It has been a long slog since we started our war on cancer here in the United States in 1971.
At times I am not certain that this has been so much of a war as opposed to a series of skirmishes that occasionally have produced incredible moments of optimism. But there have been a fair share of frustrations …
Facing the difficult issues when it comes to high quality cancer care
When I write from my clinical experience as a behavioral pediatrician, I am careful to change identifying information to protect the privacy of my patients. It is rather freeing, therefore, to write about characters in a novel. Left Neglected by Lisa Genova, who is also a neuroscientist (perhaps she took the story from some real cases) offers some important insights into this complex subject.
The story revolves around Sarah, a 37-year-old mother of three …
Heal relationships without needing a devastating life event
Bill M. is a 22-year old college student who has had asthma and diabetes since he was a child. He comes in with trouble breathing because he has no primary care doctor and is out of his inhalers. While he’s in the ER, he also says that his diabetes hasn’t been followed for years, and now his blood sugars are out of control and he has new problems with his …
How the primary care shortage affects the ER
One of the joys of being a physician is learning the patients’ histories. A joy, you say? Isn’t taking the history simply part of the doctoring routine? You’ve all been there.
When did the pain start?
What made it worse?
Did it move around or stay in one place?
I agree that inquiries like these are not intrinsically joyful, but this is not my meaning here. I refer to history here in the conventional …
Seasoned physicians know what questions to ask
A guest post by the American College of Chest Physicians, exclusive to KevinMD.com.
In light of Hurricane Sandy’s impact upon the east coast, and subsequent effect on the area’s healthcare delivery systems, many physicians and healthcare professionals are likely considering how they would respond if disaster were to strike their community. From the decision making process and preparation for evacuation to evacuation …
What if Hurricane Sandy came to your city?
As both the private and public sector aggressively shift healthcare incentives from a “do more, bill more” to a value and outcome based model, healthcare providers ignore patients role in driving outcomes at their own peril. It is generally understood that patients forget 80-90% of what they are told at the doctor’s office. As incentives no longer reward outcome over activity, this is a disaster financially for health professionals. This …
Make creative use of existing technologies to thrive in the future
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
“The tragedy of man is what dies inside himself while he still lives.”
– Albert Schweitzer
Statistically speaking
When is the last day you truly remember feeling peace, happiness and a deep sense of well being? If you cannot answer this question, you are not alone among …
Recognize and manage physician stress and burnout
I learned a lot of medicine during residency, but perhaps I actually learned even more about how to just get things done in a hospital. If you wanted a right-upper-quadrant ultrasound done for our patient, I was your man. I had a complicated series of unwritten algorithmic flow diagrams in my head that included handwriting an order, making sure that it was faxed to the right number, calling the appropriate …
Waste in medicine is disrespectful to both patients and doctors
In his brilliant 1993 satire “Et Tu, Babe,” Mark Leyner proposed a new concept in body art, which is the specialty of “visceral tattoos.” The narrator travels to Mexico where his chest is opened and the insignia of a “guy surfing a wave of lava, wearing polka-dotted trunks,” is tattooed directly on his heart. The dye used shows up on CT scans and apparently women, especially x-ray technicians, love it. …
The deep psychic effects of medical care
When it comes to public-private partnerships between health organizations and the food industry, there are many shades of grey — but Cheetos orange isn’t one of them. On September 9th of this year, however, the American Heart Association (AHA) Dallas Heart Walk saw Frito-Lay’s Chester the Cheetah riling up the crowd and helping to associate Frito-Lay and Cheetos with the emotions of the day — joy, hope, charity, happiness, spirit, camaraderie, health, …
Big Food is our modern day Big Tobacco
From the moment I first stepped into a restaurant kitchen, it felt like home; even though for the past eight years my real home has been an operating room, as I am a surgeon.
Though many on the outside may not realize it, the chef and the surgeon have much in common. Both profess modest beginnings. Cooks were slaves and surgeons were barbers. Those who did the cutting were not even …
The chef and the surgeon have much in common
A patient I’ll call Mildred came to her appointment and handed me a report from a medical screening fair at her church. She wanted to know what to do about it. The print-out said that she had a “mild” blockage in her carotid artery. They told her to discuss it with her primary care doctor (me).
You may have seen the advertisements in your local paper, or even on your local …
Companies should not scare us to sell unnecessary screening exams
Earlier this May, nurses around the country were acknowledged on a countrywide scale for their hard work and dedication to patient care during National Nurses Week. Unfortunately, as with most national appreciation days that I cannot personally be recognized for, I failed to take much notice.
Now that new doctors around the country, including myself, are in the process of growing into our roles as team-based healthcare providers, we are in …
Every week should be National Nurses Week
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We recently spoke with Nayan Kothari, MD, associate dean for education, chair and program director of the department of medicine at Drexel University College of Medicine/Saint Peter’s University Hospital in New Brunswick, N.J. He is 74 years old with long-standing spinal stenosis. He told us that his condition did not prevent him from biking and hiking regularly, and he was otherwise in good health. His medications included baby aspirin, atorvastatin …
I teach the anchoring error, but I couldn’t avoid it myself
Mommy wars aside, I think you’d have to be living under a rock if you haven’t heard the enormous and real benefits of breastfeeding. Breastfeeding is awesome on so many levels. Health of baby and mom alike. Both physical and emotional.
But, what if it doesn’t work? What if you’re a mom (like me) who couldn’t produce enough milk? Hardly any in my case.
What if you’re an adoptive parent or your baby …
The overzealous push to get all moms to breastfeed
A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary emboli. Emboli occur most often when a blood clot in the veins of the legs breaks off, travels through the right side of the heart, and gets stuck …
More information does not equal better care
When I was a resident physician, I had the coolest classmates ever. We worked together, laughed together, learned together and many of us stay in touch to this day. Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush-pilot/fishing guide and one an amateur mountaineer.
But one of the things that united us, one …
Emergency physicians who love their guns
When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.
So I spoke with her. I explained that over the course of her career she would undoubtedly see people from …
The only religion that my patients see me practice is medicine
There is a broad consensus among healthcare policy wonks that the 800 pound gorilla in the healthcare cost debate is that a big chunk of the medical care we provide — some say as much as a third — does not help. It may even make things worse for patients. Aside from the ethical issue of doing things that don’t help, and may hurt, this useless and dangerous care is …
There is more to life than avoiding death
The Surgeon had been handicapped by a burr in the plantar aspect of his left foot. All summer it had been causing discomfort on jogs, during soccer games, and,eventually, even just walking barefoot across the hardwood floors in the morning. There was something lodged in the thick skin of the strikeplate of his foot— a splinter, a piece of glass, whatever the hell— and it was really starting to cramp …
Performing surgery is not about empathy
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