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MKSAP: 72-year-old woman with severe COPD

mksap

Conditions

November 1, 2014

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

A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 …

Too many cooks in the kitchen can spoil medical care

Adam Bitterman, DO and Shalin Shah

Physician

October 28, 2014

shutterstock_61638394

There are times when a common cliché may be the best way to describe academic medicine in today’s medical centers. In fact, I have heard patients and their families complain about this, way too often. Simply put, there are many occasions when it seems that there are too many cooks in the kitchen.

When someone gets admitted to the hospital, chronic problems …

5 ways to increase your EMR efficiency

Brian Anderson, MD

Tech

October 28, 2014

One of the major reasons that health care providers resist implementing an electronic medical record (EMR) system is the belief that using it will decrease provider productivity, reducing the number of patients they can see and therefore reducing practice revenue.

However, an EMR that is designed around a streamlined workflow can enable providers to work faster and more efficiently. Having an EHR and vendor that can give you ongoing visibility and …

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5 ways to increase your EMR efficiency

Primary care physicians: 7 tips to treat health anxiety

Lynne S. Gots, PhD

Conditions

October 28, 2014

Before the Internet age, people with excessive and irrational worries about their health (we called them “hypochondriacs”) went to their doctors for reassurance. Today these patients still schedule appointment — often with exasperating frequency — with their primary care physicians when they’re concerned about an unusual lump or vague symptom. But most likely they’ll have first consulted WebMD or the Mayo Clinic website and come up with a differential diagnosis of their …

Patient perceptions of the hospital experience

James Merlino, MD

Physician

October 26, 2014

An excerpt from Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way.

Patients’ definition of their own experience is quite divergent. We ask patients for feedback, and the results are fascinating. We’ve found that patients often use the word experience in their comments: “I can’t believe how …

5 reasons why physician champions are needed

David Lee Scher, MD

Tech

October 25, 2014

It has been 5 years since the passage of the HITECH Act portion of the Affordable Care Act. The purpose of HITECH was “to promote the adoption and meaningful use of health information technology.” While the result of this legislation has been the significant increase in the adoption of EHRs, most of the potential benefits of digital technology have yet to be demonstrated. there are multiple reasons for this lack of proof.

The portions of …

When treating neo-Nazis, should physicians have a choice?

Alberto Hazan, MD

Physician

October 21, 2014

What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps.

It was the swastika tattoo next to it.

“Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain …

Why hysterectomy for many endometrial hyperplasias is often overkill

Roger Reichert, MD, PhD

Conditions

October 21, 2014

A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed …

What I love about being an anesthesiologist

Edward R. Mariano, MD

Physician

October 20, 2014

I wear a lot of hats in my job. Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table.

Many days I spend in an administrative leadership role or conducting research studies. These functions support the best interests of my patients as well as the science …

To medical students and residents: It really does get better

Trina E. Dorrah, MD

Physician

October 20, 2014

I recently attended my 10-year medical school reunion class party, and I have to admit, I had a great time. From the beginning, my class was special. We had 104 amazing people who were truly inspired to make a difference.

However, regardless of how talented and hard working you are, medical school is one of the most challenging things you will ever …

Should we use antipsychotics to treat ADHD?

Claudia M. Gold, MD

Conditions

October 19, 2014

Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior.

When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range …

Running a code is a team sport

Denitza Blagev, MD

Physician

October 18, 2014

“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU. The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her. She wasn’t breathing, her heart wasn’t working, and despite the 30 people gathered in the room, in the end, she died.

Running a code, as we call it, means that someone is …

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Running a code is a team sport

The Fault in Our Stars: Should thyroid cancer be renamed?

James Flory, MD

Conditions

October 18, 2014

Josh Green’s novel — and recent film — The Fault In Our Stars (TFIOS) is a new classic of young adult fiction, deservedly famous, and it’s easy to see why. The story is simultaneously deeply sad and really funny, mostly due to the narrator, Hazel. She is an intensely likable 16-year-old, who charms you even while she explains, stoically, that she is dying of thyroid cancer that has spread to …

There is no excuse for physicians to take advantage of vulnerable patients

Bob Doherty

Policy

October 18, 2014

Patients are being stuck with huge and unexpected medical care bills in circumstances where they have no say in selecting the physician who is billing them, and no way for them to know in advance which services the physicians would render or what it would cost them, says the New York Times.

Mr. Peter Drier received a “surprise $117,000 medical bill from …

To be or not to be: An artist in medicine

Michael Metzner

Education

October 16, 2014

gaze

“Why would an artist want to go to medical school?”

It was a good question, and one of my favorite questions asked of me during my medical school interviews. I am what one might define as an artist, and yes, I really wanted to go to medical school. I was a photographer, musician, composer, and actor. I loved the arts and they …

Why your doctor won’t refill prescriptions over the phone

Michael Kirsch, MD

Meds

October 13, 2014

Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads — often sooner than we should have — and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change …

Why do doctors still use pagers?

Fred N. Pelzman, MD

Physician

October 12, 2014

I was on call last night.

Don’t get me wrong, this is not as bad as it sounds.

With over 20 partners sharing evening call, and residents getting the calls first, we do not have it bad at all. And certainly nothing like my obstetrician friends, who seem to go in every time they are on call for labor and delivery and then …

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Why do doctors still use pagers?

The choice between motherhood and medicine

Nelly Schottel, MD

Physician

October 12, 2014

As the birth of our first child loomed on the horizon, I couldn’t help but worry. As a first time mother and a pediatrician, I found the uncertainly coupled with too much knowledge of all manner of possible problems particularly unsettling.

In addition to worrying about my baby’s health, I grew increasingly concerned about how I would handle the balancing act that all working mothers must perform. Having put motherhood off in order to complete …

Why are so many people opposed to epidurals?

Jennifer Gunter, MD

Conditions

October 10, 2014

To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger.

The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In …

It’s time to talk trade-offs in health care

Dr. Saurabh Jha

Policy

October 10, 2014

An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking …

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