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Checklists alone do not produce a culture of vigilance

Physician

March 30, 2014

A respiratory physician who I worked for had an uncanny ability of predicting the diagnoses the admitting junior doctor would fail to consider in patients presenting acutely with difficulty in breathing. He was using a checklist, which he developed after years of observing his housestaff.

As a surgical intern I was once praised for my presence of mind in cross matching blood for a patient with a rare blood group who …

4 keys to manage medical malpractice stress syndrome

Dianne Ansari-Winn, MD, MPH

Physician

March 30, 2014

Most physicians will be sued for malpractice during their career. A group at Harvard has estimated that by age 65, more than 75% of physicians in low-risk specialties such as family medicine and 99% of physicians in high-risk specialties such as surgery will have been sued. Over 95% of physicians do experience emotional distress during some or all of the process of litigation. Malpractice suits can take between …

Self-censoring of patient information may be a public health hazard

Steven Reidbord, MD

Physician

March 30, 2014

Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients. As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor. Despite her instructor’s recommendation to ask …

MKSAP: 24-year-old woman with painful muscle spasms

mksap

Conditions and Diseases

March 30, 2014

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

A 24-year-old woman is evaluated for a 3-week history of painful muscle spasms and twisting movements in the neck and trunk. She says that her neck feels as if it is being pulled backward. She also reports general restlessness and an inability to keep still. Her medical history is notable for asthma, …

Unexpected lessons from an unexpected patient

Chiduzie Madubata, MD

Physician

March 29, 2014

“I’m so sorry, but it looks like the cancer has spread.”

As I heard these words come out of my mouth, I knew that in a split second, a new reality was created in the mind of the patient that I was talking to. I looked at his face and saw that he was trying to remain strong, but in his demeanor, it was apparent that dreams were crushed and that …

Dissatisfied doctors can’t provide good patient care

Afshine Ash Emrani, MD

Health Policy

March 29, 2014

The worst news in health care is not antibiotic resistance, drug-drug interactions, hospital acquired infections, lack of communication between systems of medical records, and certainly not the alarming rate of obesity in our youth.

The worst news is the increasing number of dissatisfied physicians.

The physician, also known in the system as a “provider,” has been the direct target of assault by the government. The logic has been that if the physician …

What a World Series MVP taught me about practicing medicine

W. Lee Warren, MD

Physician

March 29, 2014

Summer, 1998
Three Rivers Stadium
Pittsburgh, Pennsylvania

It was a typical Saturday morning on call. We’d finished rounds and I’d taken the sign-out from the resident who’d worked the night before. I headed to the library, planning to do some board prep before the inevitable beeper call to the ER or ICU. I was a PGY-4 neurosurgery resident, with many previous weekends on duty to my credit. No reason to think this one would be …

Be more involved in how patients fill their prescriptions

Arshya Vahabzadeh, MD

Medications

March 29, 2014

As physicians, we often write prescriptions for our patients. Where, when, and how patients fill their prescriptions are usually outside of our realm of expertise. But should we be more involved?

On occasion, the cost of a medication and possible alternatives will be the subject of my conversation with a patient. I was surprised, however, when one of my patients complained about the price of an antidepressant that I had prescribed. …

Look for a doctor who understands healing

Barbara Kivowitz, MSW and Roanne Weisman

Patient

March 29, 2014

An excerpt from In Sickness as in Health: Helping Couples Cope with the Complexities of Illness.

You are not a statistic

Ironically, the surgeon who repaired her heart also left her heartbroken. While he and the neurologists may have considered it their obligation to present what they envisioned as …

Do patients have a right to know their doctor’s uncertainty?

Brian J. Secemsky, MD

Medical Education

March 29, 2014

Picture this.

You walk into your doctor’s office for an urgent visit for new distressing symptoms. He (or she) takes your blood pressure, temperature, heart rate. All within normal limits. He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two. You ask him what he thinks is going on.

The quandary

If it’s a slam dunk diagnosis, the branch point in …

Choosing a perfect residency: What goes into a rank list

Michael Richardson

Medical Education

March 28, 2014

What do you do when your ideal residency program does not exist? This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception. I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what …

Statistical significance doesn’t always warrant a miracle headline

Jennifer Gunter, MD

Conditions and Diseases

March 28, 2014

Interpreting studies is a dicey thing. Often I find what might be statistically significant translated into headlines that might not really get at the nuance of the study or the results.

Take these three for example:

“Pine bark extract improves severe perimenopausal symptoms”
“Two weeks of antibiotic therapy relieves IBS (irritable bowel syndrome)”
“Study: ‘Female viagra flibanserin’ works”

The first line of the last article: “Need a boost to your sex life. The magic could be in …

Apps used to monitor blood pressure need better design

Leslie Kernisan, MD, MPH

Health Technology

March 28, 2014

Here’s a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps.

I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at …

Is acetaminophen taken during pregnancy associated with ADHD?

Roy Benaroch, MD

Medications

March 28, 2014

Readers have contacted me about a recent study that links acetaminophen use in pregnancy to the later development of ADHD in children. Is Tylenol yet another thing pregnant women need to avoid?

The study, titled “Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders” was published this month in JAMA Pediatrics. Dutch researchers looked at about 60,000 children born from 1996-2002. Their parents have been filling out questionnaires and …

Can we measure what it takes to be a good doctor?

Ashish Jha, MD, MPH

Physician

March 28, 2014

I recently spoke to a quality measures development organization and it got me thinking — what makes a good doctor, and how do we measure it?

In thinking about this, I reflected on how far we have come on quality measurement. A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or …

Assure patients that we are on their side

Jordan Grumet, MD

Physician

March 28, 2014

Malcolm Gladwell thinks we should tell people whats it’s really like to be a doctor. And by God I have invested the last seven years in doing just that. I have written countless blogs, given lectures, and traveled to Ireland. I have coined the term Caring 2.0 to describe the bidirectional flow of empathy. Patients will tell us what it is like to suffer with disease, and we …

Don’t shorten medical school: Shorten undergraduate training instead

Skeptical Scalpel, MD

Medical Education

March 27, 2014

Should medical school be shortened to three years?

I say, “no.”

Here’s why.

There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase — residency training.

I do not see how medical students can choose a career path before they have …

Cancer is an international war and peace issue

Tara D. Sonenshine

Conditions and Diseases

March 27, 2014

For years internationalists have being trying to make the argument to ordinary Americans that foreign policy matters — that we must contend with complex issues overseas like countering terrorism while also focusing resources and energies on economic issues at home. We have posed it as a trade-off.

We are making the foreign affairs case the wrong way. Rather than argue the positive merits of trade or the negative repercussions of unchecked …

New feminism is about women, work, and the will to be authentic

Rhea Boyd, MD

Physician

March 27, 2014

I have a confession.

It is a secret I have held for more than 10 years and it is a lesson I have learned from other women.

As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise …

When doctors care too much

Hans Duvefelt, MD

Physician

March 27, 2014

Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients.

But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, …

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When doctors care too much

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