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Waste in medicine is disrespectful to both patients and doctors

Physician

November 5, 2012

I learned a lot of medicine during residency, but perhaps I actually learned even more about how to just get things done in a hospital. If you wanted a right-upper-quadrant ultrasound done for our patient, I was your man. I had a complicated series of unwritten algorithmic flow diagrams in my head that included handwriting an order, making sure that it was faxed to the right number, calling the appropriate …

Control Medicare costs by asking the correct question

Stephen C. Schimpff, MD

Health Policy

November 5, 2012

The Democrats and the Republican parties’ approaches to Medicare are quite different. Which approach is better? That is the wrong question. Or at least not the most important question. Instead we should consider what could be done now to actually improve patient care quality as a means to reducing costs.

Is there a good solution to the Medicare issue? Setting aside either the Democrats’ approach to basically enact price controls by …

The micro level of health reform cannot be ignored

Bob Doherty

Health Policy

November 5, 2012

Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing. But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care …

The deep psychic effects of medical care

James C. Salwitz, MD

Physician

November 4, 2012

In his brilliant 1993 satire “Et Tu, Babe,” Mark Leyner proposed a new concept in body art, which is the specialty of “visceral tattoos.” The narrator travels to Mexico where his chest is opened and the insignia of a “guy surfing a wave of lava, wearing polka-dotted trunks,” is tattooed directly on his heart. The dye used shows up on CT scans and apparently women, especially x-ray technicians, love it. …

Why speech is the Achilles’ heel of the human race

Steven Y. Park, MD

Conditions and Diseases

November 4, 2012

The Greek hero of the Trojan war, Achilles, had only one vulnerable area on his body, his heel. Similarly, modern humans also have a vulnerable part of the our anatomy, the upper airway, which simultaneously accommodates for breathing, swallowing, and speaking. The ability to talk, however, came at a price.

Evolutionary biologists have stated that speech and language development was detrimental to our health. Overdevelopment of our speech structures compromised our …

Warn patients that generic pills look different

Michael Todd Sapko, MD, PhD

Medications

November 4, 2012

Generic formulations of drugs using active pharmaceutical ingredients are an immense cost savings to patients and healthcare systems.

On the other hand, questions remain as to whether generics are truly equivalent to brand name pharmaceuticals. Are the pharmacokinetics the same? Are they bioequivalent? While this is a difficult topic to research clinically, I would argue that the vast majority of brand name and corresponding generic drugs are indeed equivalent (though there …

Does Oregon have the answer to rational rationing?

Jim deMaine, MD

Health Policy

November 4, 2012

There is a serious cost problem in USA health care which no one denies.

Yet when it comes to suggested solutions, there is a wide divergence of opinion. Attempts to use experts and evidence based guidelines for care are somehow viewed as government interfering with decisions which should be between the doctor and her patient.

States and insurance schemes have made varying attempts to deal with this. The Oregon Health …

MKSAP: 25-year-old man with abnormal liver chemistry tests

mksap

Conditions and Diseases

November 4, 2012

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

A 25-year-old man is evaluated after being turned down as a blood donor because of abnormal liver chemistry tests. The patient is healthy, takes no medications, does not smoke, and drinks alcohol socially. His parents and siblings are alive and healthy; his maternal grandfather developed type 2 diabetes mellitus at age 75 years. The …

Hearing loss is an invisible handicap

Linda Brodsky, MD

Conditions and Diseases

November 3, 2012

I was trained at a time when medical care was not a commodity. It was part art, part science, and not delivered in bits in pieces but imparted with an eye to the whole patient.

And I was trained by a master of the art and the science and the whole patient. Dr. Robert Ruben has spent his life studying the effects of communication disorders on the lives of children who …

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Hearing loss is an invisible handicap

Death is not supposed to be a comfortable subject

Eve Purdy

Medical Education

November 3, 2012

A palpable tension was present in our cab as we drove west. The taxi driver taking us to the retirement home of our patient filled the air with stories of the local prisons and the beauty of this area in the summer time. I am sure that I laughed at his light-hearted anecdotes but all I really could focus on was my heartbeat, its obvious crescendo as we drew kilometer …

Big Food is our modern day Big Tobacco

Yoni Freedhoff, MD

Physician

November 3, 2012

When it comes to public-private partnerships between health organizations and the food industry, there are many shades of grey — but Cheetos orange isn’t one of them. On September 9th of this year, however, the American Heart Association (AHA) Dallas Heart Walk saw Frito-Lay’s Chester the Cheetah riling up the crowd and helping to associate Frito-Lay and Cheetos with the emotions of the day — joy, hope, charity, happiness, spirit, camaraderie, health, …

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Big Food is our modern day Big Tobacco

MKSAP: 59-year-old man is evaluated for hypokalemia and hypertension

mksap

Conditions and Diseases

November 3, 2012

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

A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …

The chef and the surgeon have much in common

Karen Devon, MD

Physician

November 2, 2012

From the moment I first stepped into a restaurant kitchen, it felt like home; even though for the past eight years my real home has been an operating room, as I am a surgeon.

Though many on the outside may not realize it, the chef and the surgeon have much in common. Both profess modest beginnings. Cooks were slaves and surgeons were barbers. Those who did the cutting were not even …

Companies should not scare us to sell unnecessary screening exams

John Schumann, MD

Physician

November 2, 2012

A patient I’ll call Mildred came to her appointment and handed me a report from a medical screening fair at her church. She wanted to know what to do about it. The print-out said that she had a “mild” blockage in her carotid artery. They told her to discuss it with her primary care doctor (me).

You may have seen the advertisements in your local paper, or even on your local …

Every week should be National Nurses Week

Brian J. Secemsky, MD

Physician

November 2, 2012

Earlier this May, nurses around the country were acknowledged on a countrywide scale for their hard work and dedication to patient care during National Nurses Week. Unfortunately, as with most national appreciation days that I cannot personally be recognized for, I failed to take much notice.

Now that new doctors around the country, including myself, are in the process of growing into our roles as team-based healthcare providers, we are in …

I teach the anchoring error, but I couldn’t avoid it myself

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

November 2, 2012

We recently spoke with Nayan Kothari, MD, associate dean for education, chair and program director of the department of medicine at Drexel University College of Medicine/Saint Peter’s University Hospital in New Brunswick, N.J. He is 74 years old with long-standing spinal stenosis. He told us that his condition did not prevent him from biking and hiking regularly, and he was otherwise in good health. His medications included baby aspirin, atorvastatin …

Personal genomic tests may offer a teachable moment

Muin J. Khoury, MD, PhD and Katherine Kolor, PhD

Conditions and Diseases

November 2, 2012

Personal genomic tests are laboratory tests that examine up to one million or more genetic variants from a sample of saliva. These tests are available directly to consumers without involving a health-care provider. Test results are sometimes interpreted with the intention of informing disease risk and prevention strategies. Personal genomic tests are now widely available and sold directly to consumers, …

The overzealous push to get all moms to breastfeed

Melissa Arca, MD

Physician

November 1, 2012

Mommy wars aside, I think you’d have to be living under a rock if you haven’t heard the enormous and real benefits of breastfeeding. Breastfeeding is awesome on so many levels. Health of baby and mom alike. Both physical and emotional.

But, what if it doesn’t work? What if you’re a mom (like me) who couldn’t produce enough milk? Hardly any in my case.

What if you’re an adoptive parent or your baby …

More information does not equal better care

Richard Young, MD

Physician

November 1, 2012

A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary emboli. Emboli occur most often when a blood clot in the veins of the legs breaks off, travels through the right side of the heart, and gets stuck …

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