Physician

Why aren’t hospitals more attentive to the needs of patients?

Physician

September 24, 2013

In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.

On the bike path where Jha took his initial tumble, people went out of their way to …

3 stories of surgeons that I find disturbing

Skeptical Scalpel, MD

Physician

September 23, 2013

An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.

There is also said to be evidence showing that in one day he was doing as many …

How can we revise the patient medical record?

Fred N. Pelzman, MD

Physician

September 22, 2013

So what exactly do we want a patient-centered medical record to look like?

What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.

If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …

The horror and beauty of performing an amputation

Sid Schwab, MD

Physician

September 22, 2013

There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.

Stark and …

What to do after you make a medical error

Brian J. Secemsky, MD

Physician

September 21, 2013

Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.

Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …

This is the grim reality of starting a private primary care practice

Davis Liu, MD

Physician

September 20, 2013

She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors,”and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents.

So …

Painting in the OR: The evolution of surgical preparation

David Gelber, MD

Physician

September 16, 2013

One would never guess that a frequent activity in the OR is painting. I’m not referring to the application of paint to the walls of a room or house. The painting I’ve seen is limited to the patient and his or her body parts.

I suppose the first application of “paint” would be the initial scribble placed by the surgeon, marking the surgical site. This is a relatively new requirement and …

The difference between health care and disease management

Natasha Deonarain, MD, MBA

Physician

September 14, 2013

It’s no secret that America is suffering from a huge crisis in healthcare. As we watch the sun rise on Obamacare, doctors, patients, insurance executives, hospitals, small businesses and legislators alike stand agape. No one seems to have found a simple, logical solution.

The solution is in fact very simple. It’s so ridiculously simple, it might make one laugh. And, believe it or not, it’s also amazingly cheap.

But because of its …

Don’t confuse death with dignity with suicide

Peter Ubel, MD

Physician

September 9, 2013

In 2008, the state legislature of Washington passed what was called the Death with Dignity Act, a law that legalized physician assisted suicide. Under the law, terminally ill patients (predicted to have less than six months to live) can request prescriptions for lethal medications from their physicians, under a series of safeguards: multiple requests for example, determination of competency, and the like. Then, if the patients so choose, they can ingest …

A gastroenterologist dishes on unnecessary colonoscopies

Michael Kirsch, MD

Physician

September 9, 2013

We gastroenterologists are regularly summoned to bring light into dark places. We are the enlightened ones who illuminate anatomical shadows. Sure, we have tunnel vision, but we like to believe that we can think broadly and creatively as well.

We are the scope doctors.

We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights. We deliver a …

Urging doctors to take responsibility for their mistakes

Manoj Jain, MD, MPH

Physician

September 8, 2013

In 2007, I published a story in my local paper in which I confessed to having made a medical error years earlier. I’d mistakenly prescribed an antibiotic for a patient whose chart indicated an allergy to the drug.

Thankfully, the story had a happy ending. My patient recovered and took no legal action after I explained to her what had happened. I ended my article vowing to take greater care to prevent errors …

7 tips to stay away from misery on vacation

Ronan Kavanagh, MD

Physician

September 7, 2013

This year my wife and I decided to compile a list of all of the holidays we’ve had since we had kids. Its a nice list and we’re lucky to have traveled as well as we have.

I always get excited about going. There’s the anticipation of downtime away from work (and other peoples’ problems), time for relaxation, sleeping, eating, reading, and some quality time with my family. Life is just …

10 questions to ask before anesthesia

Karen S. Sibert, MD

Physician

September 4, 2013

A guest column by the American Society of Anesthesiologists.

Not so many years ago, surgeons wouldn’t operate on patients they considered too old to tolerate the stress of anesthesia and surgery. Today, however, patients of every age — from Baby Boomers to the Greatest Generation — undergo anesthesia safely for surgery and diagnostic procedures.

Realistically, even if you believe …

Read more…

10 questions to ask before anesthesia

The hubris of medicine has to end

John Mandrola, MD

Physician

September 3, 2013

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

Read more…

The hubris of medicine has to end

14 ways to drive your doctor crazy during a physical exam

WhiteCoat, MD

Physician

August 31, 2013

1. When your doctor looks into your eyes with a flashlight, shut your eyes tightly so he can’t see your pupils. Later, when your doctors asks you to shut your eyes tightly to test your eyelid strength, look at him like he’s speaking in tongues and keep your eyes open. If he whips out his flashlight to look at your pupils …

Why online dating is a bad idea for teens

Claire McCarthy, MD

Physician

August 29, 2013

Online dating is a bad idea for teens — especially young teens.

That’s why it wasn’t particularly responsible of Seventeen Magazine to publish a blog in which “dating blogger” Isabelle Furth floated the idea of using sites like Match.com to find dates. To be fair, she had concerns about the idea, and she’s in college, so theoretically old enough to make these decisions. But college kids don’t read Seventeen. Middle school …

How long do you continue to fight when death is certain?

James C. Salwitz, MD

Physician

August 28, 2013

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Not long from now, the last cancer will be defeated, and even today most with the dread disease survive. However, many still fall. This leaves us with one of the toughest questions of life. How long do you continue to fight, when death is certain? When does striving become vain hope which drains quality and creates only suffering? What makes struggle worth the …

Does your doctor know ACLS? Does it matter?

Michael Kirsch, MD

Physician

August 26, 2013

acls

Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …

Calling a consult: Disrespect from specialists hurts patients

Heidi Roman, MD

Physician

August 26, 2013

A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.

When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …

Foreign medical graduates are not the primary care solution

Shirie Leng, MD

Physician

August 23, 2013

With immigration reform under hot debate, it’s important to remember that all of us except the Native Americans are foreigners. It’s what has made our culture so diverse. People from foreign countries ideally bring the best of their cultures to the US and enrich us all with the diversity of life. This advantage lessens considerably when those visitors want to enter fields in which understanding of endemic American culture is …

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