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Acquitted of cholesterol guideline insubordination

Conditions and Diseases

November 24, 2013

A family physician in the northernmost part of the United States was acquitted last week of charges stemming from years of guideline insubordination.

Interviewed this weekend by members of the local press while he was cleaning the stall of his favorite horse, the silver-haired doctor declined making comparisons between the manure he was shoveling and the now-abandoned numeric cholesterol guidelines, and would not comment on his former accusers’ fall from their …

Understanding hypoactive sexual desire disorder

James A. Simon, MD

Conditions and Diseases

November 24, 2013

Sexuality is an essential component of a full and healthy life. However, at one time or another, sexual problems plague more than 40 percent of women in the U.S. Among the sexual issues women experience, the #1 problem reported is low sexual desire. When that’s compounded by distress — which nearly a fourth of women say they have because of their low libido — you have the hallmarks of hypoactive …

Balancing emotions and reason at the end of life

James Fausto, MD

Physician

November 24, 2013

Before you can even form a thought, emotions are influencing your judgments.
-Zimmerman and Lerner

It’s 9am on a Monday, and our palliative care team circles a table to prepare for the workday. Before us is a list of names, each representing a patient and his or her needs, support system and care team. Many are referred to us because they are suffering — be it pain, agitation, emotional distress, existential crisis …

We have lost all perspective about what is truly terrible

Emily Gibson, MD

Physician

November 24, 2013

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This wasn’t just plain terrible,
this was fancy terrible.
This was terrible with raisins in it.
-Dorothy Parker

More and more of my clinic time is devoted to evaluation and treatment of depression and anxiety rather than sore throats, coughs, UTIs and sprains/strains. An outbreak of overwhelming misery is climbing to epidemic proportions in our society.

A majority of the patients who are coming in for …

Breast density laws are based on anecdote

Dr. Saurabh Jha

Conditions and Diseases

November 24, 2013

You know that old joke. What’s a radiologist’s favorite plant? The hedge.

Radiologists are famous for equivocating, or hedging. “Pneumonia can’t be excluded, clinically correlate,” or “probably a nutrient canal but a fracture can’t be excluded with absolute certainty, correlate with point tenderness.”

Disclaiming is satisfying neither for the radiologist nor the referring physician. It confuses rather than clarifies. So one wonders why legislators have decided to codify this singularly unclinical practice …

Can student run free clinics help the health care safety net?

Jennifer Xu

Medical Education

November 23, 2013

While interviewing for medical schools last fall, I observed a strange phenomenon: every institution I encountered would underscore its student-run free clinic as a major highlight of the medical education they could offer. First- and second-year students would speak rapturously about the experience they gained from clinic. Working there, they said, reminded them of why they wanted to become doctors in the first place.

Today, the majority of all U.S. medical …

Bringing low income patients into the health care conversation

Peter Long, PhD

Health Policy

November 23, 2013

As we mark significant milestones in our changing healthcare landscape, much of the dialogue continues to focus on the goals of payers and providers. Yet the goals of a third group are just as important. In order to truly transform care delivery in coming years, our efforts must include patients — their needs, interests, and engagement — at every step.

For the first time, the Affordable Care Act (ACA) will give …

To put patients’ interests first, we have to put our own aside

Allan Joseph

Health Policy

November 23, 2013

I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …

3 tips to keep our patients happy

Brian J. Secemsky, MD

Physician

November 23, 2013

I get it. It’s not rocket science. But sometimes everyone in the field of medicine needs a bit of a refresher when it comes to keeping our patients happy.

After all, it’s a two-way street with medical providers and patients: we provide and support ways to improve and maintain the personal health of our patients while our patients provide and support the health of our careers and livelihood. We depend on …

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3 tips to keep our patients happy

Don’t resign your professional license in the midst of an investigation

George F. Indest III, JD

Physician

November 23, 2013

Do you have a medical, pharmacy or nursing license in several different states? Do you have a license in more than one health profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following.

First, you should never voluntarily relinquish or resign your license after you know …

MKSAP: 35-year-old pregnant woman with a history of pulmonary embolism

mksap

Conditions and Diseases

November 23, 2013

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

A 35-year-old woman undergoes evaluation after home pregnancy testing indicated that she is pregnant. Her medical history includes a previous idiopathic pulmonary embolism. Her only medication is a daily prenatal vitamin.

On physical examination, temperature is 36.2 °C (97.1 °F), blood pressure is 110/65 mm Hg, pulse rate is 70/min, and respiration rate …

Will video replays lead to safer surgeons?

Kevin R. Campbell, MD

Physician

November 22, 2013

Just as elite athletes are born with amazing skill, elite surgeons and doctors in other procedure-based specialties are also equipped with innate abilities that others do not possess. Surgical skill is often difficult to quantify. Certainly, outcomes data can be obtained and reputations are formed over time. Years of training allow the truly gifted surgeons to develop their skills and perfect their craft.

However, all surgeons are not created equal. During …

Academic medical centers: Should we continue to feed the beast?

Ira Nash, MD

Physician

November 22, 2013

I recently participated in a small conference devoted to “physician alignment in the academic medical center.” The meeting was sponsored by a health care consulting firm, and drew about a dozen participants from around the country. The title refers to ways in which academic centers figure out how to work with their traditionally autonomous if not completely independent physicians to advance the institutional mission. An informal format allowed us to …

Going the extra mile for patients: How friendly is too friendly?

Claire McCarthy, MD

Physician

November 22, 2013

Recently, a family in my practice decided to move out of state, back to where they had lived before. When we said goodbye, the mother said that she was sad to change pediatricians. The pediatrician they would be returning to, she said, “only takes care of strictly medical things.”

Clearly, she meant that I take care of more than the strictly medical things. I was flattered, especially since this was something …

Tips for treating patients suffering from chronic pain

David Hanscom, MD

Physician

November 22, 2013

“You are the worst doctor I have ever met.”

This was the second patient in a row to explode at me when I explained that further back surgery for his back pain had a low chance of success. I spent a couple of minutes explaining the many successes of our hospital’s pain program. Then he exploded again: “You mean I drove five hours just to hear you tell me that you …

Communicating urgently without scaring patients

Abigail Schildcrout, MD

Physician

November 22, 2013

Recently, I received a phone call in the late afternoon from someone very close to me. Please note that this someone is also a doctor. “Uh, I need you for a minute. I’m kind of freaking out. Can I talk to you?”

She had just gone to her local optometrist to get a new prescription for glasses. The optometrist looked in her eyes, told her that both of her optic nerves …

When talking with patients, sometimes we skip steps

Ilana Yurkiewicz

Medical Education

November 21, 2013

“Ms. M,” the resident says, “I saw in your chart that the last time you had surgery you had a pulmonary embolism.” She nods with recognition: “I felt like I couldn’t breathe. It was really scary.” Then: “I sure don’t want that again.” The resident lifts up the covers and sees that the patient’s calves don compression boots. “Make sure you keep the boots on,” he says, pointing.

What do boots …

Incorporating patient preferences into evidence based medicine

Jessie Gruman, PhD

Patient

November 21, 2013

Remember the figure-ground drawing from psychology 101 that demonstrates (ahem) “how edge assignment designates perceptual groupings?” I always just thought it was cool how you could look at the picture of a vase and blink and — whoa, Nellie — now you saw two people face-to-face.

I’m concerned that the frantic drive toward evidence-based medicine as a strategy for quality improvement and …

Medicine then and now: The importance of team

Greg Smith, MD

Physician

November 21, 2013

I have been visiting different sites and having staff meetings with different groups of clinicians since I came back to my psychiatric services chief job recently. I have noticed something that is very important to the smooth operation of a mental health center, and most likely any health care facility you might look at.

In order to do the best job possible and help the most people who need us, we …

Watson and Siri: The David and Goliath in health care delivery

Robert Pearl, MD

Health Technology

November 21, 2013

In every strength lies a weakness and in every weakness a strength. This maxim has held true throughout history — from biblical days to the battles of modern times.

And it holds just as true in the information technology (IT) “arms race” that’s playing out in American health care today.

In Malcolm Gladwell’s newest work David and Goliath, he suggests that when we fail to …