by RH+, MD
More than anything in life I wanted to be a family practitioner (FP).
Going into medical school there was little doubt in my mind that this was my chosen path. I chose a school that had a significant focus on primary care and was president of the Family Practice Club my second year. I had shadowed several FPs and truly enjoyed the continuity of care that went into FP.
When …
Why a doctor chose OB over family practice
Why do we physicians chart the way we do? Hopefully, you do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.
It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually …
Why the medical chart may not improve patient care
If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.
In a recent issue of the New England Journal of Medicine, internist Rich Baron Rich Baron chronicles the work of his 5-person Philadelphia office practice …
Primary care is more than just office visits
A primary care resident wrote in one of the journals recently about making the limited time she has with each patient matter the most.
How refreshing, I thought when she concluded that time ultimately is an absolute and finite resource. We often feel as if we are battling time as much as we are battling disease, and we sometimes have trouble admitting when we are losing either one of those battles. …
Primary care doctors at a competitive disadvantage to midlevels
by Diana E. Lee
One member of my health care team is a migraine specialist in another state. Since we don’t have many opportunities to work together in person, we generally try to pack a lot into my periodic two-day visits.
Last time I was there I had an experience that has left me feeling guilty all these months later.
My doctor, who I respect and admire greatly, asked if I was interested …
Don’t let a doctor make you feel uncomfortable
by John Gever
Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.
Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in …
Can chest pain patients be evaluated in the ER waiting room?
by Chris Emery
Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.
Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career …
Residents who specialize in surgery are influenced by family
by Nancy Walsh
Busy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found.
Overall, clinicians were interrupted 6.6 times per hour, and 11% of all tasks were interrupted, according to Johanna I. Westbrook, PhD, of the University of Sydney, in Australia, and colleagues.
The mean “time on task” for uninterrupted tasks was 1 minute and 26 …
Interruptions in the emergency department can lead to errors
Time to turn our attention to an unpleasant topic: Lawsuits.
Who files them?
Why? And what actually happens?
There have been oceans of ink spilled about medical malpractice. An oversimplification of the various positions on malpractice and malpractice reform goes something like this:
Why patients file medical malpractice lawsuits
by Tim Harwood
Hundreds of thousands of people each year are taking the plunge and choosing to have the life changing procedure that is laser eye surgery.
It is currently the most popular elective surgery in the world and the number of people having it done is likely to increase as the procedure becomes safer and more accurate. If you yourself are considering having laser eye surgery, then you will almost …
Choosing between Lasik and Lasek eye surgery
by Emily P. Walker
Physicians should record body mass index (BMI) of their pediatric patients during routine offices visits, according to a sweeping new plan laid out by a White House task force on ways to shrink childhood obesity rates over the next 20 years.
The inter-agency President’s Task Force on Childhood Obesity was formed three months ago as part of the Let’s Move! initiative and was given 90 days to draft …
BMI should be routinely measured in pediatric patients
by Todd Neale
British civil servants working three to four hours longer than usual per day appear to have an increased risk of having a coronary heart disease event, a prospective cohort study showed.
After accounting for traditional cardiovascular risk factors and other variables, those working 11 to 12 hours per day had a 56 percent greater risk of coronary death, nonfatal myocardial infarction, or angina than those who worked normal hours, …
Working overtime can increase coronary artery disease risk
by Todd Neale
Eating nuts improves blood lipid levels, which may help stave off heart disease, researchers found.
In a pooled analysis of 25 intervention trials, eating an average of 67 grams of nuts a day (2.4 ounces) reduced total cholesterol by 5.9% and LDL cholesterol by 7.4% (P<0.001 for both), according to Joan Sabaté, MD, DrPH, of Loma Linda University in California, and colleagues.
The ratios of total to HDL cholesterol and …
Cholesterol can be improved by eating nuts
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Spring cleaning is a tradition in many homes. The occupants open up the home to the spring air, thoroughly clean the home, and sort through the accumulated goods, getting rid of things not used for a long time and which no one wants anymore. It gives one a sense of accomplishment, makes for a more pleasant surrounding and frees up space.
Is this something that you do at your healthcare site …
Clean your healthcare site to become more efficient
I believe in the peak oil theory.
Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to …
How the oil shortage will affect hospitals and healthcare
People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein
The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. …
Waiting is a part of surgery, and how a surgeon perceives time
There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want …
How doctors choose which specialists they refer to
Those who hate hospitalists believe that students and residents are choosing hospital medicine over primary care so hospitalists are to be blamed for the primary care shortage. They also believe that the rise of hospital medicine has made primary care less attractive. Then, there is the salient argument that care transitions are more inherent and vulnerable due to hospitalists.
Of course this hatred is not new. As a …
Hospitalists are killing primary care, and other myths debunked
by Emily P. Walker
I was covering an FDA tobacco meeting a while back when I heard a Howard Koh, MD, assistant secretary of health at the Department of Health and Human Services (HHS) start his speech with the World Health Organization’s definition of health.
“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or …
Definition of health includes social well-being
An excerpt from Stay Healthy At Every Age: What Your Doctor Wants You to Know.
When you were growing up, somebody probably told you that “an ounce of prevention is worth a pound of cure.”
Many of us have learned from experience how much better it is to prevent a bad thing from happening than to try to fix the consequences once it has happened. Most people can agree that prevention …
Failing to prevent disease in patients costs lives
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