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Bluffing wasn’t a skill I was expecting to master in pathology

Physician

September 10, 2013

As a pathologist, I am one step removed from the patient. This is comforting for the most part. I render my diagnosis and another clinician communicates it to the patient. It is best this way — I have no treatment options in my own doctor toolbox to give meaning to the words I communicate. I learned this the hard way — in fellowship training.

Once I was doing a fine needle …

Don’t confuse death with dignity with suicide

Peter Ubel, MD

Physician

September 9, 2013

In 2008, the state legislature of Washington passed what was called the Death with Dignity Act, a law that legalized physician assisted suicide. Under the law, terminally ill patients (predicted to have less than six months to live) can request prescriptions for lethal medications from their physicians, under a series of safeguards: multiple requests for example, determination of competency, and the like. Then, if the patients so choose, they can ingest …

A doctor creates his own EMR out of pure survival

Rob Lamberts, MD

Health Technology

September 9, 2013

The question has been raised: Why re-invent the EMR wheel? What is so different about what I am doing that makes it necessary to go through such a painful venture? I ask myself this same question, actually.

Here’s my answer to that question.

What medical records offer:
High focus on capturing billing codes so physicians can be paid maximum for the minimum amount of work.

What I need:
No focus on billing codes, instead a …

Use the Internet to create a competitive medical marketplace

Allen Frances, MD

Health Policy

September 9, 2013

An enemy intent on ruining the U.S. economy and sabotaging our public health could do no better than burden us with our current system of health care. The crushing costs of our health expenditures almost double per person those of other developed countries, with health outcomes that fall somewhere between mediocre and lousy.

There is no single cause for our medical fiasco and no single cure — especially since all solutions …

Putting a human face on chronic pain

Angela Yang

Patient

September 9, 2013

“Forty-two-year old male, chronic pain syndrome,” the chart reads.

I’m a third-year medical student doing an elective at a physical medicine and rehabilitation clinic, and this is my first time seeing Joe.

Sitting expectantly in the exam-room chair, he’s a gaunt man with a long face and dark tattoos down his arms. Wire-rimmed glasses, stringy ponytail, faded jeans and leather jacket complete the look.

“Nice to meet you,” I say. “I’m Angela, a …

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Putting a human face on chronic pain

A gastroenterologist dishes on unnecessary colonoscopies

Michael Kirsch, MD

Physician

September 9, 2013

We gastroenterologists are regularly summoned to bring light into dark places. We are the enlightened ones who illuminate anatomical shadows. Sure, we have tunnel vision, but we like to believe that we can think broadly and creatively as well.

We are the scope doctors.

We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights. We deliver a …

In the battle for primary care, both doctors and nurses are to blame

Kim Byars, ARNP

Health Policy

September 9, 2013

Apparently the Affordable Care Act has inspired panic among some physicians groups worthy of the fear historically reserved for deadly epidemics. From the articles I read, these groups are wringing their hands in hysteria over what to do and how to survive. One solution that has apparently gained popularity in these circles is the launching of campaigns against one of the most logical solutions, nurse practitioners.

Last fall, the medical association …

The wounded healer is sometimes the best choice of therapist

Rea L. Ginsberg, LCSW-C

Patient

September 8, 2013

Sometimes, it really does take one to know one. Not every counselor can work well with every patient. It is hard to understand how people can presume to know bereavement and grief when they have lost no one of significance in their lives. Surely everyone has experienced loss at some time. However, the death of a tame woods animal is usually, qualitatively, very different from the death …

A 15 minute office visit cannot dispel a year’s worth of confusion

Karan Chhabra

Conditions and Diseases

September 8, 2013

Minutes from melting in the summer heat, I dumped my stuff at a table and homed in on the hospital café’s soda display for something -cold. The gentleman at the next table glanced my way and said, “Are you in the medical field?”

“Yes sir, I’m a medical student.”

He eyed my drink and asked, “Did you hear that diet soda can increase your risk of diabetes by 70%? Even just a few …

Selling colonics to detoxify is false advertising

Sophie M. Balzora, MD

Conditions and Diseases

September 8, 2013

Every major city has its well-advertised and well-anticipated spa week. This wonderful week of facials, massages, and rest and relaxation all at discounted prices is enough to get even the most cynical and uptight of my fellow New Yorkers giddy with excitement. With the advent of the juice cleanse craze on the scene, another cleanse that is again gaining attention is colon hydrotherapy, better known as the “colon cleanse, or …

Use visual aids to teach patients and improve decision making

Peter Wei

Conditions and Diseases

September 8, 2013

We all know that physician-patient communication is important. Poor communication, not deficient clinical skill, is the primary driver of malpractice suits; conversely, good clinical communication alone can improve patient outcomes. For example, patients of physicians with superior communication skills have been shown to have superior blood pressure control. Fortunately, physicians generally recognize the significance of good communication, and often take the time to ensure that it happens. Yet there …

High utilizers of our health care system matter

Joe Sammen

Health Policy

September 8, 2013

In the midst of the sea of change that is health reform, one thing has become increasingly clear: high utilizers of our health care system matter. A lot. Increasingly, local and national innovations have cropped up to identify the most costly patients, intervene to decrease their usage and, thus, ratchet down their cost to the system over time. To some, this approach is one of our greatest hopes of bending …

Urging doctors to take responsibility for their mistakes

Manoj Jain, MD, MPH

Physician

September 8, 2013

In 2007, I published a story in my local paper in which I confessed to having made a medical error years earlier. I’d mistakenly prescribed an antibiotic for a patient whose chart indicated an allergy to the drug.

Thankfully, the story had a happy ending. My patient recovered and took no legal action after I explained to her what had happened. I ended my article vowing to take greater care to prevent errors …

7 tips to stay away from misery on vacation

Ronan Kavanagh, MD

Physician

September 7, 2013

This year my wife and I decided to compile a list of all of the holidays we’ve had since we had kids. Its a nice list and we’re lucky to have traveled as well as we have.

I always get excited about going. There’s the anticipation of downtime away from work (and other peoples’ problems), time for relaxation, sleeping, eating, reading, and some quality time with my family. Life is just …

When should insurance cover body contouring?

Stephanie Van, MD

Conditions and Diseases

September 7, 2013

Today in clinic, I interviewed a formerly morbidly obese woman. She has lost almost 300 pounds since undergoing gastric bypass surgery a few years ago, a presentation that has become increasingly common. She was here to see the plastic surgeon for her four week follow up appointment, status post abdominal skin flap removal.

See, after losing a ton of weight, loose skin remains, especially in places like the arms and abdomen. …

A behavioral economics approach to solve obesity

Birju Rao

Health Policy

September 7, 2013

We have now entered a world where most the obviously good ideas are already taken. Someone has already invented the chair. Someone has already invented the desk. The spaces where innovation will occur now are in the crevices of where academic disciplines come together. By using paradigms from behavioral economics, I believe physicians and public health officials can navigate this uncharted interdisciplinary terrain to solve the U.S.’s current obesity problem.

In …

Don’t waste your time finding the perfect diet

Barbara Berkeley, MD

Conditions and Diseases

September 7, 2013

Nathan Pritikin: 69. Robert Atkins: 72. Roy Walford: 79. Adelle Davis: 70. Aveline Kushi: 78. Marjorie Shostak: 51. Jack LaLanne: 96. Ancel Keys:100.

David Murdock is a billionaire who believes that he knows the formula for the perfect diet. Not only has he built his own research institute to refine his theories, but he is confident that his food choices will keep him alive to the age of 125. This …

MKSAP: 54-year-old man with nephrolithiasis

mksap

Conditions and Diseases

September 7, 2013

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

A 54-year-old man is evaluated during a follow-up visit for five previous episodes of nephrolithiasis. Two of these stones were composed primarily of uric acid. After his third episode, potassium citrate was initiated. Medical history is notable for type 2 diabetes mellitus, hypertension, and hyperlipidemia. He does not have a known history of gout. …

The promise and peril of sharing costs with patients

Ishani Ganguli, MD

Medications

September 6, 2013

It wasn’t so much the side effects — nausea and belly pain that had once kept me from enjoying my aunt’s home cooking. I didn’t fill my prescription for the malaria prophylactic Malarone before a family trip to India because the $50 co-pay seemed outlandishly expensive to a medical-student-in-debt. Years later, I find that my patients skip crucial medications to treat diabetes and depression because of the reality or even …

Our dysfunctional system: Both doctors and patients are at fault

James C. Salwitz, MD

Health Policy

September 6, 2013

I do not argue with my patients. Rather, I teach, outline options and explain my point of view, as each person must choose their path. However, the other day, Audrey and I got in a tiff when she was in the office to discuss her breast cancer. We had an enthusiastic discussion not of chemotherapy, x-rays or surgical options. Nope, we disagreed about what is wrong with healthcare.

It seems to …

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