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Shared decision making is still the exception and not the rule

Physician

March 25, 2016

Joe had one of the best geriatricians in the city. So when he got a call from the pharmacist saying his new prescription was ready, he assumed that it had to do with his recent annual visit and blood draw. His suspicions were confirmed, a few minutes later, when he got through to the nurse at the office.

Joe was politely informed that he had high cholesterol and was being put …

It’s time to treat mental illness as seriously as we treat heart disease

Ramin Lalezari

Conditions and Diseases

March 25, 2016

I saw a patient last week for her chest pain. A 60-year-old woman came into the hospital because her chest tightened every time she went running. The pain would last about 20 minutes, centered on the left side of her chest, and radiated to her left arm. It lasted until she would finally take a break from running and sit down.

“This is classic,” I thought. “Stable angina.” I could now …

Doubts that surround dying is an opportunity to raise consciousness

Kevin Haselhorst, MD

Physician

March 24, 2016

An excerpt from Wishes To Die For: A Caregiver’s Guide to Advance Care Directives.

The great poet Rumi ascribes, “I should be suspicious of what I want.” Like many others, as I become older I look forward to Medicare paying for health care expenses. Being enrolled in Medicare makes health care available, yet access to health care does not ensure good health. Eating an apple a day keeps the …

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Engage patients to improve outcomes and reduce risks

David B. Troxel, MD and Robin Diamond, JD, RN

Physician

March 24, 2016

A 42-year-old patient arrived for her annual gynecologist appointment complaining of a self-detected breast lump. She had several questions about her condition and wanted to tell her doctor about a family history of breast cancer. The doctor was in a hurry and advised her to ask the staff, but the staff was busy with other patients and told her to call them later. The patient did not call.

The gynecologist ordered …

Naturopaths should be restricted from treating children. Here’s why.

Britt Marie Hermes, ND

Physician

March 24, 2016

You may be aware of Ezekiel Stephan, a 19-month-old boy, who died in 2012, after his parents chose home remedies and naturopathy for the treatment of viral meningitis. The parents currently are on trial in Canada for failing to provide the necessities of life.

Over the course of many days, Ezekiel’s condition rapidly deteriorated, but his parents chose to “give him as much natural product as possible,” including syrup, frozen …

Dementia from PPIs: A hypothesis that may have led to gastrointestinal bleeding

Jeffrey Adler, MD, Shawn Shah, MD, Jenna Koliani-Pace, MD, and Corey Siegel, MD

Medications

March 24, 2016

Over the past week, while covering the inpatient gastroenterology service, we cared for three patients who were hospitalized with gastrointestinal bleeding who were found to have large, potentially life-threating, stomach ulcers. All three of the patients had abruptly stopped their acid-suppressing proton pump inhibitor (PPI) medication in the preceding 1 to 2 weeks. With PPIs being a primary therapy for gastroesophageal reflux and ulcer treatment, why would these patients have …

Why doctors kill themselves

Pamela Wible, MD

Physician

March 23, 2016

Pamela Wible, M.D., takes on physician suicide in her TEDMED talk (delivered on November 18, 2015). Learn more about Dr. Wible and her talk at TEDMED.com. Full transcription below:

I love the three things that people fear the most: death, disease, and public speaking. Here’s how it all started. At four, I was so talkative (and bossy) no babysitter would stay with me. So I tagged along with …

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Why doctors kill themselves

Why is erectile dysfunction so politically impotent?

Arnon Krongrad, MD & Kimberly Langer

Physician

March 23, 2016

It is open season on erectile dysfunction. First, a politician in South Carolina introduced a bill to make it hard to get Viagra and then a politician in Kentucky. If the bills pass, they will hold patients with erectile dysfunction hostage to unrelated agendas. You might think that erections would be as politically untouchable as guns. After all, erections are nearly as popular as they are …

Meaningful use creates meaningless strife

Jim Schroeder, PhD

Health Technology

March 23, 2016

One of the biggest topics today in the health care field is that of meaningful use. Meaningful use is defined as using certified electronic health record (EHR) technology to improve quality, safety, efficiency, and reduce health disparities. The promise is that meaningful use will help improve patient and provider communication and increase care coordination while maintaining the privacy and confidentiality of patients.

However, serious questions are emerging about whether this is …

A medical resident commits suicide. Here’s how one colleague mourns.

Anonymous

Physician

March 23, 2016

In the hour after I heard the news, I experienced the full spectrum of typical reactions to a physician suicide.

One end of the spectrum came from the attending in a clinic, who when asked if the residents could go home and mourn their friend who just committed suicide, proceeded to tell me a story of how when her grandpa died before a final exam in medical school. She decided to …

Why doctors must learn from a patient’s perspective

Lisa Goodman-Helfand

Patient

March 23, 2016

On September 14, 2006, I was in the midst of a 218-consecutive-day hospitalization. What began as a scheduled C-section that April, resulted in a massive infection that nearly killed me. By Autumn, I was receiving physical therapy in the large hospital gym when I was raced back up to my room for my trach to be suctioned. This was not an uncommon occurrence. I was used to the process, and …

Call people by their rightful name. It matters more than you think.

M. J. Harbert, MD

Physician

March 22, 2016

There are several Tumblr sites where people submit their actual name and compare it to the name the Starbucks employee writes on the cup. There’s “Starbucks Name Fail,” “The Starbucks Name Game,” “Starbucks Can’t Spell My Name,” and “That’s Not My Name, Starbucks.”

There aren’t Tumblr sites for calling out Starbucks when they biff your drink. “Starbucks F***** Up My Drink,” “Would You Just Look at This Beverage,” and “There’s No …

Why the Flexner model is outdated for today’s medical schools

Anonymous

Medical Education

March 22, 2016

During my first year of medical school, I attended a “speed dating” event, where medical students met attendings from various specialties to get a better sense of what we could do with our lives once we graduated. Older physicians consistently remarked that they decided their future during their intern year. One even said that he waited until the end of his internship to decide on otolaryngology.

I, along with my fellow …

A gastroenterologist looks for his first job. Here’s his story.

Matthew Moeller, MD

Physician

March 22, 2016

An excerpt from What It’s Like to Become a Doctor: The Year-by-Year Journey From Medical Student to Practicing Physician, Greenbranch Publishing, 2016.

My third year of fellowship: June 2010 — July 2011

In July 2010, I began my third and final year of fellowship. This year was focused on honing all the skills we learned during our first two years. It was also time to start looking for my first …

Why this primary care doctor retired early

Eugene Rosenberg, MD

Physician

March 22, 2016

When I was growing up in the ‘50s and ‘60s, virtually every primary care doctor (pediatrician, internist, GP-there were no FPs) I knew of had his office (women in practice were rare) located in a wing of his home, with the driveway enlarged to accommodate patients. A new physician in practice would simply hang his name on a shingle in front of the house. These doctors were paid in cash, …

If this medical student was a test question, the answer would be depression

Anonymous

Medical Education

March 21, 2016

I’m not sure when it happened, but driving into the parking lot that cold winter day, I knew it had. Tears welled in red eyes, snot dripped out of my nose. I felt so alone and lost. My whole life I’d wanted this — the drive to the hospital and wondering whether I would change a life. But as I sat in my car, engine off, I didn’t want that …

A doctor confronts his addiction

Peter Grinspoon, MD

Physician

March 21, 2016

An excerpt from Free Refills: A Doctor Confronts His Addiction.

It was a frigid winter day in February 2005, when two officers — one from the state police, one from the Drug Enforcement Agency — arrived at my office and sat waiting amid the spellbinding view of the neighboring arboretum and the friendly clutter of charts, papers, stethoscopes, medical books, discarded coffee cups, and pharmaceutical samples.

At the time, …

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A doctor confronts his addiction

Why doctors should care where their patients live

Venis Wilder, MD

Conditions and Diseases

March 21, 2016

In the last month, I have used the ICD-10 codes Z59.0 (homelessness), Z59.1 (inadequate housing) and Z59.9 (unspecified housing or economic problem) far more than I ever would have imagined. Several patients came into my urban clinic with varied chief complaints, including issues with uncontrolled asthma, chest pain, stress, worsening knee pain and sciatica. However, after listening and asking questions, I quickly realized that all of these initial complaints shared a …

Why physicians need to interpret your lab results

Yul Ejnes, MD

Physician

March 21, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com.

More than ever before, patients are receiving laboratory test results, with some of their numbers in bold or with “H”s or “L”s next to them. In some cases they’re getting them straight from the lab, in accordance with federal regulations. If not from …

8 surprising things patients may not know about. But they should.

Ashley Griswold

Medical Education

March 20, 2016

1. I applied to medical school so that I could become a doctor and provide care for patients. I care about people. I am eager to be part of the health care community. I believe that most, if not all, physicians feel the same way. Physicians are also human and flawed and fallible. Everyone, including physicians, have off days and make mistakes and run late. What you may not know …

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