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When thinking about vaccines, remove the gut feelings

Physician

December 9, 2015

I’m struck, sometimes, by the vehement tone of some of the antivaccine comments you see out there. People who hate or distrust vaccines proudly proclaim that their Googling and life experiences have taught them that vaccines are bad. They don’t care what the science or the evidence shows. They know what they know.

Me? I’m not so much into vehemence and dogmatism. I’ll follow the evidence. Show me solid science that …

Medical students are depressed, but they’re taking the wrong drugs

Sebastian Hyman

Medical Education

December 9, 2015

Studies have varied in their estimates of depression in medical school students, but they all show a similarly startling trend. Medical students have a higher depression rate than their non-medical counterparts. This culminates later in life with physicians with higher than average alcohol abuse problems and higher than average suicide rates, with male MDs 1.5 times as likely, and female MDs twice as likely to commit suicide than their Read more…

Medical students are depressed, but they’re taking the wrong drugs

Fair payment and balance billing in the ER: What’s the solution?

Martin Ogle, MD

Health Policy

December 9, 2015

As health care reform drives more insured patients into the system, access to care is more critical than ever. And in protecting patient access to care, fair payment is one of the most pressing issues facing emergency physicians today.

Emergency medicine providers are in a unique position when it comes to providing patient care. Unlike physicians in private practice who can screen patients to make sure they’ll be paid for care, …

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Bringing sky-high prescription drug prices down to Earth

Erin A. Taylor

Medications

December 9, 2015

After a New York pharmaceutical company recently raised the price of a drug that’s been around for more than 60 years from $13 to $750 a pill, the nation appeared to collectively gasp over a seemingly capricious, “anything goes” approach to drug pricing. The move also revived a recurring debate over whether pharmaceuticals should have free rein to charge outrageously high prices for important medications.

Madness? Perhaps. But pharmaceutical companies are simply responding …

Change happens best when it’s done with clinicians and not to them

Peter Pronovost, MD, PhD

Health Policy

December 8, 2015

Like a pro golfer swears by a certain brand of clubs or a marathon runner has a chosen make of shoes, surgeons can form strong loyalties to the tools of their craft. Preferences for these items — such as artificial hips and knees, surgical screws, stents, pacemakers and other implants — develop over time, perhaps out of habit or acquired during their training.

Of course, surgeons should have what they need to …

Dear Justin Timberlake: An open letter from a pediatrician

Natasha Burgert, MD

Physician

December 8, 2015

Dear Mr. Timberlake,

I was not expecting to see you and I together. As a long-time fan, our names sharing space in the celebrity gossip column of In Touch Weekly was truly a surprise.

Now, JT. Can I call you, JT? I know that you remember me from a few months back. We shared some time in a darkened auditorium with a few thousand of my friends …

Being an American patriot means promoting tolerance even in the face of crisis

Nuriel Moghavem

Medical Education

December 8, 2015

I knew that friendly Mr. S on our hospice unit had been a decorated World War II hero, having fought for the United States on the Italian front lines in 1944. I knew that a grenade had exploded right next to him four weeks into combat, sending him to the hospital for months with terrible shrapnel injuries. I also knew that he wished …

Reducing hospital readmissions: The burden shouldn’t be all on the doctors

Suneel Dhand, MD

Health Policy

December 8, 2015

Readmissions to hospital, especially within 30 days of discharge, are on the radar of all health care organizations in the United States. This is due in no small part to stiff financial penalties that are now imposed on the worst performers by the federal government.

On the surface, it may seem like a reasonable thing to penalize hospitals that don’t successfully “get their patients better enough” to avoid readmission. However, the …

Society’s health should not be doctors’ responsibilities

Justin Reno, MD

Physician

December 8, 2015

I thoroughly enjoy my 65-year-old male with his horrendous diabetic foot ulcer. But there’s not enough insulin in the state of Tennessee to cover the two bacon, egg, and cheese biscuits he eats every morning.

And I adore my 57-year-old female with COPD. But the inhalers won’t work until she stops smoking two packs of cigarettes per day. I laugh every time I see that hilarious 32-year-old with hypertension. But the …

Tell Uncle Sam to go easy on older doctors

Diane Evans

Health Technology

December 7, 2015

Through Dec. 15, federal regulators will accept public comments on the next set of rules that will shape the future of medicine in the transition to a super information highway for electronic health records (EHRs). For health providers, this is a time to speak out.

One idea: Why not suggest options to give leniency to older doctors struggling with the shift to technology late in their careers?

By the government’s own estimate, …

Why is UnitedHealthcare thinking of bailing on Obamacare?

Brian C. Joondeph, MD

Health Policy

December 7, 2015

UnitedHealthcare (UHC), the nation’s largest health insurer, will likely pull out of Obamacare in 2017. Citing high costs and huge potential losses, they warned that 2016 will probably be their last year offering health insurance through the Obamacare exchanges.

Is this another example of greedy insurance companies with fat cat CEOs gouging the system? Or are economic realities interfering with the “hope and change” of Obamacare?

UHC isn’t really selling insurance. Instead …

Survival of the fittest in the ER

Nadine Himelfarb, MD

Physician

December 7, 2015

An observation that I and many of my emergency medicine colleagues have made about vacations: We need them. We need them for wellness, to recharge, to recover. Great saves, terrible tragedies, we witness it all and it can wear on you. Unfortunately, when vacation plans are made, it is not uncommon to find oneself working even more shifts before the break to offset our absence on the schedule, making the …

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Survival of the fittest in the ER

A physician reflects on her experience in Rwanda

Frances Grimstad, MD

Physician

December 7, 2015

The optimism of a Rwandan in 2015 will strike you. Take a population that has seen or been raised in the wake of more horror than the average Westerner can imagine, and bring up a problem or something negative. Too short to reach the top shelf? It’s OK, you’ll fit under doors better. Hair stands out when bright red? Easier to pick out in a crowd. Mother has had 3 …

Others can be harmed when patients lie

Nina Shapiro, MD

Medications

December 6, 2015

The other day, the mother of a nine-week-old baby girl called my office in a panic. Her daughter was having terrible breathing trouble, with coughing and wheezing. She asked to been seen that day, and of course I said yes. I asked mom how the baby had been doing overall, and she said that she’d had some noisy breathing as a newborn, but all was well until the past few …

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Others can be harmed when patients lie

4 ways to handle unsolicited health advice

Toni Bernhard, JD

Patient

December 6, 2015

Here’s the most distressing piece of unsolicited advice I’ve received to date. It showed up in my Inbox two days after I’d completed a course of radiation for breast cancer. The email was in response to an article I’d written about this new, unexpected turn my life had taken; the article included the fact that, at the time, I was in the middle of a course of radiation treatment. Here’s …

There is no oversight for prior authorizations. There should be.

Dinah Miller, MD

Medications

December 6, 2015

The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”

The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …

The administrative monstrosity of medical documentation is out of control

Rene Datta

Conditions and Diseases

December 6, 2015

The “necessity-burden monster” are words of my own choosing, and does not reflect any authoritatively-stated or generally-accepted health care paradigm. It is, for me, an apt summation for how the progressive stages of the administrative side of health care have become a degeneration to the original intention of keeping medical records: to assist in patient care.

What it has undergone, particularly in the last twenty years or so, and when compared to the …

Searching for the holy grail of clinical reasoning

Tom Peteet, MD, MPH, MEd

Medical Education

December 6, 2015

The holy grail of clinical reasoning is, in a word, assessment. Ought we to measure clinical reasoning as a function of experience, knowledge base, or as a process measure? In medical parlance, there is no “gold standard.”

In 2015, to tell whether your doctor is a great diagnostician is based more on reputation than hard evidence. This gap in evidence is all the more interesting given recent press about the inattention …

Stop the hostility among health care professionals

Marjorie Stiegler, MD

Physician

December 5, 2015

The amount of hostility among health care professionals seems to be at an all-time high. Are “scope of practice” and “turf” battles really escalating, or is it just more palpable in the modern era of anonymous comments and viral online posts? I don’t know for sure, but lately, the conversation seems louder and uglier to me.

In medical school, I heard derogatory comments (“jokes”?) from physicians and nurses alike about pretty …

Reducing antibiotic use requires a commitment from both patients and doctors

Aunna Pourang, MD

Conditions and Diseases

December 5, 2015

It was recently World Antibiotic Awareness Week and Get Smart About Antibiotics Week. According to the CDC, 2 million people in the United States become infected with antibiotic-resistant bacteria and 23,000 people die from such infections each year. What’s worse is that antibiotic resistance continues to increase.

“To give you an idea of how high the pressure is to prescribe antibiotics, I didn’t get a job once because during …