Frankly, it rankles me when people use the term “healthy fats.” We don’t make a distinction like that when we’re talking about carbohydrates, although there are certainly carbs that are nutritious and carbs that are not.
Consider the Atkins diet. I like to believe that Dr. Atkins was on the right track, but that he had some of the details wrong. Clearly, he realized that there was something about carbohydrate in …
A recent study confirmed that the doctor’s office may be one of the worst places to determine if your blood pressure is under control. The automatic rise in tension many people experience when they are being scrutinized contributes to artificially high blood pressure readings. Although many times the only way improve one’s blood pressure is through treatment (such as medication, a low salt diet, and weight loss), other times …
Simple tips to improve your blood pressure checks
Until recently, there was a financial difference between performing a “consultation” and a “new patient visit” for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).
In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all. Let’s just use this understanding as the brief background for what I’m about to say.
I …
Billing an established patient visit as a consultation
Cheryl and Susan arrived at the hospital at 6:30 AM. As was their routine, they stopped for their Starbuck’s latte and shared family stories as they walked toward the ICU. The two were well known pranksters but were widely respected for being top notch ICU nurses. The whole crew there was like a family. They went to baseball games, picnics, and vacations together. Today was like most other days. They …
Gallows humor is only a temporary release from a traumatic situation
While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.
But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …
Why do non-profit hospitals compete with each other?
There are two crises in America, both of which have a profound effect on the economy. The cost of healthcare is eating away at our ability to finance other needy areas. Poor performance of our educational system is weakening our international competitiveness. Both healthcare and education are at the precipice of complete collapse. They both deliver glaringly inferior results with prohibitive expenditures. The performance of our healthcare system relative to …
How the crises of healthcare and education are related
As a current fourth year medical student, one of the main things I look forward to after I graduate is trading in my white coat. For medical students everywhere, it’s a huge sign of accomplishment to shed the short coat and don the long one. It means you are now a real doctor.
Medical students are required to wear short white coats that might reach to their fingertips, if they’re lucky. …
It is natural for medical students to feel long white coat envy
When the patient jokingly touched my nose, I knew I had muddied the boundaries between us too much and it was too late to go back.
(Note: Except for the aforementioned sentence, all of the patient’s details and quotations have been fabricated. Events from the interview and exam have been drawn from a conglomeration of patients and scrambled to illustrate a general theme.)
It didn’t happen until the end of the interview, …
When easy familiarity blurs the boundaries
At this point, few would argue against the need for increased oversight of the legions of so-called pain management clinics that have sprung up in the past decade.
After all, an annually increasing majority of them are nothing more than lucrative cash and carries for the legal sale of prescription narcotics to anyone with a need or want — and the cash in hand. They have become a public mental health …
How pain as a vital sign contributed to prescription pill mills
The release of Steve Jobs’s biography launched a second round of well-considered articles about Jobs and his legacy. It has launched a rich, detailed, almost “too soon” debate about Jobs as a man and how we have come to define genius in this day and age. Here at Doximity (an Apple fanboy shop if there ever were one), our head of design has already joked that after reading Isaacson’s biography, …
Why Steve Jobs was the ultimate physician
The milestone of the world’s population reaching 7 billion is a fitting time to reflect upon life expectancy. Life expectancy is a rough marker of humanity and medicine’s progress in the age-old battle to attain old age.
Those born in the US this year are expected to live until 78.37 years of age if current mortality rates persist. This puts us at a sobering 50th in the world.
How long is someone …
Life expectancy is a simple number with immense ramifications
Lately, there has been increased emphasis on “preventative” care in the US now that there are some mandates under the Affordable Care Act. The U.S. Preventative Services Task Force (USPSTF) exists, which is a panel of private sector experts who recommend evidence-based preventative screenings for certain conditions based on factors such as age and gender.
As a family nurse practitioner, I base a large part of my practice on wellness and …
Is preventive health really preventative?
A recent $3 billion settlement between drug giant GlaxoSmithKline and the FDA really got me thinking. On one hand, it’s a breathtakingly huge number, breaking the old record of $2.3 billion set by Pfizer a couple of years back. And there are some initial indications that the pharmaceuticals may be cleaning up their act a bit, expanding their compliance departments, and reining in their sales forces in order to …
When FDA fines become the cost of doing business
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I noticed something different about my driving habits lately. At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are supposed to do: stop.
I don’t do that anymore. I always look to see if the road is clear, and other drivers have indeed stopped. And then I go. I have …
In both my driving habits and my surgical practice, I look both ways
I’ve had irritable bowel syndrome for 20 years, and I’m angry. About the pain, and the suffering, and the limited diet, and the huge impact that it has had on my life. But mostly, I’m angry at my doctors. No, they didn’t misdiagnose me. No, they didn’t harm me. No, they didn’t treat me like dirt. But they still made me angry.
Before we go any further, let’s get one thing straight: I know …
Why patients with irritable bowel syndrome are angry at their doctors
I am a writer as well as a doctor. My heroes are Keats, Chekhov, Williams, Coulehan, Coles, and other physician writers. And those greats of medicine too, known and unknown, who have spent their lives caring for people.
My writing is short. Really short. If it isn’t poetry, it scans like poetry. And one act plays. As in The Ride, my latest collection. Someone said if you can’t write poetry, you …
Lives focused through the lens of medicine will burn your eyes
I see five major themes in cancer care advances: new approaches to screening and diagnosis, better understanding of the role of viruses as causative agents, targeted therapies, new technologies and improved approaches to ensuring better quality of life.
Screening for the most common major cancers has been straight forward for years – women should get an annual mammogram and Pap smear, men should get a PSA test annually, both should get …
New approaches to cancer screening and diagnosis
Recently the Michigan Task Force on Nursing Practice hosted a regional forum in my area. I was fortunate enough to attend and hear from the RN’s there the many issues that they face, which are varied and challenging. The state wanted to hear from this forum of RN’s what changes were needed in the state’s nursing regulations so that certification could be updated to reflect the current nursing environment. It …
Legislating the duties that can be performed by a nurse
The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed. Some 21 states use a variation of the old definition …
The new definition for a medical emergency
When patients are sick enough to require hospitalization, medical decisions often involve nontrivial tradeoffs between risks and benefits. They require discussions with patients and families from a variety of cultures and backgrounds. And sometimes these discussions break down.
Patient-clinician communication is increasingly recognized as an integral part of clinician competency. Indeed, family-centered rounding, increasingly practiced at Children’s Hospital Boston, is a critical step in this direction. Fully adopting this practice surely …
Including communication as a system in work rounds
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