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Should spiritual beliefs play a role in end of life care?

Physician

February 12, 2013

William would come to see me every three months for his COPD (chronic obstructive pulmonary disease). We would chat about his disease, his meds, and his grief. He had lost his wife a few years back, but after 52 years he found it very hard to be without her.

On one visit he said, “Doctor deMaine, can I tell you something – and promise you won’t think I’m crazy?”

“Sure.”

“Well, my wife …

Diagnosed with brain cancer: An insurer adds to the nightmare

James Bliwas

Patient

February 11, 2013

When my 40-year old sister was diagnosed with terminal brain cancer, her one, overriding wish as the days ticked down was to die in her own home with her husband Steve and me sitting next to her, eating meals she liked that we cooked as opposed to coping with the institutional food she was being served, and for her three beloved cats to be lying on the bed with her.

It …

The creative destruction of the American family physician

Mitchell Brooks, MD

Physician

February 11, 2013

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Medical knowledge, technology and rapid clinical advances in related scientific fields are expanding in an almost exponential manner. It is thus impossible for any individual or any medical specialty to absorb and implement these strides. Consequentially we physicians and other caregivers not only tend to specialize in medicine today, we are essentially ordained to subspecialize as a result of this knowledge explosion.

The …

OpenNotes in geriatrics: 6 awkward concerns

Leslie Kernisan, MD, MPH

Physician

February 11, 2013

I found out this past weekend that the VA will be making clinician progress notes available for patients to view on the MyHealtheVet portal. In other words, the VA is going OpenNotes. (Note: I was a primary care provider in geriatrics clinic at the San Francisco VA from 2006-2010.)

My first reaction was to be impressed by this bold progressive move.

My next reaction was to …

An epic fail when it comes to mental health

Peter Elias, MD

Physician

February 11, 2013

Sometimes the health care system just does not work.

I had seen him one week earlier on a Friday afternoon, accompanied by his estranged wife. They were there because of concern about increased depression. He told me that he had stopped taking his lithium and paroxetine (Paxil) several months earlier because he felt they weren’t working. He also readily admitted to having returned to the habit of drinking one or two …

Needle exchanges: When the perfect is the enemy of the good

Ishani Ganguli, MD

Physician

February 11, 2013

Between 7:30 and 10 a.m. on a glacial late November morning, a tall white van lingers at a street corner in Boston’s South End. I consult my iPhone one more time to confirm that I’m in the right place and knock on the vehicle’s glass-paned door. Ritchie, with his oversized Las Vegas baseball cap and faint smell of cigarettes, ushers me inside and I settle in across from him on …

10 reasons why your kids are picky eaters

Lilli B. Link, MD

Conditions and Diseases

February 10, 2013

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If only it was as simple as looking into our old Magic 8 Balls® to find out if it is “very doubtful” or “decidedly so” that refusing to stop at the Good Humor® truck on the way home from school will be the right thing to do for our children. It is worries like this, along with the challenge of raising children …

A patient cheats death and changes two lives

Monica Williams-Murphy, MD

Physician

February 10, 2013

Throughout the course of my career I have probably been with hundreds of people as they transitioned into and out of death. Although I am familiar with what this journey looks like, I have not yet been privy to the journey myself. Rarely though, I have had the pleasure of listening to someone who has journeyed back from death and arrived with a story to tell. Regardless of your position …

A virtual office visit for your cold is not a good idea

Kevin Pho, MD

KevinMD

February 10, 2013

A version of this column was published on January 13, 2013 in USA Today.

Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.

I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an …

Evidence based medicine: Go beyond the headlines and dig into the data

Marc Cohen, MD

Conditions and Diseases

February 10, 2013

Labor Day weekend, a young man in his early 50s came into our hospital.

He had multi-vessel coronary artery disease. I sent him in for surgery. Every one of his vessels was blocked. The surgeon came to me and said he couldn’t find enough veins to bypass all the occlusions.

There was an artery in the back of the heart, and he didn’t have any veins left to work with. Let’s sit …

Idiopathic neuropathy: 2 steps providers can take

Shanna K. Patterson, MD

Conditions and Diseases

February 10, 2013

It is estimated that over 20 million Americans have neuropathy. Many people don’t know that prior to the advent of the obesity pandemic and the associated rising rates of diabetes, leprosy was the most common cause of neuropathy worldwide. Although it is now widely recognized that diabetes is the most common cause of neuropathy, for up to 30% of patients the cause of their neuropathy remains unknown. These cases are …

Should we expect patients to think about costs?

Skeptical Scalpel, MD

Health Policy

February 9, 2013

Not long ago, I blogged about a plastic surgeon who aggressively pursues patients who refuse to pay her bills. The state is suing her to make her stop and also considering lifting her medical license. The central theme is that she makes patients who she sees in the ED to sign a form stating that they will pay her. It is unlikely that the patients are aware of …

How pushing the Triple Aim ignores doctors and their patients

Margalit Gur-Arie

Health Policy

February 9, 2013

Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs
–ihi.org

If you stop to think about the holy grail of health care reform, also known as the Triple Aim, it sounds like a grand challenge involving wizardry or wishful thinking or worse, propaganda for the masses, particularly the last part. It’s like attempting to build a better driving machine, with better fuel efficiency at lower cost. …

Doctors lack an analytic engine: Why we need EMR 3.0

David B. Nash, MD, MBA

Health Technology

February 9, 2013

Health information technology (HIT) has had a tremendous – and mostly positive — impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver.

Like most of my colleagues, I can tick off at least five or six large “pioneer” corporations – companies like Epic, Cerner, Allscripts, Siemens – in the forefront of the technology explosion that yielded …

Why I hold off on antibiotics for my cough

Edward Pullen, MD

Medications

February 9, 2013

For as long as I can remember I have tended to develop a bad cough nearly every time I get sick in the cold and flu season. I’m not sure if I have a minor tendency to bronchospasm or if my years of passive smoke exposure as a child somehow damaged my lungs. Who knows, but I seem to have the tendency for every URI become a lingering bronchitic cough.

In …

I didn’t become a doctor to bankrupt my patients

Jordan Grumet, MD

Physician

February 8, 2013

I have come to terms with making difficult decisions. I accept the possibility of committing a mistake that will cost a life. But I never signed on to bankrupting my patients. Never!

I had been up all night tossing and turning. The stat CT scan was deemed unnecessary by the insurance company. My patient called crying saying he couldn’t afford the thousands of dollars in charges. Never …

When should a physician obtain a palliative care consult?

James C. Salwitz, MD

Physician

February 8, 2013

I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months. She was bidding me adieu, because I had referred her to hospice.

There is confusion about the role of the primary doctor, when a patient …

When patients feel trapped by doctors and the medical system

Leana Wen, MD

Physician

February 8, 2013

An excerpt from When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.

Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a headache. When she woke up this morning, her head hurt …

Why we should nurture creativity in medical residents

Vineet Arora, MD

Medical Education

February 8, 2013

I recently had the opportunity to read Daniel Pink’s Drive. I read it partly to understand why pay-for-performance often fails to accomplish its goals for complex tasks, such as patient care. However, the thing I found most interesting about this book was the way in which creativity is deliberately inspired and cultivated by industry.

I could not help but think about why we don’t deliberately nurture creativity in medical trainees. Why …

Let doctors know if you’re using alternative medicine

Claire McCarthy, MD

Physician

February 8, 2013

Lots of people are using complementary and alternative medicine (CAM) these days—things like vitamins, homeopathic or herbal medicine, chiropractors, acupuncture or massage therapy. But they don’t always tell their doctors about it.

In a study in the journal Pediatrics, researchers in Canada found that among kids with chronic health problems, 64.5 percent of them were using some form of CAM—but more than a third didn’t tell their …

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