A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Thousands of patients undergo surgery every day, but many are unaware how to better ensure a safe and comfortable experience. Too often patients feel like they’re in the passenger’s seat when entering the hospital, even under the best circumstances. When planning to undergo a surgical procedure, with …
Have a safer hospital stay: Use a checklist
The pressure on physicians to provide better care at lower costs is coming from all directions – top down from policymakers who want more accountability in how healthcare resources are being used and bottom up from patients who want more transparency in how their money is being spent. Obstetrician and gynecologists have not been spared any scrutiny. As primary care providers for many women we are in thick of the …
Choosing wisely and delivering value in obstetrics and gynecology
A new crop of medical students will begin a residency in plastic surgery this summer. They have worked long and hard to secure these coveted spots. As a service to them and the profession, I wanted to take this opportunity to help make their path a little easier by offering a bit of advice.
When asked what you do, simply say that …
Being a plastic surgeon requires a lot of explaining
It is hard to see a child in pain.
I have seen quite a few children in the emergency departments of South Carolina in the past three years, more than I could have imagined just a while ago.
Now, in the interest of full disclosure, I am not a child psychiatrist by trade. Like any general psychiatrist, my training provided me with didactic …
A psychiatric disorder or a profound lack of discipline in our kids?
I’m lucky, I work for one of the best hospitals in the country and I have access to the best medical care that our society has to offer. With one glitch, that is — when I access that care, my medical records are put into a system that can be viewed by thousands of people, some of whom include my bosses, co-workers, supervisees, neighbors, and even some of my patients.
I …
Why the days of medical privacy are over
What is a natural death, anyway?
I get it – death is part of the cycle of life. Seasons change. The moon waxes and wanes. We are born. We die. Death is natural.
But what is a “natural” death? Seriously, what comes to mind when you think of natural death? Here is a video of a natural death, taken from the Planet Earth series:
Death in nature is often violent, brutal, …
A natural death: What exactly does that mean?
Next in a continuing series.
There’s a reason for the cliche — surgeon barks out the name of an instrument, scrub nurse whacks it into the hand. The reason is this: when you are focused on a particular area — especially if it’s one in which danger lies — you don’t want to look away. If you need to change …
Why surgical instruments are the way they are
Let me start by saying that I am by no means an expert in medical oncology and I have great respect for what my colleagues in this field are able to do for their patients and their families.
From my earliest days of internal medicine training at the University of Virginia, I can remember the oncologists as being some of the most caring and compassionate physicians around. However, recently I came …
Ask patients if they feel comfortable asking questions
Physicians are bothered by their patient’s fear. One of the worst parts of actually caring is that when other people suffer and especially when they are frightened, you suffer with them. It is bad when the trepidation is about something real, such as a new disease, but it is particularly disturbing when the source of the fear is confusion or bad information.
There are several common sources of inaccurate terrifying data. …
Looking up health information online: Do you really trust your doctor?
As physicians, we are all privileged to share with our patients the experience of illness, helping to inform and guide. When we as physicians become ill ourselves, we face unique challenges and gain unique insights. This column will explore those dimensions of experience, when doctors become patients.
We recently spoke with Robert S. Brown, MD, FACP, associate professor of medicine at Harvard Medical School and attending nephrologist at Beth Israel Deaconess …
Physicians gain unique insights when they become ill themselves
Below find excerpts of an email sent by a faithful reader. I have included the whole text, but broken it down to respond to each point accordingly.
I have really enjoyed your blog postings and the sensitivity you showed toward patients. But, your new venture is a real turn off, and makes it hard for me to want to read your posts anymore.
I have been waiting for this. Expecting it. I knew …
Responding to patient concerns after changing my practice
From my interview with Andrew Thompson the other day, the issue of a medical malpractice crisis was raised. Mr. Thompson averred that such a concept is pure myth, a spook story older docs tell young interns around the campfire at night. And he may be right.
In a paper from the Journal of Healthcare Quality, researchers at Johns Hopkins demonstrated, using data from the National Practitioner Data …
How defensive medicine is akin to the war on terrorism
As a medical student nearly two decades ago, I remember how excited I was to begin my rotations on the wards. After two intense years in the classroom, I felt that I had a good fund of knowledge that I could finally apply in a clinical setting. Still, very soon after beginning my ward rotations, I noticed that while I was able to adequately manage my patients’ symptoms, I could …
The soul of our vocation is to heal our patients
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Professions that heretofore enjoyed public admiration for pursuing noble work and reputedly insisting on the highest ethical standards have been exposed. The Catholic church could write a few blog posts on this. Police officers, journalists and even teachers have also shown us that they are members of the human species and are subject to its weaknesses and frailties.
The fallacy is to expect certain professions and professionals to be more irreproachable …
Here are some reasons why physicians lie
Advancing technology has allowed life to be simple. Nowadays, when you go shopping, you slide a credit card and voila, sold. Why does it seem though some things are getting more complicated?
Dioctyl sodium sulfosuccinate is another name for Colace. We are forced to have two names for one drug: a brand name, and a generic. The pharmaceutical companies tell us they have patents mandating we live in their complicated world, …
End of life care is too complicated
To resuscitate or not to resuscitate, that is the question. Whether ’tis nobler to beat the heck out of a person on his or her way out in the hope of saving his or her one precious life, or to allow death to proceed at its own pace with expectation of a peaceful passing.
The United States has come a long way in the last 2 decades since 1991 when the …
Improving informed consent for resuscitation without playing God
For most of our patients, the student run homeless clinic is the last stop in a long, fruitless search for healthcare in the city of New Orleans. Recently, an insulin-dependent diabetic came in who had his insulin pump stolen, an unfortunate side-effect of homelessness. The physician prescribed a 150 dollar-per-month supply of insulin—far out of our price range—not knowing how much insulin costs. This was in addition to a sixty-dollar …
One expensive patient can prevent treating a dozen others
A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions and unintended consequences? You might be surprised.
What I intend to do is start with a little of the history of EBM, talk about the essential notion as originally conceived by …
Where has evidence based medicine taken us in 20 years?
As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.
We raced in the …
Doctors think about their patients all the time after they leave
It is near impossible to escape the commanding news headlines: The horrific details that are emerging about the years of violent captivity of three women in a home in Ohio; The fifteen year old Californian teenager who was allegedly sexually assaulted by three boys and then committed suicide last September.
And, internationally, the tragic case of a 23 year old woman who was gang raped and beaten to …
Violence against women is a serious public health problem
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