Every now and then a tonsillectomy patient bleeds after arriving back on the ward after surgery. On this occasion, there was nothing remarkable in the event itself. What was remarkable was the efficiency of the response.
I got the phone call from the ward sister at 11:05 am, and immediately drove the short distance back to our local hospital. I checked on my patient in the ward, confirmed the bleed, …
What big hospitals can learn from smaller ones
Although the famous clip from Jerry Maguire is about a sports agent trying to negotiate a new contract for an entitled egotistical football player, every time I see it, it reminds me of work. Put a white coat on Tom Cruise, and transplant them from a shower room to an exam room, and it becomes a pretty accurate portrait of my daily conversations with patients.
In fact, when I was on …
How medicine can be like a scene in Jerry Maguire
Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. Bottom line: There is no consensus what the future holds.
There is no question that reform is necessary to avoid absolutely bankrupting the country. However, the recent legislation is a work in progress, not yet an achievement. A change in congressional leadership could derail, …
Pro-actively improve quality, rather than reacting to liability concerns
by Francine Gaillour, MD
A piercing and entertaining article in Harvard Business Review online, “People Are Not Cogs,” by Nilofer Merchant, author of The New How, offers keen insights worth considering by healthcare executives and physician leaders.
Merchant makes some incisive points about how industry has traditionally measured productivity and hence factored in the value of the individuals on the production line:
In spite of a forest’s worth …
Physicians are not cogs: How we can be great in healthcare
I rarely get sick and have no known disease. I’m fit as a fiddle for an aging male. I jog four times a week and have strong vital signs (blood pressure is 120/70). I have no family history of heart disease.
Besides complying with adult screening recommendations and vaccines, I only see a doctor when I have a persistent cold or sore throat. I fear going to a doctor because …
Unnecessary screening tests for asymptomatic adults
by Mona Mangat, MD
“We take our children to pediatricians for medical care — not moral judgment, not privacy intrusions.”
This quote by an NRA lobbyist troubles me. The statement reveals degradation in a sacred relationship – the physician-patient relationship.
This sentiment was prompted by a Florida pediatrician that refused to continue seeing a child after the parents refused to answer whether they kept firearms in the home. Governor …
Docs vs Glocks, and the slippery slope of HB 155
I had an interesting exchange with one of our nurses recently about a long-term patient of ours.
The e-mails went something like this:
Got a fax from —-’s insurance that his Lipitor won’t be covered anymore. They will cover simvastatin, lovastatin, and pravastatin. Let me know what you want to do.
Charlie
He’s on darunavir, and all three of those statins are contraindicated because of drug-drug interactions. Rosuvastatin?
Paul
Checked with them — rosuvastatin needs …
How switching from brand name drugs to generics is sometimes absurd
All thoughtful physicians I know consider the historical theory and philosophy of homeopathy to be rubbish, balderdash, preposterous, BS, or, politely, NOT PLAUSIBLE; thus, not even worth testing for safety and efficacy.
Then, why, when one asks Mr. Google by entering … Homeopathy … and clicking, does one receive 9.9 million results?
And, why does the National Health Service of the U.K. continue to fund homeopathic hospitals, clinics, and treatments?
And why are …
The accidental genius of homeopathy thrives
As undergraduate premedical students, we learned about narrative medicine by chance in a New York Times article titled “Learning to Listen.”
After exploring the research of Dr. Rita Charon, we were both drawn to the new field and what it had to offer us as future medical professionals. The Times article explains, “Through literature, [Dr. Charon] learned how stories are built and told, and translated that …
Narrative medicine means more effective healthcare
Though there are few subjects as immediate to my experience as that described in Gardiner Harris’s article in The New York Times, “More Doctors Say No to Endless Workdays,” perhaps the truest indication of my opinion on the matter may be the fact that, upon first glance at the headline, I didn’t feel much need to read the rest of the article. More doctors say no …
We want our doctors to be perfect, but they’re human too
How and when do new medical technologies become the standard of care?
A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.
Looks a bit like a medieval torture doughnut.
The only thing that surprises me about this is that it’s not more.
Way more.
I remember the first time I actually ordered a CT scan on a patient all by myself, in …
Before getting a CT scan, ask your doctor if its really needed
When Professional Responsibility class began, I was most excited at the idea of not having to sit through another lecture on proteins and cell transport.
I was also looking forward to the class where we would be using clickers from the Library to poll audience responses during the lecture, as doing something while listening to someone talking has a much higher success rate in getting …
Is First do no harm really part of the Hippocratic Oath?
Should all health care professionals have a social media presence?
No, not necessarily.
Did I surprise you? Here I am rattling on and on about how health care professionals should all have a blog, tweet, link up and now I’m saying not everyone needs to hop onto social media.
Let me explain the apparent contradiction.
If you are a solo provider and hope to stay financially solvent, you need to market online. All …
Should all health care professionals have a social media presence?
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At some point, the novelty of a new baby wears off.
Waking up at two in the morning loses some of its appeal. Parents often tell me that their baby does not sleep well. I tell them how they can get their child to sleep through the night in just three nights. I explain that learning to sleep is a training process, either …
How a pediatrician advises parents on sleep training their children
There are many more individuals with end stage kidney failure, heart failure, chronic lung disease, or liver failure who would benefit from a transplanted kidney, heart, lung or liver than are available. Similarly, there are many people with unstable, difficult to control diabetes that could benefit from a ready source of pancreatic insulin-producing islet cells.
Today the only option for more organs available for transplant …
Can xenotransplantation help with the organ shortage?
by Alison McKnight
We are surrounded by technology. No matter where you go, you will find technology rearing its face, whether ugly and ungodly or tempting and beautiful. These advances have brought both good and evil to many professions, especially healthcare.
Twenty years ago, you would not have found signs instructing people to turn off their cell phones in physician offices. Now these signs litter both …
How technology intersects with medicine and its impact on patients
The New York Times recently published an opinion editorial entitled “Squandering Medicare’s Money“in which Dr. Rita Redberg, professor of cardiology at UCSF, proposes that much of Medicare’s financial deficit could be reduced if the government did not spend “a fortune each year on procedures that have no proven benefit.”
To support her contention, Redberg cites several studies which indicate that many routinely performed tests and treatments …
Should academic physicians have the final word on acceptable practice?
What a blessing and a curse it must have been to practice medicine fifty years ago.
Most internists had only about twenty or so medications that they used regularly. It was a curse not to have effective medications to treat many common ailments but somewhat of a blessing not to have the modern medical nightmare of having patients on 15-20 chronic medications with all the logistical problems of keeping track of …
Medication reconciliation brings the ER back to 1960
by Jack Cain
In the United States, there is a heated debate at all levels over the increased use of narcotic pain relievers, especially as part of a long-term treatment regimen for chronic pain. Part of that debate is fueled by the pejorative use of the term “drug” instead of “medication” in conjunction with the legal prescribing, dispensing and consumption of these substances.
Bias is …
Why the word “drug” promotes a public bias in chronic pain treatment
This past Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.
In 1751, when George …
A history of smallpox in America
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