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Guarding against infection falls to families as care shifts to home

Melissa Bailey

Conditions and Diseases

September 27, 2017

Angela Cooper arrived home from work to discover her daughter’s temperature had spiked to 102 degrees — a sign that the teenager, who has cancer, had a potentially deadly bloodstream infection. As Cooper rushed her daughter to the hospital, her mind raced: Had she done something to cause the infection?

Cooper, who works at a Chevy dealership in Iowa, has no medical background. She is one of thousands of parents who …

Breast cancer awareness needs to change

Linda Girgis, MD

Conditions and Diseases

September 27, 2017

Pink ribbons are everywhere, and we all know what that means: breast cancer. While this has helped raise awareness on a horrible killer and the importance of early screening, it does not address the fact that there is still no cure for stage IV cancer or the fact that men get breast cancer as well. Yes, it is important that we all know that breast cancer is prevalent in our …

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Breast cancer awareness needs to change

Why do we keep prescribing heroin for our patients?

Myles Gart, MD

Medications

September 27, 2017

In order to fully understand the issues surrounding opioid prescribing practices, it is important to review a brief history of how these drugs came to market.

Opium was the first opioid, derived from the sap of opium poppies whose growth and cultivation dates back to 3,400 BC. In the 18th century, physicians in the U.S. used opium for multiple ailments. Towards the end of the 18th century, the addictive qualities of …

A hospital invested tens of millions to preserve its community and won

Peter F. Nichol, MD, PhD

Health Policy

September 27, 2017

A dear friend who is many years my senior recently remarked that he has stopped watching television. “I’m tired of seeing all the bad s%&t that’s happening in the world. I know it’s happening, but I can’t do much about it, and it makes me depressed. I want to hear some good news stories.”

He is correct, of course. we all could use a good news story or two.

To be sure, our news media has evolved …

Physicians and magicians are not as different as you think

Robert Baker, MD

Physician

September 27, 2017

We all know what, in 1888, Rudyard Kipling pronounced to be the world’s oldest profession. But what’s the world’s second oldest? Hunter-gatherer? Nah, everybody did that. Primitive politician? That’s a tautology. Neolithic attorney? Nope. Too similar to the oldest.

I strongly suspect that the second oldest profession was healer/magician. Fire up Mr. Peabody’s Wayback time machine, and you’d probably find that the first healers were regarded as magicians, and the first …

The challenges of leaving a positive impact while practicing as a physician in another country

Farrell Tobolowsky, DO

Physician

September 26, 2017

He was approximately 75 pounds and appeared to be wasting away. Although he was only 43 years old, he had end-stage AIDS. Even in this cachectic state, he continued to refuse to eat the hospital food because he didn’t like it. After speaking at length with him, he said that he only wanted porridge with meat or “fat cakes,” both of which we did not serve in the hospital. He …

So much for repealing and replacing Obamacare. What’s next?

Brian C. Joondeph, MD

Health Policy

September 26, 2017

So much for repealing and replacing Obamacare. The Graham-Cassidy Senate bill is on life support. Members of the Senate death panel have made their decision, leaving their patient on palliative care to spend the last few days of life on heavy pain meds but without lifesaving treatments.

Death is scheduled for the end of September when time runs out on the reconciliation rules which allow the Senate to pass legislation …

How the stories of refugees affected this medical student

Weijie Violet Lin

Health Policy

September 26, 2017

If I hadn’t heard her sob, I might not have looked up. I was so immersed in her story, and so fixated on my own studious note-taking, that I didn’t doubt the steady rhythm of her voice until I heard it break. Huda’s (name changed) eyes were filling with tears, and I quickly handed over the tissue box, feeling that its trifling weight was an apt metaphor for how little …

Before you say “I’m sorry,” I challenge you to think

Sasha K. Shillcutt, MD

Physician

September 26, 2017

We as women have to stop saying “I’m sorry” for things out of our control. When we apologize for things we are not responsible for, we take a step backwards in the advancement of women in the workplace.

I am a cardiac anesthesiologist, which means I care for patients who are undergoing open-heart surgery. I work in an academic medical center and train doctors to become anesthesiologists. The operating room (OR) can …

How tech can get doctors back to seeing patients

Timothy Judson, MD, MPH and Robert Wachter, MD

Health Technology

September 26, 2017

Rates of physician burnout are rising, and many physicians cite their electronic health record (EHR) as the primary culprit. That’s no surprise, since doctors spend twice as much time on electronic health record (EHR) systems and deskwork as they do directly interacting with patients. Let that sink in for a moment. Imagine if an airline pilot spent six hours documenting every detail of a three-hour flight. Such …

Experimental treatments: When patients want something outside of standard of care

Don S. Dizon, MD

Conditions and Diseases

September 26, 2017

I was reading my emails this morning and came across one from the Foundation for Women’s Cancers, announcing September as Gynecologic Cancer Awareness Month. Their social media campaign centered on the hashtag #sharethepurplelove, and the focus on clinical trial awareness and participation. It got me thinking again about the enterprise of clinical trials, and just …

He was the perfect person to shop for health care. And he failed miserably.

Ateev Mehrotra, MD

Physician

September 26, 2017

After three months of using hot compresses to shrink the stye on my daughter’s eyelid, it wasn’t getting any smaller. My daughter is prone to this sort of growth, called a chalazion. This one would have to be removed surgically, like the one she had removed from the same eyelid two years earlier.

But there was one …

A doctor goes without a white coat. Here’s how his visits changed.

Hans Duvefelt, MD

Physician

September 25, 2017

Something very interesting happened to my patient visits when I changed my office attire.

My clean long cotton lab coats, hanging on the back of my office door, suddenly all seemed dingy when I set out to change lab coat about a week ago. I decided to pretend it was Saturday.

On Saturdays, I usually wear a pocketed button-down shirt instead of one of my usual Jermyn Street ones. I skip the …

The cost of drugs confounds this gastroenterologist

Michael Kirsch, MD

Medications

September 25, 2017

Most of us do not know the basics of economics, although we should. It impacts every one of us every day that we are alive. Yet, for most of us, once we get beyond the law of supply and demand, our knowledge of the subject starts to vaporize. I can’t explain fiscal or monetary policy. While I regard economics as a science, it seems that experts routinely interpret data differently, …

Bernie Sanders and the single-payer dream: Why we must take it seriously

Matthew Hahn, MD

Health Policy

September 25, 2017

After being out of the news for a few weeks, health care reform came back with a bang this week when Senator Bernie Sanders unleashed his Medicare for all, single-payer reform plan, now backed by sixteen Democratic senators. More than anything, to make progress on reform of our dying health care system, the nation needs to get to a place where it can engage in serious conversations about such proposals.

I …

If you cut payments to surgeons, don’t be surprised if they do more procedures

Peter Ubel, MD

Health Policy

September 25, 2017

Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the U.S. doubled, to more than one million. Experts think the figure might rise another sixfold in the next couple of decades because of our aging population.

Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. It shouldn’t be surprising, then, that the program is experimenting …

Online screening for depression: Here’s what one physician thinks about it

Maria Yang, MD

Conditions and Diseases

September 25, 2017

Inquisitive reader Amy asked me if I had any opinions about online screening for depression. The British Medical Journal recently published a debate on this issue.

What an excellent question, Amy! I read the opposing arguments, and these are my thoughts:

First, I see two different issues. The first is whether the 9-question Patient Health Questionnaire (PHQ-9) is an appropriate tool to use to screen for depression. The second is …

It’s time to ban productivity from medicine

Robert Centor, MD

Health Policy

September 25, 2017

According to Wikipedia, “Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”

Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to …

Ranking the world’s health systems: These results may surprise you

Ashish Jha, MD, MPH

Health Policy

September 24, 2017

I was recently by the New York Times’ the Upshot to rank eight health care systems they had chosen: Australia, Canada, France, Germany, Singapore, Switzerland, the United Kingdom, and the United States. This forced me to think about a pretty fundamental question: what do we want from a health care system?

What does an ideal health care system look like?

I would argue that most people want a health …

A surgical resident is held back a year. Finding out who’s right will be difficult.

Skeptical Scalpel, MD

Medical Education

September 24, 2017

A surgical resident is suing St. Louis University, its surgical residency program director, and its trauma service chief for what she claims is an unjustified decision requiring her to repeat her fourth year of training.

The St. Louis Post-Dispatch article about this has a link to a 42-page PDF describing the details of the suit. Because I suspect you won’t read that PDF and maybe not even the article, I …

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