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What the Oregon Health Study has told us so far

Health Policy

February 1, 2014

Recently, another installment was published from the research team of the Oregon Health Insurance Experiment. The major finding — Medicaid coverage results in a 40% increase in emergency department (ER) use. Many of the health care pundits quickly sifted through the scientific results to support their opinions.

You can read some of them here:

Sarah Kliff reports the facts: Expanding Medicaid doesn’t reduce ER trips. It increases them. Scott Gottlieb claims that Read more…

What the Oregon Health Study has told us so far

Affluenza: How to be sick without being sick

Janet Byron Anderson, PhD

Conditions and Diseases

February 1, 2014

The four pedestrians never saw it coming.

Around 11:45 p.m on June 15, 2013 on a road in Burleson, Texas (a suburb of Fort Worth), the driver of a stranded SUV and three people who had stopped to help her change a flat tire were killed when 16-year-old Ethan Couch smashed into them with his red pickup truck. Seven other teens were in the truck with him. Drunk, and driving 70 …

Declining care from physicians in training

Brian J. Secemsky, MD

Medical Education

February 1, 2014

Recently, I had the fortune of hearing the tale of Bob and his bum knee.

It all started when Bob picked me up at the end of a busy clinic day in his neon orange Subaru. Given that this particular shared car service promotes friendly conversation, Bob started up the gab by asking me what position I held in the medical center. After describing my work as a …

When patients write to doctors, and what it means

Miranda Fielding, MD

Physician

January 31, 2014

Where I come from, when most people refer to the Good Book, they are referring to the Bible. This is not true for my father, because to him, the Good Books are something else entirely.

He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of …

Deciding what to do with my son’s body

Jennifer Gunter, MD

Physician

January 31, 2014

My eldest son, the first-born of a set of extremely premature triplets, died a few minutes after he was born. Defying the odds I remained pregnant with my other two boys for 24 days.

After holding him for some time in the delivery room, the same room where I myself had delivered hundred of babies and passed them on to families beaming with tears of joy, I was asked about his …

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Deciding what to do with my son’s body

Primary care has to go multimedia

Jorge Stanham, MD

Health Technology

January 31, 2014

I passed the 60 mark more than a year ago and since then have been more aware of my limitations: some joint aches, getting tired easier, more need to rest and longing for a slower pace in my everyday routine. Meanwhile, general medical practice is speeding up and increasingly shedding its limitations.

As information expands exponentially, doctors need not only to keep up with the information that reaches them directly, but …

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Primary care has to go multimedia

Use Justin Bieber as a teaching moment for kids

Wendy Sue Swanson, MD

Conditions and Diseases

January 31, 2014

justin-bieber-mugshot

Justin Bieber was arrested recently in Florida for a DUI. The smirk on his face is a bit misplaced. While it’s no longer a surprise when we hear about a celebrity’s challenge with drugs and alcohol, Bieber serves up a perfect moment for education. I mean this kid (he’s 19-years-old) really could have killed himself last night. Thank goodness he’s …

Mobile applications can revolutionize preventative care

Kevin R. Campbell, MD

Health Technology

January 31, 2014

Applications for mobile devices are commonplace. These small but often sophisticated programs are quite varied and allow for anything from vehicle GPS navigation, taxicab or car pickups in New York City or rating wines and restaurants. As with most new gadgets and technologies, medicine and healthcare provide many opportunities for expansion and use. When we examine the available applications found at Apple’s App Store, it is evident that medical mobile …

Bronchiolitis and RSV: What you need to know

Christopher Johnson, MD

Conditions and Diseases

January 30, 2014

It’s time again for bronchiolitis, which usually comes in winter through spring. In some ways this problem is similar to asthma, but in other important ways it is very different. With winter upon us it’s time to reacquaint ourselves with this common entity. There is a reliable seasonal arrival of the virus we call RSV, the chief cause of bronchiolitis. The letters stand for respiratory syncytial virus, a description of what …

When something natural does indeed work

Hans Duvefelt, MD

Medications

January 30, 2014

“I used to be strong, I wrestled the bull,” Sumner Ball said, “but now I can’t even wrestle the rooster.”

On the far side of eighty-years-old, he looked lively and trim, and his weathered face hinted at a smile as his blue eyes peered straight into mine.

“I think these cholesterol pills are hurting my muscles,” he declared. “I don’t think they’re good for me.”

“Is it your back?”

I scanned through his last …

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When something natural does indeed work

A health care lobbyist discusses population health

Janice Boughton, MD

Health Policy

January 30, 2014

Recently, I attended a dinner and lecture at the local dining venue where they served huge hunks of prime rib and sauteed snow peas from some far away place where it’s spring, and chocolate mousse and wild rice. Global warming increased just slightly due to our excess consumption, but my portion would have been wasted had I stayed home. Beside the food, I was curious to see what the health care …

When it comes to back pain, time is an underused treatment

Suzanne Koven, MD

Conditions and Diseases

January 30, 2014

The doctor at the summer camp I attended as a kid believed that calamine lotion and time cured just about anything that ailed campers — and he was right. Time still heals most wounds, but patience is a tough sell to people whose visits to my office often involve taking off work or getting a babysitter, fighting traffic, and shelling out for parking and insurance co-pays.

After all that, time doesn’t …

A cognitive error when treating adolescent pharyngitis

Robert Centor, MD

Conditions and Diseases

January 30, 2014

Since prior to my entrance to medical school, common wisdom for treating sore throats involved the prevention of rheumatic fever. Since group A strep pharyngitis is the cause of most acute rheumatic fever, all efforts have focused on treating group A strep. Studies in the 1950s showed that penicillin treatment decreased the probability of patients developing rheumatic fever.

The prevailing theory in the 50s and 60s, that we should diagnose group …

Compassion is what connects us all

James C. Salwitz, MD

Physician

January 30, 2014

A large woman, she has soiled herself. With practiced motion, Bob rolls his wife onto her side. Yellow diarrhea has leaked out of the diaper, soaking the nightgown and sheets, finding its way into each fold, crease, and flaw. The room fills with odor, but the winter house remains dark; outside wind blows down the empty street. It is 2:00am and Bob is cleaning shit. Only 90 minutes asleep, he …

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Compassion is what connects us all

Refusing the flu shot: Respecting the patient’s right to choose

Jennifer Adaeze Anyaegbunam

Conditions and Diseases

January 29, 2014

I’ve spent the past four weeks learning about primary care on my family medicine rotation. A significant portion of patient care in this setting is focused on health maintenance or disease prevention. Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.

According to the Centers for Disease Control and …

Mohs surgery is vilified, physicians again fail to respond effectively

Joyce Ho, MD

Conditions and Diseases

January 29, 2014

An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.

The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a …

When patients are late: Should doctors charge extra?

Michael Kirsch, MD

Physician

January 29, 2014

While patients and physicians operate under oral agreements, business agreements are generally established in writing. In these documents, terms are outlined including contingencies in the event that foreseeable obstacles or disputes develop. Oftentimes, the two parties do not agree that a contractual term has been violated. This is when the fun begins. With a little luck, the legal profession enters the arena and can speedily resolve the disagreement in a …

The callousness of the two surgeons is what remains

Jordan Grumet, MD

Physician

January 29, 2014

When I was seventeen, I developed a medical problem due to no fault of my own. It was painful, it was embarrassing, and when it became uncomfortable enough to disrupt my life, I went to see a well known surgeon downtown.

The specialist, tucked away in the hallow halls of academia, stared down at me past a pair of spectacles perched at the end of his ever-protruding nose. When he examined …

Empathy: How an idea forever changed my approach to patients

Rob Lamberts, MD

Physician

January 29, 2014

As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on “big ideas,” such as:

What makes people choose things which cause themselves harm?
Are some people better people than others, or are they just more skilled at hiding their problems?
Is pain really a bad thing, or is our aversion to it a sign of human weakness?
Does God ever wear a hat?
Do dogs watch Oprah?
Why did I …
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Empathy: How an idea forever changed my approach to patients

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