I have a 5% chance of having a heart attack in the next 10 years. That’s not so high, but it’s higher than I want it. Most of that risk is due to my cholesterol and my age. I can’t do anything about the latter, but the former is under my complete control. Cholesterol medications can improve my cholesterol significantly. So can proper diet and exercise. That’s not true of everyone; …
A doctor resolves to cut his heart attack risk
“I’m sorry, Doctor, but we can’t have you give that talk; you have a conflict of interest since you’ve been paid to do research on that medicine.”
“Well, Senator, it’s a conflict of interest for a doctor to sell those crutches in his office.”
“It is the opinion of this newspaper that physicians should declare to each patient any ownership interest they might have in a surgery center so that the …
Stop trivializing conflict of interest
The notion that dying is a right seems nonsensical to argue: death is given to all of us equally without the need of anyone’s sanction. The right to die well, on the other hand—well, that’s another matter entirely. A good death is, in many cases, something our fellow human beings have great power to grant or deny, and is therefore, sadly, a right for which we must indeed fight.
The …
A good death is a right we must fight for
When I talk about online presence to physicians, the first question I’m often asked is, “How do I remove a negative physician rating?”
The short answer is, you can’t.
American Medical News came out with an article outlining the various legal options physicians have …
Bury bad doctor reviews with a strong physician social media presence
I have not always been excited to hear patient complaints. As a younger manager I absolutely dreaded when a patient wanted to speak to me. I felt that I had little to offer a patient who expressed anger or frustration with something that had happened and I was very impatient to get past the complaint and get back to my “job.”
Now, I can’t wait to hear patients’ complaints. Complaints …
Why patient complaints are an opportunity
Some of your relatives have had cancer. And, you’ve heard that people with a family history of the disease may be more likely to get cancer.
So, should you consider genetic testing to find out if cancer runs in your family?
Here’s what you need to know to make a more informed decision.
Most cancer cases aren’t related to family history.
Only about 5 to 10% of cancer cases are due to an …
Should you consider genetic testing?
As we approach the end of what has been another roller-coaster year for our country, it seems an appropriate time for an “annual checkup” on healthcare reform in the U.S.
Like many of my colleagues, I have followed the implementation of the monumental Patient Protection and Affordable Care Act (ACA) with great interest, mild trepidation, and a small measure of optimism.
It’s hard to believe that almost two years have flown …
An annual checkup on the Affordable Care Act
“I’m not a doctor, but I play one on TV.” It seems that everybody wants either to be a doctor or to play doctor.
There are “doctoring” nurse practitioners who some derogatorily call noctors; there are RNs who get a PhD, and are thus Doctors of Philosophy; and then there are those new DNPs, Doctors of Nursing Practice.
Of course, there are Doctors of Pharmacy, Doctors of Chiropractic, Doctors of Podiatry, …
Why the future of the American medical profession is looking good
Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously …
Saying no to your oncologist is sometimes the right thing to do
One of my most vivid memories of medical school was during my internal medicine rotation, when it had become apparent to me that, despite spending my pre-clinical years studying complex pathophysiology and pharmacology, and the fine art of history-taking and the physical exam, the actual clinical work seemed to be more like a numbers game. I felt like I was always responding to a data point: a blood pressure reading, …
The erosion of psychiatric training has consequences
The instruments were indicating to the two co-pilots at the controls of the Airbus that they needed to pull back on the stick.
They held back on the stick for 54 seconds.
This is the position they were in when the Air France jet plunged into the cold water of the Atlantic killing everyone on board.
The fix?
Recognizing that a protocol or guideline might be giving them wrong instructions, seeing that there …
They don’t make protocols for patients like me
How is a doctor allowed to mess around with body parts he doesn’t understand?
If doctors were required to understand everything we touched we wouldn’t be able to touch you at all!
The human body is still a deep mystery. Doctors understand more than most people, but what we know is still a vague approximation. Just because our educated guesses often work out well doesn’t mean we have any idea what’s actually …
The myth of physician omniscience
Evidence-based medicine and health insurers generally focus on what’s medically necessary, not what’s epidemiologically relevant, not what soothes the mind of the bereaved or of the physician grieved and mystified by the loss of a patient.
Once, the autopsy was a venerated tool for medical advancement and humility. An invaluable means of learning one’s own limitations and the extraordinary diversity in nature and human physiology, it has now become an unreimbursed …
A eulogy for the autopsy, and a call for its return
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A popular teacher at our school recently gave a lovely talk about “emotional intelligence.” I was at once proud of my school for offering such a lecture and disturbed that it was necessary. Our schedules are flooded with lectures devoted to issues such as professionalism and emotional awareness. We’ve all heard stories about insensitive doctors with terrible bedside manner and outrageous faux pas by medical students, transmitted in whispers, and …
Why emotional intelligence matters for doctors and medical students
Whether you call it Health 2.0, Medicine 2.0, or e-Health 2.0, the Internet is changing medicine in ways that challenge the status quo. This article explores how a group of amateurs who call themselves “health hackers” and “citizen scientists” are trying to use the Internet to connect with other patients, run experiments, and conduct clinical trials on their own diseases.
Dr. Gunther Eysenbach states “Medicine 2.0 applications, services and tools are …
The rise of citizen scientists and patient initiated research
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a 4.5-kg (10.0-lb) weight gain. History is significant for three episodes of weight gain and facial and lower-extremity edema lasting 4 weeks in …
MKSAP: 42-year-old woman with lymphadenopathy, fatigue, and edema
As of March 2010, there were an estimated 11.2 million undocumented immigrants in the United States. Currently, three in ten immigrants are undocumented, while only one in seven of the uninsured is an undocumented immigrant. As there exists no consensus on immigration reform, undocumented individuals will gradually become a larger share of the uninsured population due to exclusion from all programs of the Affordable Care Act.
This study utilized data …
Undocumented individuals will become a larger share of the uninsured
What if we had considered the following items within health care reform?
What if physicians were able to practice medicine with reduced fear of malpractice litigation? Some estimates believe the cost of defensive medicine approaches 30%.
What if patients were to be offered a different process for conflict resolution before litigation, one that is partially driven by greed? What if this process provided a remedy which met all our future financial and …
Health reform that offers relief from fear and greed
If you have read Michael Lewis’ book, The Blind Side, or seen the popular movie based on it, you know that the title refers to the fact that quarterbacks, who are typically right-handed, can’t see when a 300-pound opponent is charging at them from the left side. Not being able to see the full picture puts the quarterback directly in harm’s way and makes it harder for his team to …
A prescription to address healthcare’s blind side
There is a fire burning in America over an issue that at times seems hotter to me than the anger against Wall Street: obesity. Time after time when I talk about taking responsibility for our individual health by eating well, maintaining a healthy weight, and exercising more, someone responds in anger.
Many would consider me to be a wellness evangelist. They would be right. For nearly a decade I was sick …
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