It was a beautiful Monday morning in May. Yawning uncontrollably, I hopped into a Ford Hybrid with my attending and drove off to visit a patient who lived two hours away from our hospital. I woke up especially early that morning since we knew the commute would take many hours.
We drove past open fields and a few cows before pulling into a driveway of a lovely house with a cute …
From the brink of hospice to awaiting a reading machine
For the sake of patient privacy, I am going to tell this story very ambiguously and hope that the insanity of it is not missed with the lack of details.
Because most of us do clinical training with non-pediatrician tutors, we have mandatory pediatric tutorial sessions. While I had already done a little bit of lung and heart listening on some children earlier on in …
The first child patient at a pediatrics rotation
by Larry Cohen
When Florida Governor Rick Scott recently signed legislation barring doctors from asking about gun safety practices in the homes of their child patients, it sounded the alarm that physicians’ roles in community prevention are chronically misunderstood. Rather than restricting doctors’ options for involvement in prevention, we should be supporting and expanding them.
Community prevention is the creation of physical and social environments that …
Doctor support critical in the fight for community prevention
by W. Gregory Feero, MD, PhD
The 10-year anniversary of the publication of the sequence of the human genome offers primary care physicians a look into how they can incorporate genomic advances into clinical care in the next decade.
The National Institutes of Health celebrated the 10th anniversary of the publication of the sequence of the human genome and the subsequent remarkable burst of scientific and clinical …
How physicians can incorporate genomic advances into clinical care
Recently, 16 states and Washington DC have legalized medical cannabis.
An additional 10 states have pending legislation. With all the attention legalized medical marijuana has been receiving, patients have started asking if they are candidates for a prescription. Well, my answer is easy. Right now it is not legal in Illinois, although it is one of the states that is pending. Even if it does become legalized, I …
Medical marijuana in psychiatric illness
Many of you are familiar with the famous “invisible gorilla” experiment, wherein an audience, being instructed to watch closely for the number of passes made with a basketball, fails to see a rather large and deliberate gorilla march slowly across the screen, stop in mid picture and thump its chest.
In fact over 1/2 of those tested failed to notice this obvious action. The predominant response is one of suspicion and …
We need a radical change in the way health care is delivered
In the wake of sudden deaths in a young athletes, the question arises – as it does after each of these tragic events – whether all young athletes should be screened for occult heart disease before participating in sports. It appears, for instance, that 16-year-old Wes Leonard had an underlying heart condition which likely could have been identified with a simple echocardiogram.
The question is controversial, and accordingly, even the …
Should young athletes be screened for heart disease?
Comparative effectiveness outcome studies have shown that while percutaneous coronary intervention (PCI) may be more effective than optimal medical therapy (OMT) for treatment of acute coronary syndrome, it is not more effective for treatment of stable ischemic heart disease.
Results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, published in 2007 and 2008 in the NEJM, demonstrated that PCI did not improve survival or prevent myocardial …
Do physicians have the courage to implement comparative effectiveness?
There is no question that bank failure, credit problems, and other issues create a situation where people find it necessary to make payments in cash, only.
While you will never need to worry about this money clearing for payment, it is still important to be aware of some of the risks associated with taking cash payments. In most cases, once you address these issues, you …
What cash only practices should be careful of when taking payments
Perhaps you are just beginning a quality improvement program or project. Perhaps you have several project improvement projects successfully completed at your healthcare site.
No matter what your level of experience, you have encountered staff who are roadblocks to your efforts. What are you to do? Ignoring them or doing nothing will imperil your quality efforts eventually. Let me share some ideas on what to do based upon my own …
Staff who resist quality improvement efforts
It’s well known that there is a shortage of primary care physicians which is only going to get worse over time.
To address this problem, Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering and Dr. Robert Kocher, a guest scholar at the Brookings Institution, propose making medical school free. They argue that medical students would be more likely to choose primary …
Fixing primary care requires more than free medical school
by Rachel Henrickson
Everyone wants to feel like they are making a difference.
This is why, in my opinion, international medical mission trips are what every med student dreams of upon completing his or her first year of medical school. With one year of basic sciences and numerous standardized patient encounters under our belt, we are already eager to utilize our skills with “real …
Experiencing Dengue fever and lessons to prevent it during travel
Dr. Lewis didn’t sleep last night.
All day he stood, heavy in full surgical scrub with a human heart in his hands, replacing damaged valves and calcified arteries until the heart beat on its own again. After he finished, there were a few hours before the transplant to get some dinner, to call home.
The heart came on a helicopter. A young man, a bad accident, a perfect heart. Dr. Lewis pierced …
Attending physicians who work too many hours need restrictions too
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Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each …
The radiation delivered by CT scanners has gone largely unregulated
by Sara Billings, RN
I believe knowledge is power. There is no more complex topic in the healthcare debate than end-of-life care. I have been a Registered Nurse for thirty years. I deal with this every day. All of us will confront this issue eventually. When it’s your turn, I hope the medical profession will guide you to the best options for you and your family.
Often I see patients who have …
Our health system defaults toward treatment rather than compassion
I’m sorry, Mrs. Lewis, for not making it to the hospital to see you yesterday.
Yesterday was one of those days when I felt like I could never catch up. My wife was going downtown for work, and we had to get up early. While she prepared, I helped my two-year-old son get dressed. We walked my wife to the train, then waited for the nanny. She was running late: I …
An apology to a terminal patient with colon cancer
by Sam Wainwright
There’s a fascinating blog post over at the New York Times math blog that has the health policy program here at New America scratching our heads, sharpening our No. 2 pencils, and dusting off our calculators.
Turns out, German mathematicians have been studying how and why the human brain seems to struggle with comprehending risk. We find it difficult to translate the …
Why the human brain seems to struggle with comprehending risk
July is the month that new resident physicians begin their training all across the United States.
Our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (ok, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.
Anxiety-filled and debt-ridden, they will embark on …
Practical tips for new July resident physicians
Meet Elaine.
We lost touch for a while, but caught up with each other recently.
Like most girlfriends, we shared adventures of love, travel, and work. I told Elaine that I left assembly-line medicine. Now I host town hall meetings-inspiring citizens nationwide to design ideal clinics and hospitals.
Elaine shared: “If I’m kept waiting, I bill the doctor. At the twenty-minute mark, I politely tell …
Patients who bill their doctor for being late
The creation of consumer-driven health plans (CDHPs), health insurance policies with high deductibles linked to a savings option and with more financial responsibility shouldered by patients and employees and less by employers, was completely inevitable.
The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating health care expenses rising far more rapidly than wages or inflation, it’s not surprising employers …
Consumer driven health care will only shift costs if implemented poorly
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