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Out of the many he has seen, he will do his best to help just this one

Greg Smith, MD

Physician

May 19, 2014

She looked like a whipped puppy that had had a garden hose turned on it and slunk off to a far corner of the yard to dry out in the sun.

She sat there, wizened but hard, thin and wiry, dressed in standard issue blue emergency room scrubs, thin tanned face, long stringy, wet prematurely gray hair falling limply around her shoulders. She looked down at the floor, but when her …

Predicting Medicaid enrollment numbers under the Affordable Care Act

Peter Ubel, MD

Health Policy

May 19, 2014

The Affordable Care Act expanded Medicaid eligibility this year in those states which decided to follow its provisions. That means lots of people are now newly eligible for Medicaid. However, the number of people signing up for Medicaid in the states has been underwhelming. Which raises a question: How much can we expect enrollment numbers to increase over the next few years?

To begin to answer that question, a group of …

Physician suicide etiquette: What to do when your doctor dies suddenly

Pamela Wible, MD

Physician

May 19, 2014

physician suicide

An obstetrician is found dead in his bathtub. Gunshot wound to the head. An anesthesiologist dies of an overdose in a hospital closet. A family doctor is hit by a train. He’s decapitated. An internist at a medical conference jumps from his hotel balcony to his death. All true stories.

What are patients to do?

When they call for appointments, patients are …

Continuity of care increases patient satisfaction

Fred N. Pelzman, MD

Physician

May 18, 2014

Greater discontinuity equals greater dissatisfaction.

On Wednesday afternoon, one of the residents stopped in my office to talk about a patient he had just gotten off the phone with. It was a patient of his who had asthma and a recent upper respiratory tract infection for which she had received treatment at an urgent care center with an oral antibiotic and a course of steroids.

She told him that she was still …

The United States takes the spoiled rich kid approach to health care

Ashish Advani, PharmD

Health Policy

May 18, 2014

Currently, the United States spends approximately 3 trillion dollars on health care, which is roughly 18% of our gross domestic product (GDP). Not only is this more than every other country in the world, but it’s also more than the next 10 largest spenders combined. Looking backwards, health care spending rose steadily from about 9% of our GDP in 1980 to about 16% in 2008. Looking ahead, by 2020, health …

You can never be prepared for a diagnosis of breast cancer

Madhulika Sikka

Conditions and Diseases

May 18, 2014

An excerpt from A Breast Cancer Alphabet.

There is a hushed reverence in the waiting area outside the Oval Office. After all those years of The West Wing, one might think there would be a bustle of activity — a swirl of smart, earnest people walking and talking at the same time. Perhaps I would …

When we torture our patients

Shoa L. Clarke, MD, PhD

Physician

May 18, 2014

Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life.

Linda is an elderly woman with moderate dementia. She is blind …

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When we torture our patients

The white coat can be an inadvertent barrier to care

Cullen Truett

Medical Education

May 18, 2014

Don’t wear the white coat; it scares the kids.

Most children stare at me with that wide-eyed look. Thinking from their perspective, the six-foot something curly headed giant with big round glasses probably appears very strange to the little human that barely scrapes my knee. They do not cry. They just stare. I smile, and they gape. Parents laugh as I grin sheepishly. Towering over the patients, I likely appear more …

Say no to bureaucrats and yes to direct care

Josh Umbehr, MD

Physician

May 17, 2014

Yes, it really is time to revoke the health care mandates issued by bureaucrats who are not in the profession of actual healing.

Daniel F. Craviotto Jr. writes in the Wall Street Journal, “In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship.”

Craviotto, Jr. is a doctor who embodies the fight of …

Before treating physical pain, address the emotional one

David Hanscom, MD

Conditions and Diseases

May 17, 2014

The patient was a 78-year-old businessman who acted and looked about half his age. He was very pleasant and talked freely about his lower back pain and the pain down the side of his left leg, which had been a problem for about six months. It was consistently more severe when he stood or walked on it, and it immediately disappeared when he sat down. His MRI scan revealed that …

What does cable television and Obamacare have in common?

Brian C. Joondeph, MD

Health Policy

May 17, 2014

One of the many aspects of Obamacare adding overall costs for both patients and insurance companies is the feature called essential benefits. This means that Congress and the administration, in their infinite wisdom, have decreed that anyone purchasing health insurance must have a policy that includes emergency, maternity and preventative care, whether or not such coverage is needed or desired. For example, a middle-age man, such as myself, must have, and through the …

Raising kids who can talk with their doctors

Sherry Reisner

Patient

May 17, 2014

Some skills are best learned in childhood, like playing a musical instrument or speaking another language. Sure, you can learn these things later in life, but you’ll have to work harder and you may never play music or converse with the ease of someone who learned young.

The same is true about learning how to talk openly with your doctor. Kids develop their habits and attitudes about health care with every …

MKSAP: 64-year-old man with a rapidly spreading rash

mksap

Conditions and Diseases

May 17, 2014

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

A 64-year-old man is evaluated in the emergency department for a rash that first developed 3 days ago and has rapidly spread to cover most of his body. His skin is painful. He has a history of mild psoriasis and asthma. His psoriasis has been well controlled with topical corticosteroids as needed. …

What does dignity mean to patients?

Jessie Gruman, PhD

Patient

May 16, 2014

Remember in second grade when you realized that you could say the word “giraffe” 25 times and it would lose its meaning, shed the image of that gawky creature and turn into a little pile of meaningless sound? You know, when you had your first insight into the wonders of language?

I was reminded of this experience when, at a conference about patient engagement in health care, the word “dignity” was …

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What does dignity mean to patients?

Bridging the disconnect: Why this student entered medicine

Moises Gallegos

Medical Education

May 16, 2014

My family has always expressed that they’re proud of what I’m doing — the funny thing is, they go on to say that they’re unsure of exactly what I do.

My parents know I’m studying medicine and that this means I’ll be a doctor. What they don’t get is where in the process I am, what specializing means or what I’m talking about most of the time when I share stories …

Being a nurse is the noblest profession

Angelo Falcone, MD

Physician

May 16, 2014

It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured.

As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room …

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Being a nurse is the noblest profession

How do psychiatrists manage clinical uncertainty?

Steven Reidbord, MD

Conditions and Diseases

May 16, 2014

Lucia Sommers of the department of family and community medicine at the University of California, San Francisco commented on my last post, noting that clinical uncertainty among primary care physicians (PCPs) is usually regarded as tolerable at best. She was delighted that I called such uncertainty intellectually attractive, and something to embrace in psychiatry. Sommers and her co-author John Launer recently published a book that argues for managing clinical uncertainty in primary care using …

What we can learn from the looming airline pilot shortage

Roy Benaroch, MD

Health Policy

May 16, 2014

As the Wall Street Journal reported, there’s a growing shortage of qualified pilots in the US, driven by both economic reality and federal policy.

Pilots typically start their professional careers at small, regional airlines — airlines that pay, approximately, fast-food wages. Less than that, really — for the hours they work, many pilots make less than minimum wage. After a few years, these pilots have enough flight time and experience to try to …

What doctors can learn from Russian dolls

Starla Fitch, MD

Physician

May 16, 2014

As I work with more and more doctors around the country, I am encouraged by what I am witnessing:

Doctors who completely left medicine, then returned later, refreshed and recharged.
Doctors who have slightly altered their original mode of practicing, discovered the parts of medicine they love most, then magnified them.
Doctors who have added and subtracted from their recipes until the unique …
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What doctors can learn from Russian dolls

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