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Sometimes I see my ghosts in the form of my patients

Medical Education

January 8, 2016

On my medicine sub-internship, I took care of an elderly man who was a retired military surgeon. When he first came into the hospital, mentally altered from an underlying infection, he was irascible and unpleasant towards many staff members, swatting their hands away as they attempted to draw blood for lab tests.

As the infection came under control, the shell of rage fell away to a quiet dissatisfaction. The bed was …

These are the reasons why health insurers have to change

Robert Pearl, MD

Health Policy

January 8, 2016

Consumers spend 16 times as long choosing a computer as they do selecting a health plan for themselves and their family. And it should not be a big surprise.

For decades, nearly all insurance companies offered similar choices of in-network physicians and hospitals. And as a result, plans differed only minimally in clinical quality, access and service. And even when clinical outcomes varied, consumers had no easy way to access comparative data.

So …

At the end of life, medicine truly becomes an art

Don S. Dizon, MD

Physician

January 8, 2016

She had been a patient for several years, and I still remember meeting her that first time: Her breast cancer was stage IV at diagnosis, already established in her bones; she was scared; she was in pain. Surgery was taken off the table, and she was referred for medical therapy. We had discussed prognosis, the incurableness of her cancer, …

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From medicine intern to radiology resident: Is the grass greener?

Kerri Vincenti, MD

Medical Education

January 8, 2016

When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year — …

Shared decision-making in primary care: How can we make that happen?

Kenneth Lin, MD

Physician

January 7, 2016

One of the most notable things so many of last year’s biggest health stories have in common is that they envision an increased role for shared decision-making in primary care.

Some patients will want to receive few aggressive interventions at the end of life; others will want more. Some women will be fine with waiting until age 45 or 50 to get their first mammogram; others will still want to start at …

Are psychiatric disorders actually brain diseases?

Steven Reidbord, MD

Conditions and Diseases

January 7, 2016

Some maladies that attract psychiatric attention are unequivocally brain diseases. Huntington’s disease. Brain tumors. Lead poisoning. However, these are not psychiatric diseases. Huntington’s is a genetic abnormality diagnosed and treated by neurologists. Brain tumors are managed by neurosurgeons and oncologists. Lead toxicity is treated by internal medicine. Indeed, a long list of medical and surgical diseases include psychiatric features: stroke, anoxic brain injury, meningitis, lupus, diabetic ketoacidosis, and febrile delirium to name a few. One important …

Discharged too early? The decision is more complicated than you think.

Michael Kirsch, MD

Physician

January 7, 2016

Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right?

First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right …

This is why patients cannot be customers

Tanya Feke, MD

Physician

January 7, 2016

The customer is always right, or so the saying goes.

If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl.

It can sometimes …

Martin Shkreli speaks an inconvenient truth

Dr. Saurabh Jha

Medications

January 6, 2016

I don’t subscribe to conspiracy theories. I never believed a second shot was fired. Nor do I believe that Bill Clinton was stalked on the grassy knoll. So I won’t speculate that Martin Shkreli’s arrest for alleged securities fraud that happened years ago is related to his raising Daraprim’s price by 5,500 percent.

Just because something isn’t suspicious doesn’t mean that it isn’t odd.

Shkreli is a perfect poster child for rapacious …

These are the moments why we practice medicine

Tara F. Bishop, MD, MPH

Physician

January 6, 2016

When I was a new attending, an older man came to see me as a new patient. He had not seen a doctor in over thirty years and was experiencing worsening chest pain that first occurred when he walked upstairs but had progressed to pain at rest. An electrocardiogram in the office showed signs of ischemia, and I advised him that I wanted to call an ambulance to take him …

The problem with shared decision-making in appendicitis

Skeptical Scalpel, MD

Conditions and Diseases

January 6, 2016

A JAMA Surgery Viewpoint recently suggested that because of the findings of a Finnish randomized trial, surgeons now should give patients with appendicitis a choice between an appendectomy or treatment with antibiotics.

The paper acknowledged my criticisms of the Finnish study that found that simple appendicitis could be treated successfully with antibiotics in almost 75 percent of patients.

I respect the authors of the JAMA Surgery article and am happy they Read more…

The problem with shared decision-making in appendicitis

A patient is remembered. He lived life the way he wanted.

Ahmad Yousaf, MD

Physician

January 5, 2016

“Donald passed away.”

We had been sitting in the chiefs’ office with a few of the attendings who had all had Donald (name changed to protect privacy) on their service at one time or another. Everybody exhaled a collective sigh, soaking in the sting of the knowledge of Don’s death; then, within a few seconds, everybody had smiles on their faces. The smiles were born out of a personal experience with him in …

Physicians aren’t burned out. They’re abused.

Pamela Wible, MD

Physician

January 5, 2016

burnout

Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.

We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f’d up so fast? Attention medical students and doctors: It’s not your fault.

Burnout is physical and mental collapse caused by overwork.

So why …

Pediatricians should listen to parents. Here’s why.

Lisa Shulman, MD

Conditions and Diseases

January 5, 2016

Recently, during a typical day as a developmental pediatrician, I walked down the hall to schedule an ophthalmology appointment for a toddler. As I spoke with the secretary, I saw a thin “new patient” chart on her desk for another patient. I recognized the name at once and was immediately transported back 25 years ago, to when I was a fellow in training at the center and learned a very …

Why it’s time for doctors to ditch their white coats

Peter Pronovost, MD, PhD

Physician

January 5, 2016

Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients?

After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily …

Doctors are not in control. Perhaps this is our greatest challenge.

James C. Salwitz, MD

Physician

January 4, 2016

There are times, as a healer, I feel helpless. These are not just the moments when cancer consumes. I understand that the dread disease has yet been conquered, and there is still terrible loss. This not when I refer a patient elsewhere; I know my limits. Rather, these are the times when I am trapped, ignored, and the result is needless suffering.

In his classic, often quoted, 1942 short story, Runaround, …

Health IT needs to be seen but not heard

Suneel Dhand, MD

Health Technology

January 4, 2016

You may be forgiven after reading some of my articles for thinking that I’m somehow “anti-health care information technology.” It’s a subject that I’ve written a lot about over the last couple of years, mainly because I feel passionately that our use of information technology at the frontlines of health care needs to drastically improve.

But let me start first by making a confession: I love information technology. I am just …

A surefire way to see pharmaceutical reps in a timely fashion

Neil Baum, MD

Physician

January 4, 2016

Today so many physicians are not able to see pharmaceutical representatives (PRs). However, PRs do serve as a great resource and finding a way to make their visits more efficient and focused is an objective we all need to strive for.

I recall requesting an interview with Lou Holtz, then the head coach at Notre Dame, and was told by his secretary the date and time that the interview would take …

It’s time to make a spiritual legacy for 2016

Kevin Haselhorst, MD

Physician

January 4, 2016

This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy. People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity.

Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is …

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