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Physician

March 17, 2016

Like many of you, I have a fairly long commute. Recently, as I was driving and scanning the channels on Sirius, I landed on a talk program hosted by Dr. Laura Schlessinger — a certified marriage and family counselor (her PhD is in physiology) with many decades of experience, a stack of best-selling advice books, and a very long running radio show.

The caller was a young woman with a cheating husband and a …

An eye-opening week in juvenile hall

Akhilesh Pathipati, MD

Medical Education

March 17, 2016

As part of my pediatrics rotation, I recently spent a week taking care of patients at juvenile hall. The patients were physically healthy for the most part; I saw them for screening physicals that they receive while incarcerated. However, these encounters were far more than a typical physical. Instead of focusing on medical issues, we primarily talked about health behaviors and general well-being.

It was a rare opportunity to interact with …

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An eye-opening week in juvenile hall

Shame and stigma in patients with HPV-related oral cancers

Anne Katz, RN, PhD

Conditions and Diseases

March 17, 2016

Every month or two I see a patient, usually a man with prostate cancer, who is concerned that if he has intercourse with his spouse, he will give her cancer. The question is asked with sincerity, and I can see the worry in the man’s eyes. His spouse is often equally worried but she often looks embarrassed too, almost as …

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I’m a woman and a plastic surgeon. This is what beauty means to me.

Lara Devgan, MD, MPH

Physician

March 17, 2016

When I introduce myself as a plastic surgeon, I am often greeted with surprise. Between the slightly quizzical looks, the concerned head tilts, and the explicit queries, the question is clear: How could a woman of substance find herself in that line of work?

The truth is that real plastic surgery (in my world, at least) is nothing like its media representations. The nipped and tucked patients with outlandish requests, the …

Who do presidential candidates blame for high health costs?

Peter Ubel, MD

Health Policy

March 16, 2016

The United States far outspends peer countries on health care. When American politicians complain about these high health care costs, they often vilify pharmaceutical and insurance companies for profiting at the expense of the general public. As I wrote earlier, such vilification is misguided, pushing too much of the blame on individual actors rather than on the system that incentivizes individuals to act those ways.

So what it is …

Why don’t patients pick up their prescriptions?

Alister Martin, MD

Physician

March 16, 2016

As emergency physicians, we write prescriptions for patients that we discharge home for all manner of presenting complaints. I used to believe that the overwhelming majority of these prescriptions would be filled by the patient after discharge.

It turns out I was wrong.

Research estimates that patients discharged from emergency departments (EDs) fail to pick up their high urgency prescriptions, like antibiotics, nearly 35 percent of the time.

This is problematic because failure …

How many more physicians will we lose to suicide?

Anonymous

Physician

March 16, 2016

Almost two years ago I went to the funeral of a medical school classmate. A little more than three weeks before he had jumped from a parking garage after finishing his clinic. He had a loving wife and three young children. He had the respect of his colleagues and the love of his patients. There was nothing out of the ordinary in his financial or personal life. It didn’t make …

Who should bear a dying man’s burden?

Pranay Sinha, MD

Physician

March 16, 2016

Sedated by Oxycodone, Ted slept despite the rhythmic ruckus of his breathing machine. He never felt quite rested in the hospital. While awake, his gaze often lingered on a snapshot that captured him in the past: full of laughter and radiant joy with his little granddaughter, Tara. The grandfather in the photo — muscular, mischievous — barely resembled the emaciated elder in the bed who silently mouthed short answers to …

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Who should bear a dying man’s burden?

New doctors should listen to this advice if they want to last

Chris Cantilena, MD, MMM

Physician

March 15, 2016

A few years ago, the hospital where I work started new residency programs in internal medicine and family practice. Many of the residents do rotations in anesthesiology and surgery where I have an opportunity to meet and talk with them. They are eager to learn medicine of course, but they are also interested in the perspective that many of us who have been practicing medicine for many years have to …

It’s hard for patients to choose a good hospital. It shouldn’t be.

Peter Pronovost, MD, PhD

Physician

March 15, 2016

Selecting the right hospital to receive care can save your life, lower your risks of getting a complication, or even reduce your financial hardship.

The problem is that it’s extremely hard for patients to make that judgment. Sometimes, the data they need to select the best hospital for their care doesn’t exist. In other cases, it’s hard or impossible for the public to find.

For instance, if you’re getting an esophagus resection …

It’s time for hospital CEOs to listen to lectures from doctors and nurses

Edwin Leap, MD

Physician

March 15, 2016

I was working in a hospital recently and saw a note from a CEO on the computer. Notes and memos are ubiquitous these days. Bathroom walls, break-rooms, computer screens. Everywhere there is another reminder to check this, do that, mark those, record metrics, hurry up, don’t make mistakes, sign orders, complete charts, be nice and all the rest.

But this note stood out. In it, the administrator was reminding the medical …

It takes more than incentives to engage physicians

Ira Nash, MD

Physician

March 15, 2016

The idea that we have to “change incentives” for physicians is all the rage. Oceans of ink are being spilled over the transition away from the traditional fee for service payment model to a menagerie of value-based ones. At the core of much of the discussion about how to make the transition is figuring out how risk-bearing organizations like large physician groups, health systems, ACOs and the like are going …

Observation status and readmissions: The data may surprise you

Ashish Jha, MD, MPH

Health Policy

March 14, 2016

Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use. This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates. The motivation behind HRRP is simple: the readmission rate, the proportion of discharged patients who return …

Young doctors need to spend time in Veterans Affairs hospitals

Briana Buckner, MD

Physician

March 14, 2016

For most of residency, I missed the opportunity to care for veterans — mainly for selfish reasons, including my unwillingness to learn a new EMR and hospital. Once I became a chief resident, I realized that I would be spending four months at our local VA hospital. When I first came to the VA as a chief, my goals were similar to that at any other site at which I work: Get …

Concierge medicine isn’t right for this doctor. Here’s why.

Lucy Hornstein, MD

Physician

March 14, 2016

Apologies to Mark Twain, but reports of the death of private practice are somewhat exaggerated. There are still plenty of us around, and most of us are making out quite well. Not all, though. I’m quite sure the murmurs of discontent have reached many ears by now. So much so that many doctors unhappy with the status quo have taken action. One such action is to “go concierge.”

Concierge practice, also known …

Is there a Donald Trump at your hospital?

Suneel Dhand, MD

Physician

March 14, 2016

When Donald Trump announced that he was running for president last summer, most people didn’t know quite what to think. Was this serious or some sort of publicity stunt? Would he be in the race for more than just a few weeks of intense media spotlight? Would he be able to stand on a stage and debate other politicians? No matter what side of the political spectrum you fall on, …

A female physician is murdered. A call to action to end intimate partner abuse.

Esther Choo, MD, MPH

Physician

March 13, 2016

This week, the community of women physicians was rocked by the death of one in our midst, an anesthesiologist, intensivist, medical school faculty member, and mother, in an apparent domestic violence homicide. Dr. Casey Drawert (yes, we will say her name) was a highly accomplished physician married to a “prominent businessman” adding to the media-stickiness of the story. Her success clashes with our deeply entrenched biases about the demographics of domestic violence victims.

Yet …

Are essential oils safe for children?

Justin Morgan, MD

Medications

March 13, 2016

On January 5, 2016, emergency crews were called to Our Kids Daycare and Learning Center in Middleton, Idaho. The reason: concern for carbon monoxide poisoning. The daycare center’s director Robin Hagaman noted that some of the 12 toddlers in the classroom were acting strangely when they awakened from their naps and were also noted to have dilated pupils. In addition, two of the teachers were simultaneously experiencing headaches and …

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Are essential oils safe for children?

I hated breast-feeding. How that helped my patient.

Monique Tello, MD

Physician

March 13, 2016

There have been many times when I have struggled to empathize with the patient. There are certain health care issues, and certain patients, that I have found consistently frustrating over the years.

I’ve written about this, and been pretty well chastised by readers. I don’t mind, because I know that 99 percent of physicians have their kryptonite issues, and just don’t talk about it. I’ll take the heat for being honest.

My …

A routine heart exam. An unexpected problem.

Ralph Freidin, MD

Medical Education

March 13, 2016

Every fall, medical schools welcome nearly 20,000 college graduates. They arrive anticipating endless hours of lectures, too much coffee, and infinite facts to memorize. There is one thing they do not expect, however. I know. Forty-nine years ago, I was one of them.

The first day I walked onto the wards was in spring of 1967. I was in St. Louis, doing my second year of medical school. Previously my presence …