I just didn’t like the looks of him.
It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in …
The sixth sense of an experienced clinician
There are over 58 million references to “patient engagement” if one conducts a Google search. The term has been diluted and changed in the past couple of years and has become a buzz phrase, used more from a business than clinical benefit perspective.
The Center for Advancing Health defines patient engagement as “actions individuals must take to obtain the greatest benefit from the health care services available to them.” …
5 ways to engage your patients in the office
Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, 7 days a week to support her family. So, she hid her breast condition for a better time, another day. She would ask herself, which was more important: going to a doctor or buying her children dinner? For a true mother, the answer …
The costs of care was far beyond her means
Remembering why we got into medicine in the first place can often soften the edges of long, difficult days.
My story unfolded on a circuitous route to medical school. I started with a master’s degree in sociology, and my first job after I graduated was working for the Virginia Center on Aging. I administered hour-long assessment surveys to the elderly population of the state. I would drive my old Volkswagen to …
Remember why you got into medicine in the first place
A recent article in the New Republic, provocatively titled “ADHD Does Not Exist,” starts out well enough. The author, a psychiatrist with “over 50 years experience” points to the fact that ADHD describes a collection of symptoms, rather than their underlying cause. Using stimulants to control these symptoms, he argues, is analogous to prescribing pain medication for cardiac chest pain rather than addressing the underlying circulatory problem.
But my …
ADHD and the value of uncertainty
A guest column by the American Medical Association, exclusive to KevinMD.com.
It’s crunch time for our nation’s physicians. After an 11-year battle, we stand closer now than ever before to repealing Medicare’s fatally-flawed sustainable growth rate (SGR) formula.
With the introduction of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 last month, Congress took a critical step toward reforming the nation’s …
AMA: Urge Congress to repeal the SGR now
Your coffeemaker went dead on you this morning, and while lamenting your drowsiness at work, your friend Denise mentions that she just bought a new coffeemaker at Target and she absolutely loves it. You take your coffee the same way Denise does, black, strong, and all day long, so you decide to buy one for yourself.
You are a busy professional and you don’t have time to go to Target, search …
How mHealth will change the doctor-patient culture
As a philosophical coda to the 2013 cacophony over Obamacare, health care reform and the notion that doctors and their skills will be needed less in some indeterminate future, this last month saw a media frenzy about the fate of the doctor’s white coat.
It started with an article by Gonzalo Bearman and his colleagues in Infection Control and Epidemiology that asked the …
Whither the white coat and why
When first introduced four decades ago, breast cancer screening with mammography was widely regarded as an important tool in the fight against this terrible disease. It seemed obvious that the earlier it could be diagnosed the more lives could be saved. Aggressive treatment, it was thought, would prevent the cancer from spreading through the body. A huge amount of research evidence since then has slowly and painfully led to a …
The benefits of screening mammography have been greatly exaggerated
There was a very large lesion in his left frontal lobe, and no one knew what it was.
He had been admitted earlier that day, after a neighbor found him in the hallway, confused and covered in urine. Now he sat in his bed quietly, while we stared at his brain and the bright spot that didn’t quite resemble something.
It can’t be tissue death from a stroke, insisted one resident. It …
I saw my intellectual exercise as something I hadn’t before
“Hey doc, I saw on an ad on the TV last night about this new asthma inhaler. Shouldn’t I give it a try?”
This type of question would occur several times a week. When I started practicing medicine it was considered unethical to advertise medical treatments. Now, we’re bombarded with enticements for tests and treatments. The inhaler the patient requested cost $264 a month — more than double what he was …
The medical industrial complex and the surge of health costs
The past few months I have joined thousands of individuals hoping to match into a residency program in 2014. I have had interviews all over the country and spent way too much time living out of a suitcase.
For many students, residency interview season is exciting. For others, it’s stressful and exhausting. But for me, more than anything else, the interview trail was inspiring.
I am currently applying to internal medicine-primary care …
The bottleneck in ensuring sufficient primary care physicians
The Republicans have an alternative to Obamacare and they may have given the Democrats a big political gift.
The proposal was unveiled by Republican Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT).
The Republican plan targets many of the most unpopular parts of the Affordable Care Act such as expensive mandated benefits and the resulting lack of choice, the individual mandate, the employer mandate, and age-rating disruptions.
My sense is that most …
An analysis of the Republican alternative to Obamacare
ADVERTISEMENT
On February 18, 2014 the Food and Drug Administration indicated their consideration to allow pharmaceutical companies to shorten the list of possible side effects seen by millions everyday and night in pharmaceutical ads and commercials.
In recent years, citizens — patients and consumers — have been bombarded with numerous and lengthy televised commercials in which pharmaceutical companies push their medicinal wares. It’s called “direct-to-consumer” advertising (DTC).
Such DTC efforts work for detergents, …
Rid the airwaves of pharmaceutical advertising
As an internist (yes, I am a specialist, just not a subspecialist), I do no procedures. Patients pay me (albeit mostly indirectly) for my cognitive skills. But we live in a culture that seemingly rewards procedures more that pure cognition. Now I understand that procedures are not mindless. Physicians doing procedures must think prior to the procedure, during the procedure and after the procedure. But cognition without procedures seems undervalued.
The …
Solving the physician income disparity
Next in a series.
We have a real paradox in American health care. On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical and biotechnology industries continuously bring forth …
The real paradox in American health care
Considering that hospital medicine has only really taken off as a specialty within the last several years, it’s amazing how far the specialty has come.
The word “hospitalist” was first coined in 1996 when it was used in a New England Journal of Medicine article as a way of describing those internal medicine doctors who practiced inpatient medicine instead of primary care. Back then, hospital medicine was a strange new phenomenon.
Fast-forward to today, …
Hospitalist groups can make or break hospitals
When it comes to surgery for cancer, having a “positive margin” is a bad thing. It means that when the surgeon said he “got it all,” even though he meant it with all of his heart, likely he didn’t. For a woman undergoing a lumpectomy for breast cancer, that positive margin means a re-excision of the lumpectomy site or alternatively, a mastectomy. For a woman who has just had a …
Get rid of the cancer first before considering breast reconstruction
Over the course of medical school, you are expected to get comfortable with a whole host of expensive-sounding equipment (see: popsicle stick becomes tongue depressor).
You sling a stethoscope around your neck, maybe tuck a reflex hammer in your white coat pocket, and begin that privileged journey of looking for things that don’t sound or sit quite right.
You learn rather quickly that it won’t be you on stage, and somehow, you landed …
Why we need to break the silence on eating disorders
1. Process vs. product. Computers are just machines. I repeat, they are just tools. Health information technology is a shell which houses knowledge and human ability. It is nothing more. Electronic medical records may either streamline our thought processes or make them more cluttered. They will not, however, lead to better or more perfect care. They haven’t yet, and they won’t in the future. And they are prone to be adulterated …
10 reasons to feel pessimistic about health care
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