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A tough time to be a doctor, but a tougher time to be a patient

Health Policy

April 16, 2014

Doctor: “Phil, you have pneumonia.”

Phil: “Oh noes. What shall I do?”

Doctor: “Just take these red pills, here.”

Phil: “Great! I feel better already! When can I go back to work?”

Doctor: “I think in about 2 weeks. Or maybe 2 months. And actually, don’t take those red pills — these blue ones are better. It could take a few years for you to get better, and I’ll be retired by then. Here, …

The role of integrative medicine in primary care

Stephen C. Schimpff, MD

Physician

April 16, 2014

Next in a series.

Beginning with a deep understanding of medical science and years of training and experience, the primary care physician (PCP) needs to delve deeply into the patient’s personal, family and social setting in order to fully understand the context and causes of the patient’s illness. The PCP also needs to know when it is important or even critical to call upon others with specific knowledge, techniques or …

Why you need to hear from miserable doctors

Kevin Pho, MD

KevinMD

April 16, 2014

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Is being a physician a good gig, or not?

In a piece that’s gone viral, internist Daniela Drake writes a strongly-worded column in the Daily Beast about how miserable it is to be a physician:

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and …

Read more…

Why you need to hear from miserable doctors

Teaching doctors: Learning to learn in new ways

Paul Bergl, MD

Medical Education

April 16, 2014

In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence. Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is, learning to learn in new ways.

Learning to unlearn

In med school, learners amass an …

Why should practicing medicine be compared to any other occupation?

Skeptical Scalpel, MD

Physician

April 15, 2014

A while ago, Atul Gawande, the noted surgeon-author, wrote a long piece in the New Yorker on why health care should look to a restaurant called the Cheesecake Factory for some guidance on how to standardize things.

This was met with some derision by a number of physicians who pointed out, among other things, that the food at the Cheesecake Factory is not great and is loaded with calories. But I …

Testing doctors is big business

Wes Fisher, MD

Medical Education

April 15, 2014

If you want to understand the world of professional board certification, it is important to understand the business and politics of testing professionals. Such testing is big business. So big in fact, that huge international media and education companies that trade on the New York Stock Exchange have been created to service this need. According to one article on Reuters from 2012, “the entire education sector, including college and mid-career training, represents nearly 9 …

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Testing doctors is big business

The fatal error in health care

Rob Lamberts, MD

Health Policy

April 15, 2014

The janitor approached my office manager with a very worried expression. “Uh, Brenda …” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh …well … I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer …” He cleared his throat nervously, “Uh … his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on …

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The fatal error in health care

To emotionally survive cancer, we must create perspective

James C. Salwitz, MD

Physician

April 15, 2014

Hegira: To take flight to escape. To travel from a place of danger to a place of safety.

“You have cancer.”

You hear the words. Your mind does not understand.

“You have cancer.”

Shock. Distance. Isolation. Someone else. A mistake. A lie. Bizarre, strange, you float above the room. Everyone speaks; nothing is said.

“You have cancer.”

A fog-like curse, a venomous reality, a phantom idea. A cold ghost foreign to the soul. I must run. …

Physicians should not be expected to blindly follow guidelines

Jordan Grumet, MD

Physician

April 15, 2014

Barron Lerner thinks he understands doctor’s motives. In his recent article in the Atlantic he laments that physicians act on tradition and emotion over adopting new science. In defense of his position, he sites the example of how cardiologists use angioplasty and coronary artery bypass to treat coronary disease.

He states,

… cardiologists have been remarkably slow to abandon the old hypothesis, continuing to perform hundreds of thousands of bypass operations …

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Physicians should not be expected to blindly follow guidelines

A patient nearly died to save him $1110

Robert Gray, MD

Physician

April 15, 2014

Where I’m from, you can have someone killed for $5000. I will do it for $1110. I’m a hand surgeon.

I practice (or practiced, by the time you read this) in an area that is what we often refer to as “underserved.” Rather, the area isn’t, but the people I treat are. I work in a large urban referral center that has a very high proportion of Medicaid as well as …

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A patient nearly died to save him $1110

Post-operative check

Shara Yurkiewicz

Medical Education

April 14, 2014

It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery.

Do you know where you are right now?

Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon …

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Post-operative check

Did ProPublica unfairly target Dr. Yoav Golan?

Ford Vox, MD

Physician

April 14, 2014

A recent ProPublica expose co-published with the Boston Globe typifies a growing gotcha genre of health journalism that portrays doctors as the enemy in a struggle for honesty and openness in medicine. These reports make unfounded leaps in their efforts to subject doctors to levels of skepticism once reserved for politicians and lawyers. They’re going to end up doing patients a disservice. For this particular hunting expedition ProPublica set its sights on …

Caught between patient satisfaction and prescription drug abuse

Karen S. Sibert, MD

Physician

April 14, 2014

The creatures cause pain by being born, and live by inflicting pain, and in pain they mostly die.
–C. S. Lewis

The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.

The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem …

Why doctors treat patients as drug addicts

Pamela Wible, MD

Physician

April 14, 2014

Fact: Doctors want to help people.

Fact: Some people take advantage of doctors.

A doctor in Oregon shares this case:

I had an old man with cancer. He kept complaining of pain as I was increasing his opiate pain medication, Oxycontin. I was at, I forget, about 40mg four times a day or some fairly substantial dose. I ran a urine drug test. Negative …

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Why doctors treat patients as drug addicts

Why more health insurance isn’t necessarily better

Luis Collar, MD

Health Policy

April 14, 2014

Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this subtle premise before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act.

My question, however, is simple. Where is the evidence that …

Increasing the use of long-acting reversible contraception

Jeff Livingston, MD

Conditions and Diseases

April 13, 2014

Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly, about half occur in women who were using contraception at the time of conception. That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using …

Forget ultrasound: Do a proper history and physical instead

Dr. Saurabh Jha

Medical Education

April 13, 2014

A recent editorial in the New England Journal of Medicine lauded, albeit cautiously, point-of-care ultrasound that has risen to such an extent that it is now becoming an integral part of medical education.

Could the availability of ultrasound revolutionize clinical medicine in much the same way Laennec’s stethoscope broke the acoustic barrier?

Certainly this possibility can’t be ruled out. But I am not so sanguine. One thing I’m sure about: Indiscriminate …

A framework for evidence-based debate of contentious health issues

Joseph Allencherril

Medical Education

April 13, 2014

With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers.

And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.)

It is far …

There can be no global health without local staff

Varun Verma, MD

Medical Education

April 13, 2014

There are words in many languages that have no good English equivalent. During my work in Haiti, I’ve noticed my Haitian colleagues on occasion exhaling a phrase — “tet chaje” — which literally means “head charged.” More accurately, it describes a sense of being overwhelmed or conveying disbelief or frustration. Based on my limited experiences in the field, I can only begin to imagine the burnout that local providers face …

Should doctors tell parents of terminal children to quit pursuing quackery?

Suzanne Leigh

Patient

April 13, 2014

It was only a matter of time before the name Dr. Stanislaw Burzynski would grab the attention of the family of McKenzie Lowe, a 12-year-old from Hudson, N.H., with that most damning of diagnoses, a diffuse intrinsic pontine glioma, an inoperable brain tumor with a median survival of less than a year.

Like McKenzie, my own daughter was 12-years-old with a recurring brain tumor that had started to metastasize and …