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Why the cancer moonshot is already off course

Conditions and Diseases

April 25, 2016

The cancer moonshot initiative raised skepticism because of the limited funding to end cancer. Unfortunately the recently announced panel membership confirms that while the project may launch, skewed representation may tilt the mission off course.

It is no surprise that the panel heavily tilts toward immunology, medical oncology, surgery and big science. But three core specialties you would find at any tumor board are missing: pathology, radiology, and radiation …

Choose your own ER adventure

Raj Waghmare, MD

Physician

April 25, 2016

It’s October, and it’s beautiful outside; warm, sunny with a lazy breeze. Colorful. Two hours into my ER shift, I meet Bridgette, a 77 year old who volunteers four days a week. She arrived by ambulance, but walks easily, and feels silly for being here.

She sits comfortably on the exam table and tells me her story: Two hours earlier, she was gardening at the seniors’ center when she had a sudden sharp pain in …

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Choose your own ER adventure

The challenge of translating research to clinical practice

Kyle Morawski, MD and Joshua Liao, MD

Medical Education

April 25, 2016

Despite convincing results for many health care interventions, translating evidence from research into clinical practice is often challenging. Implementation barriers are myriad and complex, but a number may arise from core design issues. While real-world environments are clearly vital to the success of any intervention, many traditional research efforts are structured to remove them from the proverbial equation.

In studying the impact of a new medication, for instance, a group might …

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How to perform services that increase primary care revenue

Betsy Nicoletti, MS

Health Policy

April 24, 2016

CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems …

This is what a physician wants in an EMR. Please build it.

Sam Slishman, MD

Health Technology

April 24, 2016

Adding “electronic” means sortable, searchable, bigger attic, more junk. Unfortunately, no one has the guts to actually clean it. Are urinalyses from the 90s still important, or are we just being sentimental?

For everything we do in medicine, there are intended effects and side effects. During my emergency medicine residency there was a mandate that attending physicians had to see each patient cared for by their residents. While a hard transition, …

Why paying hospitals for clerkships is good, and necessary

Heidi Chumley, MD, MBA

Medical Education

April 24, 2016

Critics have been making the rounds again with a warmed-over complaint: International medical schools that offer U.S. teaching hospitals financial support for clerkship programs are unfairly buying access for their students instead of “more deserving” U.S.-based students. As the proud dean of a Caribbean medical school, I want to set the record straight yet again: This argument is hollow and based on a false dichotomy. In fact, the argument has …

Every physician is a wounded healer

Chris Cantilena, MD, MMM

Physician

April 24, 2016

I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …

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Every physician is a wounded healer

There are far too many homophobic doctors and nurses

Janet Boivin, RN

Patient

April 23, 2016

As a registered nurse and health care writer and editor for more than 25 years, I routinely wrote or assigned stories to other writers about the health of LGBT individuals. I valued these stories not only because I was a nurse, but also because I thought the subject was worthy of coverage. I believed our nurse readers should be aware of the specific health needs of their LGBT patients.

I followed …

Ask patients how they feel, along with how they are feeling

Daniel L. Meltzer, MD, MPH

Physician

April 23, 2016

“How are you feeling?”

It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility. But, do we ever stop to think: What is really the point of this question? What information are we trying to glean? I think for most of us, we’re asking the question with a cognitive bias towards the physical. How are they “physically” feeling: better, …

Learn the physical exam by following an oncologist

Miriam A. Knoll, MD and George Dawson, MD

Medical Education

April 23, 2016

“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)

In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …

MKSAP: 55-year-old man is evaluated following a screening for type 2 diabetes mellitus

mksap

Conditions and Diseases

April 23, 2016

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

A 55-year-old man is evaluated following a screening for type 2 diabetes mellitus. He is asymptomatic. He has a history of hypertension and hyperlipidemia. There is no history of anemia, liver disease, or kidney disease. Medications are lisinopril and rosuvastatin.

On physical examination, blood pressure is 123/76 mm Hg and pulse rate is 72/min. …

Drug addiction is a learning disorder

Randi Hutter Epstein, MD, MPH

Conditions and Diseases

April 22, 2016

When I think back about what I learned about drug addiction in medical school in the 1980s, I can’t think of much.

Sure, I talked to plenty of patients who had been snorting coke and injecting heroine. One man with AIDS promised to teach me how to draw blood, if I’d sit by his side and keep him company. He didn’t have any other visitors. Maximum security prison where he was …

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Drug addiction is a learning disorder

How a physician suicide 30 years ago affected this doctor today

Niran S. Al-Agba, MD

Physician

April 22, 2016

Physicians have one of the highest rates of suicide of any profession: nearly twice the rate of the general population. 400 physicians commit suicide each year in the United States. The stress of being a doctor is constant and unrelenting. The majority of us are perfectionists with a strong work ethic: your classic Type A personality. Maybe we set ourselves up for failure and then cannot accept when it inevitably …

An objective national standard for clinical skills is critical. Here’s why.

Kenneth Simons, MD

Medical Education

April 22, 2016

How do you learn to be a good doctor? Sure, you study anatomy, and make flashcards, and memorize nerve pathways, but what makes someone a good doctor is the way they apply all that knowledge to real patients with compassion and diagnostic expertise. Strong “doctoring” skills, like listening carefully, taking a comprehensive history, explaining medication and treatment options clearly and patiently, and writing notes that colleagues can understand, are what …

Stop telling younger generations not to become doctors

Darin Williams, MD

Medical Education

April 22, 2016

His eyes were as wide open as his mouth as he slowly placed his beer on the bar without looking away from me. Making no effort to wipe the thick foam from his upper lip, the man continued to stare in disbelief, “That’s the coolest thing I’ve ever heard.”

The thirty-something C-something-O was blown away by what I did for work. By this time a small crowd had gathered, standing in …

Should cardiologists evaluate their obsession with LDLs and HDLs?

Robert Centor, MD

Conditions and Diseases

April 21, 2016

This post is purposely controversial. I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue. This post is hypothesis challenging. I may be right, or I may be wrong. I hope we get some debate on my speculations.

The latest blow to the cholesterol hypothesis: “Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart …

A death that feels good to a surgeon’s soul

Jamie Coleman, MD

Physician

April 21, 2016

He had loved her with all his being for more than six decades. In the last two years of their 61-year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him.

When I met him, I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia …

Is the government’s National Pain Strategy doomed to fail?

Kenneth Lin, MD

Conditions and Diseases

April 21, 2016

Over the past few months, the federal government has mobilized against what is being called “the opioid crisis“: a national epidemic of fatal overdoses that in 2014 claimed more than 14,000 lives, the most ever recorded. Since most of these opioids were originally prescribed by physicians to treat pain, the Centers for Disease Control and Prevention recently finalized a guideline containing recommendations …

If meaningful use is a great idea, why isn’t it employed more widely?

Richard Gunderman, MD, PhD

Health Technology

April 20, 2016

A decade ago, electronic health records were aggressively promoted for a number of reasons. Proponents claimed that they would facilitate the sharing of health information, reduce error rates in health care, increase health care efficiency, and lower costs. Enthusiasts included the technology companies, consultants, and IT specialists who stood to reap substantial financial rewards from a system-wide switch to electronic records.

Even some health professionals shared in the enthusiasm. Compared to the …

Meals for new parents is food for the soul

Katie Lockwood, MD

Physician

April 20, 2016

When I had my first baby, one of my friends coordinated a meal train where coworkers could sign up to bring our new family a dinner every other night. Those first few weeks of motherhood were such a chaotic blur that I do not even remember how many weeks this meal delivery went on for except to say that it was both long enough and over too quickly. There was …

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