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Fixing the breakdown in patient satisfaction

Physician

August 4, 2016

Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent — in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to …

Access to guns is easy. Access to trauma care is becoming more difficult.

Eric Beam, MD

Physician

August 4, 2016

Now that the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself, and our legislature will again fail to enact any meaningful reform.

Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why …

We are all connected to the well-being of LGBTQ youth and their families

Alexis Drutchas, MD

Physician

August 3, 2016

The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not …

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Pass-fail is here to stay in medical schools. And that’s a good thing.

Francis Deng, MD and Austin Wesevich

Medical Education

August 3, 2016

Starting this fall, second-year students will no longer have the stress of grades at our medical school, Washington University in St. Louis (WashU). In extending the pass-fail system from the first year to the second preclinical year, WashU joins the other 18 of the top 20 research medical schools on U.S. News and World Report that grade the entire preclinical curriculum on a pass-fail basis. (The sole holdout is Penn, …

A guide to surviving chronic disease

Alberto Hazan, MD and Jordana Haber, MD

Conditions and Diseases

August 3, 2016

For many people with chronic disease, the toughest thing is convincing themselves they’re not crazy. This is especially true for those with an illness with no clear etiology.

For millions of people around the world suffering from multiple sclerosis, lupus, fibromyalgia, chronic abdominal pain, ALS, rheumatoid arthritis, certain types of cancer, chronic fatigue syndrome, and hundreds of other illnesses, just making it through the day is overwhelming. Not only do many of …

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A guide to surviving chronic disease

Will integrated health care startups make health care better?

Davis Liu, MD

Health Technology

August 3, 2016

With Obamacare and creation of health insurance exchanges, many believed that health insurers would compete for patients much the same way hotels, rental cars companies, and airlines compete for customers. By comparing identical benefits packages from different insurers, patients could select their insurer based on the monthly premium and the extent of the hospital and physician network.

In a recent Vox article, Ezra Klein urged insurers do “something like …

This is what makes a good doctor

Isaac S. Chan, MD, PhD

Physician

August 2, 2016

In the medical field, it is said that July, not April, is the cruelest month. It even has a name, the July Effect. In June, hospitals hum and smoothly operate after a year of working out the kinks. In July, they welcome, or dread, the arrival of new recruits: newly minted physicians and medical students, eager to prove themselves, yet raw and untrained. For me, as a senior resident, it …

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This is what makes a good doctor

You don’t have to love your specialty. Here’s why.

Laurel Fick, MD

Medical Education

August 2, 2016

It’s that time of year where upcoming fourth-year students are frantically preparing applications for their chosen specialties. Statements like “I LOVE psoriasis,” and “’I’m fascinated by the colon,” are heard from eager, smiling, seemingly-passionate faces when asking preceptors for a “strong letter of recommendation.’”

But what about you? You know, the one whose specialty decision-making process feels more like being tossed into an M.C. Escher lithograph than the instant, undeniable attraction …

The psychiatrist with a psychiatrist

Kali Cyrus, MD, MPH

Physician

August 2, 2016

I sat across from her and in my most official yet trusting psychiatrist’s tone gave the spiel I delivered many times.

“Amanda, I’d like to start you on a medication that might help your depression. Like every medication it can cause side effects, however, many people have no side effects or only have minor ones. This drug can cause weight gain, increased risk of diabetes, and increased risk of heart disease.”

A …

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The psychiatrist with a psychiatrist

To fix rural health care, you have to understand it first

Niran S. Al-Agba, MD

Health Policy

August 2, 2016

Recently, physicians in small private practices and rural areas breathed a collective sigh of relief. There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed. Thank you, Mr. Slavitt, for listening. I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind. We have a window of opportunity for rural health care to survive, but we …

It’s time to disrupt basic communications in hospitals. Here’s one idea.

Michael Lee, MD, JD

Health Technology

August 1, 2016

I had just taken over three other residents’ phones and pagers when 2-year-old “Bryce” jumped off the couch in our oncology unit, landed on his chin, and bit completely through his lower lip. I quickly reviewed his platelet level from that morning, examined him, and began calling plastic surgery and anesthesia for sutures. While I was on one phone, a second one started ringing. I declined the call and tried …

The most powerful driver of medical costs is hope

Dr. Saurabh Jha

Physician

August 1, 2016

When diagnosed with abdominal mesothelioma, a rare cancer with a blighted future, evolutionary biologist and writer, Stephen Jay Gould, turned his attention to the statistics; specifically, the central tendency of survival with the tumor. The central tendency — mean (average), median and mode — project like skyscrapers in a populated city and are the summary statements of a statistical distribution.

The “average” is both meaningful and meaningless. The average utility of …

10 pieces of advice for new physicians

Michelle M. Kittleson, MD

Medical Education

August 1, 2016

I am blessed to love being a doctor. As the child of two physicians, and the fifth generation of physicians in my family, I had no choice but to go to medical school. But from the first day of medical school, I loved it. What a privilege, to know how the human body works! And I didn’t think medical school was particularly fun: I thought it was hard. The first …

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10 pieces of advice for new physicians

A medical student’s first trauma

Shama Patel, MD

Medical Education

August 1, 2016

“Code fifty-two, emergency room. Code fifty-two, emergency room,” blared over the loud speaker in the hospital. Simultaneously a chorus of beepers went off, like crickets on a sticky summer day.

I glanced down at my pager that echoed the same message “CODE 52, EMERGENCY ROOM.” The same message flashed across the screen three more times as I ran quickly down the main hallway. Code 52 meant trauma. I was about to …

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A medical student’s first trauma

Healing at the hospital begins with peace and quiet

Pallabi Sanyal-Dey, MD

Physician

July 31, 2016

The space can make a difference. I had already spent over two years working as a hospitalist at San Francisco General Hospital, and I had become accustomed to the old building and all its challenges. Fast forward to the end of May 2016 to one of my first shifts working in the new building, a.k.a “The Zuck”: Zuckerberg San Francisco General (ZSFG). Change had never felt so good.

I walked across the …

The worst thing about being an internal medicine intern

Marc N. Katz, MD

Physician

July 31, 2016

The only thing I love more than complaining about being a doctor is actually being a doctor. Intern year sucks. There’s no way around it. I wake up at 5:15 a.m. to get to the floor at 6:00 a.m. and I rarely leave at 5:00 p.m. when my shift is scheduled to end assuming I’m not on call until 9:00 p.m.

I often feel my stomach growl at 9:00 a.m. and …

The hospital with a high episiotomy rate

Nicole Calloway Rankins, MD

Conditions and Diseases

July 31, 2016

I have been an OB/GYN hospitalist at a busy suburban community hospital for almost one year. I truly love my job. However, I’ve noticed something unexpected that’s prompted me to pause. There are several physicians — good, clinically competent, kind physicians — who frequently perform episiotomies. Routine episiotomy is not recommended. In my training and eight years of practice prior to becoming a hospitalist I rarely saw it used. So …

Physician tips to tame your email inbox

Neil Baum, MD

Health Technology

July 31, 2016

I am an email junkie and spend more time than I would like to admit on emails every day. I start my day by looking at emails, and I end every evening reviewing emails. And yes, I spend time during the day checking the computer for pertinent emails that need my attention. I think many physicians are of the same ilk.

According to Alexandra Samuels, who is the author of Work …

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Physician tips to tame your email inbox

Nurses identify 10 needs health startups should focus on

Priyanka Agarwal, MD, MBA, Desiree Matloob, MA, and Fiahna Cabana

Health Technology

July 30, 2016

Startups looking to partner with health systems: This list is for you.

So often, it seems like new technologies being developed for health care don’t address the areas of largest need. We sat down with nursing leaders at the University of California, San Francisco (UCSF) to get a sense of what clinical problems could be best addressed by technology.

The following list was compiled from interviews with Sheila Antrum (president and senior …

Blinded by cash: The financial crisis of refugee health care

Eyad Gharaibeh

Conditions and Diseases

July 30, 2016

“I only have 10 percent of my eyesight remaining, but that’s not the problem. I am looking for mercy.”

My eyes drifted back and forth between Abu-Adnan’s face squinting into the distance, and the shuffling prayer beads swaddled in his right hand. I fizzled with frustration as my cochlea’s raced to transcribe his traumatic story into an appropriate emotional response.

This 65-year-old Syrian refugee from the Golan Heights pleaded me for a …

Real physician voices, twice a week

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