Can telepsychiatry really work?

Physician
September 2, 2013

I have been asked one question about my work in telepsychiatry more that any other, hands down.

“Can you really help a mental health patient like that, through a television screen?”

The quick and dirty answer? Yes, absolutely.

The extended answer? Read on.

Psychiatry is an intensely personal specialty. It requires knowing yourself as a doctor, as a therapist, as a consultant, and as a person more than any other kind of medical practice I …

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Can telepsychiatry really work?

Your EMR is watching you

Health Technology
September 2, 2013

A recent article on American Medical News titled “Medical charting errors can drive patient liability suits” led with a case involving a bad outcome after coronary artery bypass surgery. The plaintiff’s attorney alleged that the doctors did not review the patient’s lab results or x-rays because they did not specific say so in the medical record.

The article quoted a defense attorney who said, “By the time [the doctors] are deposed, …

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Your EMR is watching you

Why hospice is special to me

Physician
September 2, 2013

When socializing with fellow young physicians, most of whom are not in palliative medicine, I am reminded that I have the unique opportunity to share time and attention with my patients. We reflect on “the old days” of medicine, where physicians had long standing relationships with their patients which allowed them to more easily direct medical decision making which was appropriate for the individual patient. I often tell others I …

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Why hospice is special to me

Is the end near for small community hospitals?

Physician
September 2, 2013

Are the days numbered for Salem Community Hospital and other community hospitals around the country? Recently, a local story happened that made me think of this.

The announcement was made that the Akron General Health System was being purchased by a joint venture of Cleveland Clinic and Community Health Systems (CHS). CHS is a Tennessee-based hospital operator who also owns three other hospitals in the Northeastern Ohio area where I live.

Six months …

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Is the end near for small community hospitals?

When I see young pregnant patients, I see potential and opportunity

Physician
September 2, 2013

When I look in the eyes of a pregnant teenage patient, I see my wife. My wife was a teen mother.  She was a teen mother who beat the odds.  She is not a statistic. She is an example of the tremendous potential that lies before each and every teen facing the challenges of teen pregnancy.  Pregnancy did not stop her from succeeding.   My wife tells the story of riding …

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When I see young pregnant patients, I see potential and opportunity

To the legislators blocking Medicaid expansion

Health Policy
September 1, 2013

As a primary care doctor I typically see 20-25 patients a day in my private practice. My community is gearing up for changes and is planning measures to integrate the many private practices locally. I was asked to serve on a committee evaluating software solutions to connect the disparate electronic medical records in the community, and had several hours of meetings at the hospital at the beginning of the week. …

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To the legislators blocking Medicaid expansion

Financial advice for brand new doctors

Physician
September 1, 2013

This past July, the newest doctors, interns, have continued their journey in becoming experienced doctors. These newly minted and graduated doctors have excitement, anxiety, and anticipation not unlike the first day of medical school, college, or high school.

But as new doctors begin their next step, we rarely talk about those who also graduated. Specifically, doctors who have completed their residency and in some cases their advanced fellowship training. What about …

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Financial advice for brand new doctors

Redesigning residency training: The evidence is lacking

Medical Education
September 1, 2013

Three-year program residents graduating in June 2013 like me represented a unique cohort in medicine. As interns we experienced the 2003 ACGME duty-hour restrictions and the 2011 ACGME changes as residents. For example, I took thirty-hour call with a resident my intern year and ended residency with a dizzying iteration of a mixed call/shift system composed of multiple handoffs, residents, and interns. But this story is a call to more …

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Redesigning residency training: The evidence is lacking

For medical students, learning to keep their emotions aside

Medical Education
September 1, 2013

Flowers and bees.

By no means is that very telling of my current life. On the contrary, I get glimpses of different times of the day when I go into patients’ rooms and look out the window or if by chance the anesthesiologist decides to open the curtains in the OR (yes, this hospital has windows in its ORs!).

So this topic of flowers and bees is very random. But it just …

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For medical students, learning to keep their emotions aside

Can technology help individualized medical decision making?

Physician
September 1, 2013

Shouldn’t everyone get an individualized assessment of likely benefits, burdens, and risks before making a big medical decision?

I was asked this question recently, during an interview for an Internet radio show on aging.

Per my host’s request, I’d been explaining the practice of geriatrics, and talking about the geriatric approach to addressing the medical needs of older adults. Since I’d mentioned that aging often brings on greater risk of side-effects or …

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Can technology help individualized medical decision making?

14 ways to drive your doctor crazy during a physical exam

Physician
August 31, 2013

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1. When your doctor looks into your eyes with a flashlight, shut your eyes tightly so he can’t see your pupils. Later, when your doctors asks you to shut your eyes tightly to test your eyelid strength, look at him like he’s speaking in tongues and keep your eyes open. If he whips out his flashlight to look at your pupils …

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14 ways to drive your doctor crazy during a physical exam

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Women physicians in academia: The academic versus the biological clock

Medical Education
August 31, 2013

Undoubtedly, those pursuing a career in academic medicine have a tough time line.  In most medical schools, somewhere between the 7th and 10th year, depending on whether the academic clock was stopped for pregnancy, the fate of the academic physician is decided.  During these years when women have the biologic clock ticking, they also have the “up or out” academic clock ticking.

This rush to create academic contributors is pure insanity, …

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Women physicians in academia: The academic versus the biological clock

A huddle has the potential to change the way we care for patients

Physician
August 31, 2013

Having gotten all of the members of our team on board, how do we get them to actually get together?

We’ve all got busy days, all have lots of jobs to do, pulled in multiple different directions. The time needed to be thoughtful and really invest in the patient’s care is missing from our day. We need to make room for it, to get together, to really apply ourselves to …

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A huddle has the potential to change the way we care for patients

Dissection is as much exploration as it is self-evaluation

Medical Education
August 31, 2013

We had our first human dissection recently. We gloved up, scrubbed up, and wielded a scalpel – the key to opening the secrets hidden below our skin.

Our donor, an older gentleman who died of cancer and gave his body to the advancement of medical education, lay on his back. He was abnormally frigid and unnaturally rigid – cold and stiff to the touch. His face remained shrouded with a white …

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Dissection is as much exploration as it is self-evaluation

Reflecting on the final year of pediatrics residency

Medical Education
August 31, 2013

Now in my final year of residency in pediatrics, there will be a lot of “lasts.” Since the time we are kids, we often remember our different “lasts,” especially when it comes to school.

During the back-to-school rush at our primary care clinic, I had the opportunity to talk with several rising senior high school students who will be starting their “last first-day of high school” this week. I vividly remember …

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Reflecting on the final year of pediatrics residency

MKSAP: 35-year-old woman with fever and headache

Conditions and Diseases
August 31, 2013

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

A 35-year-old woman is evaluated for a 1-day history of fever, headache, myalgia, arthralgia, and neck stiffness. The patient is sexually active. She had a similar episode 2 years ago, at which time results of cerebrospinal fluid (CSF) analysis showed lymphocytic meningitis. All culture results were negative, and her symptoms resolved over the next …

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MKSAP: 35-year-old woman with fever and headache

Social networks influence parents’ vaccine decisions

Physician
August 30, 2013

We live in a profoundly different time today when it comes to caregiving, parenting, and gaining health care/advice than we did even 5 or 10 years ago. The Internet has changed things dramatically.

During an interview recently a reporter asked, “You were raised on digital media, yes?”  Well, no. I didn’t started using email until late 1995 just prior to leaving college, didn’t get a cell phone until I was teaching, didn’t …

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Social networks influence parents’ vaccine decisions

In our efforts to be thorough, we are probably causing more harm

Physician
August 30, 2013

Fear is more pain than is the pain it fears.
– Sir Philip Sidney

In our specialist age it has, in fact, become a major function of the general physician to examine thoroughly, to explain simply, to reassure as far as may be, and to protect his patients from unnecessary medical or surgical interventions.
– John A Ryle, MD, 1948 in the Journal of Mental Science, published by The Royal Medico-Psychological Association

Re-reading my …

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In our efforts to be thorough, we are probably causing more harm

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