Medicine is plagued by a form of prejudice called “specialism.” (Yes, I just made up that word, but it fits.) In medical school we were united; we were all in the same boat; we were a team making our way through the gauntlet together. And then it came time to choose a specialty.
A satirical article by “Lord Lockwell” circulated on social …
This isn’t Game of Thrones. Physicians need to help each other.
Here are ten ways that Internet diagnosing interferes with your health care.
1. Dr. Google doesn’t know you. Can’t see you, can’t hear your story, can’t smell you, and can’t touch you. It doesn’t have intuition or gut feelings about you.
2. The Internet breeds cyberchondria in some and false reassurance in others. The more complex the problem, the more likely your self-diagnosis …
Dr. Google will never know you or care as much as I do
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for a 1-year history of fatigue, headaches, poor sleep, depression, intermittently blurred vision, and weakness when climbing stairs. She takes no medication. Following a physical exam and lab studies, what diagnostic tests should be performed next?
On physical examination, vital signs are normal. Bilateral ptosis and diplopia are …
MKSAP: 30-year-old woman is evaluated for a 1-year history of fatigue
The medical field, more so than many other professional arenas, is continuously struggling to balance the concepts of increasing quality metrics, decreasing overall expenditure, and riding the crest of the current technological and scientific expansion wave. Within the past half century, our profession has borne witness to an explosion of advancement, and with this has come a contemporaneous increase in both the need for sub-specialization and, bluntly, the associated cost of …
Dense breast tissue: What is the role for additional screening?
As Baltimore erupts in fiery protest following the death of Freddie Gray, the city joins scores of others who have recently challenged the role of police in community.
With the disproportionate representation of black males in the correctional system and the videotaped deaths of those approached by police for seemingly petty infractions, the longstanding concern for a criminal justice system that differentially treats communities of color, is …
The Baltimore riots: We should look beyond stereotypes
I see some odd things in my clinic. One recent diagnostic dilemma was a man in his late fifties with shortness of breath.
He had been born with a ventricular septal defect and had undergone surgery for this in his infancy. During his lifetime, he had seldom gone to doctors and always thought he was in fairly good health, maybe just of a weak constitution. A smoker since age 13, he …
A rare case in a rural doctor’s office
If you are a doctor, nurse, patient, or just someone interested in patient safety, you should read a five-part story called “The Overdose: Harm in a Wired Hospital” excerpted from a book The Digital Doctor by Dr. Robert Wachter.
Dr. Wachter and the hospital are to be commended for publicizing this incident so others may learn from it. The hospital staff, the patient, and his mother, also deserve credit for allowing their …
The downsides of automating health care
A variety of factors contributes to the challenge. First, even in this era, in which autism is a household word, it is not unusual for me to give the diagnosis to parents who have not considered the possibility that their child has autism. Statistically speaking, the children we see at Albert Einstein College of Medicine’s Children’s Evaluation and Rehabilitation Center for these initial evaluations are very young — on average, 24 months …
After an autism diagnosis: A new parental role
The riots in Baltimore are all over the news. As a parent, it would seem like the best thing to say to your kids is that riots are bad, that violence isn’t the way to solve anything.
But that would be missing the point — and missing an opportunity.
Don’t get me wrong; I don’t think that riots are good or that violence is the way to solve things. But what is …
What to tell your kids about the Baltimore riots
The recent killing of Walter Scott was another brutal reminder of the home African-Americans wake to daily. Their America, is one where your father might not come home at night, because his brake light went out, and that cost him his life. It’s a place where petty crimes are penalized by life sentences, doled out on the streets by the very men and women charged with their …
Walter Scott and a physician’s conscience
JAMA published an opinion piece about the controversial issue of patients secretly recording their physicians during encounters. We live in the era of the smartphone. Everyone has one — soccer moms, teenagers, young kids who can’t even read yet, elderly nursing home patients who can’t safely feed themselves. Everyone. And these devices have amazing powers of audiovisual capability. We all know this. …
When is it OK to secretly record your doctor?
It has been known for a long time that “health care” — all the stuff that we do, prescribe and provide — is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care.
I …
Why it’s time to improve the social determinants of health
In the old days, blockbuster drugs were moderately expensive pills taken by hundreds of thousands of patients. Think blood pressure, cholesterol and diabetes pills. But today, many blockbusters are designed to target much less common diseases, illnesses like multiple sclerosis and rheumatoid arthritis or even specific subcategories of cancer. These medications have become blockbusters not through the sheer volume of their sales, but as a result of their staggeringly high …
Why are affordable drugs so expensive?
ADVERTISEMENT
She was so young — only 32 when diagnosed with ovarian cancer. She had given birth to a son only four months earlier and by all rights should have been celebrating being a new mother. But, instead, she had developed acute pelvic pain, undergone emergent removal of her uterus and ovaries, and was now in my office to discuss …
A patient this oncologist can’t forget
As a wife and mother, I have days that are very difficult, especially since my husband is in training. I go several days in a row where I only see him right before bedtime, and some days he is unable to see our son at all. I often feel like I have no control of our schedule, and am lucky to …
Fellowship training, as viewed by a physician’s spouse
A few weeks ago I wrote a piece about performance metrics in medicine. People asked me: “Well, if you don’t like the metrics, what would you use?” So I thought about this, and the best way I can think of to explain what I mean is to use an example from a different field: education.
Standardized testing has become ubiquitous in schools. …
Doctoring to the test. Look to education for a cautionary tale.
I recently read a discussion by three hypertension specialists, Drs. Jan Basile, Dominic Sica and David Kountz, on how to treat resistant hypertension. Resistant hypertension is blood pressure that remains above goal despite treatment with three drugs, from different classes, one of which must be a diuretic. 10 to 15 percent of patients with high blood pressure will have resistant hypertension. These are the people who always seem to have …
Resistant hypertension? Or failure to take blood pressure correctly?
It has taken me almost two years to be able to write this. We said goodbye to our beloved dog in early May of 2013. I grieved for well over a year.
About a month-and-a-half prior to his death, we had a big medical scare with him. I wrote at that time about how dealing with a veterinary emergency can provide us with some insights and practice parallels to dealing with …
End-of-life care: What I learned from a pet’s death
While reading the book Lean In by Sheryl Sandberg, I was mesmerized by her insight about the self-perpetuating difficulties women face during their careers; however, something was missing.
Mrs. Sandberg, the COO of Facebook, wrote an enlightening novel about the differences in mindset between the genders and how this hinders women in their career. I found that she was spot on with my experience as a woman pursuing medicine. Like Mrs. …
As an under-represented medical professional: Lean in
I recently discussed both the merits and needs for the use of mobile technologies in clinical trials. Recruiting patients via social media is now a reality and has been a topic of discussion in many forums, including mainstream medical journals. There is no question that online patient support groups serve unique purposes. There are regulatory issues involved in this arena.
However, new regulatory frameworks need to be developed in the age of digital …
How mobile technology can improve clinical trials
Get free updates delivered free to your inbox.
