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How do we empower patients with information while not scaring them?

Paul Bergl, MD

Medical Education

October 9, 2013

“What do you think, Doctor?”

For a novice physician, these worlds can quickly jolt a relatively straightforward conversation into a jumble of partially formed thoughts, suppositions, jargon, and (sometimes) incoherent ramblings. Even for simpler questions, the fumbling trainee does not have a convenient script that has been refined through years of recitation. Thus, many conversations that residents have with patients are truly occurring for the first time. And unfortunately, this novelty …

The conundrum of forcing treatment on psychiatric patients

Allen Frances, MD

Conditions and Diseases

October 9, 2013

When is it justified to force treatment on someone?

Some would shout a resounding,impassioned, all inclusive, “Never!” No psychiatric coercion, not ever, not even under the most seemingly urgent of circumstances.

I once put the question to its supreme test — 35 years ago while having dinner with Tom Szasz. Tom was the probably the greatest defender of patient rights since Pinel (the father of modern psychiatry who, two centuries ago, started …

Radiation from x-rays and living in Denver: They’re not the same

Jennifer Gunter, MD

Conditions and Diseases

October 9, 2013

My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.

My son, Oliver, has had more radiation than most people will have. Ever. In fact, …

What if exercise counseling came in prescription form?

Suzanne Koven, MD

Physician

October 8, 2013

Mark Twain once quipped: “Everyone talks about the weather, but nobody does anything about it.”

Is the same true of exercise? Despite a growing, multibillion dollar fitness industry, despite an increase in sales of treadmills, weights, and other home exercise equipment, despite public education campaigns like Let’s Move, eighty percent of Americans — four out of five of us–do not get the recommended amount of cardiovascular and strength training. 41 million Americans belong to …

Life for patients and their families is so much more than data

James C. Salwitz, MD

Physician

October 8, 2013

One of the first things I teach medical students is to be aware that they have arrived in a bizarre land. The strange things they see, the disturbed experiences they have, the weird stories they hear, are like noting else in life. I advise students to stay in touch with their feelings, to note what shocks, frightens, or embarrasses them. Remember those emotions now, because as doctors learn their craft …

Technology should not define medical education

Terence P. Ma, PhD

Medical Education

October 8, 2013

In July, I began an exciting role at Einstein: assistant dean for educational informatics. One of my main objectives is to optimize the use of technology to advance and deepen learning. But as much as I welcome it, technology alone will not achieve our educational goals.

Recently, David J. Hefland, the president and vice chancellor of Canada’s Quest University, characterized the model of contemporary education as “students as empty vessels that must be …

Obesity in children: What is the responsibility of doctors?

Manoj Jain, MD, MPH

Conditions and Diseases

October 8, 2013

Lying in a hospital bed, my seriously obese patient could barely see her swollen and odorous right foot over her abdominal fat. The foot was soon to be amputated, the result of an untreatable infection exacerbated by diabetes and kidney failure, which developed in part because of obesity. Her two children, ages 6 and 12, hovered from the hospital bed to the couch. In between, the bedside table was strewn …

Clinicians do not have the luxury to not care about costs

Sarah Jorgenson

Health Policy

October 8, 2013

In a large lecture hall of fellow clinicians-to-be, I was told that my job as a physician is not to be concerned with costs but rather to treat patients. My wrist, moving frantically left to right on my page taking notes, stopped. I looked up and my mind wandered: What an odd message to tell those who will be listening to ill people’s symptoms, prescribing medicine, ordering tests and orchestrating …

Sub-internship: The small stones are under my guardianship

Shara Yurkiewicz

Medical Education

October 8, 2013

On my second day of fourth year, I had to make a decision.

“Mr. K would like Miralax,” read the nurse’s page.

A medical sub-internship, which a student completes in her fourth year, is designed to be an internship with training wheels. The main difference between third and fourth year is that the third year reports to an intern (who makes a decision) while the fourth year replaces the intern. Last year …

The great irony of health care reform

Wes Fisher, MD

Health Policy

October 7, 2013

The great irony of health care reform is that really, nothing is new. Everything, it seems, remains cloaked in secrecy.

Yes, there are things called exchanges now. And millions upon millions of dollars will be spent on Internet, social media, TV, print, and radio advertising touting the law. There will be counselors there to help people make an informed choice.

But there’s still a new complicated, unreadable law that promises much, but …

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The great irony of health care reform

I support the Affordable Care Act, but not Obamacare

Kenneth Lin, MD

Health Policy

October 7, 2013

More than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly …

Why your premium may rise under Obamacare

Edward Pullen, MD

Health Policy

October 7, 2013

The Affordable Care Act (ACA) will make insurers unable to exclude Americans with serious health problems from enrolling in insurance plans. This is among the most popular aspects of Obamacare. It is also the most likely explanation for huge premium increases in plans for individuals not on employer group policies.

Persons employed by companies with insurance plans for their employees, usually called group plans, routinely accept all eligible employees, regardless of …

How the Obamacare exchanges will transform health care

Robert Pearl, MD

Health Policy

October 7, 2013

When the next phase of the Affordable Care Act (ACA) kicks into gear January 1, 2014, each state will be required to offer its residents access to health care insurance through an online marketplace, often referred to as a “health insurance exchange.” These exchanges are now open for business on Oct. 1, 2013, allowing individuals to sign up online, by phone or in-person, with health insurance coverage starting next year.

Until now, buying health …

The problem with Obamacare is that it doesn’t do enough

John Mandrola, MD

Health Policy

October 7, 2013

Obamacare is here. It’s really here.

You might be wondering what’s been going on in the hospital or office — the contact points where health care actually happens.

The funny thing is: nothing seems any different.

And this is the problem with Obamacare. It hasn’t, won’t, or perhaps couldn’t, change the fundamental problem with US health care. Namely, that it is too big, too disruptive, and too devoid of nuance. In this way, health care …

A day at the VA during the shutdown

Megan S. Lemay, MD

Health Policy

October 7, 2013

“Thank God you’re still here, Doc! It looks like they already laid off half the pharmacy department! The line is out the door!”

“Don’t worry, Mr. Golati! It’s just a regular day at the VA!” I replied.

October 1st at the VA Hospital was like every other day in most ways. It was still hard to find a parking space in the far-too-small lot. The hallways still bustled with white coats, smiling vets, …

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A day at the VA during the shutdown

To cut hospital costs, look at the supply chain

David B. Nash, MD, MBA

Health Policy

October 6, 2013

As deliberations over how to make healthcare more cost-effective continue to play out in forums across the country — from the U.S. Congress to state governments to health systems and hospitals — it strikes me that we are paying insufficient attention to what should be an obvious consideration – the cost of supplies.

Supplies run the gamut — from operating tables, artificial knees, intravenous solutions, and wound dressings to bed linens, …

A patient’s perspective on domestic violence

Melissa Travis, PhD

Patient

October 6, 2013

I often read advice to doctors about how to screen for domestic violence. I was that woman for many years. I was that child and I know for a fact my pediatrician knew but was afraid to report it. And then I grew up and became that woman.

Physical violence while brutal, doesn’t compare to the controlling, creeping intimate fear sustained in such relationships. My then husband came with me to some of …

Being a good medical student doesn’t mean you’ll be a good doctor

Amy Faith Ho, MD

Medical Education

October 6, 2013

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There is a saying that you enter medical school wanting to help people but exit it wanting to help yourself. It may be a cynical view, but a realistic one. The criteria for being a good medical student are far different from being a good doctor. Medical education may be breeding a legion of self-serving, grade-grubbing, SOAP-note spewing machines rather than …

Physicians are fearful of fulfilling their duty to treat pain

James Patrick Murphy, MD

Medications

October 6, 2013

I recently testified before the Medical Licensing Board of Indiana regarding the pending emergency rules for physicians prescribing opioids for chronic pain. The session went on for four intense hours — ten minutes of which had been promised to me.

At my turn, I stated my name, told the Board I hailed from Indiana’s prescription ground zero, gave a brief summary of my credentials, thanked the Board, the American Academy …

What the unbundling of Craigslist has to do with today’s EMRs

Brian Manning

Health Technology

October 6, 2013

Recently there’s been a lot of talk about the law of bundling and subsequent unbundling of web services. Many have used Andrew Parker’s brilliant image below to make the point.

Craigslist came along and bundled everything into one place and, as a result, completely dominated. They destroyed multiple businesses in the process (including the rental and roommate web service I worked with …

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