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Palliative care: A medical student’s reflection

Justin Wang

Conditions and Diseases

August 31, 2014

Jack was the very first palliative care patient I met. Visiting him in his home, I feared the worst: emaciation, pain, a fluxing state of consciousness, and the otherwise bed-bound shadow of a former life. Instead, the first sight I was greeted with was a beaming smile beneath a bushy moustache. But for his IV lines and analgesia pump, Jack might have passed for a completely well middle-aged man, certainly …

Can the Ebola epidemic promote the development of medicine?

Chiduzie Madubata, MD

Conditions and Diseases

August 31, 2014

Having been born and raised in the United States, I have become accustomed to the reputation of the U.S. as being ahead of the curve in terms of advances in numerous fields including medicine, and the research that we produce in these fields strongly backs up this claim. I have been reminded of this over the past few days while following coverage of the Ebola outbreak in West Africa.

American health …

How many servings of fruits and vegetables should we eat a day?

James McCormack, PharmD

Conditions and Diseases

August 30, 2014

Many organizations cook up recommendations for the number of fruit and vegetable servings you should eat every day. Well known examples include the USDA which suggests two cups of fruit and two and a half cups of vegetables daily (approximately 8 to 10 servings), the American Heart Association which recommends 8 to 10 and the Harvard School of Public Health suggests somewhere between five and 13 servings of fruit and …

Disappointing outcomes despite a massive investment in EHRs

Mark Nunlist, MD and Betsy Nicoletti, MS

Health Technology

August 30, 2014

The Health Information Technology for Economic and Clinical Health Act of 2009 committed to the expanded adoption of health information technology, expecting electronic health records (EHRs) to transform medical care while promising dramatic improvements in quality, efficiency and safety. Five years and $25 billion later, the results have fallen short of expectations, and there are multiple reasons for our disappointment.

First, EHRs were designed to document the provision of health care …

Deciphering hospital bills is not for the faint of heart

Paul Ruggieri, MD

Physician

August 30, 2014

An excerpt from The Cost of Cutting: A Surgeon Reveals the Truth Behind a Multibillion-Dollar Industry.

Deciphering the hieroglyphics of hospital bills, especially when it involves surgery, is not a job for the faint of heart. As Mr. Wilkes discovered when comparing notes with a friend, there’s another puzzle: the huge variation in charges between hospitals and surgi‐centers for the same operation. For surgeons, too, trying to figure …

An American doctor’s experience with the NHS

Jennifer Gunter, MD

Physician

August 30, 2014

You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital.

Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abbey. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought …

Health care data is meaningless without context

Hans Duvefelt, MD

Physician

August 30, 2014

Cholesterol is bad. Cholesterol is an essential building block for important hormones.

Eggs are bad. Eggs are a complete protein food.

Salt is bad. Salt is essential for life.

High blood pressure kills people. No blood pressure defines death.

High blood sugar causes eye and kidney damage. Low blood sugar causes falls, fractures and car wrecks.

Low potassium causes heart rhythm problems. High potassium causes heart rhythm problems.

Too little vitamin B12 causes nerve damage. Too …

MKSAP: 55-year-old man with a wrist fracture and anemia

mksap

Conditions and Diseases

August 30, 2014

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

A 55-year-old man is reevaluated during a follow-up examination for a wrist fracture and anemia. The patient is otherwise asymptomatic. He was treated in the emergency department 2 weeks ago after he slipped in his driveway and sustained a right wrist fracture; mild iron deficiency anemia was detected at that time. He …

How to be a great health care administrator

Suneel Dhand, MD

Physician

August 29, 2014

In no other field is unity and collaboration between administrators and frontline staff more important than in health care. Unfortunately my own experience is that the disconnect and mistrust, especially from doctors and nurses, towards hospital administration is growing larger all the time.

Let me start off by saying that I have intimate experience of both sides of the divide. Obviously as …

Health care big data will fail unless we remove the silos

Jason Giffi, DO

Health Technology

August 29, 2014

A few days ago a colleague of mine was inching south through the mother of all traffic jams: 60 straight miles of construction work on I-95 just south Washington, DC. The three-lane highway was jammed. Route 1, which runs parallel to I-95 was also jammed. Cars were stalled in the middle of the highway having run out of gas from waiting so long.

He looked at the map on his phone …

Confessions of a rebound doctor: The impact of narrow networks

Meg Edison, MD

Health Policy

August 29, 2014

“We lost our regular doctor with Obamacare, so now we have to see you.”

I routinely ask my new patients how they heard about our pediatric office, and this is the answer I dread most. My pediatric practice is a very nice and modern private office, and in my opinion, full of excellent physicians. I entrust my own children’s care to my partners. But none of that matters when you’re the rebound doctor, the …

The medical chart is coming to an end. Here’s why.

Mike Sevilla, MD

Physician

August 29, 2014

“Dr. Sevilla, I have a question for you,” a patient asked me this week. “I’m going to tell you something, but I DO NOT want it put in the chart.” Hmm, I asked myself, can I really do that? It’s the patient’s wish, right?

The patient went on to tell me that she heard about this week’s story about a hospital network being hacked and 4.5 million records being stolen. …

Why Liberians raided the Ebola clinic

Kristin C. Prewitt

Conditions and Diseases

August 29, 2014

“No Ebola in West Point” was the reported cry of the local crowd that attacked a quarantine center and freed patients in a township near Liberia’s capital. Their words signaled skepticism toward the Liberian government and disbelief in the spread of the Ebola virus.

The cries of the crowd were met with cries of shock and dismay on Twitter and other social media. “Are they crazy or just stupid?” one …

Read more…

Why Liberians raided the Ebola clinic

Inhaled medications: Nefarious reasons for the lack of competition

John F. Hunt, MD

Medications

August 29, 2014

Check out the prices for nebulizer solutions of albuterol and budesonide (generic Pulmicort). They are totally affordable. $4 for a month for albuterol. $14 for a month for budesonide respules. Pulmicort respules used to be very expensive. Now even the branded budesonide is less than 10% of a monthly cable bill.

Then check out the prices of inhaled steroids delivered through meter dose inhaler (MDI) or dry powder inhaler (DPI). These …

2 ways to improve doctors: feedback and reflection

Randi Sokol, MD, MPH

Physician

August 28, 2014

In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question.

As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming …

How much health care data is mined without your knowledge?

Martine Ehrenclou, MA

Health Technology

August 28, 2014

The Business Insider article, “Senator Warns Fitbit is a Privacy Nightmare and Could be Tracking Your Movements,” reports that Senator Chuck Schumer called for federal protections to prevent companies like Fitbit from collecting, sharing and selling consumer data to health insurers, employers and others. Fitbit, like Nike+FuelBand and Jawbone, sells wearable trackers that monitor sleep, health functions and physical activity.

Senator Schumer accused FitBit and Smartphone apps of sharing …

Medicare’s trust fund has been extended. Big deal.

Tanya Feke, MD

Health Policy

August 28, 2014

The Medicare trust fund has been extended to 2030, 4 years longer than projections made just one year ago. This sounds like wonderful news until you take a closer look. The fine print reveals that this is little more than campaign rhetoric. Four years in the grand scheme means little when you look at the real numbers.

More baby boomers approach eligibility age every day. In 2012, there were 50.8 million …

High-yield and protected time: A medical student’s take

Hamsika Chandrasekar

Medical Education

August 28, 2014

Learning in medical school often feels like learning a completely new language. There are numerous acronyms (OPQRST, CAGE) and molecules (IL-1, TGF-beta) and more. But most striking to me are two particularly ubiquitous buzzwords: “high-yield” and “protected time.”

I feel like I heard both these terms — and particularly the former — thrown around every single week of this past school year. High-yield has been used to refer to, as you …

Hospitals are taking a page from the big pharma playbook

Trudy Lieberman

Health Policy

August 28, 2014

I recently wrote about a hospital system in Colorado that had discovered a way to cross market its more profitable emergency room services if a patient first came to its urgent care center. Pretty clever! Then recently I came across another health care marketing trick close to home and just as sly. As I sat on a New York subway one sizzler of a day, an ad for an ice cream …

Lying to receive pain medications hurts patients in true pain

Kenneth Lin, MD

Conditions and Diseases

August 28, 2014

My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they …

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