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Will Mayor Bloomberg win the war on prescription drug abuse?

Shadowfax, MD

Physician

February 7, 2013

Recently, there was a bit of hue and cry regarding Mayor Bloomberg’s report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department.

Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians … “It prevents me …

The nursing shortage: Why it isn’t a good time to become a nurse

David Williams

Health Policy

February 7, 2013

For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.

Yet somehow 43 percent of newly-licensed RNs can’t find jobs within …

How to know whether your cough is serious

Suzanne Koven, MD

Conditions and Diseases

February 7, 2013

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I saw 17 patients in my primary care practice yesterday. Six of them were coughing.

One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …

I wonder what Lance Armstrong tells his kids

Jennifer Gunter, MD

Physician

February 7, 2013

My membranes ruptured at 22 weeks during my pregnancy. It was the evening of July 5th, 2003. Two days later my first son was born and died. The task before me was bed rest and squeeze as many more days (hopefully weeks) out of the pregnancy as possible to save my other two sons. It was, to put it mildly, a very low time.

To pass the hours I read, slept, …

The days of the primary care gatekeeper are coming to an end

Jeffrey Parks, MD

Physician

February 6, 2013

The American Journal of Surgery had a nice little (38 patient cohort) study from the VA database that tried to determine the process by which patients make informed decisions on elective surgery. The results were rather surprising, at first glance.

Sixty-nine percent of patients decided to have surgery before meeting their surgeon, and 47% stated that the surgeon did not influence their decision. Although the surgeon was an important source of …

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The days of the primary care gatekeeper are coming to an end

Answers to common vaccine questions from patients

Davis Liu, MD

Medications

February 6, 2013

One of the true joys of being a primary care doctor is partnering and educating patients to make the best decision for themselves and their families. Though they may not always agree with what I have to say, at least I know I’ve done my best to give them the information they need to be informed. What follows are common conversations I …

5 reasons why mobile technology needs clinical trials

David Lee Scher, MD

Health Technology

February 6, 2013

I have long been a proponent of proven technology in the digital health space. Probably the most obvious reason is to dispel the generalized notion that these technologies are flimsy. The HHS Text4HealthTask Force has endorsed clinical studies in its recommendations. There certainly have been studies performed. One interesting one, the final report of The National Mobile Health Worker Project of the …

Clostridium difficile: A fecal transplant when all else fails

Janice Boughton, MD

Conditions and Diseases

February 6, 2013

The bacteria that live in our healthy guts are a garden of cooperating and competing species that help to determine our intestinal health. When we take antibiotics, we kill countless bystander bacteria in our guts and sometimes develop changes in our digestion which can be severe. Clostridium difficile infection is one of these conditions, a superinfection with a bacterium which is pretty resistant to antibiotics and causes infection of the …

Law enforcement and medicine: The ties that bind both professions

Michael Kirsch, MD

Physician

February 6, 2013

Sometimes, I feel like I belong in law enforcement. There was a time in my life that I seriously considered a career where I would haul in the bad guys and make society a better place. Of course, every American male youngster fantasized that he would one day drive the Aston Martin, get the girl, defuse the bomb, and sip on a …

Outrage: The crisis in patient safety

Jessie Gruman, PhD

Patient

February 5, 2013

Sometimes, angry patients and dissident doctors and nurses warn us about the impending patient revolution – how health care is so unsafe, of such poor quality and so expensive for us patients that we are soon going to rise up out of our beds, go to our windows and, in unison, holler, “I’m mad as hell and I’m not going to take it anymore!”

We’ll riot in the streets, …

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Outrage: The crisis in patient safety

Do we really know what is going on with health care spending?

Bob Doherty

Health Policy

February 5, 2013

Trying to figure out what is going on with health care costs is like Alice’s adventures in Wonderland, things are just getting curiouser and curiouser. To illustrate: which of the following statements do you think are correct?

1. It’s been 50 years since health care costs increased this slowly.
2. The U.S. spends more on healthcare than any other country but our health is …

What are the different types of anesthesia?

Shirie Leng, MD

Physician

February 5, 2013

For most people, anesthesia is one of the more mysterious branches of medicine. What we do for patients is done, generally, when they are asleep. You the patient don’t exactly know what we are going to do, or how it’s done, but you put yourselves in our hands willingly. It’s sort of a weird relationship we have with other humans. We have done our job right if our patients don’t …

Why doctors and nurses should be required to have flu shots

Robert Wachter, MD

Physician

February 5, 2013

I was recently speaking to the clinical leaders of a mid-sized hospital, and a senior administrator posed the question, “should we require our doctors and nurses to get flu shots?” The answer, I said, is yes, and it isn’t just to prevent the flu. It’s to get into the habit of making our folks do the right thing when it comes to patient safety.

Preventing the flu is very important. In …

Should medical school deans have ties to pharma?

Deep Ramachandran, MD

Physician

February 5, 2013

One of the first posts I wrote was a about how pharmaceutical reps provide lunch for physicians while presenting information about a medication that they are promoting. The post, and others like it, have generated visceral reactions on the part of the public. A similar article to the one that I wrote prompted comments like “Get over yourself and buy your own lunch” and “I’m certainly glad …

What is observation care? Clearing up common misperceptions

Robbin Dick, MD

Health Policy

February 4, 2013

To treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.

Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, …

The ethics of EMR: How unproven technology affects patients

Wes Fisher, MD

Health Technology

February 4, 2013

The implementation of the electronic medical record (EMR) in American medicine gained a powerful foothold in medical care with the passage of the American Reinvestment and Recovery Act (ARRA) in 2009. With the passage of this act came the promise of improved efficiencies, safety and ultimately reduced cost delivery for health care. Also, some $18 billion dollars in financial incentives were offered to physicians …

Saying goodbye: Seeing a patient just admitted to hospice care

Kathy Nieder, MD

Physician

February 4, 2013

It’s Friday afternoon and I check the day’s schedule. A name jumps out at me and I groan a little and worry — what am I going to say to someone I’ve treated for twenty years, who’s my age and just been admitted to hospice care? If this is goodbye, how do I as a physician, who is more than an acquaintance but not quite a friend, handle this appointment?

All …

Experiencing the revolving door of physicians in the hospital

Elaine Waples

Patient

February 4, 2013

Complications from my cancer sent me to the hospital again recently. The news that I was in trouble came unexpectedly from my oncologist’s office Thanksgiving eve, following a routine blood test. “Your liver numbers are out of whack.” My response was “Really?” as if I’d been notified that my driver’s license had expired.

I was diagnosed with a blocked bile duct and I …

Is Lance Armstrong really a bad guy?

Rob Lamberts, MD

Physician

February 4, 2013

“Lance Armstrong is a bad guy who has done some very good things.”

These are the words of a sports radio personality I listened to yesterday. He was obviously commenting on the confession (to my pal Oprah) by Armstrong about his use of performance enhancing drugs. The sportscaster, along with many I heard talk on the subject, were not as upset by the …

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Is Lance Armstrong really a bad guy?

A view from Mexico: Reforming resident work hours

Cesar Lucio, MD

Medical Education

February 3, 2013

Mexican medical residents have been submerged in a bygone system for decades. More than 100 work hours a week, scanty pay and psychological warfare are the everyday burden for residents in our country. You can read more about the working conditions of Mexican residents in my guest post, “The life of a medical resident in Mexico.”

Gradual progress is being made thanks to 30 years of pushing …