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Physician

Why unnecessary cesareans is a misnomer

One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that…

One thing I have learned by being active in the obstetrics and birthing blogosphere is that there are a whole lot of people out there that think that most cesarean deliveries are unnecessary. While most of them will admit that some cesareans are medically required, its pretty rare that the ones that have had a cesarean looks at their cesarean that way.

A popular term bandied about is “Unnecesarean”, a catchy …

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Why unnecessary cesareans is a misnomer

Physician

What’s the difference between family practice and med-peds?

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement: I have a…

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians.  My unique view stems from the fact that …

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What’s the difference between family practice and med-peds?

Physician

Doctor appointment tips every patient can use

Doctors, both generalists and specialists, have constraints on their time. New practices and new approaches need to happen in order to maximize everyone's time. In addition to bringing your co-payment, you should "invest" in the visit and do your part,…

Doctors, both generalists and specialists, have constraints on their time. New practices and new approaches need to happen in order to maximize everyone’s time. In addition to bringing your co-payment, you should “invest” in the visit and do your part, so that by the time the visit has ended, a successful plan of care is developed.

Here are some helpful tips to make the most of your medical appointments.

Doctor appointment tips every patient can use

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Patient

What to say to a person who is sick

When I ran into Paul S. not knowing he had cancer, I barely recognized him and struggled with what to say. “What happened?” didn’t seem appropriate, although it was my initial reaction. I believe I said, “I barely recognized you,”…

When I ran into Paul S. not knowing he had cancer, I barely recognized him and struggled with what to say. “What happened?” didn’t seem appropriate, although it was my initial reaction. I believe I said, “I barely recognized you,” which was true. I’ve been in many situations where I wasn’t sure what to say to someone who was ill or in distress; I wanted to be supportive …

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What to say to a person who is sick

Conditions and Diseases

Many doctors order tests rather than do a history and physical

"Take a good history, do a good exam." I have not contributed to my treasure of quotes with this title. No one reading the headline well hit their head and mutter, "Wow!" Yet one can wonder about the lack of…

“Take a good history, do a good exam.”

I have not contributed to my treasure of quotes with this title.  No one reading the headline well hit their head and mutter, “Wow!”  Yet one can wonder about the lack of careful history taking and basic physical examination skills.

This delightful new blog post written by an internal medicine resident says it well: Defensive medicine supersedes quality medicine.

You should read …

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Many doctors order tests rather than do a history and physical

Health Policy

Wanting better health care shouldn’t be conservative or liberal

I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at…

I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at all.”

For some of us, improving the health care system is more than a passing fancy.  I’m a health services researcher.  It’s my job.  Those people on the TV pay attention …

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Wanting better health care shouldn’t be conservative or liberal

Health Technology

Why health IT usability matters to patients

It’s widely rumored that a health IT industry executive was unhappy about suggestions that systems have to be usable in the eyes of employees who use them while caring for us. (Us. The patients. Your mother.) According to the rumor,…

It’s widely rumored that a health IT industry executive was unhappy about suggestions that systems have to be usable in the eyes of employees who use them while caring for us. (Us. The patients. Your mother.)

According to the rumor, the exec said, “Over my dead body.” As if he ran the agency.

Whether or not the rumor’s true it’s not funny. So when I was asked to represent the patient perspective …

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Why health IT usability matters to patients

Health Technology

Converting paper charts to electronic medical records tips

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this…

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.

One of the biggest challenges we have been facing is how to convert …

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Converting paper charts to electronic medical records tips

Health Technology

Physicians deserve to be compensated for time spent on email

Dr. Wes, a blogging cardiologist, posted a follow-up to his recent post on e-mail correspondence between physicians and patients. The majority of emails he receives tend to be for very simple things like checking a lab result. Current EMRs don’t…

Dr. Wes, a blogging cardiologist, posted a follow-up to his recent post on e-mail correspondence between physicians and patients.

The majority of emails he receives tend to be for very simple things like checking a lab result.

Current EMRs don’t make reviewing and sharing lab values efficient. Dr. Wes writes:

[O]ur current model of the electronic medical record sending every single result to our inbasket, even though it contains …

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Physicians deserve to be compensated for time spent on email

Conditions and Diseases

10 reasons why doctors over-order tests

by Neel Shah, MD What are the top reasons doctors over-order tests? 1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost —…

by Neel Shah, MD

What are the top reasons doctors over-order tests?

1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.

2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.

3. Pre-emptive ordering. For residents, who do much of …

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10 reasons why doctors over-order tests

Patient

The $100 question about patient empowerment

by Devin Gross Here’s a question. It’s not a 5¢ or $5 question that anybody can solve on their own without much thought or effort. It’s a $100 ask-an-expert or think-about-it-for-a-second question. What’s the point of patient empowerment? Much of…

by Devin Gross

Here’s a question. It’s not a 5¢ or $5 question that anybody can solve on their own without much thought or effort. It’s a $100 ask-an-expert or think-about-it-for-a-second question.

What’s the point of patient empowerment?

Much of the current discussion of empowerment deals with patients who for one reason or another have had to fight for their care. CNN’s Elizabeth Cohen opens her book, …

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The $100 question about patient empowerment

Health Policy

Should reduced ER use be a measure of health reform?

In making the case for health care reform, inappropriate utilization of emergency rooms is frequently cited as an example of our inefficient system and an important factor behind the staggering cost of U.S. health care. At first, the logic makes…

In making the case for health care reform, inappropriate utilization of emergency rooms is frequently cited as an example of our inefficient system and an important factor behind the staggering cost of U.S. health care.

At first, the logic makes sense: emergency rooms have to treat people, so the uninsured often turn there for care, including primary care, which is very expensive to provide in an emergency room, and would be …

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Should reduced ER use be a measure of health reform?

Health Policy

A difficult time for health insurance companies in Massachusetts

This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think…

This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think that is just a sign of the times. Hospitals face a similar issue, too. Doctors are certainly next in line.

But the Massachusetts insurers have an additional problem. They have been …

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A difficult time for health insurance companies in Massachusetts

Patient

Are toning shoes safe or effective?

Grandmother Pat LaColla, 82, was lured by the hype—"get in shape without setting foot in a gym"—when she bought a pair of Skechers last year, wincing at the $100 price tag. Toning shoes like those she bought are the newest…

Grandmother Pat LaColla, 82, was lured by the hype—”get in shape without setting foot in a gym”—when she bought a pair of Skechers last year, wincing at the $100 price tag. Toning shoes like those she bought are the newest craze in athletic footwear, projected to grow 500 percent to become a $1.5 billion market this year.

Although the designs vary, toners typically have strongly curved, thickened soles. From the moment …

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Are toning shoes safe or effective?

Conditions and Diseases

Cycling helps this patient with a sarcoma

by Kristina Fiore Jennifer Goodman Linn, 39, has been through five surgeries and six rounds of chemotherapy since 2004, trying to control the sarcoma that keeps growing in her abdomen. Goodman Linn has what her doctors call a rare form…

by Kristina Fiore

Jennifer Goodman Linn, 39, has been through five surgeries and six rounds of chemotherapy since 2004, trying to control the sarcoma that keeps growing in her abdomen.

Goodman Linn has what her doctors call a rare form of a rare cancer — an MFH sarcoma, also known as an undifferentiated high grade pleiomorphic sarcoma. It’s remained confined to her retroperitoneal …

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Cycling helps this patient with a sarcoma

Patient

Tips for patients during an emergency department visit

An excerpt from Treat Me, Not My Age: A Doctor's Guide to Getting the Best Care as You or a Loved One Gets Older. by Mark Lachs, MD Over my twenty-five-year medical career, the route by which people are admitted…

An excerpt from Treat Me, Not My Age: A Doctor’s Guide to Getting the Best Care as You or a Loved One Gets Older.

by Mark Lachs, MD

Over my twenty-five-year medical career, the route by which people are admitted to the hospital for an overnight stay has subtly evolved in ways that most patients (and even many doctors) may not realize. Specifically, the proportion of patients …

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Tips for patients during an emergency department visit

Conditions and Diseases

Marginal treatments at a high emotional cost from families

My father passed away about two weeks ago after battling a brain tumor for some time. Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one…

My father passed away about two weeks ago after battling a brain tumor for some time.

Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one medication for seizure control for about ten months. Around Christmas of 2009, however, he landed in the hospital in status epilepticus that took three days to control. After these days of …

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Marginal treatments at a high emotional cost from families

Conditions and Diseases

When patients are willing to share their stories

We say we exchange words when we meet. What we exchange is souls. -Minot J. Savage It was Monday evening. The shelves in the electronics department overflowed with different styles, prices, and brands of headphones, all displayed in sealed plastic…

We say we exchange words when we meet. What we exchange is souls.
-Minot J. Savage

It was Monday evening. The shelves in the electronics department overflowed with different styles, prices, and brands of headphones, all displayed in sealed plastic cases. I was in the mood to buy but was baffled by the array of options in front of me. This was not going to be as simple as I had thought.

A young …

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When patients are willing to share their stories

Conditions and Diseases

How you can avoid skin cancer risk

Skin cancer is the most common form of cancer diagnosed in the United States. There are three major types: basal cell, squamous cell and melanoma. Of those, basal cell and squamous cell are most common, accounting for about 3.5 million…

Skin cancer is the most common form of cancer diagnosed in the United States.

There are three major types: basal cell, squamous cell and melanoma. Of those, basal cell and squamous cell are most common, accounting for about 3.5 million cases in the United States per year. Although, these types typically do not metastasize, they can be quite disfiguring, particularly after resection when they occur on the face. On a population …

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How you can avoid skin cancer risk

Conditions and Diseases

Why the expansion of Alzheimer’s may not be helpful

You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer's. Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at…

You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.

Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.

It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed …

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Why the expansion of Alzheimer’s may not be helpful

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