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What being a cancer survivor has taught me about food

Elaine Waples

Patient

November 30, 2012

It’s no surprise that Americans are tilting the scales in the wrong direction. We are straining our waistlines and health coverage beyond the limits.

Unfortunately we live in a culture that promotes it.

Recently, I tuned into my favorite TV food channel to watch famous chefs create exotic dishes with quail eggs and artichokes. Instead I tapped into back-to-back shows that claimed to represent American food. The hosts were a well-known southern …

The movement against obesity threatens many livelihoods

Michael Kirsch, MD

Physician

November 29, 2012

One cannot escape the issue of rising obesity rates in the United States. A current statistic predicts that by the year 2030, 42% of us will be obese. The ramifications of this ponderous eventuality could indeed weigh down and sink the nation. Some of the consequences include:

Zillions of health care dollars spent treating obesity directly.
Gazillions of health care dollars treating medical consequences of obesity.
Loss of economic productivity from a bloated …
Read more…

The movement against obesity threatens many livelihoods

The benefit of CT scans for the diagnosis of appendicitis

Skeptical Scalpel, MD

Conditions and Diseases

November 29, 2012

Amid the mounting concern about radiation exposure and future increases in cancer rates comes a report from Washington State describing the benefits of imaging, particularly CT scanning, for the diagnosis of appendicitis.

The authors collected data from some 55 hospitals of all types and sizes over a six-year period for more than 19,300 patients older than age 15; 91% of patients underwent one or more imaging studies. There were …

How pain control comes from the front and back

Shara Yurkiewicz

Physician

November 29, 2012

She had only been in the hospital twice in her life: once when she was nine and now, 60 years later. She had gotten tonsils out then. She was getting tumors out now.

Her abdomen hurt when she was awake. Her abdomen would also hurt during exploratory surgery, although she wouldn’t be able to feel it under general anesthesia. Her body would feel it, though, and could respond by dangerously spiking …

It’s amazing what I’ve learned from patients

Janice Boughton, MD

Physician

November 29, 2012

Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …

How Medicare will devalue the work of psychiatrists

Dinah Miller, MD

Physician

November 29, 2012

For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management. It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on …

The importance of diet and nutrition in cancer patients

James C. Salwitz, MD

Conditions and Diseases

November 28, 2012

Starve a cold, feed a fever. Eat a balanced diet, don’t overeat, he is so thin he should fatten up before he wastes away, avoid junk food, she needs to keep her weight down. Our society is obsessed with food and food advice, and nowhere is that more true than when dealing with cancer.

Nearly 100% of the time when an oncologist sees a new patient, they are asked about nutrition. …

I remembered again what it was like to be a patient

Maria Yang, MD

Physician

November 28, 2012

It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour.

The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop.

“I’ll let the …

Reasonable and necessary: 2 words Medicare has trouble with

Jaan Sidorov, MD

Health Policy

November 28, 2012

If you get sick, health insurance should cover all the “stuff” necessary to make you better, right?

While that sounds good in principle, Uncle Sam has made it a lot more complicated than that. As we continue to struggle with health reform, this New England Journal article on “Medicare’s Enduring Struggle to Define Reasonable and Necessary Care” is very timely.

According to Drs. Neumann and Chambers, Medicare has always covered medical services that …

Telling someone of a loved one’s death never gets easier

Kevin Dorsey, MD

Physician

November 28, 2012

About thirty years ago, after I’d completed my internal medicine residency and a rheumatology fellowship, my wife and I moved with our three-year-old son to my wife’s hometown.

There I joined a multispecialty group practice as the second rheumatologist. Over time, the plan was for me to build a rheumatology practice, but while that was happening I took on all kinds of patients, both primary-care and intensive-care. I felt very comfortable …

Prognosis near the end of life: We need better tools

Robert Wachter, MD

Physician

November 28, 2012

The human capacity to deny reality is one of our defining characteristics. Evolutionarily, it has often served us well, inspiring us to press onward against long odds. Without denial, the American settlers might have aborted their westward trek somewhere around Pittsburgh; Steve Jobs might thrown up his hands after the demise of the Lisa; and Martin Luther King’s famous speech might have been entitled, “I Have a Strategic Plan and …

We will soon be heading for a medical cost fiscal cliff

Timothy Johnson, MD, MPH

Health Policy

November 27, 2012

Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public’s radar.

Big mistake – although I do understand the public’s shifting interest in the General’s sex life and, much more serious, the heartbreaking tragedy of the renewed hostilities between Israel and Gaza.

I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – …

How insurers take advantage of the EMTALA mandate

Myles Riner, MD

Health Policy

November 27, 2012

Emergency care providers (emergency physicians and specialists on-call for the ER) are at a significant disadvantage when it comes to trying to get paid fairly for services rendered to enrollees of commercial health plans. Most other health care providers are able to: 1) screen prospective patients to make sure they will get paid appropriately for the care, 2) elect not to care for a plan’s enrollees, or participate in a …

A physician takes his flu vaccine under protest

Doug McGuff, MD

Physician

November 27, 2012

To hospital administration,

I am writing this letter to inform you that when I take my mandated influenza vaccine I will be doing so under protest and with the understanding that failure to do so could result in loss of my ability to earn income for myself and my family. Unfortunately, I do not qualify for any of the exemptions allowed by our facility. Since I am not religious, I have …

A rare case when needs of the dying should be secondary

Monica Williams-Murphy, MD

Physician

November 27, 2012

I pulled the stifling surgical mask off my face as I left my last patient’s room. I had just finished suturing a complicated facial laceration and was bone-tired from the evening. Glancing at the clock, I saw that mercifully, my shift was over.

Collapsing into my chair to finish up my charting, I was slightly annoyed when my nurse held a clip-board in front of my face, “Here is your next …

Income inequality among physicians should matter to patients

Manoj Jain, MD, MPH

Physician

November 27, 2012

Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”

This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the …

Click, click, click: How can I help you today?

Stewart Segal, MD

Physician

November 26, 2012

Click, click, click, “Hello, how are you today?”

Click, click, click, “How long have you had a sore throat?”

Click, click, click, “Have you had a fever?”

Click, click, click, “Have a seat on my exam table, please.”

Click, click, click, welcome to my day. Let me introduce myself, I’m a professional clicker. I used to be a member of a highly respected and sought after profession; a doctor. The modern world of government/insurer …

Mean doctors and nice nurses: It’s time to change our brand

Karen S. Sibert, MD

Physician

November 26, 2012

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery. She hadn’t lost weight and clearly was feeling discouraged about practically everything. She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, …

I want to be there when that cancer freight train hits

Miranda Fielding, MD

Physician

November 26, 2012

Sometimes, you can see cancer coming. What I mean is that when we sign up for that mammogram, or that PSA blood test, there has to be some tiny little part of us that says, “Ok, this time it’s my turn. This time I’m the one who’s going to get the call.”

Sometimes the cancer sneaks up on us—that nagging little cough that makes us want to—suddenly and belatedly—quit smoking. Or …

Why aren’t more people talking about physician suicide?

Pamela Wible, MD

Physician

November 26, 2012

I live in Eugene — a sweet little community with snow-capped mountains, farmers’ markets and the friendliest people around.

But a few weeks ago, one of our beloved pediatricians shot himself in the head in a public park. Earlier this year, one of our surgeons was found dead in his car from carbon monoxide poisoning.

And just before him, a urologist shot himself in the head in his backyard. Before him, a …