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EMRs displaces medicine’s art. Here’s why that matters.

Health Technology
March 10, 2016

I know a wise old forester. Ask him any question and he’ll answer, “Well, now, it depends on what you want.”

“Should we clear this underbrush or just leave it?” It depends on what you want.

I realize this can explain any choice we’ve made: that is, we have what we have because, at some level, that’s what we want. In that light, let me discuss electronic medical records.

EMRs can be wonderfully …

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EMRs displaces medicine’s art. Here’s why that matters.

A gastroenterologist shares practical advice on probiotics

Medications
March 10, 2016

The microbiome is among the hottest topics in medical and scientific research. The National Institutes of Health and private foundations have invested hundreds of millions of dollars in research to define and characterize the human microbiome. In the next decade, billions more will be devoted to deciphering how microbes influence human health in a positive manner. The White House even issued a national call to action for …

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A gastroenterologist shares practical advice on probiotics

Why I joined the battle as a physician

Medical Education
March 10, 2016

“… slipped the surly bonds of earth to touch the face of God.”

This quote, borrowed in part from poet and pilot John Gillespie McGee, Jr., was used by President Ronald Reagan to honor the seven astronauts killed in the Challenger shuttle explosion. I was in the 6th grade when I first heard this phrase. In a tiny schoolroom in remote West Texas, President Reagan’s speech was broadcast and replayed over the …

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Why I joined the battle as a physician

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What you don’t know about anal sex. A gastroenterologist explains.

Conditions and Diseases
March 10, 2016

Although it is still early, 2016 is already shaping up to be a year to remember in science: Long-postulated gravitational waves were finally discovered, the CDC scrambles to battle Zika virus on multiple continents, and long-awaited clinical testing begins for a new HIV vaccine.

Editor’s note (2026): The HIV vaccine regimen tested in the HIV Vaccine Trials Network’s HVTN 100 study moved on to a larger …

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What you don’t know about anal sex. A gastroenterologist explains.

Should the USPSTF include specialists?

Conditions and Diseases
March 9, 2016

The United States Preventive Services Task Force (USPSTF) was created by the federal government in 1984 to provide recommendations to primary care practitioners on the scientific efficacy of screening. In 2010, the federal government linked USPSTF recommendations with national healthcare policy when the Affordable Care Act mandated free coverage by Medicare and private insurance for all screening exams that receive a USPSTF recommendation of A or B.  …

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Should the USPSTF include specialists?

I’m an emergency doctor and I’ve become human

Physician
March 9, 2016

We walk down the halls, time and time again, each encounter a new discovery, mystery, or typical presentation.  As ED providers, we see new faces, entwined with “frequent flyers” that have become in a weird way part of the family.  Our job is often loosely entangled with our identity and existence.  It becomes hard to have dinner conversations without discussing therapies, changes in health care, Obamacare, or “unusual cases.”  We …

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I’m an emergency doctor and I’ve become human

How palm reading helps this physician today

Physician
March 9, 2016

I grew up in a house of spirituality, homeopathy, palmistry, astrology, art, and science alike. My father, with a masters degree in statistics, is a computer systems architect. He also fancies himself an amateur palm reader. The irritation with which I reluctantly used to give my hands over to my father, before the SATs, college decisions, medical school admissions, and my residency match results was real, but I was always …

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How palm reading helps this physician today

Should doctors marry doctors? Here are the challenges they face.

Physician
March 9, 2016

Fifty years ago, it was very uncommon to find doctors married to other doctors. Why? To answer that question, we need to explore the sociology of the time. Fewer women went to college, which meant fewer female doctors. Many couples married early, right out of high school or right after college. If the wife had career aspirations herself, these were often put aside in order to help her husband get …

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Should doctors marry doctors? Here are the challenges they face.

The heartbreak of dating an exhausted medical resident

Physician
March 8, 2016

When I was finishing my fifth year of studies as clinical psychology doctoral student, I fell in love with a second-year medical resident; a wanderer at heart with the softest smile and a way of listening that made me feel like the whole world stopped when I spoke. Whenever possible, we found ourselves in the forest exploring the world on foot or, if the weather was bad, on long drives …

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The heartbreak of dating an exhausted medical resident

Time macho: Why I’m part of the problem

Medical Education
March 8, 2016

It was a concept intimately familiar to me long before anyone gave it a name. From my earliest days in college, I felt surrounded by people who packed their days with meetings, activities, sports practices or competitions; classes, study groups, and research; for whom every moment had been spoken for and each day didn’t so much end as spill over into the next. The standard was clear: to do any …

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Time macho: Why I’m part of the problem

The problem with cultural competency in medical education

Medical Education
March 8, 2016

“Let’s say a Chinese patient comes into labor and delivery … simply logs onto the CultureVision website. Next, click on the Chinese section and finally click ‘Labor, Birth and Aftercare.’ Just that quickly you have the information you are looking for.”

CultureVision boasts that it is the “first comprehensive, user-friendly database that gives health care professionals access to culturally competent care.” The website’s automatic slideshow, entitled “Did you Know?” shifts between messages such as: …

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The problem with cultural competency in medical education

How a young doctor treats young patients

Physician
March 8, 2016

On a typical day in a major hospital, patients pass through the emergency room with different ailments. Some of them are coming in to check out minor aches and pains, and others are coming in barely responsive with a life-threatening condition. Outside of the pediatric ward, all of the patients coming in are adults, and the majority of them are advanced in years, showing signs of chronic conditions taking effect …

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How a young doctor treats young patients

Spare your loved ones from this dreaded scenario

Physician
March 7, 2016

What if you woke up tomorrow and learned that your grandmother had been kidnapped overnight by a couple of strangers, thrown in a white van, and taken to a distant warehouse where she spent the subsequent forty-five minutes being tortured before finally succumbing to her death?

Where she was repeatedly beaten in the chest, where a tube was shoved down her throat, where she was tasered with high voltage, where a …

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Spare your loved ones from this dreaded scenario

Why we need to build bridges between primary care and anesthesiology

Physician
March 7, 2016

The numbers haven’t changed significantly in several years — only five percent of the U.S. population consumes a full 50 percent of annual health care spending, and just one percent is responsible for nearly 23 percent of spending.

Within the top 10 percent of high spenders, most (nearly 80 percent) are age 45 or older. About 42 percent are persistent high consumers year after year, while the majority requires high spending …

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Why we need to build bridges between primary care and anesthesiology

Society must decide what it wants from health insurance

Physician
March 7, 2016

Jeffrey Lurie is the owner of my beloved Philadelphia Eagles.   He pays the players.  He picks the coaches.  But I think we would agree that his checkbook should not allow him to be the one who calls the offensive plays.  The coach should do that.

So why is it different in health care?

I have a patient who was diagnosed with polymyositis.  Polymyositis is an autoimmune disease that causes inflammation of muscles …

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Society must decide what it wants from health insurance

It’s time for an honest conversation about pain management

Medications
March 7, 2016

Psoriatic arthritis can be a debilitating condition. It can lead to painful complications such as neuropathy. Its treatments can lead to complications such as shingles, which can leave a patient with continuing pain. Ehlers-Danlos Syndrome is for most patients a painful condition that leads to spontaneous dislocations, early arthritis, and frequent migraines. My husband and I have decades of experience between us in living with these conditions.

My husband and I …

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It’s time for an honest conversation about pain management

Why Sir William Osler is the cure to online cynicism

Physician
March 6, 2016

Comments have again morphed into an essay. And, once again, they’re in response to a blog post by Dr. Suneel Dhand: When it comes to positive change, physicians are their own worst enemy. I thought it was excellent and spot-on. My first comment read in part:

When reading this post — before I read the comments — I found myself silently nodding … maybe because I agree with much …

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Why Sir William Osler is the cure to online cynicism

A family caught in a vortex of questionable medical care

Patient
March 6, 2016

I am an ENT surgeon, a friend of the author, the patient, and their daughter, whose intervention saved his life. This is a smart, loving family caught in a terrible vortex of terrible medical care until they pulled themselves out, and a story that physicians must read, as we struggle to reinstate humanity and humility into our noble profession. Here is Paul’s tale, as told by his wife.

***

On a mid-December …

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A family caught in a vortex of questionable medical care

These are the 4 words every child needs to hear

Physician
March 6, 2016

As a child and adolescent psychiatrist, I have the privilege of working with many children who are victims of severe abuse, neglect, and trauma.  Some, in turn, become perpetrators of violence. One adolescent, let’s call him Steven, told me that he wants to be an electrician, but he is struggling to earn his high school diploma, which he needs in order to enroll in technical school. When I inquired about …

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These are the 4 words every child needs to hear

An ounce of influenza vaccine is worth at least a few tons of Tamiflu

Conditions and Diseases
March 6, 2016

It’s still flu season, although the flu gods have shown a bit more mercy than in years past.  So many variables determine whether each winter brings a relatively mild flu season, a “flunami,” or something in between.  I’m a country boy doing primary care in the city, and I have only a modest understanding of which influenza strain is circulating, the concepts of antigenic drift and shift, and how the …

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An ounce of influenza vaccine is worth at least a few tons of Tamiflu

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