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It’s time for doctors to stop feeling guilty for taking time off

Physician

March 2, 2016

There’s a code among physicians, both in the private and academic setting. It is that, as a physician — unless you are dying, or very close to it — you show up to work. Taking unscheduled time off, for either physical illness or grieving, is not easy as a physician. Doctors experience a huge amount of guilt and pressure, and rather than experience that, most of us will drag ourselves …

Shielding patients from difficult diagnoses undermines their autonomy

Brian J. Carlisle, MD

Physician

March 2, 2016

The affection families express for their dying loved ones can take many forms. Recently, I saw a spry 91-year-old Spanish-speaking gentleman with lung cancer which had consumed the better part of his right lung. He had a large family with many doting daughters. In his neighborhood, he was popular and well respected. He, according his family, had “many girlfriends.” His lung cancer was no doubt a result of a …

Let’s fix performance measurement for physicians

Yul Ejnes, MD

Physician

March 2, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com.

I have a “like-hate” relationship with clinical metrics, performance measurements, and other such things. By now, almost all physicians live with them in the form of insurer “report cards,” PQRS, and “meaningful” use. Some of us have even more exposure to them by participating in …

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True confessions of a hospitalized hospitalist

Jeff Manaloto, MD

Physician

March 2, 2016

A road trip from Georgia to New York was going splendid, dare I say, wonderful — catching up with old friends and family — when it took an unforeseen and slightly less desirable turn: I got admitted with a small bowel obstruction. Thanks to truly excellent care from a community hospital, I am home and now subjected to endless computer questions from my father that has me briefly contemplating readmission …

Doctoring to the test: The unintended consequences of performance measures

Peter Pronovost, MD, PhD

Physician

March 1, 2016

As standardized exam scores increasingly define success for students, teachers and schools, parents worry about the dangers of “teaching to the test” — and of their children being judged by tests with low or unknown validity. We want our children to perform well on tests, of course, yet only if they measure something that students, patients, and teachers believe really matter. We also want the education system to inspire students …

3 immediate ways health IT can improve

Suneel Dhand, MD

Health Technology

March 1, 2016

We’ve got a long way to go before information technology solutions at the frontlines of health care fulfill their enormous potential. The suboptimal, clunky and cumbersome design of most IT systems is responsible for much misery among physicians and nurses on a daily basis. Part of the problem is that hospitals and clinics have rolled out these solutions rapidly and somewhat haphazardly to fulfill meaningful use requirements and gain much-needed …

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3 immediate ways health IT can improve

Explaining the physician anxiety behind performance measures

Bob Doherty

Health Policy

March 1, 2016

Just as the U.S. health care system is about to make performance measurement a central feature of … well, just about everything doctors do … some prominent and highly influential physicians are asking for a pause and reassessment.

Writing for the New York Times, Dr. Bob Watcher argues that, “Two of our most vital industries, health care, and education, have become increasingly subjected to metrics and measurements. Of course, …

The future of Zika virus? How rubella provides clues.

Naline Lai, MD and Julie Kardos, MD

Conditions and Diseases

March 1, 2016

The Zika virus in the news these days reminds us of another microcephaly-causing virus which scourged our world in the not-so-distant past. In the years right before we were born (the late 1960s), the virus rubella routinely swept through the United States and the rest of the world. The airborne germ rubella, just like the Zika virus, caused most people just a mild illness that they usually never even knew that they …

Not just a tech: Everyone’s important in the OR

Nina Shapiro, MD

Physician

February 29, 2016

The other day, I was operating on a little girl with a congenital ear abnormality. Not life and death stuff, but delicate surgery nonetheless. My surgical scrub technician was someone with whom I hadn’t worked before, and I asked him if he was enrolled in the operating room nurse training program, as many of the new folks are.

“No, I’m just a tech.”

I stopped what I was doing and replied: “You …

The surgeon who gave a teenager a new smile

Bhupesh Vasisht, MD

Physician

February 29, 2016

The brave teenager was sitting in the corner of the hallway away from other children. A long, torn cloth covered his face, more specifically his mouth. After slowly approaching him, I sat down right next to him. He shifted slightly away from me with a sheepish wide asymmetric grin on his face. As I began to converse with him through a translator, it became obvious he did not want to …

Should medical school have a language requirement?

Hamsika Chandrasekar

Medical Education

February 29, 2016

Over the past eight months, I’ve rotated at the Palo Alto VA, Santa Clara Kaiser, Stanford outpatient family medicine, and pediatrics clinics, and most recently, at Santa Clara Valley. At the VA and Kaiser, all my patients spoke English. Occasionally, at Stanford’s outpatient sites, our patients spoke a language other than English; however, this never felt like a barrier to care because Stanford had phone interpreters available, as well as …

How filmmaking made me a better science communicator

Edison Leung

Medical Education

February 29, 2016

One of my favorite shows to watch as a kid was Bill Nye the Science Guy. I fondly recall being glued to the television as Bill enthusiastically explained the mysterious wonders of the universe with all of his props, gizmos, and gadgets. Unlike science teachers at school, whose seemingly endless lectures bored me, Bill Nye’s hands-on, interactive approach held my attention. He simplified complex science concepts so well that even …

5 reasons why physicians fail as leaders

Robert Pearl, MD

Physician

February 28, 2016

Most physicians are smart and very talented. They’re skilled clinicians and technically superb. But despite such abilities, they fail to get others to follow them, once they take on the role of leader. As a consequence, they’re unable to get physicians to change or improve performance.

Jay Conger, a professor of business at Claremont McKenna College who has devoted his career to the study of leadership, has helped me understand why …

What health care leaders can learn from Yahoo’s failure

Rob Cosinuke

Health Policy

February 28, 2016

I’ve been following Marissa Mayer’s tenure for nearly four years at Yahoo. Not just because I was initially tapped to lead athenahealth’s integration of another mature advertising-driven mobile company — Epocrates — but because Yahoo, with its complexity and technology legacies, and highly competitive, fast-paced market environment, reminds me of many of the country’s largest health care delivery systems.

Both are facing significant headwinds to stay relevant in their respective industries …

Surgeons are human, not superhuman: The agenda behind the FIRST trial

Dr. Eunice J. Minford

Physician

February 28, 2016

The FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial randomized American surgical residency programs to one of two arms:

Standard group continued with their current standard restricted hours practice of 80 hours per week with time for breaks/rest and a limit to hours of work at any one time.
“Flexible” hours group removed current restrictions on hours worked at any one time and waived the need for breaks …
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Surgeons are human, not superhuman: The agenda behind the FIRST trial

Ignore Martin Shkreli. Focus on drug prices instead.

Naomi Freundlich

Medications

February 28, 2016

Activism over prescription drug pricing has reached a fever pitch. The recent House subcommittee hearings featuring testimony (or non-testimony in the case of bad-boy Martin Shkreli) from Turing Pharmaceuticals and Valeant executives provided an outlet for public outrage over those companies’ price gouging on life-saving drugs. Meanwhile, presidential candidates Hillary Clinton and Bernie Sanders have both talked up plans to rein in spending on prescription drugs, and even Donald Trump …

Don’t deny access for vaccine skeptics. Here’s why.

W. Ryan Neuhofel, DO, MPH

Conditions and Diseases

February 27, 2016

Potential patients — usually parents — occasionally ask me if I am “vaccine-friendly.” After having this question posed to me numerous times, I’m prepared for the conversation that follows. I’ve tried to ease into it in various ways, but none has proven universally comfortable.

The question’s phrasing is telling about a person’s perspective. It implies that their previous experiences with physicians were perceived as “unfriendly.” Also, my defensive side infers it …

Doctors should define who they are

Natasha Deonarain, MD, MBA

Physician

February 27, 2016

There’s stress written all over their faces.

Poised in that precarious time of life, transitioning between the teenage freedom years and the responsibilities of adulthood, those six first-year medical students look anguished. Their collective eyebrows knit together.

I’ve given them a challenging homework assignment: “Write a 500 to 1,000 word essay and read it to the class next week.”

“I’ve got a question,” J says. “You told us to write an essay about …

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Doctors should define who they are

Reduce physician burnout with meditation and mindfulness

Ayoosh Pareek

Conditions and Diseases

February 27, 2016

It is easy to lose oneself while swimming in a sea of medical facts surrounded by overburdened physicians and high-acuity cases. Initially, it is difficult taking care of one patient, much less a whole service. The transition from student to student-doctor is not as homophonic as the semantics would suggest — and this transition affects the mental health of thousands of medical students each year.

Medicine is less a profession and …

MKSAP: 42-year-old woman with palpitations

mksap

Conditions and Diseases

February 27, 2016

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

A 42-year-old woman is evaluated for episodes of palpitations that last several seconds in duration. They occur once or twice a month and are accompanied by lightheadedness and mild dyspnea. She has not experienced loss of consciousness. The episodes are not precipitated by any particular activity, including exercise. She takes no medications.

On physical examination, the …

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