Today I went to Middle of Nowhere, Ireland for a rural lumps and bumps clinic. I really enjoy the outings to the country, hanging around the little hospitals, and seeing the old farmers who drive in on their tractors (true story).
I had the chance to see a nice variety of patients: from swallowing difficulties to sebaceous cysts, urinary retention to infected toe nails. For me the real fun is with …
A Canadian medical student training in Ireland
In 2000, nearly 60% of physicians were practicing independently. Compare that to two years from now, when it’s predicted that just 33% will continue to practice solely outside of a larger health system. According to a report from Accenture, the global consulting company that released those figures, between now and 2013, the rate at which independent doctors are being employed by larger systems will increase by 5% …
How physicians develop their careers is undergoing a fundamental shift
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated for a 2-year history of infertility. He and his wife have been unable to conceive since marrying 2 years ago. Analysis of a semen sample provided 3 weeks ago during an infertility evaluation showed azoospermia. The patient has a strong libido …
MKSAP: 25-year-old man is evaluated for infertility
For years, it has been widely known throughout the medical profession that basic education in nutrition for training physicians has simply been ineffective. And whether this failure was due to a lack of time or simply a failure of emphasis, the point remains that the medical profession in general is woefully inadequate when it comes to a sound knowledge base related to nutrition and its effects on optimal health. …
Does your doctor really know what you should be eating?
On July 24, 1998, a psychotic schizophrenic gunman entered a side entrance at the U.S. Capitol. As he approached Rep. John DeLay’s office, he exchanged fire with two Capitol Police officers who later died of their wounds. The gunman was badly wounded as well.
Senator Bill Frist, a cardiologist, was leaving the Capitol when Congressional aides informed him that some men needed urgent medical assistance.
A New York Times article tells …
Non-judgmental regard can show the best of humanity
In New York, I worked for an organization called Project for Psychiatric Outreach to the Homeless (PPOH). It has a humble history: Over 20 years ago, a group of psychiatrists were sitting around and discussing the need for psychiatric services for the homeless. They decided to volunteer their time and skills to this population.
The organization grew and, for both administrative and financial reasons, eventually became part of another social …
The fiscal realities of health care are demoralizing
Health care professionals are a cynical lot. We joke about the “fad or buzzword of the month,” usually some vague concept heralded by the powers on high. Our job is to promote the idea, knowing full well that the “next big thing” is probably right around the corner.
Take “patient-centered.” It sure feels like a buzz word. I suspect most hospital and physician executives, and their ad agency partners, …
Why hospitals and physicians should get serious about patient-centered care
Tom Sullivan, blogging over at Policy and Medicine, recently noticed another flurry of activity in the long running debate about conflicts of interest. His post is titled Coordinated Ad Hominem Attacks on Physician-Industry Relationships in Guideline Development: The Next Frontier?
He opens, saying, “Recently, we saw concerted attacks on clinical guidelines committees, but interestingly, not on the science coming out of them. Instead, the attacks were focused on whether the writers …
Judging a guideline just by financial interest is intellectually lazy
The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.
Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine …
Stop paying for tests that don’t improve health
Six months after Congress passed the health reform law last year, the Institute of Medicine of the National Academy of Sciences issued a landmark report on nursing. Although seemingly separate events at the time, it’s clear now that they are integrally linked: Never has quality care been more dependent on the total engagement of nurses as well as other health professionals.
At its core, the Affordable Care Act is about …
Quality care is dependent on the total engagement of nurses
I remember when my best friend was in the hospital thirty years ago and I brought her 3 year old daughter to visit. My friend could not speak. She could only blink one eye and was paralyzed on one side. How she was able to communicate was through the blink of her one eye. I felt her energy of wanting to spend time with those she loved. It was Christmastime …
Compassionate care is a crucial component of care
The revolution in medicine brought about by greater understanding of genomics has led to a number of targeted therapies in cancer care.
The basic concept is to first find the genomic change or mutation that leads to a disease, then learn its gene product and then develop a drug that inhibits the action of the aberrant gene product. The first was imatinib (Gleevec) for chromic myelocytic leukemia (CML.) When a …
Targeted therapies improve cancer treatment
The wards had an odd sanguine feeling that day. The large glass pane doors were streaming a glow from the summer outside, and all was right because I had actually managed to have a lunch break. The High Care Ward is where the most intense monitoring is done so that we doctors can observe suffering in slow motion. I can’t remember what brought me there but in the first bed …
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Marcie transitioned to my care when she turned sixteen. She felt too grown up now to be in the same waiting room with “kids” at the children’s clinic. But she wasn’t doing well.
Her pediatrician had suspected the problem shortly after birth. She wasn’t growing normally, had nasal congestion, and more respiratory infections than usual. A sweat chloride test was ordered which was positive. The diagnosis was cystic fibrosis (CF). The …
Discussing end of life issues with a teenager
With just a few minutes of research on prostate cancer, you will find that it is the most common cancer in men; approximately 1 in 6 men will develop prostate cancer in their lifetime. In these few minutes you will also identify the only two methods available for prostate cancer screening: PSA tests and digital rectal exams (DRE). Alone, these exams are not very sensitive in detecting prostate cancer, …
PSA testing: Information is better than ignorance
One might assume that inmates in correctional facilities would not be influenced by big pharma’s direct-to-consumer advertising (DTCA) strategies. After all, their communication channels with the outside world have largely been silenced.
However, many do have access to television. And despite an increase in online pharmaceutical marketing, TV remains a common medium for trying to persuade patients to “ask your doctor” about drug X. Inmates also read magazines, another common …
Direct to consumer advertising works in correction facilities
During my transition from public to private health, I have indeed noticed some interesting differences that have forced me to practice medicine a perhaps a tad differently. One big surprise: in private health, I have to admit that I have been pretty astounded to see that my patients quite heavily rely on the Internet before they even come to see me for their given ailments.
In public health, some of my …
5 tips to evaluate medical websites
In May of 2001, I got sick with what the doctors thought was an acute viral infection. But I didn’t recover. As the months went by and I didn’t get better, I felt as if I’d entered a parallel universe that I didn’t know existed. One reason this universe is largely invisible is that many people living with chronic pain or illness don’t look any different from those around …
The challenges of living with invisible pain or illness
Cancer screening has always been an emotional topic.
In recent years, both prostate and breast cancer screening have come under increasing scrutiny. Studies are beginning to question the benefits of early detection, and, in the case of prostate cancer screening, whether more harm is done than good.
In fact, the USPSTF recently downgraded their prostate cancer screening recommendation.
In a recent study from …
The power of gut feeling in cancer screening
Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who wrote those thousands of articles I’ve read? Dr. Seuss?
Evidence based medicine, or EBM, may be just another way to remove a physician’s autonomy. This trend has marched on for years, …
Evidence based medicine removes a physician’s autonomy
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