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Improving drug adherence will take more than money and technology

Medications

September 16, 2017

I recently asked, “Who’s to blame?” for patients not taking their medications and cited a couple of papers describing the poor state of medication adherence. I concluded nonadherence was a huge problem, and doctors failing to educate their patients was not a major cause.

To support my contention that physicians are not the reason why patients do not take their medications as ordered I submit the following new information.

How anti-vaccine parents are finding doctors willing to exempt their kids

Ana B. Ibarra and Barbara Feder Ostrov

Conditions and Diseases

September 16, 2017

Dr. Tara Zandvliet was inundated with calls and emails from parents last year, after California passed a law nixing personal beliefs as an exemption from school vaccinations. Suddenly, many parents sought exemptions for medical reasons.

Someone even faked two medical exemption forms purportedly written by the San Diego pediatrician, copying a legitimate document she’d provided for a patient and writing in the names of students she’d never treated, she said. She …

MKSAP: 54-year-old man with elevated blood pressure

mksap

Conditions and Diseases

September 16, 2017

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

A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications.

On this visit and on two subsequent nurse visits, the patient’s blood pressure measurements are less than 140/90 mm Hg. BMI is 34. Cardiac examination reveals an …

The surprising sleeping arrangements of an emergency physician

Edwin Leap, MD

Physician

September 15, 2017

I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time. During that time I stayed in a lot of hotels. But, occasionally, I had more unique accommodations. Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal. I actually like sleeping in airports occasionally. When you’re stuck, you’re stuck. Weather or …

The toughest task in emergency medicine

Jay Baruch, MD

Physician

September 15, 2017

I’m a physician, a husband and dad, a guy who tries to live by the golden rule. But sometimes I’m an escort into sadness and despair, plunging families into the darkest emotional depths with the news I must give.

One particular case from years prior stands out. Mary (whose name and identifying details have …

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The toughest task in emergency medicine

What does it mean to be a progressive doctor?

Surafel Tsega, MD

Health Policy

September 15, 2017

A curious post popped up on my Facebook feed recently: “Another doctor running for office!” A picture of an attractive family was nestled below that exclamation, asking to show your support (in the form of dollars) for this doctor running as a Democrat for the House of Representatives. It had that sense of enthusiasm that implied I was obligated to be excited, but instead came off more like Jeb Bush’s …

This South Pacific island will change how you think about health care

Kevin R. Campbell, MD

Physician

September 15, 2017

For the last several weeks, I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki. Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power). The inhabitants are subsistence fishermen and farmers. They are filled with joy and a real sense of community. While on the island, I found extremely high rates of high …

Use your voice to change health care

Michael Weiss, MD

Health Policy

September 15, 2017

I’m pleasantly surprised to see how a growing number of physicians are finally starting to percolate openly with their extreme dissatisfaction about a just how broken our medical system is. I admire and am proud of these brave vanguards who are a minority but have seemed to pick up steam. I still don’t hear their fearless voices carried in major media outlets (shame on these outlets!), but they are more …

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Use your voice to change health care

Take back our practices with physician cooperatives

Maiysha Clairborne, MD

Physician

September 14, 2017

One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed. The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today.

Furthermore, all the talk about mindfulness only riles up more anger in physicians as they feel they are …

Pay off debt, invest, or both: Advice to young physicians

Another Second Opinion, MD

Physician Finance

September 14, 2017

Let me start by saying that I am a huge Dave Ramsey fan. When I completed residency and began my current position, The Total Money Makeover was the first personal finance book I read, and pardon the cliché, but it changed my life. It instilled in me a strong foundation in money management and offered me a road map to handle the situation I was in: hundreds of thousands of dollar in …

A safe space is needed to talk about medical errors

Saba Fatima, MD

Physician

September 14, 2017

Two months into my pediatric residency, while working on an overnight call, I encountered my first medical mistake. We, fortunately, had had a very good night, and all patients had remained stable. It was an hour before sign-out to the morning team, that I received a page. I quickly held my pager and dialed the 4-digit number, only to find a busy dial tone. I was a little surprised and …

What it’s like to be on call during a hurricane

Monica Verduzco-Gutierrez, MD

Physician

September 14, 2017

As an attending and educator, I give a lecture to the residents each year about stroke syndromes. In the lecture, I use mnemonics, pictures, and associations, so that the trainees can retain the information in non-traditional ways and have fun learning what could be otherwise dull material. When I talk about the internal carotid artery stroke syndromes, I bring up the possibility of “the good, the bad and the ugly” …

A nurse returns from vacation. And she’s thankful to the ICU she came back to.

Debbie Moore-Black, RN

Conditions and Diseases

September 14, 2017

I’m in the ICU and was just back from an incredible tropical vacation. Nine days of vegging out on the beach. The glistening ocean was just steps away from the five-star hotel I was staying in, where doormen greeted me with fruity daiquiris and a staff that couldn’t wait to serve my every whim.

I was in paradise, and far, far away from the reality of my day-to-day existence as an …

A resident deals with being a wife, mother, and doctor

Dawn Browne, MD

Physician

September 14, 2017

As a second-year family medicine resident, wife of a nurse and mother of an almost-two-year-old, the feeling of just not being enough has a suffocating hold on me some days. Non satis. Sounds like a pretty good gig when I talk with others outside the medical profession and friends from home. Training to be a doctor? Great. Happily married to an amazing man who’s taking time off work to raise …

Stop exploiting medical students and residents

Samer W. Cabbabe, MD

Physician

September 13, 2017

Approximately 300-400 physicians commit suicide annually. Given that a typical doctor has about 2,300 patients under his or her care, that means more than a million Americans will lose a physician to suicide this year.

In a study of six medical schools, almost seven percent of students said they had thought of ending their lives in the last two weeks. In another recent study, 29 percent of residents …

Health care reform: A free-market solution works in other countries

Kent Holtorf, MD

Health Policy

September 13, 2017

Repealing and replacing the Affordable Care Act is on indefinite life support. The political consensus was that President Trump needed to pass health care reform to be able to move forward with his legislative agenda. While this may be true, the passing of any repeal and replacement bill without fundamental reforms has little chance of long-term success, likely defining Trump’s presidency as a failure no matter how successful he is …

What rejection taught this doctor

Caitlin Smith, MD

Physician

September 13, 2017

I sat on my floor, surrounded by boxes in various states of organization and disarray, sifting through a pile of papers. I was moving for my surgical fellowship and, of course, put off packing to the last minute. However, in the middle of the hectic and scattered process, a particular stack of papers caught my eye; I felt the need to pause and go through them. They were old and …

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What rejection taught this doctor

When we talk about quality, what exactly do we mean?

John Corsino, DPT

Health Policy

September 12, 2017

It’s a health care buzzword for sure, but when we talk about quality, what do we mean? We can compare the quality of similar things and focus on its absence, but otherwise, putting the idea into words becomes complicated. Context is important. And so is perspective: One’s position within the health care system influences how he defines quality to a larger degree than it does at a restaurant, or in …

A pediatrician was bullied by his fellow physicians on Twitter

Mick Connors, MD

Social Media in Medicine

September 12, 2017

#Tweetiatrician is a common hashtag used by pediatricians as a way I assumed to find advocates for children’s issues.

Recently, I used this hashtag to start a new Twitter account. I sought educated dialogue on Medicaid, health care reform, vaccination, and other pediatric topics.

I am a pediatric emergency medicine physician and consider myself a strong advocate for children and seldom agree with any political party. My advocacy work in many forms …

Pursuing a career as a physician: A reminder why

Sangrag Ganguli

Medical Education

September 12, 2017

Last week, I spent a few hours completing an online module for one of my immunology courses. The purpose of this module was simply to expose students to the format of lecturing and assessments that would take place throughout the length of this course.

The portion of the module that I found really exciting was a series of videos depicting scenes at a local clinic where a physician examined a patient …

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