I have lived on the Gulf Coast for all but 5 of my 50 years. I grew up in Baton Rouge, Louisiana and now live in Mobile Alabama.
I was educated in the public schools during the height of the desegregation battles and my experiences were colored by those battles in a number of ways. I ran track in high school and was in the racial minority on that team (as …
Southern states may block the government from delivering health care
by Krupali Tejura, MD
I am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.
To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: …
Root beer bonds a chemotherapy patient with his oncologist
According to the Washington Post, it is highly unlikely that Congress will undo the planned “sustainable growth rate formula” (SGR) mandated Medicare fee schedule cuts. While there’s an outside chance of a fix, the American Medical Association, as well as other organized physician groups, can’t be happy about the constant threat of the 20% payment reductions.
Recall that the SGR was signed into law back in 1998. It was designed to …
Why the sustainable growth rate formula (SGR) is here to stay
I recently debated Steve DiFillippo, owner of Davio’s and Avila’s restaurants, on the WGBH program Greater Boston, hosted by Emily Rooney. The topic? The effect of the Massachusetts Gift Ban law on area restaurants.
On one level, it was a friendly debate on the economic impact of the law on those restaurants that depend on drug company sponsored dinners for a chunk of their income.
But on another level, this is a …
Effect of the Massachusetts Gift Ban law on area restaurants
Recently, yet another alarming Computerized Physician Order Entry (CPOE) study made headlines.
According to Healthcare IT News, The Leapfrog Group, a staunch advocate of CPOE, is now sounding the alarm on untested CPOE as their new study “points to jeopardy to patients when using health IT.” Up until now we had inconclusive studies pointing to increased and also decreased mortality in one hospital or another following CPOE implementation, but …
Computerized Physician Order Entry (CPOE) affects patient safety
Recently while cleaning out my office in anticipation of my new job, I discovered that I had unknowingly been witness to an historic moment in child psychiatry. I found a binder from a course I had taken in June of 2001 sponsored by Harvard Medical School on Major Psychiatric Illnesses in Children and Adolescents.
Though I did not remember until I looked at my scrawled notes in the margins, on Saturday …
Too many young children are medicated with powerful drugs
by Shawn Vuong
Recently, our class learned and practiced how to correctly ‘scrub’ for surgery. During this little lab activity, we were all gowned up and washing our hands when a couple of classmates asked if I was going to be a surgeon.
I said I didn’t really know yet, although I did find surgery pretty fascinating. With that, they told me that they thought I would make a good surgeon. due …
Does a stereotypical surgical personality exist?
A single mom juggling two jobs and four kids may be right in thinking her life is complicated – but it is certainly not complex – at least not in the scientific sense of the word.
In medicine we also differentiate between procedures that are complicated (difficult, requiring skill) and complex (no clear solutions, unknown and incalculable risks, unpredictable outcome).
The best description of complexity was the “simplified” one I found in …
Obesity is a complex problem that may not have simple solutions
An excerpt from Why Some Things Should Not Be for Sale: The Moral Limits of Markets.
by Debra Satz
Sometimes what critics of pregnancy contracts have in mind is not the effect of such contracts on the relationship between reproductive labor and a woman’s sense of self, but their effect on her views (and ours) of the mother-fetus and mother-child bond.
On this …
Contract pregnancy ethics and moral issues
Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice.
This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has …
Treating vitamin D deficiency requires caution
There is no class of medications in the history of the world that has been better studied that statins.
This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).
Simply …
Statins for heart disease and stroke, and debunking statin myths
by Lone Hummelshoj
Earlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated “National Women’s Health Week” and before it Mother’s Day. One study suggested Americans would spend a total of $14.6 billion in May alone to honor our mothers. And we should honor our mothers!
However, for millions of women with endometriosis, motherhood is elusive. In fact, an estimated …
For women with endometriosis, motherhood is elusive
Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.
Webster’s defines “assume” as “to take as granted or true.” The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription …
Assumptions in medicine can inhibit care
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An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.
In 1993, the FDA approved Neurontin for the treatment of epilepsy. This should have been a cause for celebration at Warner-Lambert, the drug company that introduced it, but the celebration was muted. The FDA …
How drug companies sell psychiatrists on their drugs
What follows are ten thoughts on checks and balances in health reform.
I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father’s legacy.
There …
Checks and balances in health reform
Maybe you’ve been assuming that when it comes time to go live on your EMR, you’ll simply scan each patient’s old paper chart into the electronic system.
Maybe you haven’t given it much thought because you’re focusing on the change in your work flow when you start to use the EMR to document patient encounters.
Well, it’s time to pay attention to the transfer, because the conversion of the paper chart can …
Converting from paper chart to an EMR: Keep daily use in mind
by James Gaulte, MD
Apart from some apparently radically contradictory expressed views on patient “centeredness” and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United States.
What he wants is well explained in this commentary from National Review Online as is the authors’ reasoning of why …
The medical system Donald Berwick prefers in the United States
According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals.
First, what is the July Effect? It represents an entire transition in the hospital, during which medical students become interns, interns become senior residents, and second or third-year residents become chief residents. …
Fix the July Effect for incoming interns and residents
Cancer prevention is built around screening. In screening, the hope is to catch cancer at an earlier stage than it would be found otherwise and increase options for treatment and chances of cure. In some cases, screening prevents cancer — for example, when a precancerous polyp is removed from the colon during colonoscopy — but generally it is aimed at early detection.
What if instead we could prevent cancer from developing …
Tamoxifen for breast cancer prevention is not routinely used
The following op-ed was published on July 18th, 2010 in USA Today.
A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.
Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the …
Burnout in doctors and stressed physicians hurt patients
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