“Am I a hypochondriac?”

It’s a question I hear with quite some regularity, almost never from people who suffer from bona fide anxiety disorders related to their health.

No, the fact that all you have is a simple upper respiratory infection — the common cold — instead of a potentially lethal strain of H1N1 avian flu does not qualify. Not when your response to my reassurance is relief. That’s completely appropriate, and …

An early school-year phone call: Could my child be autistic?

Lisa Shulman, MD

Conditions and Diseases

September 16, 2014

Back-to-school shopping, new sneakers and first-day outfits, sharpened pencils and fresh notebooks in oversized backpacks by the door: As a parent, these are the images I’ve come to associate with the start of every school year.

But with my 20-plus-year history as a developmental pediatrician specializing in autism at Albert Einstein’s Children’s Evaluation and Rehabilitation Center, I have an added association with the start of the school year: a particular type of …

Low-fat or low-carb diets: Interpreting results of the new study

Albert Fuchs, MD

Conditions and Diseases

September 16, 2014

The joys of September! Parents gleefully shove their reluctant children onto school buses, the palm trees in Los Angeles don’t change color, and everyone realizes that they gained 20 pounds during their summer vacation. It’s time to get serious again about losing weight.

But how should you eat to best help you shed the extra pounds? Many people are passionate about their favorite diet, but there is very little data comparing …

5 things EMRs should learn from social media

Val Jones, MD

Health Technology

September 16, 2014

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As a physician who openly despises many aspects of current EMRs (see “How An EMR Gave My Patient Syphilis” or “The Medical Chart: Ground Zero For The Deterioration Of Patient Care” ) I recognize that they are here to stay. And so, since we’re all stuck with these digital middlemen, I have some suggestions (based on popular social media platform functionality) …

Alternative medicine: There should only be one standard

Hans Duvefelt, MD

Medications

September 16, 2014

“Doctor, what do you think of alternative medicine?” a patient with chronic fatigue syndrome asked me the other day. She was interested in doing something more for her severe fatigue. “Would acupuncture help me?”

I paused and, as I have done many times before, answered that my training and most of my clinical experience has been in Western, allopathic medicine. (Ironically, the word “allopathic” was first used as a derogatory term …

Chance: The difference between an unlucky surgeon and a killer

Skeptical Scalpel, MD

Physician

September 15, 2014

Risk-adjusted 30- to 90-day outcome data for selected types of operations done by specific surgeons and hospitals are now being publicly posted online by England’s National Health Service.

According to the site, “Any hospital or consultant [attending surgeon in the UK] identified as an outlier will be investigated and action taken to improve data quality and/or patient care.”

After cardiac surgery outcomes data were made public in New York, some interesting unexpected consequences were …

Attentive questioning: You can’t learn this in a medical school classroom

Christine Sunu

Medical Education

September 15, 2014

I don’t remember how many patients I saw at the health fair before George came to me; none of them were as memorable. George was a tall, stooped man with a serious expression. His skin was weathered but he couldn’t be called elderly by any means. I guessed that his age hovered somewhere around forty. He looked serious and spoke quietly. He had no interest in being rude, but no …

The worst-case scenario: When patient satisfaction goes too far

Suneel Dhand, MD

Physician

September 15, 2014

Everyone involved in health care, and particularly hospital care, has witnessed a sea change over the last decade. Things that were never even thought about, let alone formally taught to frontline doctors and nurses, have now come to the forefront.

Chief among these is the drive towards improving patient satisfaction and delivering a more optimal hospital experience. True, a large part of this is due to federal incentives and tying reimbursements …

Bob Sears: Public health isn’t something his parents need to think about

Roy Benaroch, MD

Physician

September 15, 2014

Recently, the Los Angeles Times reported on California pediatrician Dr. Bob Sears’ role as a favorite among vaccine-fearing parents. What he tells them is absolute nonsense that he has freely admitted he made up in a Reddit interview. Now he’s let a little more honesty shine through. He told the reporter:

“I do think the disease danger is low enough where I think you can safely raise an unvaccinated child in today’s society,” …

Joan Rivers: Pushing the limits of outpatient care

Karen S. Sibert, MD

Physician

September 15, 2014

There are minor operations and procedures, but there are no minor anesthetics. This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers.

Ms. Rivers’ funeral was held on September 7. Like so many of her fans, I appreciated her quick wit as she entertained us for decades, poking fun at herself and …

Reducing health care costs through company wellness plans

Stephen C. Schimpff, MD

Health Policy

September 14, 2014

Part of a series.

Employers have seen their health care costs rise dramatically over the years. To compensate, they have expected employees to pay an increasing portion of the health care insurance premium, expected employees to pay significant co-pays with each physician visit and have purchased policies that restrict individuals to a narrow network of doctors and hospitals. Largely these have not worked. They have offset some of the expenditures but …

5 things people get wrong about Canada’s health system

Kathleen O’Grady and Noralou Roos, PhD

Health Policy

September 14, 2014

The Canadian health care system is often held up as an example to model or to avoid at all costs in the debates on health care in America, and elsewhere. Yet there are a startling number of misconceptions — on both sides of the partisan divide — about how the Canadian health system actually works, often from experts who should know better. Here are the facts.

1. Doctors are self-employed, not …

MKSAP: 32-year-old man with cough and nasal congestion

mksap

Conditions and Diseases

September 14, 2014

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

A 32-year-old man is evaluated for a 3-day history of productive cough, sore throat, coryza, rhinorrhea, nasal congestion, generalized myalgia, and fatigue. His sputum is slightly yellow. His two children (ages 3 years and 1 year) had similar symptoms 1 week ago. He is a nonsmoker and has no history of asthma.

On …

Buying physician practices does not equate to clinical integration

Alexandra S. Brown, MD

Health Policy

September 14, 2014

I read an article recently that implied the practice of hospitals acquiring physician groups encouraged “clinical integration and multidisciplinary team-based health care.”

I guess that would depend on your definition of clinical integration.

The American Hospital Association has a particularly cogent one, which is: “[A practice] needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, …

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