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Here are some reasons why physicians lie

Physician

June 6, 2013

Professions that heretofore enjoyed public admiration for pursuing noble work and reputedly insisting on the highest ethical standards have been exposed. The Catholic church could write a few blog posts on this. Police officers, journalists and even teachers have also shown us that they are members of the human species and are subject to its weaknesses and frailties.

The fallacy is to expect certain professions and professionals to be more irreproachable …

Getting tested for the BRCA mutation: 4 booby traps to watch out for

Jan Gurley, MD

Conditions and Diseases

June 5, 2013

The first time I wrestled with the issue of whether to get my breasts cut off, I was in my early forties. Partners in life, my breasts had done right by me. They delighted me in all their underwhelming adolescent glory. Then they’d been a source of panting, wriggling joy for so much of my adult life. They’d amazed me after pregnancy when I became a fount of Bessie-the-cow milk …

Don’t punish all doctors to find a few dangerous physicians

Shirie Leng, MD

Medications

June 5, 2013

One of the things that used to make physicians different from other providers is the ability to prescribe drugs. This is not true anymore, but the majority of prescriptions are still written by doctors. Prescribing practices of physicians vary widely across different populations and specialties. If a doctor takes Medicare patients, his prescribing patterns are part of the mountains of data Medicare collects about it’s patients. In 2003 the government …

What should medical students expect from health reform?

Italo M. Brown, MPH

Health Policy

June 5, 2013

In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a 2nd year medical student. The overwhelming majority cited their respective USMLE Step 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses all are worth their respective weights, the one date that should bear the most gravity in the minds …

End of life care is too complicated

Gene Uzawa Dorio, MD

Physician

June 5, 2013

Advancing technology has allowed life to be simple. Nowadays, when you go shopping, you slide a credit card and voila, sold. Why does it seem though some things are getting more complicated?

Dioctyl sodium sulfosuccinate is another name for Colace. We are forced to have two names for one drug: a brand name, and a generic. The pharmaceutical companies tell us they have patents mandating we live in their complicated world, …

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End of life care is too complicated

Letting your infant cry it out: Will it hurt your baby?

Roy Benaroch, MD

Conditions and Diseases

June 5, 2013

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Jess, like many parents, has been hearing conflicting information about what crying can do to your baby.

She wrote: “So, my husband and I accidentally let our kiddo (5.5 months) cry it out. So of course, I’m spending all sorts of time on Google finding out that I’ve caused long-term damage to my son and he’ll be more likely to get ADHD and …

Fixing obesity is not complicated

David L. Katz, MD

Conditions and Diseases

June 4, 2013

I recently spoke at a symposium on nutrition and public health at the Tuck School of Business at my alma mater in beautiful Hanover, N.H., Dartmouth College. Among others on the panel with me was Richard Starmann, the former head of corporate communications for McDonald’s. Those with even a modest number of Katz-column frequent flyer miles can readily guess how often he and I agreed.

One point Mr. Starmann made, more …

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Fixing obesity is not complicated

How Obamacare will largely eliminate price variations

Peter Ubel, MD

Health Policy

June 4, 2013

If you have been paying attention to US healthcare policy debates lately, you know that hospitals have a price problem. Walk across the street from one hospital to a competitor hospital, and you could easily find yourself facing a $30,000 increase in your medical bills. At one extreme for instance recent information shows that replacing your hip with a surgical implant might cost anywhere from $5000 to …

User friendly recording of data often seems like an EHR afterthought

David Mokotoff, MD

Health Technology

June 4, 2013

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As I began logging on to my third different hospital EHR (electronic health record) recently, I contemplated how much more of this I could take. Being less than a year from planned retirement, the nuances of learning a new EHR and CPOE (computerized physician order entry) system is not fun. Furthermore, every hour I spend learning a new and unique system is …

Improving informed consent for resuscitation without playing God

Janice Boughton, MD

Physician

June 4, 2013

To resuscitate or not to resuscitate, that is the question. Whether ’tis nobler to beat the heck out of a person on his or her way out in the hope of saving his or her one precious life, or to allow death to proceed at its own pace with expectation of a peaceful passing.

The United States has come a long way in the last 2 decades since 1991 when the …

Does shared decision making really increase health costs?

Dave deBronkart

Patient

June 4, 2013

In the business of medicine, one of the brightest hopes is the potential for re-optimizing our spend around what patients want. That’s important because decades of research in the field of shared decision making have shown that when there’s a range of options to treat a condition, informed patients choose less spending and less invasive treatment.

That’s a good thing.

Unfortunately, the University of Chicago …

Cardiologists should lead the way in shared decision making

John Mandrola, MD

Conditions and Diseases

June 4, 2013

Look at this sample question from the American College of Cardiology self-assessment. Tell me whether you see the problem. (It came in a mass advertisement-email, so I don’t think it is a secret.)

Sample question

A 75-year-old woman is referred to you with a murmur. She has had the murmur for many years and has been followed by her primary care doctor. Recently she has noted increasing symptoms of shortness of …

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Cardiologists should lead the way in shared decision making

Why do hospitals buy primary care practices?

Doug Farrago, MD

Health Policy

June 3, 2013

One reason is to apply an extra “facility fee” to patients’ bills.

Another reason is that primary care docs generate a ton of money for the hospital. A new survey was sent to hospital chief financial officers across the nation and based on data submitted by 102 facilities, it found that PCPs generate more annual revenue than specialists do.

PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a …

One expensive patient can prevent treating a dozen others

Amol Sura

Physician

June 3, 2013

For most of our patients, the student run homeless clinic is the last stop in a long, fruitless search for healthcare in the city of New Orleans. Recently, an insulin-dependent diabetic came in who had his insulin pump stolen, an unfortunate side-effect of homelessness. The physician prescribed a 150 dollar-per-month supply of insulin—far out of our price range—not knowing how much insulin costs. This was in addition to a sixty-dollar …

Where has evidence based medicine taken us in 20 years?

Robert Donnell, MD

Physician

June 3, 2013

A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions and unintended consequences? You might be surprised.

What I intend to do is start with a little of the history of EBM, talk about the essential notion as originally conceived by …

Doctors think about their patients all the time after they leave

Jennifer Stella, MD

Physician

June 3, 2013

As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.

We raced in the …

How doctors will use Google Glass

Chris Rangel, MD

Health Technology

June 3, 2013

Google Glass will be like the Segway. It’s really cool but it will have only a few practical uses and won’t be a paradigm shifter. Segway never won widespread acceptance in a culture dominated by cars and Google Glass is unlikely to win over people who prefer to wear their smart phones on the waist instead of on their face.

Still, …

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How doctors will use Google Glass

Why medical residents should do house calls

Aftab Iqbal, MD

Medical Education

June 2, 2013

During my ambulatory care rotation, I got the opportunity to tag along with my attending on a house call to a geriatric couple. The husband, “Joe,” had recently been in the hospital for severe respiratory illness. His wife, “Sally,” had recently fallen and broken her hip and was recovering from a hip replacement.

While my attending checked on Sally, he advised me to talk to Joe. We chatted a while about …