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Violence against women is a serious public health problem

Physician

June 2, 2013

It is near impossible to escape the commanding news headlines: The horrific details that are emerging about the years of violent captivity of three women in a home in Ohio; The fifteen year old Californian teenager who was allegedly sexually assaulted by three boys and then committed suicide last September.

And, internationally, the tragic case of a 23 year old woman who was gang raped and beaten to …

Let’s change the way we select medical students

Christopher Johnson, MD

Medical Education

June 2, 2013

Students wishing to go to medical school — premedical students — have gone through pretty much the same process for nearly a century. The requirements have some variability according to the whims of particular medical schools, but in general a person wishing to go to medical school needs a four year collage degree, during which he or she has completed two years of chemistry (including organic chemistry), a year of …

Why caregivers should care about digital backups

Naomi Cahn and Rev. Amy Ziettlow

Patient

June 2, 2013

You’ve heard all of the advice about backing up your computer regularly, making sure that you have your passwords stored in a safe place, protecting yourself against digital identity theft, but what does that have to do with providing care for a person with special needs?

Let’s count the ways.

First: Resources. Much of the information you need is online, and your personalized data may be password-protected. Anyone who has ever been …

Will patients trade human imperfection for computerized perfection?

James C. Salwitz, MD

Physician

June 2, 2013

The Atlantic this week published a provocative article entitled “The Robot Will See You Now.” Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care. In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?”

The IT version of health includes continuous medical monitoring (i.e. your watch will …

Suicide in baby boomers: Convince them that hope is not lost

Albert Fuchs, MD

Conditions and Diseases

June 1, 2013

Every primary care doctor has had the experience of listening to a very depressed patient explain that things are hopeless, that chronic medical problems or financial setbacks or family conflicts have pushed the patient past his ability to cope, that he can’t imagine how things could ever get better, that he would be better off dead.

Unfortunately, suicide in the United States is increasingly common. An article in …

Address the financial burden of medical treatment

Yousuf Zafar, MD

Physician

June 1, 2013

Everyone is talking about health care costs these days. The presentations usually start with a chart of rising health care expenditures, the tip of the line pointing skywards. Next come exhaustive (and exhausting) tables, more charts, all punctuated with a final shrug of uncertainty from the speaker: What is the solution to rising costs? Of course, there is not just one.

But in the morass of data, we can lose the …

Being a psych patient in the emergency department

Greg Smith, MD

Physician

June 1, 2013

So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security …

What I look for in an EMR: Think of a good story

Rob Lamberts, MD

Physician

June 1, 2013

So how’s my new practice going? In some ways things are going about as well as they could. My patients are amazed when I answer their emails or (even more surprisingly) answer the phone.

“Hello, this is Dr. Lamberts,” I say. This usually results in a long pause, followed by a confused and timid voice saying something like, “well…uh…I was expecting to get Jamie.”

Yet I am often able to deal with …

Charging passengers by the pound is unfair

Arya M. Sharma, MD

Physician

June 1, 2013

obese airplanes

Recently the wires have been active with suggestions that people with obesity pay more for airline travel. This discussion was prompted by a Samoan airline announcing that they would begin charging passengers by the pound. It was also stimulated by Bharat Bhatta, an economist from Norway suggesting that heavier passengers pay a surcharge while lighter passengers are offered discounts.

The logical argument …

MKSAP: 78-year-old woman is evaluated for incontinence

mksap

Conditions and Diseases

June 1, 2013

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

A 78-year-old woman living in a nursing home is evaluated for incontinence. Over the past year, she has had progressive decline in her cognitive status and now spends most of the day in bed. She requires coaxing to join the other residents in their communal meals and requires assistance for eating and bathing. When …

Wary about the Angelina Jolie effect on breast cancer screening

Kenneth Lin, MD

Conditions and Diseases

May 31, 2013

There is nothing like a celebrity to call attention to a preventable disease, especially if that disease is cancer. In March 2000, then-Today Show host Katie Couric, whose husband Jay Monahan died of colorectal cancer in 1998, underwent a live colonoscopy to promote uptake of colorectal cancer screening. Over the next 9 months, national colonoscopy utilization rates rose by 20 percent, a phenomenon that researchers dubbed “Read more…

Wary about the Angelina Jolie effect on breast cancer screening

Why you shouldn’t give medical advice on Twitter

Iltifat Husain, MD

Social Media in Medicine

May 31, 2013

A few weeks ago I was following an online discussion conducted by a widely followed health site.

During the discussion, they had a physician who was giving out wellness advice to users via Twitter.

That physician had one tweet in particular that terrified me.

Medical-twitter14-338x600

As the above screenshot shows, one tweet mentioned that when in doubt regarding …

Medical nomenclature is needlessly complex

Reflex Hammer

Medical Education

May 31, 2013

Try your hand at a question from one of our anatomy exams.

What nerve supplies the obturator internus muscle (a muscle in the pelvis)?

The correct answer is the “nerve to obturator internus.” It’s like answering who is buried in Grant’s Tomb.

As a time-strapped medical student, it feels like a godsend when a medical term is named in an obvious way. Even a lay person can intuit the meaning of medical terms …

How physician-owned hospitals are making teaching hospitals pay

Joanne Conroy, MD

Health Policy

May 31, 2013

I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their vigilance is the most significant driver of quality. It is a shame that physician-owned hospitals are accelerating the creation of a two-tier system …

Risk stratify patients to best use non-physician providers

Doug Olson, MD

Health Policy

May 31, 2013

“There are two diagnoses you will never make: those you didn’t think about, and those you have never heard of.”

This quote, ascribed to many an attending physician over the years, underlies what has become on some levels a vitriolic discussion of primary care delivery in the United States today. It was recently highlighted by a study published in the New England Journal of Medicine.

This article showed a real …

What parents can do to support teen drivers

Wendy Sue Swanson, MD

Conditions and Diseases

May 31, 2013

I’m going to sound very middle-aged in this post. Whenever I talk about texting and driving I tend to show my age. I don’t know how it happened or when it was that I truly became a grown-up, but when it comes to texting and driving I feel nothing like a sixteen year-old.

Unfortunately, teens are particularly vulnerable in the car. Motor vehicle accidents are the number one killer of teens …

The only thing a cleanse truly cleans is your wallet

Jennifer Gunter, MD

Medications

May 30, 2013

From time to time I get asked about cleanses. What is typically meant by a “cleanse” is only drinking a juice concoction for several days. Some cleanses add things like cider vinegar, cayenne pepper, or other supposedly “healthy” substances.

The most common reasons to “cleanse” that I hear from people who drink these things include:

Lose weight
Feel better
Remove “toxins”

Let’s start with weight loss. Cleanses are very low calorie and don’t contain protein …

Lessons from a diagnosis of skin cancer

J. Leonard Lichtenfeld, MD

Conditions and Diseases

May 30, 2013

I have been diagnosed with skin cancer.

There really isn’t much special about that, since it is a distinction I share with over 2 million Americans who have a skin cancer removed every year. Fortunately, for most, it is a cancer that is not of particular concern since most can be removed. But even those “simple” surgeries–as I have learned …

Read more…

Lessons from a diagnosis of skin cancer

A brave new world as more physicians become employed

Brian Klepper, PhD

Health Policy

May 30, 2013

Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice management headaches. On the down side, they’ll be accountable for generating significant revenues, sometimes independent of care appropriateness.

Most also are aware that the same care services they provide now will …

Fearing HIPAA: My patients are getting worse care

Rob Lamberts, MD

Physician

May 30, 2013

Dear HIPAA:

I’m sure you get a lot of hate mail, especially from folks in my profession, so when you got this letter from me you probably assumed it was more of the same. Let me reassure you: I am not one of those docs. I do think patient privacy is important, and actually found you quite useful when facing unwanted probing questions from family members. I believe the only way …

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