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How managed care caused the mental health care crisis

Kevin

Physician

May 24, 2011

by George H. Northrup, PhD

No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.

With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress. Money has typically been a …

How medical students are key to innovating in medicine

Aaron J. Stupple, MD

Medical Education

May 24, 2011

Why does health care seem to lag behind other industries in innovation?

There’s a temptation to manufacture reasons that don’t necessarily explain why health care has not seen the kinds of revolutionary changes evident in industries from computing and telecommunications to music and retail? People routinely marvel at how easy it is to manage their bank account these days, but they don’t appreciate continuing to wait hours in their doctors’ offices, …

Getting into residency: What medical students need to know

Kevin

Medical Education

May 24, 2011

by James Lamberg

When medical students are applying for residency positions, what do program directors care about most? This may become the ultimate question for many students on clinical rotations.

Thankfully, publications exist to help answer this very problem.

Unfortunately, many students are not aware of this published information. In a 2005 article from Medical Education Online titled “Residency Selection …

The tension between physicians and health policy experts

Kevin Pho, MD

KevinMD

May 24, 2011

There’s an underlying tension between physicians and health policy experts.

Health policy experts take subtle jibes against physicians in their analyses, with many feeling American doctors are overpaid, which exacerbates health costs. They tend to be politically progressive, and generally dismiss the issues that most doctors care deeply about. Medical malpractice, tort reform and the cost of medical education, for instance.

And …

How denying patient requests may not impact patient satisfaction

Steve Wilkins, MPH

Patient

May 24, 2011

Does physician denial of patient requests result in decreased patient satisfaction?

The short answer: No.

At least not in the context of a strong physician-patient relationship.

Many physicians have legitimate concerns about the prospects of having their salary or level reimbursement linked to patient satisfaction. I would too given the way most health …

Pros and cons of private or hospital owned practice

Mary Pat Whaley

Physician

May 24, 2011

Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers. Private practices are almost exclusively for-profit. Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments.

Hospitals can be for-profit, not-for-profit …

Why pain cannot be a vital sign

Lucy Hornstein, MD

Physician

May 23, 2011

There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand.

The problem is that the word “sign” has a specific meaning in …

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Why pain cannot be a vital sign

Why confused, weak elderly patients are subjected to aggressive care

Edwin Leap, MD

Physician

May 23, 2011

Lying on the backboard, a frail little old lady moaned with discomfort.

She had fallen beside her bed in the nursing home and was then tightly bound by straps onto the backboard, a cervical collar pushing her chin up and holding her immobile. A person not familiar with modern medicine might think the ensemble looked like a torture device. Indeed, it can …

Improve health journalism to improve consumer knowledge and decisions

Lisa Gualtieri, PhD

Patient

May 23, 2011

Gary Schwitzer is Publisher of HealthNewsReview.org, where he and his team grade daily health news coverage. He works to improve health journalism with the goal of improving consumer knowledge and decision-making. He was the founding editor-in-chief of the MayoClinic.com site. While his guest lecture at Web Strategies for Health Communication was on health news reporting, I realized that his review criteria seemed equally applicable to any health content …

Breast implants and the risk of cancer

Anthony Youn, MD

Conditions and Diseases

May 23, 2011

The FDA has issued a statement alerting physicians and patients to a possible link between breast implants and a rare type of cancer. Although anaplastic large cell lymphoma (ALCL) is extremely rare, the FDA believes that women with breast implants may have a very small but increased risk of developing the condition.

ALCL in the presence of breast implants has been noted in sporadic case reports over the past 25 years. To date, …

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Breast implants and the risk of cancer

Transitions of a first year medical student

Kevin

Medical Education

May 23, 2011

by Kristine Casal

The moment you get accepted to medical school, you never really think about how everything is going to be different. You figure everything’s going to stay the way they are, with the exception of the inevitable long and laborious hours of studying day and night. You don’t think about how much time you won’t have …

Vascular diseases that present as obstructive atherosclerotic arterial disease

Kevin

Conditions and Diseases

May 23, 2011

by Joe F. Lau, MD and Jeffrey W. Olin, MD

Physicians who perform percutaneous endovascular procedures encounter a multitude of vascular diseases that may masquerade as obstructive atherosclerotic arterial disease. While atherosclerosis is clearly the most common condition seen, complex inflammatory, genetic or structural processes may either not be amenable to an endovascular approach or actually be harmful and thus lead to outcomes that are not …

When chronic illness strikes: Tips on talking to family and close friends

Toni Bernhard, JD

Patient

May 23, 2011

In the summer of 2001, I was preparing to begin my 19th year on the faculty of U.C. Davis School of Law. Then I got sick with what the doctors thought was an acute viral infection. I have yet to recover.

Being diagnosed with a chronic illness or condition can take a toll on your relationships, partly because all of the …

How physicians can take more responsibility in the care of patients

Michael Aaronson, MD

Physician

May 22, 2011

Medical care in America isn’t doing so well when compared to other developed nations. Historically physicians did not want to take ownership of their patients’ problems. Patients have free will. They can “choose” to be non-adherent. They can choose to not take the medication the doctor prescribes — even if the one prescribed is $70 dollars a month when there is a $4 dollar Read more…

How physicians can take more responsibility in the care of patients

Does psychiatry treat symptoms or diseases?

Steve Balt, MD

Physician

May 22, 2011

Do we treat diseases or symptoms in psychiatry? While this question might sound philosophical in nature, it’s actually a very practical one in terms of treatment strategies we espouse, medications and other interventions we employ, and, of course, how we pay for mental health care.

It’s also a question that lies at the heart of what psychiatry is all about.

Anyone who has been …

What is normal for a teen with diabetes?

Kevin

Patient

May 21, 2011

by Doctor D, MD

A teacher asks Doctor D about a diabetic teenager in his class: “His sugar readings are often over 400. His mom says this is normal. Can this be normal?”

What is normal?

a) A state of harmony within the body and mind that leads to health and well-being.
b) The typical or status quo for a person; the way things usually are.
c) WTF? There is no such …

MKSAP: 32-year-old man with crampy abdominal pain

mksap

Conditions and Diseases

May 21, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he …

End of life care requires individual family decisions

Dan McCoy, MD

Physician

May 21, 2011

When anyone brings up the idea of end of life care, you are thrown a political football. Yet, the failure to have these discussions with your loved ones creates an expensive and emotional mess.

I can’t tell you the number of times I’ve been sitting at a table with friends and this issue has surfaced with almost unanimous consent: they all want to …

The difficult road to becoming a doctor

Kevin

Medical Education

May 20, 2011

On May 15, 2011, 147 students embarked on their careers as doctors as they graduated from the University of Pennsylvania School of Medicine.

One student, Jenny Rowland, who will pursue a career in Radiology and continue her training at Penn, shared her personal thoughts and emotions as she prepared to graduate.

by Jenny Rowland, MD

I’m not a typical PennMed student.

I’m 31 years old, and I …

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The difficult road to becoming a doctor

Cancer will always be a part of a patient’s identity

Ann Silberman

Patient

May 20, 2011

So, you’ve cut off your breast(s) and poisoned and radiated your body. You’ve hit all your medical milestones – surgery, chemo, herceptin. You’ve recovered and the hair on your legs has grown back to plague you, and you have gotten back to a normal life. Work, jobs, family. Shaving.

Yet you are changed. You didn’t expect this, but each time you get dressed or undressed, you can’t help but notice your mastectomy …