Why I hate the SOAP note

Physician
November 19, 2012

Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.

But sometimes, medical lingo has …

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What are the biggest issues with EMR today?

Tech
November 19, 2012

As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping.  The medical record is vital to the care of the patient.  It tells the story of each patient’s journey through the medical system.  The idea of centralizing all pertinent medical information is, in theory, a step in the right direction.  In utopia, there would be one medical record …

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The difference between complications and negligence

Conditions
November 17, 2012

A patient who was minutes away from his colonoscopy, asked me how many colonoscopies I had performed. Before I could answer, he quickly followed-up asking if any of my patients developed perforation of the colon after the procedure.

I satisfied his initial inquiry when I informed him that I have intruded into at least 20,000 colons in the past 2 decades. With regard to his second and more ‘penetrating’ question, I …

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Is it possible to ignore prostate cancer?

Conditions
November 17, 2012

Is it possible to ignore a cancer?  Prostate cancer infests almost 250,000 men in this country each year and will kill 28,000 men in the United States in 2012, over 200,000 around the world.  Many lose their lives “too soon”, dying in their 60s or even their 50s.  Nonetheless, authorities do not recommend the PSA blood test for routine screening of this disease.  How can this make sense?  Partly this …

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The volume of low acuity patients in the ER is not a myth

Physician
November 8, 2012

I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify.

The point in contention is an interesting one: we know the nation’s ERs are overwhelmed and overcrowded. That’s old news. We also …

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The growing culture of hostile dependency towards doctors

Physician
November 8, 2012

Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.

Honest fact: The morale of doctors in the real world is low–and sinking lower.

I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”

Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:

Because …

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Reasons why doctors overtreat and overtest

Physician
November 7, 2012

The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”

The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.

The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.

Let …

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The micro level of health reform cannot be ignored

Policy
November 5, 2012

Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing.  But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care …

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MKSAP: 59-year-old man is evaluated for hypokalemia and hypertension

Conditions
November 3, 2012

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

A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …

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The chef and the surgeon have much in common

Physician
November 2, 2012

From the moment I first stepped into a restaurant kitchen, it felt like home; even though for the past eight years my real home has been an operating room, as I am a surgeon.

Though many on the outside may not realize it, the chef and the surgeon have much in common. Both profess modest beginnings. Cooks were slaves and surgeons were barbers. Those who did the cutting were not even …

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I teach the anchoring error, but I couldn’t avoid it myself

Physician
November 2, 2012

We recently spoke with Nayan Kothari, MD, associate dean for education, chair and program director of the department of medicine at Drexel University College of Medicine/Saint Peter’s University Hospital in New Brunswick, N.J. He is 74 years old with long-standing spinal stenosis. He told us that his condition did not prevent him from biking and hiking regularly, and he was otherwise in good health. His medications included baby aspirin, atorvastatin …

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Oral board exams: A window into how you behave in the operating room

Physician
October 26, 2012

When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.

But instead, there …

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Why doctors shouldn’t treat their family and friends

Physician
October 24, 2012

It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?

In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to …

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Why doctors don’t like to go to doctors

Physician
October 24, 2012

Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …

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It is both a privilege and an honor to be a primary care physician

Physician
October 21, 2012

With all of its frustrations and challenges, I love my job.  In fact, the very things that make primary care so difficult and often times exhausting are also what make it in my opinion the most awesome field in medicine.

When I was in grade school, I wanted to be a physician.  My parents would take me to the pediatrician for routine check-ups or when I wasn’t feeling so great and I remember …

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How gross anatomy changes you forever

Education
October 21, 2012

After a week of medical school orientation, followed by two weeks in the classroom studying cellular organelles and biochemical pathways, our class was finally going to start the centuries-old rite of passage that is human gross anatomy. For many students, it will be first time seeing a dead body. The anatomy lab is where future surgeons will make their first cut with a scalpel, without the pressure of life and …

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Having our own doctor treat us in the hospital is a thing of the past

Physician
October 19, 2012

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …

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When can a doctor call in sick?

Physician
October 18, 2012

I struggle every time I’m ill. This week, it’s not so much my own illness that’s been the major problem. It’s the kids. Because they can’t sleep. And if they can’t sleep, we can’t sleep.

It started last week with this upper respiratory bug that’s going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the “three year cold.” This one …

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Why the RVU system gives a false sense of productivity

Physician
October 17, 2012

One of my biggest problems of the RVU system is that it decided by a secret society composed of specialists. Nobody seems to have a problem that a “secret society” decides how much work and how much cost should be allocated to a medical service.

Medical procedures are very dangerous and have a lot of risk, but so is trying to provide healthcare to a complicated 2-year old that can’t tell …

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