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What is the ideal number of CT scans for headaches in children?

Conditions and Diseases

August 27, 2013

Many, myself included, have written about the overuse of head computed tomography (CT) scanning in children. This concern has become more focused now that we have some data on the radiation risk of those scans. The bottom line is not that we should stop doing head CTs in children, but that we should always balance the risk against the benefit, just as we should do with all medical testing. In …

Will delays pose a big problem for Obamacare?

Bob Doherty

Health Policy

August 27, 2013

“What, me worry?” could pretty much characterize how Obamacare supporters are reacting to the news that the administration is delaying or modifying the implementation of some of its requirements. Like Alfred E. Neuman, they are expressing a public confidence that there is no reason to worry, everything is fine, the announced delays aren’t really that important, and Obamacare will be up and running and ready to start enrolling people on October 1. No worries.

“The …

The fall and recovery of a cardiac surgeon

Larry Zaroff, MD, PhD

Physician

August 26, 2013

Four months after having a knee replacement, I stumbled into the bathroom at 3am, not fully awake, hoping to urinate.

Losing my balance, I fell. The result was a compound fracture of my left leg — the one with the prosthetic knee.

Gazing at my shiny white kneecap, I lost all logic, all control. I simply cried.

At eighty, I was unprepared for this unexpected anatomy lesson: my twenty-nine years as a surgeon …

What I learned from my mother’s hospital admission

Robert Wachter, MD

Physician

August 26, 2013

A few weeks ago, a middle-aged man decided to tweet about his mother’s illness from her bedside. The tweets went viral and became the subject of a national conversation. The man, of course, was NPR anchorman Scott Simon, and his reflections about his mother’s illness and ultimate death are poignant, insightful, and well worth your time.

Those same days, and unaware of Simon’s real-time reports, I also found myself caring for my hospitalized …

Know the human being behind the diagnosis

Miranda Fielding, MD

Physician

August 26, 2013

When I was a resident in radiation oncology, I thought I already knew a lot about medicine. After all, I had just completed an internal medicine residency, and had taken and passed my boards. Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code …

Does your doctor know ACLS? Does it matter?

Michael Kirsch, MD

Physician

August 26, 2013

acls

Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …

Calling a consult: Disrespect from specialists hurts patients

Heidi Roman, MD

Physician

August 26, 2013

A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.

When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …

Hand hygiene in hospitals has gone too far

Karen S. Sibert, MD

Physician

August 26, 2013

hand washing

We’ve run amok with wearing gloves in the hospital. And by “we” I mean every healthcare worker in sight. I see people putting on gloves before they’ll give a patient a clean warm blanket. This is not only ridiculous, it’s actually harmful. Here’s why.

We learned the hard way in the 1980s, during the early days of the AIDS epidemic, that the …

The initial cut of the surgeon is a leap of faith

Sid Schwab, MD

Physician

August 25, 2013

When Tiger Woods addresses the ball, he’s focused like a cat that heard a rustle in the leaves. He takes a few practice swings, moves up to position, adjusts his feet, steadies his shoulders, locks his eyes onto the target. He waits until there’s absolute silence, brings his breathing under control, funnels all his energy into the impending swing; takes the club back, and explodes in an immensely balletic movement. …

The medical home requires building a better team

Fred N. Pelzman, MD

Health Policy

August 25, 2013

How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home?

Doctors (attendings and residents), nurse practitioners, nurses, medical assistants, phlebotomists, registrars, medical secretaries, social workers, community care organizers, pharmacists … the list goes on and on.

As it is right now, everyone is so busy trying to do their own job, to keep up with all of their paperwork, to …

Medicare places hospitals in a discharge conundrum

David Mokotoff, MD

Health Policy

August 25, 2013

A long time ago, in a bygone era, hospital discharges were simple. As a physician, you decided when to admit and discharge a patient from the hospital. Unfortunately, this process was often inefficient, costly, and subject to the whims of doctor and patient. Medicare, and other third-party payers, ultimately realized that this format made little sense and motivated keeping patients in the hospital too long. Many unethical doctors gamed the …

Do the name and ethnicity of your doctor matter?

Qing Meng Zhang, MD

Physician

August 25, 2013

I would like to begin this article with a question: Do the name and ethnicity of a doctor affect your decision when choosing a physician?

America has always been a melting pot with diverse cultures and ethnicity. The medical field is a melting pot in its own right with its own politics, conflicts, racial disparities and the like.

When I was starting medical school, my mother suggested that I should change my Chinese …

The mixed blessing of health information technology

James Marroquin, MD

Health Technology

August 25, 2013

The recent revelation of the NSA’s top-secret mass surveillance program by Edward Snowden has spotlighted the benefits and burdens of our increasingly digitally connected world. According to President Obama, monitoring our phone calls, emails, and web activity has helped thwart dozens of terrorist attacks. But the idea of the government keeping track of what had hitherto seemed private raises the specter of an Orwellian world in which everyone is under …

It’s a miracle: The connection between saints and doctors

Rajeev Kurapati, MD

Physician

August 25, 2013

saints

To approve sainthood to a pope, the Vatican only needs one miracle. And there we have it, a new saint.

Pope John Paul was named a saint by Francis after a Costa Rican woman is said to have been cured from a brain aneurysm after praying to John Paul in 2011. His first miracle, curing a French nun of Parkinson’s disease, was also …

Failing a patient 3 times: A case of moral medical malpractice

Monica Williams-Murphy, MD

Physician

August 24, 2013

Standing up from my computer terminal to go see another patient, I caught a glimpse of a small, spindly frail woman being rolled by paramedics into one of my shock and trauma rooms.

Very calmly, I remarked, “That woman is dying.”

The medical student who was rotating with me was unnerved that I would make such a pronouncement out of a mere casual observance, “Oh my goodness! How can you just say …

Aviation doesn’t hold all the answers to patient safety in health care

Suneel Dhand, MD

Health Policy

August 24, 2013

Slowly but surely, patient safety is taking its’ rightful place at the forefront of American medicine. Ever since the landmark report from the Institute of Medicine in 1999, To Err is Human: Building a Safer Health System, the issue has been gaining increased traction year on year. Dismal patient safety statistics in some hospitals are correctly being highlighted by the media, with pressure growing on senior leadership and administrators to vigorously …

Why are there so few women physician leaders?

Linda Li

Medical Education

August 24, 2013

In July 2011, I made the decision to defer matriculation to medical school for a year. While I was hoping to relax in Philadelphia before entering a lifelong journey in medical training, what I got instead was one of the most emotionally tiring and challenging years of my life.

3 months after I decided to defer medical school, my aunt was diagnosed with acute myeloid leukemia. She was immediately hospitalized and …

The beauty of direct pay physicians

Bryan J. Treacy, MD

Physician

August 24, 2013

A recent review by CNN shows that the percentage of physicians who have gone to a direct pay practice has doubled in the past year. Currently, 6% of physicians are in this mode of health care delivery and the numbers are expected to rise as health care reform takes hold.

The beauty of direct pay physicians is that they are working for the patient, not an insurance company or government entity. …

Read more…

The beauty of direct pay physicians

I am an orphan: A medical school without a family medicine department

Seth Rosenblatt, MD

Medical Education

August 24, 2013

I am a fourth year medical student that attends an institution that does not have a department of family medicine.

Currently there are only 10 such allopathic institutions in the country. When I tell colleagues and friends that I intend to enter family medicine they say, “oh primary care?” While yes, it is true that family physicians obviously practice primary care, I am disheartened that my colleagues do not know or …

MKSAP: 51-year-old man with increased fatigue and decreased exercise tolerance

mksap

Conditions and Diseases

August 24, 2013

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

A 51-year-old man is evaluated for a 6-month history of increased fatigue and decreased exercise tolerance. He is otherwise well with no significant medical history.

On physical examination, temperature is 37.3 °C (99.1 °F), blood pressure is 115/75 mm Hg, pulse rate is 76/min, and respiration rate is 14/min. The abdomen is soft with no …

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