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For psychiatric patients in the ED, waiting is the hardest part

Greg Smith, MD

Physician

July 3, 2013

There was the time I was hugging a trashcan in the lobby of the community hospital ED just a few blocks from my house. Not because I have a molded plastic fetish or because I like the smell of trash, mind you. I had an itinerant renal calculus, otherwise known as a kidney stone that was moving through my urinary system.

It. Hurt. Like. Hell.

I. Wanted. To. Die.

I was throwing up …

Education that occurs among patients in a group

Suzanne Koven, MD

Physician

July 2, 2013

Several years ago I cut my hand badly on a broken glass and required surgery to reattach a tendon. For a few weeks after the operation, I attended regular sessions in a physical therapy department devoted to people with hand injuries. There were no closed curtains in the large therapy room — we bared only our hands, after all. As I had my fingers warmed, splinted, or stretched, I observed …

Obesity as a disease: The challenge for physicians

Sherry Pagoto, PhD

Conditions and Diseases

July 2, 2013

Following the lead of the World Health Organization and the National Institutes of Health, the American Medical Association declared obesity a “disease.” The AMA cited the plethora of evidence linking obesity to chronic disease including the number one cause of mortality in the US, cardiovascular disease. They describe the move as an effort to urge physicians and third party payers to recognize the need for obesity treatment ranging from behavioral …

The powerful effects of culture and lifestyle on health

Kevin R. Campbell, MD

Health Policy

July 2, 2013

As Americans we spend more money on healthcare per capita than any other nation in the world. We have the latest medical innovations and for decades have been able to provide cutting edge therapy without regard to cost. However, as a profession, doctors are not doing nearly enough when it comes to prevention of disease. Certainly, costs will be reduced if we are able to prevent chronic illness and associated …

Overcoming the resistance to same day appointments

Mark Novotny, MD

Physician

July 2, 2013

This past weekend I spent time relearning some life lessons.

On Saturday, I picked up a couple screens from the hardware store to reinstall them after they were nearly destroyed by our neighborhood bear. The bear seems to think she will find the birdfeeder that used to hang nearby, so she stands on our deck and leans on whatever is nearby (our screened porch) while she looks for it. Then she heads …

Complicated Obamacare clears a very low bar

Kevin Pho, MD

KevinMD

July 2, 2013

The following column was published on May 29th, 2013 in the New York Times’ Room for Debate blog, which asked the question, “Is Obamacare too complicated to succeed?”

Is the Affordable Care Act complicated? Of course it is. Even one of its architects concedes that it is phenomenally complex. Why? To pass, it had to be contorted to satisfy a number of special interest groups.

As its major reforms are implemented …

The man who brought down the Canadian abortion law

Jennifer Gunter, MD

Physician

July 1, 2013

Henry Morgentaler died recently. He was the man who almost single handedly brought down the Canadian abortion law. Sickened by what was happening in filthy, clandestine clinics he began doing safe, albeit illegal, procedures in his office. He was arrested but always maintained that a jury would never find him guilty. And he was right.

Years later when I was in medical school and then residency I marveled at …

The tension between oncology and palliative care

James C. Salwitz, MD

Physician

July 1, 2013

One of the benefits of being an oncologist is that, as a rule, people appreciate our work. That does not mean they want to hear about our day, and the response when someone learns my vocation is rarely, “Hey, that’s sounds like fun!”

Nonetheless, at least there is a modicum of respect. However, I found a group of people with major questions about the work of cancer docs or at least …

When is genetic testing appropriate for children?

Courtney Schmidt, PharmD

Conditions and Diseases

July 1, 2013

Angelina Jolie shared publicly her decision to have a preventive double mastectomy after genetic testing revealed that, due to a mutation in the BRCA1 gene, she carried an 87% risk of developing breast cancer and a 50% risk of developing ovarian cancer. Jolie identifies her mother’s decade-long struggle with ovarian cancer and death from that disease six years ago as one of the primary influences behind her decision.

Angelina Jolie’s …

Addressing racial disparities in health care

Ashish Jha, MD, MPH

Health Policy

July 1, 2013

Racial disparities in health and healthcare are a persistent and troubling problem for the U.S. Despite substantial policy efforts to the contrary, racial and ethnic minorities, especially African-Americans, often receive a lower quality of care and have worse outcomes. The key questions, of course, are why do these disparities exist, and what might we do about them?

Over the past decade, two primary theories have emerged to explain disparities and propose …

What does managing a loved one’s digital legacy really look like?

Naomi Cahn and Rev. Amy Ziettlow

Social Media in Medicine

July 1, 2013

With the recent Pew Report announcing that “caregivers are wired for support” and digital estate planning resources entering our mainstream consciousness, many of us have been inspired to think about the end of life and our online selves. And we should. Hundreds of thousands of Facebook users die each year, the average American believes that she has almost $55,000 worth of digital assets, though most of us – Read more…

What does managing a loved one’s digital legacy really look like?

A powerful address to graduating medical students

Wes Fisher, MD

Medical Education

July 1, 2013

Dear Graduating Class of 2013,

I appreciate the opportunity to address such an impressive pool of medical school attendees. From the first day of medical school when you were introduced to your cadaver, you have endured countless lectures and lab hours, physical examination and sensitivity training sessions, and ward rotations under the watchful eye of senior residents and attendings. Today, you will hold something that few people are privileged to …

How to create clear patient education materials

Erin Marcus, MD

Patient

June 30, 2013

Clear communication from doctors, nurses, hospitals and clinics is essential for patients to manage their health care effectively. But creating easily understood materials isn’t simple. Many health workers don’t realize when they’re using technical terms, and many non-medical people have problems reading and understanding scientific and mathematical concepts.

Fortunately, several web sites offer helpful advice about how to create patient-friendly educational print materials. Two of the most useful are the National …

Confronting the reality of uncertainty in medicine

Allen Frances, MD

Physician

June 30, 2013

Medical care in the U.S. over-promises and under delivers. It costs about twice as much as in most other developed countries, but compared to them manages to produce only mediocre health outcomes. The profit motive has resulted in badly misallocated resources — too much testing and treatment for people who don’t need it and lousy access for many who do.

The impact of advances in medical science on the delivery of …

The patient is the center of the medical home

Amberly Killmer, RN

Patient

June 30, 2013

My patient and I had spent most of the 45-minute appointment discussing the challenges of living with diabetes and some ways that he could begin changing his eating and exercise habits. I started to wrap up the visit and asked him, “Which of these changes can I follow up with you about next week?”

He looked at me incredulously and said, “You are supposed to tell me what to do: I’m …

4 complaints of physician employees and 1 solution to fix them

Dike Drummond, MD

Physician

June 30, 2013

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …

Nelson Mandela: Recognize the end of life equation

Monica Williams-Murphy, MD

Physician

June 30, 2013

By typical end-of-life definitions, Nelson Mandela is dying (he is in critical condition after a lengthy hospital stay, and has had multiple recent admissions). Those of us in the healthcare professions see this end-of-life equation all of the time: increasing severity of illness and frequency of hospitalizations plus advanced age almost always equals dying. Now, everyone likes to believe this equation may be altered by hopes, prayers, and modern medicine. …

The power of culture in health care

David L. Katz, MD

Physician

June 30, 2013

Our culture — at least the movie-going part of it — seems to have embraced the adage: With great power comes great responsibility. Somehow, at the same time, it seems to have ignored the inevitable, underlying principle: Power and responsibility are conjoined. This, in turn, implies a corollary our culture also neglects routinely, if not universally: Before anyone can reasonably be expected to take responsibility, they must be suitably empowered.

After …

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The power of culture in health care

Colonoscopies don’t need anesthesiologists

Shirie Leng, MD

Physician

June 29, 2013

Where do I start with this: The $2.7 Trillion Medical Bill.

I’m going to let Ms. Rosenthal tell you about how many unnecessary colonoscopies we do. I’ll let her tell you how much more it costs here than anywhere else. I will address the anesthesia bit.

Let me tell you a little story. When I was a baby anesthesiologist my hospital sent anesthesiologists downstairs to do anesthesia for GI procedures …