by Thomas Goetz
Enough about patients: What is a doctor to do?
In the past few months, since The Decision Tree book came out, I’ve had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a …
How can doctors successfully engage their patients?
by Travis G. Bias, DO
Throughout my involvement in organized medicine, I’ve met friends who I hold in high regard, and colleagues for whom I hope to one day work. One of my favorites, a neurosurgery resident buddy of mine, claims specialists should be paid more than primary care physicians. But, I am a third-year family medicine resident, preparing to enter the practicing world. And …
How to meet the primary care demand in the next decade
by Timothy Dempsey and Pamela Savitz
Last month, the National Football League inducted seven of its all-time great players into its Hall of Fame in a ceremony filled with nostalgia and memories of legendary careers long-finished.
While this was going on, there was another type of induction ceremony taking place around the country. Yet, these celebrations lacked recollections of past achievements by retired legends finally receiving …
The White Coat Ceremony and its effect on medical students
Learn the art of observation.
“The whole art of medicine is in observation… but to educate the eye to see, the ear to hear and the finger to feel takes time, and to make a beginning, to start a man on the right path, is all that you can do.”
– Wiliam Osler
One of my favourite books as a medical student was Michael Zatouroff’s Physical Signs in General Medicine, a book brimming …
The art of medicine is in observation
Recent rules issued by the Accreditation Council for Graduate Medical Education (ACGME) for resident work hours have further limited the consecutive and total number of hours that medical trainees may work. These measures, originally created because of safety concerns, are intended to decrease the number of fatigue-related errors made by physicians in training. They have received broad support within the medical community.
A recent story published by Mike Lillis in The …
Should OSHA create work rules for physicians in training?
by Ruben J. Rucoba, MD
Has it come to this? Do we really need, as a profession, to measure ourselves against others like a bunch of schoolboys? After reading Dr. Son’s article, “Does being a lawyer or journalist stack up with being a physician?”, I feel compelled to reply.
As a practicing pediatrician, I, too, feel the nobility and privilege of my profession, and count myself lucky …
A physician’s worth doesn’t need a professional hierarchy
One of the more effective criticisms of the health reform law (Affordable Care Act, or ACA) is that it hurts Medicare. It also is wrong.
Effective, in that it has been widely reported that seniors are more likely to express negative views of the ACA than other age groups. (Although the Kaiser Family Foundation’s Drew Altman, citing the group’s most recent tracking polls, writes that seniors’ opposition to …
How the Affordable Care Act helps Medicare
One of the most difficult family decisions can be whether to move an aging parent(s) out of their own home and into assisted living or even a nursing home. I’ve seen families face this dilemma numerous times. (After my psychiatry residency, I completed a geriatric psychiatry fellowship and also spent the first few years in practice consulting at nursing homes.)
Nobody wants to face this situation.
In fact, I’ve seen repeated instances …
Technology can help your aging parents
An excerpt from Doctor Guilt?
by Everett Winslow Lovrien, MD
This is the story of a boy who had hemophilia, a bleeding disorder that resulted in pain, disability and death before adulthood. A new medicine was developed which brought an end to suffering and increased longevity in persons with hemophilia. The effect of the new medicine was like magic. It was a remarkable revolutionary advancement …
A drug to treat hemophilia was polluted with hepatitis viruses and HIV
When I was a resident in internal medicine many years ago, I saw an elderly woman who came to the ER complaining of chest pain and shortness of breath. She had a history of heart disease. When I listened to her chest, the crackles I heard emanating from her wet lungs told me she had congestive heart failure. I treated her chest pain and gave her diuretics to help her get rid of the water that was making …
Reduce medical malpractice and create a culture of patient safety
It would be difficult today to be connected to medicine as either a provider or a consumer and not be aware of the existence of free-standing ambulatory care centers.
Their usual habitat is along a suburban commercial strip, and their presence is generally announced by a well-lit sign displaying a hyphenated medical name, corporate-logo style. The ambulatory care center, known to much of the public as the “walk-in clinic,” is less …
Doctors working in an ambulatory care clinic
You are now out of the Gray Zone, and you are now a member of an exclusive club.
But membership to this club comes at a steep price. Membership is not offered, it is not dependent on your income, title nor your social status. Membership is granted simply by surviving or living with a grave or potentially fatal illness or injury and realizing just how fragile life is and how quickly …
Surviving a potentially fatal injury and the fragility of life
We at the Los Angeles County/USC Medical Center are generally credited with having created the “Panic Value” or “Critical Value” laboratory reporting system in 1969.
A Panic or Critical Value is a laboratory finding at such variance with normal as to be life-threatening if something is not done quickly, and for which there is a corrective action that can be taken.
We determined that it was the laboratory’s responsibility to recognize such …
Is the critical value reporting system truly life saving?
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by Marianna Rakovitsky, RPh
Recently there has been a lot of controversy about the use of NSAIDs and heart health.
NSAIDs are medications for pain and inflammation. Many of them are sold over the counter and they are used by millions of people for various aches and pains as well as for more serious chronic conditions such as arthritis. Aspirin is technically an NSAID, but its effects …
Controversy about NSAIDs and heart health
I had been running late on another busy summer day. The type of day where you gain one step and lose two. Meetings and paperwork had filled up another summer morning. Baseball games, swimming practices, and soccer scrimmages had filled up another summer afternoon. And for this particular summer evening, I was scheduled to work an odd emergency room shift from eight p.m. to four a.m.
While driving to work, I …
A sweet and tender moment between a mother and daughter
If you wake up every morning needing to hack up lots of thick mucous or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into full-blown viral symptoms.
Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, …
Common throat problems that sleep apnea sufferers face
by Keith Humphreys, PhD
When my friend Paul Costello left the Carter Administration, he wrote a funny New York Times article suggesting a special course for departing staffers:
There ought to be an “outward bound” course for White House employees facing exile. Must we face this cruel and unusual punishment cold turkey?
Maybe people were tougher back then – I personally would have collapsed five minutes into the first day of the …
How working in the White House breaks down your body
A rising second year medical student read some of my posts and wrote me a kind note asking if I would write something for students. I taught students and ran surgical clerkships at community teaching hospitals for my entire career until about 19 months ago.
I also was prompted to address this subject after reading a recent New York Times story about a new admissions policy at Mt. Sinai …
Advice for a second year medical student
Something happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”
This was not without consequences.
• Americans became increasingly preoccupied with diet, exercise, and health habits.
• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.
• …
How a tyranny of health is bad for both patients and physicians
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man with a history of a systolic murmur presents for further assessment of exertional dyspnea. He has had dyspnea his entire life, but has noted a recent deterioration in his exercise capacity. He has no other medical conditions and is on …
MKSAP: A 70-year-old man with a history of a systolic murmur presents with exertional dyspnea
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