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The triangle of blame for the opioid epidemic

Health Policy

November 14, 2017

Prescription opioid abuse is one of the United States’ greatest public health challenges. Approximately 97.5 million Americans consume opioids annually, and around 90 people die every day from opioid overuse. The last time in recent history a health care crisis garnered this much public attention was following the release of the 1964 “Surgeon General’s Report on Smoking and Health” correlating smoking to heart disease and …

Physicians: Want to overcome burnout? Start studying business.

Trevin Cardon

Physician

November 14, 2017

I have no business background: zero, zilch, nada. Growing up, I was the kid who bought the lemonade, not the one who set up shop on the busy street corner. My parents bought the cookie dough, coupon book and every other school fundraiser from the kid next door instead of their own child. Job interviews? Never had them. All the jobs I’ve ever had I got because I knew the …

Paging the surgeon general: America needs you

Linda Girgis, MD

Health Policy

November 14, 2017

The Office of the Surgeon General existed since 1871 when Dr. John Woodworth was appointed the first supervising surgeon of the national hospital system. In the previous year, the Marine Hospital was reorganized into the national hospital system. On January 4, 1889, Congress formally recognized the new personnel system as the Commissioned Corps. The Corps was established along military lines and initially consisted of only physicians. They …

Want to make meaningful connections with patients? Here’s how.

Gil C. Grimes, MD

Physician

November 14, 2017

“How did you know what to say to her?” asked the resident, “We have been trying to figure her out all morning and have gotten nowhere.” An expression of mixed curiosity and frustration crossed her face.

“I try not to focus on how she is acting, as much as I try to talk to the part of her Jesus would love,” I found myself answering. This catchphrase would find its way …

Physicians: Be nice to your pregnant colleagues

Avani Trivedi, DO

Physician

November 14, 2017

After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.” Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?”

After it’s told to you over and over again by your male co-residents and even some of my …

Let’s get one thing clear: pre-op comments from primary care

Fred N. Pelzman, MD

Physician

November 13, 2017

Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to …

“Thank you for being who you are”: an excerpt from a novel

Judy Salz, MD

Physician

November 13, 2017

An excerpt from Worthy.

“Breakfast ready? Bacon smells good!” Mark finished buttoning his shirt and joined Linda at the kitchen table.

“I Googled funding for my clinic, but I didn’t find what I was looking for,” Linda said, filling their mugs with steaming coffee. “There has to be something out there for me!” She banged her fist on …

What man’s best friend taught me during a patient’s death

Debbie Moore-Black, RN

Conditions and Diseases

November 13, 2017

Years ago in a 15-bed acute medical-surgical ICU, the nursing supervisor contacted me about a special assignment. Once I knew what it was, I said, “Absolutely.”

We were about to admit a patient in his 40s with end-stage AIDS/HIV. He asked to be a DNR, but his MD wanted to admit him to the ICU for close monitoring. But the patient had a special request. Even with IV antibiotics and pain …

Lifting up women physicians makes us all better

Jim Eubanks

Medical Education

November 13, 2017

As a male medical student, I have developed a growing interest in and enthusiasm for recent efforts to raise awareness about workforce gender disparities in medicine. Though women comprise over 45 percent of resident physicians and 50 percent of medical students in the United States, research reveals deficits in key surrogate measures of successful integration. There are pay and promotion gaps, and women are much less …

Want a simple and easy-to-use EMR? Well, you can have it for free.

Mark Leeds, DO

Health Technology

November 13, 2017

You may have heard of open-source software. When it comes to open-source, “free” has two meanings. First, you can download open-source programs at no cost. Second, “free” means freedom. The software is free in the sense that it belongs to you as much as it belongs to anyone else. If you download an open-source program, you can use it in any way you choose. You can use it forever as-is, …

If Medicare wants value, it should cancel MACRA

Matthew Hahn, MD

Health Policy

November 13, 2017

From the CMS website, October 30, 2017, “Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation … We need to move from fee-for-service to a system that pays for value and quality — but how we define value and quality today is a problem. We all know it: Clinicians and hospitals have to report …

A meditation in medical school

Orly Farber

Medical Education

November 12, 2017

Breathing is different when you know what your lungs look like.

I first realized this during a meditation session at Stanford’s Windhover building. The space — a large, subdivided room — is a self-described sanctuary in the heart of campus. The walls are mostly glass, broken up by long, clay-colored steel beams. Natural light, filtered through the surrounding trees, streams in to illuminate five larger-than-life paintings — a series called “The …

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A meditation in medical school

How can patients navigate our complicated health care system?

Linda Girgis, MD

Patient

November 12, 2017

It is not enough to know that a patient’s medical condition warrants an MRI. For most insurance companies, a diagnostic test of this sort requires what is known as a prior-authorization. But, the doctor saying the patient needs this test often fails. The insurance company has a certain guideline the patient must travel first before they will consider the test.

For example, a patient with back pain and numbness in one …

The rise of patient navigators is a sign that medical billing needs to be reformed

Michael Kirsch, MD

Physician

November 12, 2017

To accomplish certain tasks, we need a little help from our friends. No one can do it all, although many of us are more resourceful than others. Some folks are adventurous and dive into a new arena with excitement. They may be tinkerers who aren’t afraid to play with new gadgets. Sure, they might break some china, but they are apt to widen their skill set and enrich their lives. …

3 steps to a better health care system

Manoj Jain, MD, MPH

Health Policy

November 11, 2017

A friend recently asked me, “Where do we go from here?” The friend was referring to our impasse with health care in America. The Democrats have failed to repair the Affordable Care Act, and the Republicans have failed to repeal or replace it.

With the status quo, I can understand our health care system providing lower quality care compared to its counterpart industrialized nations. I can even tolerate lack of access to …

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3 steps to a better health care system

The patients that make you realize that we are part of a larger human family

Alexander Rakowsky, MD

Physician

November 11, 2017

T was the last patient of a busier than usual morning. “New patient, establish care” was her reason for visit. As I would soon find out with the help of our remarkable Arabic interpreter, T and her family recently moved to our area after spending the better part of 3 years moving from refugee camp to refugee camp trying to escape the ravages of the civil war in their native …

Have you been reported under the Sunshine Act?

Another Second Opinion, MD

Health Policy

November 11, 2017

The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010. This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers.

The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive …

Veterans deserve our full attention

Chiduzie Madubata, MD

Physician

November 11, 2017

When I walked into the hospital room with my team to meet him for the first time, what struck me was how young he looked. He was listed as 26 years old, but he looked younger than that. He looked so young that it was hard to believe he had served a tour in Iraq a few years prior, or that he likely saw things there that no one would …

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Veterans deserve our full attention

MKSAP: 32-year-old man with a rash on his face and midchest

mksap

Conditions and Diseases

November 11, 2017

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

A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well. Medical history is significant for a …

We all treat the whole patient. We must avoid tunnel vision at all costs.

Sara Scarlet, MD

Physician

November 10, 2017

In loving memory of my grandfather, my first physician mentor.

Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the …

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