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A 77 percent success rate is good enough for a guy without insurance

Patient

September 26, 2013

The doctor was adamant. “This is America, not Sweden,” he told me. “We operate.”

How did this happen to me? I wondered, looking at him across the ER exam room. How could I, a healthcare provider, not have insurance?

I had woken up that morning with a mildly upset stomach. Nonetheless, I’d gone to my job (begun only six weeks earlier) as a physician assistant at a Beverly Hills HIV clinic. I’d seen patients …

Going all the way should mean more than completing high school

Greg Smith, MD

Physician

September 26, 2013

So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?

Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who …

Unregulated gun access and its drain on medical resources

Julia Frank, MD

Physician

September 25, 2013

On September 17, 2013, I joined the growing ranks of physicians who have gotten a message they hoped never to receive: “There has been a mass shooting in the area. Prepare to receive casualties.”

That morning, a gunman was indiscriminately mowing down people at the US Navy Yard. Within an hour my hospital had geared up to provide both medical and supportive care, answer calls from those seeking to know the …

Does the amount of interns’ time spent in direct patient care matter?

Paul Bergl, MD

Medical Education

September 25, 2013

Recently in NEJM Journal Watch General Medicine, Abigail Zuger reviewed an article from the Journal of General Internal Medicine in which researchers examined how medical interns spend their time. The results from this time motion study might be concerning but are not unexpected. The investigators found that interns on inpatient rotations spend only 12% of their time in direct patient care and spend only 8 minutes daily with each patient on their inpatient services. Dr. Zuger notes this …

The time to get flu shots is now

Wendy Sue Swanson, MD

Conditions and Diseases

September 25, 2013

Please don’t tune me out on this one. Don’t let this post resemble Gary Larson’s The Far Side cartoon where you only hear, “Blah, blah, blah, Flu shot, blah, blah, blah, Flu shot, blah, blah, blah”

I write about flu every year because it’s one infectious disease that is not only more aggressive and dangerous for babies and young children, it’s vaccine preventable. The flu causes high fever, terrible cough, body aches, and significant discomfort. …

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The time to get flu shots is now

Childhood obesity: A problem of will and money

David L. Katz, MD

Conditions and Diseases

September 25, 2013

The American Heart Association recently published a sobering “scientific statement” on severe obesity among children and adolescents in the U.S. in their flagship journal, Circulation. The report, predictably spawning widespread attention in the popular press, suggests that by reasonable criteria, between 4 percent and 6 percent of our kids between the ages of 2 and 19 have severe obesity.

Those percentages probably don’t fully convey how common that makes this ominous condition. …

A symptom that will hasten Medicare’s eventual insolvency

Henry Kimmel, PsyD

Conditions and Diseases

September 25, 2013

Days from her 80th birthday, “Nancy” (not her real name) is doing well. She’s active, exercises, drives, travels, and lives alone in a multi-story apartment building without an elevator. Her busy schedule of weekly activities includes several appointments with physicians. Nancy’s medical needs are covered by Medicare.

Nancy’s been in psychotherapy for a half-century. She’s seen me, her psychotherapist, for the past three years. Nancy reports difficulty developing meaningful …

The catch behind free prostate cancer screening

Janice Boughton, MD

Conditions and Diseases

September 25, 2013

I just got an email from a hospital where I sometimes practice with a picture of two aging but clearly active and vital men standing on a beach with the words “free prostate cancer screening” printed below in an attractive font. The hospital is sponsoring the screening, along with the urology clinic affiliated with the hospital. The advertisement gives guidelines for who should avail themselves of this service, including men …

The side effects of cancer treatment can become permanent glitches

Jessie Gruman, PhD

Patient

September 24, 2013

Sara was treated for multiple myeloma in the mid-90s and had a stem cell transplant seven years ago. When I asked her husband how she was doing, he said, “Pretty well … just the gift of a little edema in one arm and some neuropathy in her feet.”

On one hand you think, “Hey! That’s great! Those little gifts — those side effects — are a small price to pay.”

On the …

Why aren’t hospitals more attentive to the needs of patients?

Leslie Kernisan, MD, MPH

Physician

September 24, 2013

In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.

On the bike path where Jha took his initial tumble, people went out of their way to …

Can sexualized images from pop music be a teachable moment?

Heidi Roman, MD

Conditions and Diseases

September 24, 2013

miley-cyrus-we-cant-stop-1-650-430

I have a confession. I like pop music. During my commute each day I admit I often make the mind-bending switch between NPR and the top 40 station. Even if you trend toward a more high-brow music collection, perhaps you’ll allow me that these tunes are catchy and they’ve got a beat. But lately I’m feeling fairly conflicted about it.

I didn’t watch the VMAs. …

The relative value of how physicians are paid needs to change

Toni Brayer, MD

Health Policy

September 24, 2013

The Centers for Medicare and Medicaid (CMS) sets the rates all physicians get paid and insurance companies base their rates on the same formula. So who creates the formula? Well, it’s the doctors, silly! Or at least some of the doctors. Here’s how it works.

A 31-member committee formed by the American Medical Association is made up of representatives from the various specialty societies. This Relative Value Update Committee (RUC) meets …

Addressing the disparities in those using patient portals

Zackary Berger, MD, PhD

Health Technology

September 24, 2013

My institution recently switched from its home-grown electronic medical record (EMR) to EPIC, a system for which many great things have been promised. Indeed, it is a considerable improvement over the past one. A number of hopes have been pinned on the latest-generation EMRs, not the least of which is the idea that finally, with this newest generation of tools, a nexus can be created and sustained among comparative effectiveness …

3 stories of surgeons that I find disturbing

Skeptical Scalpel, MD

Physician

September 23, 2013

An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.

There is also said to be evidence showing that in one day he was doing as many …

Don’t blame millennials for the drop in board exam pass rates

Robert Centor, MD

Medical Education

September 23, 2013

You have to love the blogosphere. The latest big issue concerns lower ABIM pass rates. Here are a series of blog posts worth considering.

Dumber Doctors?

One concern that has a ring of truth to it is that young doctors have become great “looker-uppers,” and have lost the sense of what it’s like to actually read and study medicine. While doctors enter the profession with a commitment to lifelong learning, some of …

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Don’t blame millennials for the drop in board exam pass rates

Being good doctor requires bearing witness

John Schumann, MD

Physician

September 23, 2013

I was naive when I decided to enter medicine. My impressions then were that doctors always “did” stuff — for patients, and to patients. We would do stuff to you (examinations, blood tests, scans, surgeries) in order to help you.

A lot of time and education later, I’ve learned that that straightforward paradigm is far from the only way that doctors help people. In fact, following that mostly simple formula (you come to us, we do stuff to …

Hospice also saves the doctor

James C. Salwitz, MD

Physician

September 23, 2013

You are taking care of a patient with metastatic pancreatic cancer. The disease has spread, surgery is not an option and second line chemotherapy has failed. He is in pain, but is poorly compliant with narcotic directions. He keeps falling down the stairs. His wife cries all the time. The family is desperate for help. The patient is in the office with loved ones, looking for guidance.

“What do we do …

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Hospice also saves the doctor

With the patient hemorrhaging, doctors are backed into a corner

Jordan Grumet, MD

Physician

September 23, 2013

We were pretty damn lucky that she was young and healthy.

The surgery had been technically successful. I watched as the resident finished with the last sutures. Although the attending had already left the room, I looked on with the eagerness of a third year student. Orders were written, and the patient was transferred to recovery.

It was a routine hysterectomy. None of the pizazz and flare of a gynecology-oncology surgery, but …

How I almost missed a patient’s incredibly powerful story

StorytellERdoc, MD

Patient

September 23, 2013

He was an ornery kind of fellow, evident by his scowl and beady, glaring eyes that greeted me upon my entrance into his room. The nurse, thankfully, had given me a heads-up on this eighty-five year-old gentleman’s demeanor. With her kind warning, I felt prepared to be tested by this patient’s demanding and abrupt nature.

What I wasn’t ready for, though, was this man’s physical appearance. He was extremely small in …

How can we revise the patient medical record?

Fred N. Pelzman, MD

Physician

September 22, 2013

So what exactly do we want a patient-centered medical record to look like?

What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.

If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …