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Trapped between two conflicting professional obligations

Physician

October 6, 2013

As the sixty-something-year-old woman and I shook hands and sat down to get acquainted during her “new patient” visit, she pulled out a small stack of papers and a thick spiral-bound notebook. I glanced at her problem list in the electronic chart: diabetes, obesity, hypertension, anxiety — the usual. She handed me the notebook and a printed Excel spreadsheet with several columns: her medications (a handful), the supplements she takes …

Primary care has a marketing problem

Shailey Prasad, MD, MPH

Physician

October 5, 2013

I recently saw a sticker on a bus shelter. It was an arrow about 10 inches long and 6 inches wide. It seemed to be pointing to the bus map. “This is Public Health,” it said. The sticker, part of a larger campaign, gave me pause. Sure, a bus stop is public health because it a marker of mass transportation; it symbolizes improved access and decreased pollution from individual cars. Looking …

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Primary care has a marketing problem

Communicating with patients with serious or terminal cancers

Michelle Brandt

Physician

October 5, 2013

Earlier this month, a candid and powerful personal essay was published by Jessica Rice, a thirtysomething woman with terminal cancer. An emerging theme of Jessica’s piece was the importance of frank conversation between physician and patient, and I was curious what a provider — someone who has difficult conversations on an almost daily basis — would think of this patient’s story and perspective.

Thoracic oncologist Kavitha Jennifer Ramchandran, MD, read the piece …

How postpartum depression affects children

Nicole Letourneau, PhD and Justin Joschko

Conditions and Diseases

October 5, 2013

At long last, people are talking about postpartum depression. Dismissed for years as no more than a touch of the baby blues or else unheard of entirely, postpartum depression — or PPD, as it is often known — has become an open subject. Healthcare providers are aware of it, many nurses and physicians routinely screen mothers for it, and articles in parenting magazines and major newspapers have been written about …

A primer on addressing patients

Edward Leigh

Patient

October 5, 2013

The lyrics to Janet Jackson’s song, Nasty, includes this line, “No, my first name ain’t baby, it’s Janet. Ms. Jackson if you’re nasty.” Miss Jackson doesn’t like being called, “baby,” and neither do a lot of patients.

Many healthcare professionals call patients by nicknames, such as, “honey” and “sweetie.” I believe these are terms of endearment and in most cases meant with genuine warm feelings toward patients. However, from interviewing hundreds …

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A primer on addressing patients

EMRs make it easier to just order the test

Corbin Rayfield

Medical Education

October 5, 2013

The discourse on the problems of the modern healthcare system contains much vitriol and blame. There is a distinct flavor of adversarial combat in the discussion; pitting physicians, those in the trenches, with those politicians and lawmakers on the other side. With estimates of healthcare costs exceeding 15% of the gross domestic product of the United States, it is easy to understand the passion that the topic evokes. The complexity …

MKSAP: 56-year-old woman with Sjögren syndrome

mksap

Conditions and Diseases

October 5, 2013

A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids.

On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 116/64 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. Oral mucous membranes are dry. There is a new firm, left parotid …

There can be hope at the end of life

Don S. Dizon, MD

Physician

October 4, 2013

I remember when Susan*, a close friend of mine with breast cancer (who had been living with metastatic disease for about a year before), was told she was terminal. Beyond the shock and fear, Susan felt grief and anguish that her life would end so much sooner than she (or any of us) had expected. Suddenly, Susan had so many big …

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There can be hope at the end of life

Examining the link between bacteria and obesity

David L. Katz, MD

Conditions and Diseases

October 4, 2013

We have, it seems, moved on from acknowledging it takes a village to raise a human being. We are well into the realm of realization that it takes a village just to be one. More and more studies are demonstrating the importance of the germs that outnumber our cells by an order of magnitude at least, to virtually every aspect of physiology. But while epiphanies of this …

It is perfectly fine to be emotional in front of patients

Bruce Campbell, MD

Medical Education

October 4, 2013

Medicine offers you a front-row seat on life. Meaning is all around you. When you can see it, it gives you a sense of gratitude for the opportunity to do this work.
-Rachel Naomi Remen

The first-year medical student cried openly during the session. Not hard, but enough to be embarrassed.

“I’m really sorry,” she said, “but this is one of the things that scares me most about going into medicine. I cry …

Fear of disease needs to overcome the fear of vaccines

Mike Sevilla, MD

Conditions and Diseases

October 4, 2013

One of the reasons I love social media is that it keeps me up to date on breaking news stories. Here are two stories that came through my social media channels recently. Both of these have to do with immunizations, which, of course, is a healthcare and social media hot topic, especially among pediatricians.

“U.S. Measles Cases in 2013 May Be The Most In 17 …

The fallacy of the current resident duty hour rules

Akhil Narang, MD

Medical Education

October 4, 2013

Discussions of resident duty hour reforms reached the point of ad nauseam a few years ago. Everyone had their say — program directors (“In 2003 we instituted an 80 hour work week, in 2011 we switched to 16 hour shifts, what’s next – online residencies!?”), senior residents (“What? I have to write H&Ps again? I don’t even know my computer password!”), interns (“I thought I was done with cross-covering after this …

Our wellbeing is tied to that of our patients

Natalie Wilcox

Medical Education

October 4, 2013

I don’t have time for this, I thought as I attempted to walk the twenty minutes from home to my Mind-Body Medicine class at a ten minute pace. I felt a sharp cramp in my abdomen, reminding me that I had just wolfed down dinner without taking a break for enjoyment or digestion. By the time I reached the medical school building the sky was dark, my face glistened with …

This is what’s so difficult about doctoring

Jordan Grumet, MD

Physician

October 3, 2013

There was nothing wrong with Sarah’s vocal cords. Her tumor had spread throughout the abdomen, but her voice was unaffected. Yet minutes after learning of the voraciousness of her metastases, she pursed her lips and began to communicate with head nods and hand gestures only.

I met her for the first time in the nursing home. I sat down quietly at her bedside on a Sunday morning. I was in the …

Force feeding in Guantanamo: Why doctors shouldn’t participate

Michael Kirsch, MD

Physician

October 3, 2013

Nearly every physician regards himself as an ethical practitioner. Nearly none of us are, at least not fully. There is no bright line that separates ethical from improper behavior. Indeed, it is because the boundary is fuzzy that ethicists and the rest of us wrestle with contentious controversies. It is, therefore, expected that ethicists are divided on many issues, much as the U.S. Supreme Court is often split in its …

6 thoughts after testifying at a medical malpractice trial

Robert Centor, MD

Physician

October 3, 2013

A few weeks ago I was an expert witness in a malpractice trial. In this post I will use generalities and specifically not reveal any details of the patient or the court case. I first became involved in this process several years ago. My involvement included a deposition, reviewing medical records, reviewing other expert depositions, discussing the patient’s most unfortunate story with lawyers for two different defendants, and finally testifying. …

Preventing disease is a problem for the health industry

Rob Lamberts, MD

Physician

October 3, 2013

“Daddy?”

“Yes, Jonathan?”

“Sometimes my leg hurts.”

“Yes?”

“Why does it hurt?”

“Uh, that’s a tough question. Does it hurt a lot?”

“No, just every once in a while.”

“OK, and where does it hurt.”

He gives an expression of disbelief at the stupidity of the question. ”My leg!”

“Where on your leg?”

“I don’t know,” patience now growing thin. ”I just want to know what’s causing it.”

“Well, Jonathan, it doesn’t work that way. My main job is to make …

How to ensure you receive the right amount of care

Leana Wen, MD

Physician

October 3, 2013

In a recent blog post, I discussed the harms of a new epidemic: too much medical care. We also don’t want the opposite. In fact, much of the driving force leading to overdiagnosis and overtreatment is this fear of rationing.

So what can you do to ensure that you obtain just the right amount of care?

It isn’t easy — if it were, if there an algorithm that would give …

Real patient engagement depends on defining it correctly

Leslie Kernisan, MD, MPH

Physician

October 3, 2013

What is patient engagement?

Everyone agrees that it’s a good thing, and that we healthcare providers should be fostering it.

How to do so, however, depends on just what you believe patient engagement means.

As Dan Munro recently pointed out, the term “patient engagement” is a hot buzz phrase, and — in the best tradition of such phrases — it’s amorphous enough and appealing enough to mean just about anything.

Provided …

Why I stopped working with mail order pharmacies

Deep Ramachandran, MD

Medications

October 2, 2013

Mail order pharmacies like Express Scripts and Medco have become increasingly prominent players in health care. But these companies are a lot more than simply mail order pharmacies, they are in fact a new generation of pharmacy benefit managers (PBMs). PBMs are essentially middle-men between insurance and pharmacy, with companies like Express Scripts merging the dual functions of a PBM and pharmacist into one. PBMs manage and administer medication benefits …

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