The voice on the phone is demanding, quavering, pleading; “Dr. deMaine you are going to be the attending critical care doctor when our mother is transferred to your hospital today. She needs to be taken off the respirator and allowed to die. We have been pleading with the doctors at the burn center, but they keep doing more procedures. We want her off life support as soon as she gets …
Medicine is slowly facing the issue of futile care
One recent morning, my grandma awoke with abdominal pain. She was taken to a good, local community hospital and diagnosed with acute ischemic bowel. There are various causes of ischemic bowel, but regardless of cause, getting the right care quickly determines whether such patients live or die.
After speaking with her physicians, I called some friends. A quick discussion with colleagues in radiology, surgery, and gastroenterology helped me know that the …
Would patients benefit from experts who never meet them?
We heard from a patient during our dermatology week, who worked as a medical laboratory technician, running hundreds of blood samples every day, and frequently using her own blood as the negative control. Then she began to notice that the numbers stopped making sense. Her ANA had shot through the roof and her white blood cells started dropping.
“I couldn’t use my blood as the negative control anymore,” she said, shrugging …
The unspoken assumption that doctors are well
The vaccination debate has been raging over the last several years. As I write this, it is important to know I do not write this blog to creat debate or ill feelings from either side. I wish only to provide one health care provider’s view of the issues surrounding vaccinations. From a mother standpoint, I have friends who choose to vaccinate their children, and those who do not. Our friendships do not …
Why I advocate every day for children to be vaccinated
Just as posited in a prior article featured on KevinMD.com, where it was suggested that implementing an EMR/EHR has significant attraction to prospective physician candidates, I would like to also recommend that a similar stance can be adopted with respect your practice’s your web presence.
In other words, is your website putting your best foot forward for not only prospective patients, but also to prospective physicians and others who …
Why your website is important to recruit physicians
During our medical training we are taught to use evidence based medicine. This means using the most up to date scientific research data that has been analyzed and accepted as fact. But does this mean every patient we see fits into the evidence based medicine algorithm that we have been taught to use?
I hope not. For this would mean we would only be following half of medicine. The art of …
What happened to the art of medicine?
Not many years ago it was assumed that most cancers were not caused by viruses. Today it is clear that many are and the list is growing. Head and neck cancers are either caused by the environment (especially tobacco) or by the human papilloma virus, the same virus that causes cervical cancer and some genital warts.
The incidence of HPV-related head and neck cancer has been rising rapidly in the past …
Quality of life issues in caring for cancer patients
My 64-year-old patient with terminal cancer and less than six months to live wanted to go to Oregon. He was contemplating assisted suicide, which is legal there. “My life has been long and good,” he said. “I believe it is my right. I want the ability to say it’s too much, I can’t do it anymore. A person should have a dignified quality of life.”
Another one of my patients, an …
Doctors are reluctant to have end of life conversations
I took my daughter to the orthodontist last week to get braces.
There’s a lot about the process that seems better than when I was a kid. Mostly, it’s that instead of having to slide brackets around each of your teeth (yishk!) the orthodontist just paints a special glue on the enamel and places the brace on the front of each tooth. Kids get to pick the color of their braces …
What doctors can learn from the orthodontist’s office
There’s a new term that has entered the medical lexicon. The word is wellness. Hospitals and medical offices are incorporating this term into their mission statements, corporate names, business cards, medical conferences and other marketing materials. The Cleveland Clinic Foundation has appointed a Chief Wellness Officer, an intriguing fluffy title that does not clearly denote this individual’s role and function. This is deliberate, as the word wellness is designed …
Is wellness simply a hospital marketing term?
In 2000, nearly 60% of physicians were practicing independently. Compare that to two years from now, when it’s predicted that just 33% will continue to practice solely outside of a larger health system. According to a report from Accenture, the global consulting company that released those figures, between now and 2013, the rate at which independent doctors are being employed by larger systems will increase by 5% …
How physicians develop their careers is undergoing a fundamental shift
In New York, I worked for an organization called Project for Psychiatric Outreach to the Homeless (PPOH). It has a humble history: Over 20 years ago, a group of psychiatrists were sitting around and discussing the need for psychiatric services for the homeless. They decided to volunteer their time and skills to this population.
The organization grew and, for both administrative and financial reasons, eventually became part of another social …
The fiscal realities of health care are demoralizing
Tom Sullivan, blogging over at Policy and Medicine, recently noticed another flurry of activity in the long running debate about conflicts of interest. His post is titled Coordinated Ad Hominem Attacks on Physician-Industry Relationships in Guideline Development: The Next Frontier?
He opens, saying, “Recently, we saw concerted attacks on clinical guidelines committees, but interestingly, not on the science coming out of them. Instead, the attacks were focused on whether the writers …
Judging a guideline just by financial interest is intellectually lazy
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There are important medical studies, and then there are landmark studies–the kind of science that disrupts the entire medical community. The most recent game-changer was published recently in the Lancet.
Well known surgeon and author, Dr. Atul Gawande and colleagues published this important look-back study on the intensity and variation of surgical care of 1.8 million elderly patients in the US. They put numbers to the well-known and ever-expanding problem of …
Aggressive care at the end of life continues to grow
Three young mothers under the age of 40 are dead because they wanted to be beautiful. Kellee Lee-Howard wanted a slimmer body. Ditto Maria Shortall and Rohie Kah-Orukatan. Shortall worked as a housekeeper; Lee-Howard was the mother of six kids and Kah-Orukotan died at the same place where she received manicures. What do these women have in common besides being minorities? They had liposuction procedures performed by men who offered …
Physicians who cash in on a woman’s desire to be beautiful
For the last 3 weeks, I’ve been working as a sub-intern on the family practice inpatient service in one of the local hospitals. It’s been quite a time! I’ve sure been kept busy, but learning a lot and seeing a lot. With a moment of downtime, I wanted to share a reflection I had yesterday.
We’re all familiar with the glamorous “saves” in medicine. It’s the car accident victim that undergoes …
I do what I know is harmful for my body
“I don’t need no doctor ’cause I know what’s ailing me.
He gave me a medicated lotion
But it didn’t soothe my emotion.”
-John Mayer
If someone asked you to draw your image of medicine, what would you sketch? Would it be a person wearing a long white coat with a stethoscope? Would your picture be set in a hospital room, the ER, or the office setting? Would there be any patients in your …
What does your personal image of medicine look like?
Dear future practicing physician,
Choose primary care. I know all around you there are pressures to choose to become a specialist. I remember those pressures well. In medical school, one of my favorite mentors was predicting that after I got a taste of primary care, I would “come crawling back” to him. I still chuckle about that conversation to this day. In residency, I remember several seminars for us built …
Dear future practicing physician, choose primary care
Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf. It stems originally from a recent op-ed by Lucian Leape: “Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate medical education …
The problem with round the clock hospitalist coverage
Public health has often focused on prevention tools that impact an entire community or population. Before Henry Bigelow MD described the use of Ether in 1846 to mitigate pain during surgery or Joseph Lister MD discovered the value of sterile technique, surgical candidates were few. Even if one were convinced tolerate the pain of surgery, more than half would die from the risk of infection. For most of surgical …
Why haven’t surgeons been on the front line of public health?
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