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Does patient engagement set patients up for failure?

Patient

June 9, 2013

“Maybe we shouldn’t urge people to engage in their health care: it sets them up for failure and punishment from their clinicians.”

A senior patient advocate and researcher recently made this comment to a gathering of experts in patient engagement.

For a few minutes, I was inclined to agree with her. I thought back over the previous three months: the passive aggressive (and aggressive-aggressive) responses of some of my clinicians to my …

Why setting consistent boundaries is important

Alex Lickerman, MD

Conditions and Diseases

June 9, 2013

A few weeks ago my wife, my son, and I went out for dinner. My son, though usually well-behaved and pleasant, was boisterous and disruptive, alternately leaping off his seat to crawl under the table and banging his silverware on his water glass to see what different volume of sound he could make it produce. Our tolerance for disciplining him patiently having been exhausted in us both by our respective challenging …

How to know if your baby has autism

Naline Lai, MD and Julie Kardos, MD

Conditions and Diseases

June 8, 2013

Autism is a communication disorder where children have difficulty relating to other people. Pediatricians watch for speech delay as a sign of autism. Even before your child is expected to start talking, around a year old, you can watch for communication milestones. Problems attaining these milestones may indicate autism or other disorders such as hearing loss, vision loss, isolated language delay, or other developmental delays.

By six weeks of age, your …

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How to know if your baby has autism

It is not feasible for a provider to be expert in everything

Patrice Wade, DNP

Conditions and Diseases

June 8, 2013

Since I’ve always had an interest in food and nutrition, as a young nurse and student, I just assumed that all health care providers assessed nutrition. After all, we know how important it is. However, as a staff nurse in the ER and a nurse practitioner doctoral student, I learned that wasn’t true. Many providers in both arenas reported it was not the priority that medication and disease management were.

Throughout …

How the Oregon Medicaid experiment is a failure

Thomas Santo, MD

Health Policy

June 8, 2013

T.Santo - Oregon Medicaid (media)

An important article was recently published in the New England Journal of Medicine, titled The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. This study provides a rare look at the effects of expanding Medicaid coverage (specifically, Oregon Health Plan, Oregon’s version of Medicaid) to a population of previously uninsured patients. Having practiced medicine in Portland, …

How defensive medicine is akin to the war on terrorism

Jeffrey Parks, MD

Physician

June 8, 2013

From my interview with Andrew Thompson the other day, the issue of a medical malpractice crisis was raised. Mr. Thompson averred that such a concept is pure myth, a spook story older docs tell young interns around the campfire at night. And he may be right.

In a paper from the Journal of Healthcare Quality, researchers at Johns Hopkins demonstrated, using data from the National Practitioner Data …

Prescription labels need to come in languages other than English

David Margolius, MD

Medications

June 8, 2013

As the saying goes, “With great power comes great responsibility.” That applies to physicians when prescribing medications, but it also should apply to pharmacies when they’re dispensing medications.

In December, after seven years of exams, lectures and rounds, I received my medical license. Finally, I had the power to prescribe medications without the co-signature of my supervisor. “Be careful,” she advised, “remember the …

MKSAP: 52-year-old man with leg pain and swelling

mksap

Conditions and Diseases

June 8, 2013

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

A 52-year-old man is evaluated in the emergency department for a 5-day history of right leg pain and swelling. He has never had a previous episode of venous thromboembolism. Following a physical exam and ultrasonography, what is the most appropriate management of this patient’s transition to warfarin therapy?

On physical examination, temperature is 36.5 °C …

The soul of our vocation is to heal our patients

Rose Kumar, MD

Physician

June 7, 2013

As a medical student nearly two decades ago, I remember how excited I was to begin my rotations on the wards. After two intense years in the classroom, I felt that I had a good fund of knowledge that I could finally apply in a clinical setting. Still, very soon after beginning my ward rotations, I noticed that while I was able to adequately manage my patients’ symptoms, I could …

Why I’m skeptical of a test for newly diagnosed prostate cancer

J. Leonard Lichtenfeld, MD

Conditions and Diseases

June 7, 2013

Coming to an office near you: a new test that can “confidently” predict whether or not you need to have aggressive therapy for your newly diagnosed prostate cancer.

Really?

That’s what the press reports would lead you to believe. And it’s really going to catch your attention if you’re one of the tens of thousands of men who will …

Is medicine a choice or a calling?

Eric J. Keller, MD

Medical Education

June 7, 2013

Over the last couple months, I have often been asked what I plan to do as a recent college graduate. My response has been that I will be attending medical school in Chicago.

“Oh! Medical school!” many exclaim as their eyes light up, “So you’re going to be a rich doctor.”

This response as well as most others I have received seemed to imply that medicine is an ideal profession if one …

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Is medicine a choice or a calling?

An important step toward cost transparency

Ishani Ganguli, MD

Health Policy

June 7, 2013

How much to treat this pneumonia? The Centers for Medicare and Medicaid took a step towards answering such questions by publicly releasing how much each of 3000+ U.S. hospitals charged Medicare for 100 common medical issues in 2011 and how much Medicare actually paid them.

The charges were remarkably variable, even among hospitals that share a zip code. Massachusetts hospitals tended to charge below the national average (eg. …

The ultimate DIY project: Create your own EMR

Rob Lamberts, MD

Health Technology

June 7, 2013

There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber. Yes, that hole has been there about a year, and it has been on my to d0 list for the duration, daring me to show if I inherited any of the fix it genes I got from my father. Why not hire someone to come fix it? I …

When it comes to cancer, laughter and humor can humanize

Don S. Dizon, MD

Conditions and Diseases

June 6, 2013

“What do you think?” my nurse, Laura, had asked as we discussed her call from Ms. Lyons (name changed to protect privacy.)

Ms. Lyons, an ovarian cancer survivor whom I have known for years, had called Laura after she had developed a discoloration on her abdominal wall and vague abdominal pain. She thought it might have something to do with her anticoagulation …

Simply knowing about health risks does not change behavior

Arya M. Sharma, MD

Conditions and Diseases

June 6, 2013

Exercise is good for you. Eat more fruits and vegetables. Stop smoking. Drink less alcohol. Such messages abound in public health campaigns and there is a firm belief that they will ultimately change behavior. This is based on the assumption that individuals are motivated to change behaviors to reduce their individual health risks.

While healthy individuals may understandably ignore such messages, one would certainly assume that people who already have conditions …

The BRCA mutation: Screening, breast and ovarian cancer prevention

Margaret Polaneczky, MD

Conditions and Diseases

June 6, 2013

In an editorial in the New York Times entitled “My Medical Choice,” Anjelina Jolie has come out publicly as a carrier of the BRCA1 gene, which places her at high risk for both breast and ovarian cancer. She has undergone a prophylactic nipple-sparing mastectomy with plans for future removal of her ovaries to prevent ovarian cancer:

I choose not to keep my story private because there are many women …

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The BRCA mutation: Screening, breast and ovarian cancer prevention

To improve patient safety, lawyers need to embrace transparency too

Kevin Pho, MD

KevinMD

June 6, 2013

How do we reduce medical errors?

It’s a question at the forefront of the minds medical and policy leaders today. Entire books have been devoted to the subject, and there is no shortage of suggestions to improve patient safety.

Internist Danielle Ofri recently wrote a New York Times op-ed on the issue, where she reflected on a “near miss” she had during …

Is self-rationing of medications a good or a bad thing?

Trudy Lieberman

Medications

June 6, 2013

In America, the conventional wisdom is that we don’t ration health care. But we do, and there’s no better example than patients rationing themselves when it comes to the medicines they take.

Recently, a young twenty-something I know had a nagging cough—seasonal allergies, her doctor said and prescribed a generic medicine for asthma and allergies. She did not fill the prescription—the $160 price tag was too steep. Although she had health …

Cultivate more upstreamists to transform health care

Rishi Manchanda, MD, MPH

Health Policy

June 6, 2013

An excerpt from The Upstream Doctors: Medical Innovators Track Sickness to Its Source.

There’s a story widely known in public health circles about three friends and a river. I retell it this way:

Three friends approach a wide, beautiful river leading to a waterfall. The idyllic scene is shattered by the cries of a small child in the water, flailing his arms while struggling to stay afloat. He’s fast approaching the …

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Cultivate more upstreamists to transform health care

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