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The sad state of EMRs: How they are doing more harm than good

Val Jones, MD

Health Technology

August 30, 2013

I used to be a big believer in the transformative power of digital data in medicine. In fact, I devoted the past decade of my life to assisting the “movement” towards better record keeping and shared data. It seemed intuitive that breaking down the information silos in healthcare would be the first logical step in establishing price transparency, promoting evidence-based practices, and empowering patients to become more engaged in their …

CT scans and radiation: How can patients limit risk?

Roy Benaroch, MD

Conditions and Diseases

August 30, 2013

I’ve been writing a lot about CT scans lately. Why are so many being done, and which children with head trauma really need one? CTs are really kind of neat—it’s amazing that we can peer into your body to see what’s going on in there. But like every other medical intervention and treatment, there are positives and negatives, pros and cons, a ying and a yang.

I’ve mentioned some downsides …

After an adverse event: What should doctors disclose to patients?

Marjorie Stiegler, MD

Physician

August 30, 2013

What should doctors disclose to patients in the aftermath of adverse events? Does it matter if the adverse event was related to an error? Does it matter if it was preventable or not, anticipated or unexpected?

Recently, I was at the Carolina Refresher Course facilitating a session on adverse events in anesthesiology. We touched on a variety of issues, but spent the most time discussing the importance of disclosure conversations, as …

We must demand a return to meaningful notes

Robert Centor, MD

Physician

August 30, 2013

I had a nice conversation with a dermatologist at a party recently. He started complaining about the notes he receives from other physicians. He used terms like piles and piles of junk.

Talk to any experienced physician and they will tell you that once upon a time our teachers taught us to write notes appropriate to the situation, not appropriate to the billing system.

Several years ago I ranted about the necessity …

Dear patients: My skill set no longer matches your needs

Jordan Grumet, MD

Physician

August 29, 2013

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Dear patients,

It has been a hard week. I wanted to take a moment to personally apologize for all that you have endured. As one who has witnessed your pains and struggles, I can only wince with each new passing hurdle you are forced to leap over. This business of disease and illness is not for the weak of heart (metaphorically, that …

What good is Medicaid expansion if no doctor sees Medicaid patients?

Peter Ubel, MD

Health Policy

August 29, 2013

With its expansion of Medicaid eligibility, the Affordable Care Act (a.k.a. Obamacare) was supposed to go a long way towards providing healthcare coverage to millions of uninsured Americans. That accomplishment was dealt a large blow by the Supreme Court, when it forbade the federal government from requiring states to expand Medicaid coverage. Nevertheless, many states plan to offer Medicaid to anyone with incomes at or below 138% of the Federal …

Should the definition of cancer be changed?

Alyson B. Moadel, PhD

Conditions and Diseases

August 29, 2013

I’ve dedicated my entire career to helping those diagnosed with cancer cope better, so they can regain the best quality of life possible. I was heartened by a recent New York Times article detailing efforts by the National Cancer Institute (NCI) to change the definition of cancer and potentially eliminate the use of the word for those diagnoses that might never …

Who accommodates a doctor with a disability?

Suzanne Koven, MD

Physician

August 29, 2013

In my practice, as in most medical practices, we accommodate patients’ particular needs in all kinds of ways: wheelchair accessible rooms and hallways, interpreters of virtually all languages including American Sign Language, gowns and instruments in a wide range of sizes, information sheets and videos suitable for patients with a variety of educational backgrounds.

No one questions the appropriateness of these accommodations.

But what about when the doctor or nurse requires an …

Why online dating is a bad idea for teens

Claire McCarthy, MD

Physician

August 29, 2013

Online dating is a bad idea for teens — especially young teens.

That’s why it wasn’t particularly responsible of Seventeen Magazine to publish a blog in which “dating blogger” Isabelle Furth floated the idea of using sites like Match.com to find dates. To be fair, she had concerns about the idea, and she’s in college, so theoretically old enough to make these decisions. But college kids don’t read Seventeen. Middle school …

The young doctor’s organized orientation to electronic dehumanization

Wes Fisher, MD

Physician

August 29, 2013

“It looks like you’ve done very well, Mr. Smith.”

“Thank you, doctor.”

He left the patient’s room and ambled back to the nurses station, legs tired and ankles somewhat swollen. It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day. He sat down at the computer and logged in. That’s when he looked up briefly …

A change of heart on medical marijuana

Sanjay Gupta, MD

Medications

August 28, 2013

After investigating the potential of cannabis as a medication over the last year, I had a change of heart. I am more convinced than ever that we need to study this like any other medication and not deny it to people who may currently benefit.

The response to our reporting on this topic has been robust, and we will continue to seek the answers people want …

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A change of heart on medical marijuana

Will lung cancer screening CT become standard of care for smokers?

Anonymous

Conditions and Diseases

August 28, 2013

Lung cancer screening CT took its most important step toward widespread implementation last week when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meet entry criteria for the National Lung Screening Trial (age 55-79, with 30+ pack-years smoking history and quit < 15 years) should undergo yearly low-dose lung cancer screening CT.

The recommendation earned a Grade B in …

How long do you continue to fight when death is certain?

James C. Salwitz, MD

Physician

August 28, 2013

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Not long from now, the last cancer will be defeated, and even today most with the dread disease survive. However, many still fall. This leaves us with one of the toughest questions of life. How long do you continue to fight, when death is certain? When does striving become vain hope which drains quality and creates only suffering? What makes struggle worth the …

Do we need less art in medicine?

Vipul Kella, MD

Health Policy

August 28, 2013

After eating at my favorite restaurant last week, I started to think why I enjoyed it so much. I have been eating at the same place regularly for years, but never stopped to think about what makes it special. After thinking about it for a bit, I came up with one word: consistency. I know that every time I eat there I can expect the same dish prepared the exact …

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Do we need less art in medicine?

Choosing a doctor is like choosing a spouse

Kevin R. Campbell, MD

Physician

August 28, 2013

Just as in marriage, the ability to communicate is essential to any successful doctor-patient relationship. In fact, the most successful doctor-patient relationships are a lot like a marriage. Both parties must be willing to listen, to negotiate and to support each other’s decisions. Outcomes improve significantly when patients are engaged in their own healt hcare. Engagement only occurs when doctors and patients are able to effectively work together to solve …

Should hospitals subsidize physician salaries?

Janice Boughton, MD

Health Policy

August 28, 2013

I have been doing locum tenens work as a hospitalist for nearly two years. One of my reasons for doing this is that the practice of medicine in the US is very interesting, and by working in very different places I get to see how things work and don’t work, and make up cool theories. I have time to read and listen to people and have become curious about several …

After cancer treatment, primary care becomes even more important

Jessie Gruman, PhD

Patient

August 27, 2013

Having cancer has infected me and many others with the irritating tendency to view any persistent, troubling symptom through the lens of a recurrence or a diagnosis of a new primary cancer. A friend of mine who is nearly five years post-kidney cancer treatment casually remarked the other day that he needed to see a doctor about his sore ankle: it could be arthritis, but it might be cancer, of …

Seeking an end to the prostate cancer and finasteride discussion

J. Leonard Lichtenfeld, MD

Conditions and Diseases

August 27, 2013

We’ve all heard the phrase, “When you come to a fork in the road, take it.” Well, that saying may hold particular relevance while reviewing a new research report published in the New England Journal of Medicine.

The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of …

Legalizing marijuana: What happens if Medicaid starts paying for it?

Doug Farrago, MD

Medications

August 27, 2013

Dr. Sanjay Gutpa has come out on the side of medical marijuana. To him, that is a big deal. Here is a snippet of what he said:

I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients …

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Legalizing marijuana: What happens if Medicaid starts paying for it?