Colonoscopy after a positive stool test: Does the time frame matter?

Conditions and Diseases
November 10, 2017

There are some questions in health care that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to a different number of hours sitting the ER before receiving antibiotics after the decision is made that the patient has a bacterial infection requiring antibiotics. There are some questions where the best available …

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Colonoscopy after a positive stool test: Does the time frame matter?

A patient readmission: Could it have been avoided?

Physician
November 10, 2017

It is not unusual to see a patient for a timely transition of care visit after a hospital admission and within a minute of entering the exam room know with all the bones in your body that this person needs to go back into the hospital.

The funny thing is that when that happens, if the patient has Medicare, we may indirectly suffer financially from such “avoidable readmissions.” We belong to …

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A patient readmission: Could it have been avoided?

In defense of Sigmund Freud

Conditions and Diseases
November 10, 2017

As a medical student, I immortalized myself with my classmates when I informed a lecturing psychiatry professor that I considered Freud’s theories slightly more credible than the nuns’ tales about guardian angels. The lecturer ignored my obnoxious comment and continued his lecture. But Freudians have been on the defensive for the past decade. This trend culminated when the Library of Congress was forced to cancel a tribute to Freud in …

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In defense of Sigmund Freud

This emergency physician is the drunk whisperer

Physician
November 10, 2017

I have picked up Mr. Reynolds (not his real name). He is a frequent visitor to the ED for alcohol intoxication. He was found drunk on a street making a scene, and a good samaritan called him in.

Paramedics bring him in. He is not bashful about showing his discontent for his arrival to the ED. He promptly flips off the charge nurse and continues to verbally berate the paramedics. The …

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This emergency physician is the drunk whisperer

In today’s political era, my patients save me. Here’s how.

Physician
November 10, 2017

As physicians, our patients generally look up to us as people who make a great impact on their lives and sometimes even save them. But over the last year, I’d have to say that it’s my patients who have repeatedly saved me, starting with a four-month-old baby girl on November 9th, 2016.

The morning after election day, I walked into my first patient’s room at 9 a.m. Like most of the …

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In today’s political era, my patients save me. Here’s how.

Being a doctor has saved my life

Physician
November 9, 2017

I ran a 5K last weekend. I succumbed to peer pressure. The more others talked about running it, I decided I could be a runner too.

My patients describe their HIIT workouts (high-intensity interval training, for those of you not in-the-know), PiYo classes (Pilates-Yoga combination), increasing mileage for an upcoming duathlon/triathlon/marathon, and now I can proudly share my measly 5K experience with them. Of course, I will leave out the small …

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Being a doctor has saved my life

Does the medical profession need their version of the NRA?

Health Policy
November 9, 2017

Years ago, our government had a problem with health care. Medicare and other health care costs were spiraling out of control. It was clear that the problem was rapidly advancing technology and pressure to provide that technology to everyone who was demanding it. But the government, as usual, choose a politically motivated solution.

They went after the one group involved who was the most disorganized, least clear on its desires and …

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Does the medical profession need their version of the NRA?

Burnout during residency? Yep, and here’s what it taught me.

Physician
November 9, 2017

You’ve probably heard this story before: a young physician, who has spent all of his or her life succeeding and building goals, stumbles into a career without meaning or enthusiasm. Indeed, my story about burnout is much like the rest.

Like so many before me, I entered into a career in medicine motivated and eager to change the world through the care of my patients. I grew up in a family …

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Burnout during residency? Yep, and here’s what it taught me.

Registered nurse for president!

Health Policy
November 9, 2017

The United States of America is home to the free and land of the great. So many have died attempting to flee from war, dictatorships, and poverty to gain access. Once a country with such strong influence, it’s now divided by bipartisan views and gridlocked actions. As a nation, we struggle to find solutions for our poor outcomes. Why does such a great country rank so poorly in education and …

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Registered nurse for president!

Drug price hikes sometimes have catastrophic effects on patients

Medications
November 9, 2017

When I found out my patient was in the hospital again for the third time in six months, I wondered why her asthma had flared. Was the cold weather bothering her? Was her treatment regimen inadequate? When I spoke with her, I discovered the heartbreaking truth: she had been limiting her albuterol inhaler use because she simply could not afford to take it as much as she needed.

For many of …

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Drug price hikes sometimes have catastrophic effects on patients

Why we need a new approach to end of life care

Physician
November 9, 2017

Looking at how incredibly expensive the last few months of life are for anyone in this country, I think most would be quite shocked. In 2014, there were approximately 2.6 million deaths in the U.S. According to a Keiser Permanente study, 2.1 million of those deaths were Medicare related. Medicare’s annual budget is right around $600 billion, and it has been revealed that one-third of that total is spent in …

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Why we need a new approach to end of life care

3 skills that make physicians excellent in business

Physician
November 9, 2017

Let’s get one thing straight: You already have kick ass skills as a physician, skills that are valuable outside of clinical care settings. So whenever my physician friends turn to me for advice on making a transition in their career, I have to remind them: It’s not about learning new skills, it’s about translating your existing skill set to new business applications. Think digital health startup CEO, chief medical officer, …

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3 skills that make physicians excellent in business

This doctor isn’t burned out. Here’s her advice.

Physician
November 8, 2017

Recently, I took a few minutes to fill out a survey on physician burnout.   A slew of studies offer estimates of physician burnout of up to 50 percent.  In my field of primary care, the documentation and regulatory burdens may cause the number to soar even higher.

I am rounding out my fifth year in a busy suburban private practice and I am not burned out.  These questions moved me to …

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This doctor isn’t burned out. Here’s her advice.

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My hospital hacked my computer

Health Technology
November 8, 2017

Hospital email is supposed to be secure. This means that when you get an email with possible sensitive information, you receive a link to connect to a secure email product, requiring passwords, sign-ins and maybe even a bit of personal information.

Being what they are, hospitals tend to swap software products and we find some new “secure solution” that hits us, urging us to give email, make a password and possibly …

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My hospital hacked my computer

Here’s how a trip to Nepal stopped this medical student’s depression

Medical Education
November 8, 2017

“Please walk slowly,” cautioned Sunita, my interpreter, as I crept down the stony switchback trail towards the rural Nepali village of Dhulikhel. Sunita, in her petite navy ballet flats, hopped down the rocks as easily as the speckled goats grazing nearby.

Emboldened by her speed, I stepped along eagerly, only to catch my size-ten neon running sneaker on a root and splat face-first into the dust. Looking up, I saw four …

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Here’s how a trip to Nepal stopped this medical student’s depression

She sees difficult patients, but is a difficult patient herself

Medical Education
November 8, 2017

The patient is a 27-year-old Caucasian woman: slender, well-groomed. She is sitting in the office of her urologist, and she is unconsciously twisting her hands as she interrupts the doctor, having finally worked up the nerve.

“I know you told me to expect some pain for a while after the lithotripsy. But I’ve been having pain in my bladder, even when I don’t think there are any stones. It started two …

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She sees difficult patients, but is a difficult patient herself

No one cares about the doctors

Patient
November 8, 2017

I love my doctors.

I have an undiagnosable autoimmune disease. It’s mostly manageable, my lab work is perfect, and I rarely get sick. I get allergy shots and take blood pressure medication. I always have at least low level, mostly familiar, physical symptoms. Occasionally a new one appears. Sometimes it is scary.

I could have sued any or all of my doctors over the last decade-plus. I could be “livin’ large.” They …

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No one cares about the doctors

Psychological first aid can mitigate the effects of overwhelming trauma and loss

Conditions and Diseases
November 7, 2017

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My grandmother was filled with grief as she told me by phone about life on the island of St. Thomas after Hurricanes Irma and Maria had blasted through it. “Tears keep running from my eyes uncontrollably because everyone on the island is suffering,” she lamented, then paused, too sad to continue. I could picture her in her …

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Psychological first aid can mitigate the effects of overwhelming trauma and loss

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