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If it’s not in the computer, you didn’t order it

Edwin Leap, MD

Physician

March 26, 2014

They used to tell us, as physicians, that “if it isn’t on the chart, it didn’t happen.” We could protest all day, to billing companies, insurers or attorneys, “I did that. It’s assumed. I always do the same thing every time.” But they would retort, “nope, it’s not in the chart.” So we learned to detail everything, every time, every movement. Every consideration and justification. The idea being, our ‘thought process’ …

The surgeon general nominee: Both the NRA and Vivek Murthy are wrong

Vamsi Aribindi, MD

Health Policy

March 26, 2014

There’s a bit of buzz in the news recently over President Obama’s nominee for surgeon general, Dr. Vivek Murthy.

It’s worth pausing here to note the last truly consequential surgeon general: Dr. C Everett Koop single-handedly carried out the entirety of the Reagan Administration’s AIDS response (to be clear — this is true because of how little the Reagan administration did, not because of how much Koop did); fought hard …

A case where a meta-analysis can help

Christopher Johnson, MD

Conditions and Diseases

March 26, 2014

Clinical medical research — finding out which treatments help and which ones don’t (or even make the situation worse) — is tough research to do. In the laboratory a scientist can control conditions so that only one thing is different between the control and the experimental groups. This isolates the effect of the particular thing and one can see if there is any difference in outcomes depending upon what is …

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A case where a meta-analysis can help

A struggle against cancer becomes a financial worry

Laura Sander, MD, MPH

Physician

March 26, 2014

“I walked in a person, and out a cancer patient,” my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine — the side on the exam table or gurney, as opposed to the one standing over it. As a physician I was used to the latter. This is my family’s story in our new position, and how the cost of medical care has impacted …

NephMadness 2014: Let’s reinvigorate nephrology

Matthew A. Sparks, MD

Medical Education

March 26, 2014

The field of nephrology is in a workforce crisis. We as a subspecialty have witnessed a steady decline in the number of applicants perusing nephrology fellowship over the last several years. In fact, fewer than 100 US medical school applicants participated in the 2014 nephrology fellowship match. This is a sobering statistic as 403 nephrology slots were available in this year’s …

A 10-step process to finding a good doctor

Val Jones, MD

Physician

March 25, 2014

Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way …

What are the characteristics of a good primary care physician?

Stephen C. Schimpff, MD

Physician

March 25, 2014

Next in a series.

As a general rule, PCPs like people. This was true of them long before they started medical school and it will have only blossomed further during training. Ask PCPs, as I have with in depth interviews, and they will tell you that certain types of individuals are drawn to primary care careers.

They like to converse with people. They enjoy getting to know about a person — …

How to make practicing slow medicine a reality

Christine A. Sinsky, MD

Physician

March 25, 2014

“Medication mishaps cause a huge number of hospitalizations and in fact the majority of hospital readmissions. Making more time for visits with aging and complex patients is critical to avoid mishaps of poor communication and rushed decisions. A dose of ‘slow medicine’ may get us to our goal of system sustainability faster,” writes colleague and fellow blogger Dr. David Moen.

Dr. Moen distills Dr. Dennis McCullough’s ideas about slow medicine down …

Vitamin and mineral supplements for healthy individuals don’t work

Jim deMaine, MD

Medications

March 25, 2014

When I was in medical school, our nutrition researchers taught us that vitamins didn’t do much good and only made expensive urine (where the water soluble ones end up). We did learn about the classic vitamin deficiencies like scurvy, beriberi, rickets, etc. But the evidence that healthy people should take vitamins was marginal at best.

Is our search for immortality the reason that we turn to the pill or potion? Do …

The whole critical access system needs to be reconsidered

Janice Boughton, MD

Health Policy

March 25, 2014

My home hospital is small. In a town of just over 20,000 people, this hospital has 25 beds and is designated “critical access” by Medicare because it is felt to be necessary to the health care of the community. Critical access is a designation which was introduced in 1997 when modernization of Medicare payment systems threatened to close a large proportion of hospitals in small communities which were unable to …

When insurers dictate medical decisions

James C. Salwitz, MD

Physician

March 25, 2014

Have you ever had a conversation that rattles around in your head for days? Maybe, it changed what you thought you knew about the world. Perhaps the ideas or comments did not make any sense. I had a discussion last week and it seemed that logic stood on its head. The means was defined by the end, with no connection to the beginning, or more exactly, the tail wagged the …

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When insurers dictate medical decisions

Why the days of the stethoscope are numbered

Suneel Dhand, MD

Health Technology

March 24, 2014

The stethoscope has been a symbol of the medical profession for two centuries. Dr. René Laennec probably had no idea how his idea would take off when he first invented the simple wooden tube in Paris back in 1816. After a few modifications over the course of the next several decades, it evolved into what we know today.

A central part of the physical examination, the stethoscope currently gives doctors priceless information about the cardiac and …

What Sweden can teach us about primary care

Andreas Mitchell

Health Policy

March 24, 2014

Fulfilling every stereotype, I sat at my grandparents’ house in southern Sweden, sipping elderberry juice out of an IKEA glass and eating meatballs with lingonberry jam. It was Christmas Eve, and I was enjoying a getaway from the rigors of medical school. However, it wasn’t a complete escape, as my grandparents loved talking about medicine and the differences between health care in the United States and Sweden.

In this particular conversation, …

Help people understand what it is really like to be a physician

Robert Pearl, MD

Physician

March 24, 2014

In a recent article, Malcolm Gladwell dissected and diagnosed American health care.

Throughout our interview, he tackled controversial topics from the Affordable Care Act and medical malpractice to the contrasting Canadian health care system and much more. I expected him to dive deep below the surface and provide new and intriguing perspectives. He didn’t disappoint.

But it was his closing comment that caught me off guard. When I asked Gladwell …

Everybody judges in the exam room

Edward Chang

Medical Education

March 23, 2014

As a medical student, I am being taught not to judge patients. If a patient tells me that he has smoked cigarettes for forty years of his life despite the protests of his wife, I am supposed to nod my head understandingly without showing my inherent disapproval. If a patient tells me that she has given her husband genital herpes because she is cheating on him, I am not supposed …

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Everybody judges in the exam room

Is it any wonder why young doctors shun primary care?

Fred N. Pelzman, MD

Physician

March 23, 2014

With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead.

This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages.

Response in the press has already raised issues with this, suggesting that this move would do little …

How to answer difficult vaccine questions from parents

Andrew Cronyn, MD

Conditions and Diseases

March 23, 2014

A recent blog comes to the conclusion that non-vaccinating parents believe their pediatrician “would have to be staggeringly incompetent, negligent or malicious to keep administering (vaccines).” Using this as the premise, this pediatrician goes on to say that these patients should be dismissed from our practices.

First off, these parents don’t think we’re the enemy. The reason they bring their kids to see …

Why medical schools discourage entrepreneurs

Jonathan O’Donnell

Medical Education

March 23, 2014

As a medical student looking to explore entrepreneurship, I quickly came across Shiv Gaglani’s October 2013 article in Entrepreneur, entitled “Why Medical Schools are Pumping Out Entrepreneurs,” in which he the highlights similarities and differences he sees between medical students and entrepreneurs. I was struck by his proposed differences — he does not share his take on their origins, so I have come to delineate my own view.

Medical students …

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