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Anesthesia outside the operating room: A growing trend

Dawn Baker, MD

Physician

September 7, 2014

I opened my obligatory late-afternoon email to find my work schedule for the next morning: three general anesthetics for MRIs. My heart sank. A week before, I had been assigned to the new neurosciences MRI suite for a 6-hour interventional radiology procedure, followed by another intervention in the CT scanner. My first thought: Who is trying to punish me?

It’s well known in the anesthesiology field that these types of cases …

From house staff to healer of the homeless

Lipi Roy, MD, MPH

Physician

September 6, 2014

The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation.
– Sir William Osler

“You’re not gonna be happy with me, doc,” Richard said as he walked into the exam room at the Pine Street …

Doctors cannot speak about the reality of death and dying

Monica Williams-Murphy, MD

Physician

September 6, 2014

I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information).

I never cease to be amazed that most doctors cannot speak straightforwardly and compassionately about …

The vaccination decision isn’t a purely personal one

Claire McCarthy, MD

Medications

September 6, 2014

These days, we hear a lot about the risks of vaccines. As a pediatrician, I talk to many parents who are very frightened about those risks — and some choose not to vaccinate because of their fear.

Some of the risks we hear about are real, but some of them aren’t.

I absolutely support the right of every parent to make what they feel is the best decision for their child. The …

Her life made her into the physician she is today

Diana Brozyna, MD

Physician

September 6, 2014

I became a physician in 2001, after originally having a career in business. I wanted to become a doctor to be able to do something important. I felt that if I needed to work, and to leave my children in day care, I at least wanted to be doing something that was meaningful to me. My job as a business manager didn’t fulfill me in that way.

Over the years, I’ve …

Once more, I had learned my lesson about pain and vulnerability

H. Lee Kagan, MD

Physician

September 6, 2014

The nasogastric tube was killing me. It had been in place for twelve hours now, threading its way up my nose and down my throat, past my esophagus, into my stomach. Try as I might, I couldn’t swallow away the nasty lump stuck to the back of my throat. And every time I tried, it hurt.

Decades before, as a physician-in-training in upstate New York, I’d put in more nasogastric (NG) …

MKSAP: 42-year-old woman with crampy abdominal pain

mksap

Conditions and Diseases

September 6, 2014

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

A 42-year-old woman is evaluated for an 8-month history of crampy abdominal pain and three loose bowel movements per day. The pain is relieved by a bowel movement. There are no nocturnal bowel movements, and there is no blood or dark tarry material in the stool. She has not had fever, night …

A physician is now biased towards over-testing. Here’s why.

Val Jones, MD

Conditions and Diseases

September 5, 2014

Health screening is part of good preventive care, though over-screening can lead to increased costs, and potential patient harm. Health care professional societies have recently developed excellent public service announcements describing the dangers of over-testing, and new research suggests that though additional medical interventions are associated with increased patient satisfaction, they also lead (ironically) to higher mortality rates.

And so, in a system attempting to shift to a “less is more” …

Should hospital physicians only work on one floor?

Suneel Dhand, MD

Physician

September 5, 2014

A major debate taking place in the hospital medicine community over the last several years concerns the way in which we cohort patients on the medical floors. The traditional way is to have patients belonging to each doctor scattered across the hospital on several different floors. This is in contrast to designing a geographical system where all the patients for any one doctor are located on a single floor.

On the …

The study you never heard of: Small practices aren’t dead yet

Margalit Gur-Arie

Health Policy

September 5, 2014

shutterstock_7556908

According to a new Commonwealth Fund sponsored study published in Health Affairs, “Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions.” The study of over one thousand practices of various sizes and ownerships, conducted by some of the most respected names in health care, found that the smallest independent primary care practices, that are physician owned, provide better care …

Thinning hair, and a heavy soul

Samyukta Mullangi

Conditions and Diseases

September 5, 2014

My patient suddenly leaned forward, swung her hair up, and began to push it this way and that, determined to find and show me the partitions that her hair made when rested in a new equilibrium.

It was a warm Thursday afternoon and we were in dermatology clinic. This 20-something young professional had come to have her scalp examined. She’d noticed a sudden increase in the quantity of hair follicles that …

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Thinning hair, and a heavy soul

Hospitals should not control the decisions of pregnant women

Ruth Macklin, PhD

Health Policy

September 5, 2014

shutterstock_131198657

Doctors, hospitals and judges have over the years attempted to control the decisions of pregnant women. In a recent Florida case, it’s not clear whether the controllers sought to protect the fetus, the woman or both. They may have wanted to protect the hospital from potential liability.

The case involved a 39-week-pregnant woman.

According to a press release issued by the National Advocates for …

Want to become a doctor? 5 criteria you should consider.

Robert Centor, MD

Medical Education

September 4, 2014

While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine.

But that is me, is it you?

A medical tweeter than everyone should follow @medicalaxioms had these tweets recently:

If you become a doctor for wealth or prestige, you are going …

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Want to become a doctor? 5 criteria you should consider.

A physician remembers his first patient of the new millennium

Gregory Bledsoe, MD

Physician

September 4, 2014

It was January 1, 2000, and I was an intern in emergency medicine at the University of Arkansas for Medical Sciences.

I had gone to sleep the night before listening to celebratory fireworks and congratulating myself for surviving Y2K. Now I was walking into the emergency department of our large, level 1 trauma center where I was furthering my medical training. Like most urban ERs, this one was a busy place …

Can direct primary care solve the physician shortage?

Brett Clark

Health Policy

September 4, 2014

One of my main interests in primary care is providing care to all people, regardless of their income or ability to pay. In my limited experience with health care, I have found it most rewarding to work with the underserved and underprivileged, those who do not have their own money available to allocate to health care. These patients are on Medicaid or are at the mercy of free clinics. This is why I …

Does owning cancer equipment change treatment patterns?

Robert Pearl, MD

Physician

September 4, 2014

Today’s article follows the money trail to expose a different form of bias: the kind that takes place when doctors own their own diagnostic and therapeutic equipment.

For people living with cancer, this kind of bias can have a particularly painful impact.

Radiation therapy brings out medical bias

In the United States, cancer is the second most common cause of death, killing nearly 600,000 Americans …

One doctor’s day: Everything comes full circle eventually

Jordan Grumet, MD

Physician

September 4, 2014

Sometimes my day is like a book. The first chapter may begin in the darkness of a self imposed corner as a phone call is made. A voice, full with the thickness of slumber, answers unexpectedly.

“I think today is the day.”

No matter how many years I have been discussing death I still find myself using poor euphemisms. The bane of medical school teaching, I often struggle with the directness. “Your mother …

Beware your doctor’s knee-jerk reflex: 3 questions to ask

David L. Katz, MD

Physician

September 3, 2014

We are, I trust, all but universally familiar with the knee-jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response.

The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet …

Will lower prices for genomic tests raise medical costs?

Peter Ubel, MD

Conditions and Diseases

September 3, 2014

The first time scientists sequenced a person’s entire genome, it took more than a decade and cost hundreds of millions of dollars. Currently, such sequencing takes less than twenty-four hours and costs less than $5,000.

To put that into perspective, Myriad Genetics charges $3,000 to test for mutations in just two genes associated with breast cancer. The days of affordable genomic sequencing are rapidly approaching. But will such testing bankrupt us?

In most consumer …

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