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You can easily become the physician that you judge

Physician

September 7, 2015

A recent paper in the Annals of Internal Medicine has sparked a large media response.

In it, two incidents are described: In one, a male OB/GYN is prepping a patient’s vaginal area for surgery, which involves running a brush soaked in Betadine or ChloraPrep solution over the labia, mons pubis, perineum, and inner thighs when the patient is already put to sleep by anesthesia. He makes an appalling joke, “I …

Avoiding a senseless, costly coda to a mother’s life

Benjamin Schnapp, MD

Physician

September 7, 2015

“Tell me about your mother.”

That is always how it begins. There was never quite enough time the last few years, time to put her affairs in order, time to talk about the unpleasantness that comes at the end of life. Now here we were, standing watch beside her stretcher in the emergency room. Upstairs was the grim certainty of the intensive care unit, the ceaseless beep-beep-beep of the life-support machines, …

Do physician health programs increase physician suicides?

Pamela Wible, MD

Physician

September 7, 2015

How do we care for the people who care for us? As doctors, we’re immersed in pain and suffering — as a career. We cry when our patients die. We feel grief anxiety, depression — even suicidal — all occupational hazards of our profession.

A recent Medscape article on physician health programs suggests the people who are here to help us may actually be doing more harm than …

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Did the Ice Bucket Challenge really lead to ALS research breakthroughs?

Paul Marantz, MD, MPH

Conditions and Diseases

September 7, 2015

Everyone, it seems, knows about the Ice Bucket Challenge, the viral phenomenon that raised record-breaking sums for the Amyotrophic Lateral Sclerosis (ALS) Association. This feel-good movement was critiqued by many, but no one can claim it was a bad thing: It raised lots of money, the Read more…

Did the Ice Bucket Challenge really lead to ALS research breakthroughs?

An emergency physician stops at a roadside accident. He finds out he’s not needed.

Edwin Leap, MD

Physician

September 6, 2015

My family was driving to see our new niece this past Saturday. While passing through a town on the way, we came upon a motorcycle accident. The rider had been hit by a vehicle and was lying on the pavement with a growing crowd of people who wanted to help. I’ve done it before. I did CPR at the scene of a wreck when I was in medical school, and …

How can we measure the doctor-patient relationship?

Margalit Gur-Arie

Health Policy

September 6, 2015

Sixty years ago, before he became a controversial figure in the field of psychiatry, Dr. Thomas S. Szasz co-authored an article for the Archives of Internal Medicine (now JAMA Internal Medicine) on “The Basic Models of the Doctor-Patient Relationship,” which is well worth reading today, particularly for those who believe that patient empowerment/engagement is a novel and disruptive innovation of our digital times.

The paper is describing …

How coordinated care can reduce hospital-acquired infections

Manoj Jain, MD, MPH

Conditions and Diseases

September 6, 2015

It was a week into my elderly patient’s hospital admission when he began to have fever and profuse diarrhea, some 10 to 12 bowel movement a day. The diagnosis was not hard to make: a stool test showed he had C. difficile.

Another patient, a thin women in her late 40s who had become paraplegic after a gunshot wound decades ago, came in from a nursing home when her urinary catheter …

When compassionate care isn’t truly compassionate

Enstin Ye

Medical Education

September 5, 2015

How special is it that, as medical students, we are involved intimately in the lives of strangers? We get to be eyewitnesses to their most vulnerable moments, both celebrating the joy of new life and mourning the loss of loved ones. Students on their OB/GYN rotation triumphantly update their Facebook statuses with their first delivery of a baby, a new soul who will grow up not knowing how special they are …

Why physician burnout and work-life balance is a first-world problem

Karen S. Sibert, MD

Physician

September 5, 2015

Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?

Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?

Every day, I go to work and see the example of the …

Physician burnout starts in medical school. But it doesn’t have to.

Yan Yu, MD

Medical Education

September 5, 2015

I collapsed onto the rickety cot in the hospital on-call room. It was 3 a.m. Over the last twenty hours, fueled only by coffee and occasional bites to eat, I had done morning rounds on my patients, assisted with appendix and gall bladder surgeries, inserted and pulled tubes into and out of bodies, cut open a large intestine filled with feces, took patient histories in clinic, attended afternoon teaching, and …

Test your medicine knowledge: 84-year-old man with cough and nasal congestion

mksap

Conditions and Diseases

September 5, 2015

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

An 84-year-old man is evaluated for a 5-day history of rhinitis, nasal congestion, sneezing, and nonproductive cough. The symptoms began with a sore throat, which resolved after 24 hours. He has mild ear pain when blowing his nose or coughing. He has a history of coronary artery disease and hypertension. Medications are …

The public diagnosis of cancer and how President Carter did it right

Victor R. Laurion

Conditions and Diseases

September 4, 2015

President Jimmy Carter has been diagnosed with metastatic melanoma. Recently, he gave a press conference where he discussed the history of his illness, his plans for treatment, and answered questions from the media. It was superb.

Carter, now 90 years old, demonstrated an impressive understanding of his medical circumstance. As someone who thinks and writes on patient empowerment, here are my favorite …

The time for medical liability reform is now. Here’s why.

Tom Murphy, MD

Physician

September 4, 2015

Have you been injured? Call us at this number! You may be entitled to a reward!

We have all seen these advertisements on TV. Our society has become conditioned to expect perfection. If a patient suffers a known complication from a condition or dies, there is a feeling that someone must be held accountable — even if everything was done perfectly from a medical standpoint. Medical malpractice litigation has exploded over …

Is patient-centered care part of the problem?

Reba Peoples, MD

Physician

September 4, 2015

What is the difference between a health care system and a Burger King? In a health care system, you can’t always have it your way.

At some point in our training, most physicians are introduced to the Institute of Medicine’s landmark report on Crossing the Quality Chasm. The report outlines 6 key elements that are necessary for providing high-quality care: safety, timeliness, effectiveness, efficiency, equitability and patient centeredness. Although I recognize …

Bedside ultrasound should be used by more doctors. Here’s why.

Shaun Cole, MD

Physician

September 4, 2015

The trauma doors flew open, and a middle age man was rushed into the room. All we knew in those moments was that a seemingly lifeless body lay in front of us. There was no pulse and chest compressions were started. After several minutes of no response, another physician hurried out of the room and returned with an ultrasound. Within seconds of placing the probe on the man’s chest, the …

Antibiotics for appendicitis: 3 unintended consequences

Dr. Saurabh Jha

Conditions and Diseases

September 3, 2015

A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 percent of patients. Depending on how this is framed, you can celebrate a 70 percent success or lament a 30 percent failure. Much of the debate in health care is a battle of framing. The study has limitations. Finland is not just a land of the Read more…

Antibiotics for appendicitis: 3 unintended consequences

5 things OB/GYNs should know about treating survivors of childhood cancer

Lisa Diller, MD

Conditions and Diseases

September 3, 2015

Recent research shows improvement in long-term survival rates for childhood cancer patients, but also highlights the challenges that remain for many of the almost 400,000 survivors in the United States. Among these survivors are women facing gynecological health issues from the late effects of their treatment. What follows are several areas of concern that gynecologists and obstetricians should consider when treating women who had cancer as girls.

1. Treatment summary. …

Judging without judging is the physician’s paradox

Anonymous

Medical Education

September 3, 2015

Let me be the first to admit that my mind’s internal and unspoken dialogue produces scathing critiques of the people whose behavior or ideologies are divergent from my own. This isn’t to say that I intentionally treat anyone differently because of personal differences that I observe.

On the contrary, I make a conscious effort to make my actions and spoken words consistent among everyone with whom I interact, particularly when I’m …

6 questions parents don’t ask their pediatricians but really should

Claire McCarthy, MD

Physician

September 3, 2015

As a pediatrician, I get lots of questions from parents — but sometimes I wish they would ask different ones.

That’s what check-ups are for, really: questions. Aside from questions about illnesses (obviously my purview, as a doctor), I get questions about just about every aspect of a child’s life. The parents of babies and young children ask the most — here are some of the most common:

Should my baby’s poop …

Patient empowerment: Scaffolding has a place in health care

James C. Salwitz, MD

Physician

September 2, 2015

A colleague complained that during a particular type of critical conversation his advice is ignored. Women with breast cancer deciding whether to have mastectomies disregard his guidance and seem to have reached a conclusion before he discusses the issue. Given that this physician has committed his career to the study and treatment of breast cancer, communicates clearly and patiently, projects caring and compassion, I thought that his observation warranted discussion.

Some …

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