In the wake of the Newtown shootings, as a country we are all taking a step back, looking at our laws and our policies and thinking about what we can do to prevent unspeakable tragedies like the deaths of those children from happening again.
I am not a gun owner and never will be, but I am not advocating getting rid of all the guns. I totally get that there are …
If I’m wrong about guns, can you please explain why?
I recently blogged about the question of what the difference is between a doctor and a nurse, now that advanced practice nurses can do so many of the same things physicians do. As both a nurse and a doctor I thought maybe I could wade into that quagmire. In that post I suggested that the real difference is one of ultimate responsibility. A reader pointed out that this …
The medical model versus the nursing model: A difference in philosophy
If you drink coffee, I have some bad news and some good news. The bad news is that the more cups of coffee you drink, the higher your risk of dying early. The good news is that if you “risk adjust,” then the more cups of coffee you drink, the lower your risk of dying early. Let me explain.
According to a Read more…
Can coffee help you live longer?
We were instructed not to knock, that the examiners would invite us in when they were ready. Even under the bright lights and unforgiving atmosphere of an operating room emergency, I couldn’t recall being this nervous. Yet today, in the dimly lit hallway of a three-star hotel, my hands trembled without a bleeding patient or sharp instrument anywhere nearby. I glanced left …
It’s not hard to do surgery, it’s hard to get to do surgery
I know what I want in healthcare. I want it to be efficient, effective, thoughtful and inexpensive. I want it to create healthy people who don’t need very much health care. I want it to involve elegant solutions to problems that take less time, money and effort. I want it to be so much easier and less expensive that taking care of all of our people uses even less resources …
What does American healthcare want?
How to effectively keep tabs on a patient’s multiple medical problems? And how to do so without losing sight of the whole person?
The first question is the one I wrote about in a recent blog post. The second was the theme of many of the responses and also LinkedIn.
I love this second question; it’s an issue that’s always been of interest to me. Plus it’s especially relevant in geriatrics, where …
How to effectively follow a patient’s multiple medical problems
The unexamined life is not worth living.
–Plato
There are obstacles to dignity at the end of life. Disease inflicted pain and debilitation, cost and confusion, poor planning and fear, all aggravated by our societal ignorance regarding dying, result in unneeded suffering and isolation. In addition, it occurs to me that a hindrance to control and quality is that we are overwhelmed by the pressure of our day-to-day lives. In other words, …
When I first heard of the tragic accidental shooting death of a 2-year old girl by her 5-year old brother, at first I thought it was because some adult left their gun out and was not supervising the children properly.
Not too many things surprise me anymore, but this time I was surprised when I found out that poor supervision was only part of the issue and that the 5-year-old was …
Giving a gun as a gift: How young is too young?
As I sit on this old wooden pew, I rock side-to-side to ensure that blood flows to each part of my bottom. We’ve been at this rented church for 75 minutes listening to the sounds of my daughter’s violin class recital and now it’s time for the last piece.
A high school student with a large tattoo of a stanza on her left …
3 steps physicians use to become an expert and avoid mediocrity
The fight for equality for lesbian, gay, bisexual, and transgender citizens has been a long and storied one. We have fought for rights related to family, marriage, anti-discrimination and service to our country. We have reveled in the freedom to be openly ourselves in public and have cheered as the fight for equality became a priority not only for ourselves but also for our straight allies. As Rhode Island recently …
LGBT health care equality: Be your patient’s advocate
The real problem is not whether machines think, but whether men do.
– B. F. Skinner
When I was a relatively junior member of the surgical faculty, an even more junior member came to my office and announced that a general surgeon and gynecologist in Georgia had performed gallbladder surgery with a laparoscope.
“Stupid stunt,” I snorted, or something equally derisive and all-knowing.
Some weeks or months later he returned to the topic, telling …
Will the da Vinci robot go the way of laparoscopic surgery?
Prostate cancer is the most commonly diagnosed non–skin cancer among U.S. men. It can be life-threatening, and many men have cancer without knowing it. For those reasons, doctors sometimes look for prostate cancer in healthy men (screen for cancer) by measuring blood levels of prostate-specific antigen (PSA), a protein secreted by the prostate gland. High PSA levels can be caused by cancer and may lead a doctor to take a …
How one urologist approaches PSA testing
You might think a thing sold by a huge manufacturer of children’s toys and furniture as a “sleeper” would a safe, appropriate place for a baby to sleep. It is, after all, called a “sleeper.” But it is not a safe place for your baby to sleep.
The Fisher Price Newborn Rock ‘n Play Sleeper is a sling-shaped baby holder sort of gizmo, …
Is this Fisher Price sleeper safe for infants?
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A few weeks ago I had the distinct privilege to attend TEDMED as a Front Line Scholar. TEDMED isn’t your usual medical conference; artists share the stage with scientists and your notions of what healthcare could be are shifted.
While the talks I attended were often inspiring and eye-opening, the interaction with fellow attendees was by far the most enriching aspect of the …
Why the conversations that start in TEDMED need to continue
This is a call to arms to my fellow providers to protect our patients from themselves and our willingness to comply with their requests. We live and practice in a society filled with fear of medications and their side effects. People will not take blood pressure, cholesterol, or diabetic medication because of the side effects they have heard or read about.
However, these same patients will take antibiotics every day of …
Prescribing antibiotics: It’s time to draw a hard line
About half of all children in the United States with an autistic spectrum disorder are diagnosed at age five or older, according to a May 2012 NCHS (National Center for Health Statistics) data brief. However, many parents are suspicious much sooner. As part of autism awareness month, we bring you clues into toddler development that can alert you to a potential issue.
Pediatricians often use a questionnaire called the M-CHAT (Modified …
How to know if your toddler has autism
A few years ago, I sat in a coding lecture for urgent care providers given by a very entrepreneurial physician assistant. An emergency room doctor, who had recently established his own private clinic, put up his hand to ask a question. He seemed puzzled.
“I can see your point about coding at a higher level for a sore throat when I was younger,” he said. “I used to take longer to …
3 ways for doctors to reclaim their value
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old woman is evaluated during the fourth week of an uneventful pregnancy. She has a 3-year history of primary hypothyroidism due to Hashimoto thyroiditis that is treated with levothyroxine, 125 µg/d. She also takes prenatal vitamins and iron sulfate.
On physical examination, temperature is 37.1 °C (98.8 °F), blood pressure is 128/80 mm Hg, …
MKSAP: 27-year-old pregnant woman with hypothyroidism
Bobby was admitted to the hospital once again with overwhelming fatigue and shortness of breath. Yet this 37 year old farmer looked the picture of health. He grew up on a farm rising before dawn, milking cows and working long days in the fields with hay or corn. He was never seriously ill as a child and was a good football halfback in high school.
But this was his third admission …
Medical problems can be uncovered by a history and physical exam
“No aspect of health IT entails as much uncertainty as the magnitude of its potential benefits.”
A few years into the Meaningful Use program, it seems this quote from a 2008 Congressional Budget Office report entitled “Evidence on the Costs and Benefits of Health Information Technology” may have been written with the assistance of a crystal ball.
Fast forward to 2013.
“Just from reading a week’s worth of news, …
Why it’s risky to pay for a proprietary health IT system
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