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The difference between medical practice and medical training

Physician

August 3, 2014

I have never experienced a military boot camp. I have however completed a rather intense three-year residency in internal medicine followed by another grueling, three-year fellowship in pulmonary and critical care medicine. I like to think that my experiences were not unlike those of military training.

As a matter of fact, being on the medical wards at the county hospital was referred to as being, “in the trenches.” It was true. …

The first-year medical student and the 114-year-old patient

Elyse Linson, MPH

Medical Education

August 3, 2014

I thought the most important thing I had learned while working in the emergency department as a first-year medical student was to bop and weave. The impeccable foot skills I harnessed as a youth lacrosse player were put to great use- to stay out of the way. The quiet whisper of a nurse trying to slide behind me, and — BAM — back against the wall. I can hear the …

The $16.7 million x-ray: Possible beats probable in court

Dr. Saurabh Jha

Physician

August 3, 2014

In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray.

The verdict reminds one of the words of John Bradford, the heretic, who was burnt at the stakes. “There but for the grace of God go I.”

Many radiologists will sympathize with both the patient who …

Health care at half the cost: What will that actually look like?

Joe Flower

Health Policy

August 2, 2014

Health care costs far too much. We can do it better for half the cost. But if we did cut the cost in half, we would cut the jobs in half, wipe out 9% of the economy and plunge the country into a depression.

Really? It’s that simple? Half the cost equals half the jobs? So we’re doomed either way?

Actually, no. It’s not that simple. We cannot of course forecast with …

Requiring a prescription for pseudoephedrine: How effective is that?

David P. Smith, MD

Medications

August 2, 2014

The State of Mississippi passed a law in 2010 which banned sales of pseudoephedrine without a prescription. The law has resulted in a dramatic improvement in which 698 total methamphetamine (meth) incidents with 314 operational labs were identified in 2010 while there were 119 incidents with only 8 labs in 2013. Other states such as Tennessee are considering similar laws and Oregon already has a law in place as restrictive …

The execution in Arizona: There’s no mystery why it took so long

Karen S. Sibert, MD

Medications

August 2, 2014

There’s no mystery about why the July 23 execution of Joseph Wood in Arizona took so long. From the anesthesiologist’s point of view, it doesn’t seem surprising that the combination of drugs used — midazolam and hydromorphone — might take nearly two hours to cause death.

Here’s why.

The convicted murderer didn’t receive one component of the usual mixture of drugs used in lethal injection: a muscle relaxant. The traditional cocktail includes …

What if jet lag was infectious?

Alberto Hazan, MD

Conditions and Diseases

August 2, 2014

Jet lag, also known as desynchronosis or flight fatigue, is defined as “extreme tiredness and other physical effects felt by a person after a long flight across several time zones.” Besides insomnia, symptoms of jet lag include weakness, fatigue, dehydration, body aches, diarrhea, dizziness, headache, irritability, and memory loss. Jet lag is one of the circadian rhythm disorders; others include shift work disorder, sleep phase disorder, and irregular sleep-wake rhythm.

Symptoms …

Read more…

What if jet lag was infectious?

Are vasectomies a risk factor for prostate cancer?

Rajiv Singal, MD

Conditions and Diseases

August 2, 2014

Recently, I realized that patients coming to my office seeking vasectomies required an additional piece in their counseling. What led to this change? Earlier this month a study out of Harvard University suggested an association between vasectomy and lethal prostate cancer. Published in the Journal of Clinical Oncology, the researchers found that “men with a history of vasectomy had a 10% increased risk of prostate cancer, …

Scribes put humanity back into the practice of medicine

Jim Pagano, MD

Physician

August 2, 2014

In a recent posting Dr. Kaylan Baban mused about the ubiquity of scribes and some of the reasons behind this growing phenomenon. Among them were the usual suspects: increasing patient loads leading to decreased visit times with the provider, increasing non-clinical demands monopolizing time that would be better spent actually practicing medicine, and improved legibility of notes, which are now the patient’s property and are used for …

The ethics of trainee-patient encounters: Are we practicing on the poor?

Nicole Van Groningen, MD

Medical Education

August 1, 2014

I performed my first paracentesis in November of my intern year. It was 3 a.m., and I was on overnight call in a packed ICU. The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name. He didn’t know I was an intern. He didn’t know I’d never even attempted a paracentesis before.

After I finished, I added the patient’s name to my procedure card. I hurried to get an ABG …

Law and medicine are more intertwined than they should be

Michael Kirsch, MD

Physician

August 1, 2014

I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform.

I’m not suggesting that an unwelcome …

I’m not worried about ICD-10. Here’s why.

P. J. Parmar, MD

Physician

August 1, 2014

It is possible to categorize every human ailment, and assign every disease a code. This is called the International Classification of Diseases (ICD), which was first formalized as a short list of malaises at a meeting in Paris in 1900. Since then, this list has been revised ten times, getting longer each time, in an effort to aid epidemiological and policy matters around the world. The ninth edition (ICD-9) has …

Measuring the value of emergency department care

Robbin Dick, MD

Physician

August 1, 2014

Emergency department directors measure value in their departments with a number of metrics that are tracked religiously: door-to-provider times, ambulance drop-off times, left without being seen rates, length of stay for discharged patients, diversion hours, and 72-hour returns all come to mind.

These metrics clearly measure the performance of the emergency department, what to they do, if anything, to measure the value of care being provided? These metrics are often …

A short term focus on costs is expensive in the long run

Adam Philip Stern, MD

Physician

August 1, 2014

Mr. D was my patient in the partial hospital program for the chronically and persistently mentally ill, and he was barely maintaining the level of functioning necessary to remain outside of the inpatient unit. A middle aged man with long-term psychotic and depressive symptoms, Mr. D’s care was made even more complicated by an extensive history of alcohol dependence and intravenous drug use that had left him with a severely …

The problematic impact of To Err is Human

Thomas D. Guastavino, MD

Physician

August 1, 2014

November, 1999 was a watershed for physicians. It is then that the infamous “To Err is Human” report was issued by the Institute of Medicine claiming that close to 100,000 patients were needlessly dying due to preventable medical errors. The report was a bombshell, having a significant impact on how medicine was practiced. 15 years later we are still evaluating that impact.

To anyone who took the time to read the …

Reflecting on the first month as a new physician

Amy Faith Ho, MD

Medical Education

August 1, 2014

July as a newly minted intern: It was the best of times, it was the worst of times.

The only analogy I can make is you feel like a middle school kid sitting in a PhD course, desperately trying to back-learn everything in a language of acronym alphabet soup you’ve never heard before.

If medical school is drinking from a fire hose, this is trying to sip from Niagara Falls. You have …

Working the night shift as a resident physician

Brian J. Secemsky, MD

Medical Education

August 1, 2014

night shift

You’ve changed.

No longer do we see you sluggishly walking en route to work every morning with refillable coffee thermos in one hand, robotically scanning some kind of social media feed with the other.

We are concerned that the regular and cyclic day time group texts received from you are now occurring at odd hours of the night. Your persistence to move …

A lack of social education in medical schools today

Anonymous

Medical Education

July 31, 2014

I’m a second-year medical student, and quite recently, a lecture left me with serious doubts about the state of social awareness in the medical field and schools. The dermatologist lecturing described a patient with secondary syphilis, stating he felt the case was odd since, “He [the patient] didn’t look gay or anything,” as if only homosexual men could contract that disease.

I was hurt. I not only belong to a racial …

A physician responds to OpenNotes critics

Peter Elias, MD

Physician

July 31, 2014

There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this …

Patient satisfaction has come full circle. Why you need to care.

Trina E. Dorrah, MD

Physician

July 31, 2014

I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient satisfaction. Lately, I’ve spent a lot of time discussing a patient satisfaction survey known as CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CG-CAHPS is …

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