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Should doctors give marriage advice?

Patient

February 2, 2011

Doctors have no trouble or compunction giving these good pieces of advice:

stop smoking
lose weight
eat less saturated fat
wash your hands
vaccinate
schedule your mammogram
get a colonoscopy

These all likely can augment both life quality and expectancy.

Do doctors, then, (in appropriate situations obviously) go the extra mile and tell a patient to get married? There are reasonable reports church-going adds to longevity, but with sensitivity to broaching religious beliefs, doctors may be reluctant to suggest …

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Should doctors give marriage advice?

Change health behavior with a gentle nudge

Howard Luks, MD

Patient

February 2, 2011

Gentle nudges is a concept termed recently to describe a micro-choice movement that is beginning to carve out a sizable niche in the healthcare start-up space, and is gaining a lot of well deserved national attention. The secret ingredient relates to the power of a gentle nudge; verbal, text or otherwise to accomplish a change in the behavior of the person who receives the nudge. We are just starting to …

The threat of malpractice means doctors cannot acknowledge their fallibility

Maggie Kozel, MD

Physician

February 2, 2011

An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011).

We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, someone else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave …

Patient-physician relationships in medical malpractice

Kathleen Clark, PhD

Physician

February 2, 2011

I recently read a post from Jan Gurley, MD on here on KevinMD.com.

Her opinion is that medical malpractice lawsuits are a “crap-shoot”; she notes that “malpractice lawsuits fail when it comes to medical errors-in both directions. People who’ve suffered from errors both don’t sue, and lose suits, in the same percentages that people who sued have no suffered from errors.”

Assuming that information is correct for purposes of this …

Treating a patient in a small town versus a big city

StorytellERdoc, MD

Conditions and Diseases

February 1, 2011

I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.

I …

Mass shootings is a symptom of our nation’s broken health care system

Kevin

Patient

February 1, 2011

by Dora Calott Wang, MD

There will be more shooting rampages, like that which targeted Congresswoman Gabrielle Giffords in Tucson recently-as long as it is easier to get a gun than mental health care. Our current epidemic of mass shootings is but a symptom of our nation’s broken health care system. Poor access to medical care jeopardizes an individual’s health. But when the mentally ill or the seriously distressed can’t access …

Laryngopharyngeal reflux disease and a complex case or chronic cough

Steven Y. Park, MD

Conditions and Diseases

February 1, 2011

Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.

A 49 year old healthy woman presented to …

Health reform repeal will lead to single payer, Medicare for all

Kevin Pho, MD

KevinMD

February 1, 2011

In a guest post last year, physician-author Richard Reece commented that the individual mandate may collapse health reform.

Those words came to mind as Judge Vinson not only ruled the individual mandate unconstitutional, but the entire Affordable Care Act, as well.

Nobody likes to be mandated to do anything, least of all purchase health insurance, and this was always the sticking point with the current iteration of health reform.

So, what …

Praise nurses without comparing them to physicians

Shara Yurkiewicz

Physician

February 1, 2011

Doctors vs. nurses (or doctors vs. nurse practitioners, or doctors vs. physician assistants, or what have you). The debate is old, tired, unimaginative, divisive, and wrong-headed–for reasons that are too obvious even to list. Does it get perpetuated because it garners comments (175 of them, to be exact)? Snarkniess is not appreciated by this reader, at least.

The New York Times recently ran a column by one of its editors, “Read more…

Praise nurses without comparing them to physicians

Marcus Welby and the relentless growth of specialization

Jan Henderson, PhD

Physician

January 31, 2011

In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.

In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed …

Focus advance care planning on outcomes

Kevin

Conditions and Diseases

January 31, 2011

by Drew Rosielle, MD

The Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what they’d want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes. Good one for the teaching file.

That is, instead of thinking of ACP as patients pre-specifying “if X …

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Focus advance care planning on outcomes

Patient safety lapses in the hospital

David B. Nash, MD, MBA

Physician

January 31, 2011

Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy — and, frankly, a certain amount of discomfort — to a fourth-year medical student’s account of his grandmother’s recent hospitalization at a well regarded inpatient facility in New York City.

Admitted with an initial diagnosis of pneumonia, Cole Zanetti’s grandmother languished in the hospital for almost four weeks.

As the medically …

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Patient safety lapses in the hospital

Help your doctor formulate an accurate differential diagnosis

Stewart Segal, MD

Conditions and Diseases

January 31, 2011

Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct …

Patient advocacy is essential in health insurance appeals

Steven Reznick, MD

Patient

January 30, 2011

An active 61 year female, who has been in my practice for 30 years, developed strange aches and pains and abdominal symptoms. My evaluation turned up nothing.

I then asked for help at the University of Miami rheumatology and gastroenterology divisions. With the help of a brilliant local gastroenterologist and rheumatologist, and after a trip to Johns Hopkins Medical Center and the Mayo Clinic, collagenous …

Having insurance does not mean you get health care

Joseph Paduda

Health Policy

January 30, 2011

There’s no question the Accountable Care Act needs work – everyone agrees on that.

So let’s talk about the specifics – what needs fixing, why, and how can we get those fixes passed.

First, let’s understand how bad our current system is. Some who want to repeal and/or replace the ACA continue to publicly state we have “the best health care in the world.”

While that may – or may not – have …

Healthcare costs can be reduced with emerging business models

Joe Flower

Health Policy

January 29, 2011

Here’s a simple key to parsing the future economics of healthcare. We have been trying for over 30 years to control healthcare costs. And there is little evidence that any of these efforts have had much effect. For decades the rise in healthcare costs has been consistently several times higher than the general inflation level.

There have been dozens of schemes used in various parts of the industry — inpatient, ambulatory, …

Where an extremely premature baby immediately receives care matters

Jennifer Gunter, MD

Conditions and Diseases

January 28, 2011

When you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.

A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also …

Integrity, discipline, respect: Using kung fu to control your eating

Melanie Lane, MD

Conditions and Diseases

January 28, 2011

About seven months ago, I began training kung fu with my family. Our classes are intense and require the students to really pull out our personal best. Periodically our instructor will remind us by shouting out, “Train like a black belt!” when she catches us being sloppy or less than enthusiastic. Her exclamation inspires me to squat a little lower in my horse stance, amps up my intensity, and focuses …

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