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We could use more nudges in health care. Can you think of any?

Physician

March 27, 2016

A nudge is a form of social engineering to make better choices. In the world of patient safety and medical decisions, it shares some of the concepts of human factors engineering.

Richard Thaler and Cass Sustein may be the world’s authority on the nudge concept, and have a great book by the same name.

Nudges help people to choose their own best decisions by making the easiest, laziest choices — the defaults — …

This doctor quit medicine. But she really tried to make it work.

Rebecca Reyes, MD, JD

Physician

March 27, 2016

It is exactly 49 steps from my bedroom to my garage. It is a 23-mile drive to the hospital and 75 steps to the unit. It takes 10 seconds to walk to the nursing station. I can measure what it takes to get me to work each morning with absolute certainty. I know because I have measured it a million times hoping something will prevent me from reaching my destination. …

This doctor orders pregnancy tests on men. You’re probably doing it too.

Dennis Bethel, MD

Health Technology

March 27, 2016

I order pregnancy tests on men. In fact, I do it pretty frequently.

Now before you go and question my professional competency, let me assure you that I went to a good medical school. I also completed a four-year residency in emergency medicine at a top-notch residency program. I was board-certified less than one year after finishing and have maintained that status ever since.

Despite this, I still order pregnancy tests on men.

Perhaps …

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From volunteer to family physician: A medical student’s journey

Farrah Fong

Medical Education

March 27, 2016

Sometimes, it’s difficult to recall that single defining moment or person that sends you on the path you’re meant to take in life. I was fortunate in that I found that experience halfway through my undergraduate career at the University of California, Davis. I had recently lost my grandmother; although I’d wanted to help, all I’d been able to do at the hospital was translate for her. That overwhelming sense …

When debating inpatient vs. observation, remember this history lesson

Suneel Dhand, MD

Health Policy

March 26, 2016

The observation versus inpatient distinction is rightly getting more media and public attention with each passing month. In a nutshell, for anyone reading who is not familiar with what this is all about, it’s essentially a way of categorizing people when they get admitted to hospital.

You are either deemed an inpatient (basically a more complex case) or an observation (a less serious case). The individual reasons and checkboxes that have …

No, doctors aren’t to blame for burnout

Starla Fitch, MD

Physician

March 26, 2016

It makes me crazy when I hear things like, “Doctors are to blame for burnout. They need to just be tougher.”

Are people really serious?

This is like comparing us to people who are eating super-sized fast food meals daily, while complaining about their jeans being too tight. Not the same.

Some will say that burnout is a given and just goes with the territory.

Many debate whether this is something that needs to …

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No, doctors aren’t to blame for burnout

Teaching students should be the primary focus of medical schools

Robert Centor, MD

Medical Education

March 26, 2016

An anonymous medical student has this post on KevinMD — A star medical student feels like he made a terrible decision:

And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where …

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Teaching students should be the primary focus of medical schools

MKSAP: 48-year-old woman with type 1 diabetes mellitus

mksap

Conditions and Diseases

March 26, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 48-year-old woman returns for a follow-up visit for management of type 1 diabetes mellitus. She reports doing well since the last visit. Overall, she believes that most of her blood glucose levels are at goal, but is concerned about occasional episodes of hyperglycemia occurring in the morning before breakfast. She eats a bedtime snack …

Confused by food labels? You’re not alone.

Roy Benaroch, MD

Conditions and Diseases

March 25, 2016

There’s been a push lately for more explicit labeling of foods — to make sure that consumers know that what they’re buying is organic, or free-range, or natural, or GMO-free, etc. But these labels don’t tell the whole story. Sometimes, they’re outright lies.

For instance, “organic” veggies still contain plenty of pesticides. There are the natural pesticides that ordinarily occur in food, plus the organic-OK chemical pesticides that …

Shared decision making is still the exception and not the rule

Jordan Grumet, MD

Physician

March 25, 2016

Joe had one of the best geriatricians in the city. So when he got a call from the pharmacist saying his new prescription was ready, he assumed that it had to do with his recent annual visit and blood draw. His suspicions were confirmed, a few minutes later, when he got through to the nurse at the office.

Joe was politely informed that he had high cholesterol and was being put …

It’s time to treat mental illness as seriously as we treat heart disease

Ramin Lalezari

Conditions and Diseases

March 25, 2016

I saw a patient last week for her chest pain. A 60-year-old woman came into the hospital because her chest tightened every time she went running. The pain would last about 20 minutes, centered on the left side of her chest, and radiated to her left arm. It lasted until she would finally take a break from running and sit down.

“This is classic,” I thought. “Stable angina.” I could now …

Doubts that surround dying is an opportunity to raise consciousness

Kevin Haselhorst, MD

Physician

March 24, 2016

An excerpt from Wishes To Die For: A Caregiver’s Guide to Advance Care Directives.

The great poet Rumi ascribes, “I should be suspicious of what I want.” Like many others, as I become older I look forward to Medicare paying for health care expenses. Being enrolled in Medicare makes health care available, yet access to health care does not ensure good health. Eating an apple a day keeps the …

Engage patients to improve outcomes and reduce risks

David B. Troxel, MD and Robin Diamond, JD, RN

Physician

March 24, 2016

A 42-year-old patient arrived for her annual gynecologist appointment complaining of a self-detected breast lump. She had several questions about her condition and wanted to tell her doctor about a family history of breast cancer. The doctor was in a hurry and advised her to ask the staff, but the staff was busy with other patients and told her to call them later. The patient did not call.

The gynecologist ordered …

Naturopaths should be restricted from treating children. Here’s why.

Britt Marie Hermes, ND

Physician

March 24, 2016

You may be aware of Ezekiel Stephan, a 19-month-old boy, who died in 2012, after his parents chose home remedies and naturopathy for the treatment of viral meningitis. The parents currently are on trial in Canada for failing to provide the necessities of life.

Over the course of many days, Ezekiel’s condition rapidly deteriorated, but his parents chose to “give him as much natural product as possible,” including syrup, frozen …

Dementia from PPIs: A hypothesis that may have led to gastrointestinal bleeding

Jeffrey Adler, MD, Shawn Shah, MD, Jenna Koliani-Pace, MD, and Corey Siegel, MD

Medications

March 24, 2016

Over the past week, while covering the inpatient gastroenterology service, we cared for three patients who were hospitalized with gastrointestinal bleeding who were found to have large, potentially life-threating, stomach ulcers. All three of the patients had abruptly stopped their acid-suppressing proton pump inhibitor (PPI) medication in the preceding 1 to 2 weeks. With PPIs being a primary therapy for gastroesophageal reflux and ulcer treatment, why would these patients have …

Why doctors kill themselves

Pamela Wible, MD

Physician

March 23, 2016

Pamela Wible, M.D., takes on physician suicide in her TEDMED talk (delivered on November 18, 2015). Learn more about Dr. Wible and her talk at TEDMED.com. Full transcription below:

I love the three things that people fear the most: death, disease, and public speaking. Here’s how it all started. At four, I was so talkative (and bossy) no babysitter would stay with me. So I tagged along with …

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Why doctors kill themselves

Why is erectile dysfunction so politically impotent?

Arnon Krongrad, MD & Kimberly Langer

Physician

March 23, 2016

It is open season on erectile dysfunction. First, a politician in South Carolina introduced a bill to make it hard to get Viagra and then a politician in Kentucky. If the bills pass, they will hold patients with erectile dysfunction hostage to unrelated agendas. You might think that erections would be as politically untouchable as guns. After all, erections are nearly as popular as they are …

Meaningful use creates meaningless strife

Jim Schroeder, PhD

Health Technology

March 23, 2016

One of the biggest topics today in the health care field is that of meaningful use. Meaningful use is defined as using certified electronic health record (EHR) technology to improve quality, safety, efficiency, and reduce health disparities. The promise is that meaningful use will help improve patient and provider communication and increase care coordination while maintaining the privacy and confidentiality of patients.

However, serious questions are emerging about whether this is …

A medical resident commits suicide. Here’s how one colleague mourns.

Anonymous

Physician

March 23, 2016

In the hour after I heard the news, I experienced the full spectrum of typical reactions to a physician suicide.

One end of the spectrum came from the attending in a clinic, who when asked if the residents could go home and mourn their friend who just committed suicide, proceeded to tell me a story of how when her grandpa died before a final exam in medical school. She decided to …

Why doctors must learn from a patient’s perspective

Lisa Goodman-Helfand

Patient

March 23, 2016

On September 14, 2006, I was in the midst of a 218-consecutive-day hospitalization. What began as a scheduled C-section that April, resulted in a massive infection that nearly killed me. By Autumn, I was receiving physical therapy in the large hospital gym when I was raced back up to my room for my trach to be suctioned. This was not an uncommon occurrence. I was used to the process, and …

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