Next in a continuing series.
Would you know what I mean if I describe whistling without whistling? Barely pursing the lips, making little quasi-audible windy sounds while inhaling and exhaling, in tune yet nearly silent? Unless there’s music playing, that’s what I do when I operate. And for reasons about which I have absolutely no clue, I nearly always “whistle” The Caisson Song. I’ve always wondered if anyone …
Behind the scenes of a total colectomy
One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.
Like many old consumer problems, health …
Navigating the shopping troubles with insurance exchanges
Recently I came across yet another media article with suggestions as to how digital health products can gain more widespread adoption. The writer notes that “we can learn a lot from the pharma and healthcare industries,” and goes on to discuss the importance of engaging the doctor.
This article, like many I read, doesn’t acknowledge the downsides of using pharma’s tactics.
I have to assume that this is because from a business …
Physician education: The downside of taking a business approach
The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don’t even know that Obamacare is the law. Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it.
I understand that there is confusion about the way it will work and who will be affected. …
Why Obamacare is a marketing fail
It is unfortunate, but now medicine is on the clock. We now must not only battle disease, but we must also battle time. Physicians are asked to do more in less time. Innovations such as EMR (which in theory are supposed to increase efficiency) sometimes actually slow clinical practice to a halt.
Additionally, ongoing debate exists as to how best train medical residents and prepare them for the practice of medicine. …
Medicine is on the clock: An unfortunate reality
The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex. Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped. Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling. The lung cancer has spread, metastasized. Really bad news.
A …
A guide to giving bad news to patients
As I shopped for a new car last year, I realized that my priorities were considered odd by most car salesmen. The three most important characteristics I desired in a new car were good gas mileage, good crash safety, and relatively low concentrations of “new car smells.” The often celebrated (but particularly noxious) new car smell is actually a synthetic blend of respiratory irritants and potential carcinogens off-gassing from the …
Beware of that new car smell when shopping for a new car
There is a certain irony in the nearly immediate juxtaposition of the rare introduction of a new FDA-approved drug for weight loss (Belviq) to the marketplace and the recognition of obesity as a “disease” by the AMA. A line from the movie Jerry Maguire comes to mind: “You complete me!” Drugs need diseases; diseases need drugs.
And that’s part of what has me completely worried. The notion that obesity is a disease will inevitably invite a …
Obesity is much more like drowning than a disease
I’m not big on spying on teens generally. I think that privacy is important. And by the time they are teens, in most cases we need to trust that at least some of the stuff we’ve said for years has stuck–and we need to let them learn to be independent and make choices without us.
That said, if you have a teen who drives, there’s some spying I suggest, assuming you …
Check to see if your teen is texting when driving
The fact that cunnilingus increases a man’s risk of developing oral cancer has been all over the Internet recently with Michael Douglas’ disclosure that he had an HPV-positive tumor.
To recap: some strains of human papilloma virus (HPV) are oncogenic, meaning they induce changes in a cell’s DNA that can lead to cancer. The same strains of HPV that are oncogenic in the genital tract for women, causing both cervical cancer …
How to reduce the risk of oral cancer
Recently, Dr. Mike Sevilla decided to hang up his podcasting mic, his blogging tools, his Twitter creds, and his Facebook presence, all in one fell swoop. Find out more about Mike the man, and why he decided to take this drastic action, at his website.
Now, I have known Mike for some time on Twitter primarily, where we will sometimes comment back and forth about issues of the …
Why this doctor writes and puts himself out there
Sometimes it’s the simplest things that can make all the difference. Unfortunately, when it comes to informing patients with a new diagnosis of pulmonary fibrosis what to expect, things are anything but simple.
For years, pulmonologists have dreaded the moment when we inform patients of a diagnosis of pulmonary fibrosis. The discussion invariably involves informing them that this disease (which they have probably never heard of) may either kill them or …
Determining the prognosis of patients with pulmonary fibrosis
The seemingly irreconcilable conflict between the medical and nursing professions usually boils down to one question: who is in charge? Physicians often use a football analogy: they are the quarterbacks of the team, calling the plays that others on the gridiron must follow, because of their greater training and skills. Advanced practice nurses (APNs) respond: not so, we are also highly trained and qualified to call the plays and lead …
There should be no quarterbacks in health care
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Unplanned readmissions to the hospital have been the focus of much attention in recent years for obvious reasons. First, they are relatively easy to measure using administrative claims data. Second, like all inpatient hospitalizations, they cost a lot of money–and are therefore a target for reducing spending. Third, they are a proxy for quality of care, as at least some portion of them are likely avoidable if the hospital does …
Is the hospital readmission rate a measure of quality?
Hardly a day goes by when some news outlet does not report, often breathlessly, some new breakthrough in cancer research. We need to turn a skeptical eye on most of these reports, particularly those that contain information about very preliminary research findings. The always astute Gary Schweitzer gives a good perspective on this in his HealthNewsReview.org; it’s a good site to bookmark if you follow the medical news.
News on cancer breakthroughs: Curb your enthusiasm
I have been thinking a lot about C. Everett Koop lately, ever since his death on February 25 at the ripe old age of 96 and more recently with the announcement that our current Surgeon General, Regina Benjamin, is planning to step down from that post. In particular, I have been pondering what made Koop such an effective Surgeon General, and what …
Would C. Everett Koop be an effective Surgeon General today?
The more complex and high stakes a health care decision is, like with genetic testing and mastectomies, the more difficult it can be to find your way. There are no “right” answers, only guideposts to help you choose a path that is best for you.
Decision-making alone. When my kids went to camp in the fifth grade, they got to experience something called the Solo Hike. Counselors took them up into the …
Three tumors, two breasts, one very difficult decision
I knew from last night’s house call that my patient Bessie’s time was near. All day long I’d felt the familiar churning inside, the sickly sweet combination of anticipated dread and anticipated relief. So when the phone rang while I was exercising at home, I wasn’t surprised. I quickly dropped the barbell weights to answer the call before it went to voice mail.
It was Bessie’s daughter, Susan.
“Mom is gone,” she …
The words I say aren’t as important as my presence
Hi.
I’m Rob and I am a recovering doctor. Yeah, I am recovering … doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better. I …
Confessions of a recovering doctor
The biggest mistake patients make isn’t what you think. It isn’t turning down tests or treatments their doctors recommend. Nor is it deciding not to take the medicines their doctors prescribe. It isn’t insisting on getting a test or beginning a treatment their doctors recommend against, either, and it isn’t failing to exercise, stay out of the sun (or use sunscreen), quit smoking, or lose weight. No, the biggest mistake …
What is the biggest mistake patients make?
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