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Mental illness: Is it organ dysfunction like any other?

Physician

April 19, 2015

I often get referrals from the town’s free clinic. As you would imagine, the patients often have a unique set of problems, coming as they do from the underserved segment of society.

One such patient, Julia, was a fiftyish-year-old woman who had recently moved to town from California. She went to the free clinic (not really sure what the original complaint was) and ended up getting a physical exam that revealed …

These are the clinicians you want for your ACO

Tommy Prewitt, MD

Health Policy

April 18, 2015

I am of the belief that every ACO must be physician-led. We must depend on them not only for clinical improvement, but also for developing a culture of improvement. Culture is vitally important. Culture trumps dollars, technology, data, and about anything else you would use in clinical medicine.

If I was getting into the ACO business, I would start recruiting clinicians that embrace these characteristics:

1. Team leadership. Every doc is a leader to some degree, …

The truth about sex in the hospital

Alexandra Robbins

Patient

April 18, 2015

An excerpt from The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital.

The outdated caricature of the sexy nurse — breasts straining buttons on a form-fitting white minidress, shapely legs slipped into white heels — remains pervasive and global. Nurses say it also holds the profession back.

Imagery that sexualizes nurses presents a difficult job requiring significant expertise as nothing more than a …

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The truth about sex in the hospital

Moving towards a culture of care during end-of-life conversations

Elizabeth Dzeng, MD, MPH

Physician

April 18, 2015

Americans are waking up to the fact that the $170 billion that Medicare spends on the last six months of life is not helping us die well. Instead, the way we die today tends to be protracted, undignified, and painful. Sarah Palin’s “death panel” debacle temporarily stifled all discussion on the subject, but the silence has been broken by dialogue inspired by the Institute of Medicine’s recent report, Dying in …

MKSAP: 46-year-old woman is evaluated before a dental cleaning

mksap

Conditions and Diseases

April 18, 2015

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

A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and …

A tale of two surgeons: Which would you choose?

Thomas D. Guastavino, MD

Physician

April 17, 2015

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Let’s face it, residency is no picnic. A combination of on the job training and trial by fire, no physician who has gone through it and survived will ever forget the experience. The emotions run from jubilation to sheer terror. It is inevitable that some of the people you interact with will leave a lasting impression. In the case of the …

Reflecting on the physician’s social contract

Hadi J. Minhas

Physician

April 17, 2015

“55-year-old man with history of laryngeal carcinoma, status-post radiation therapy, laryngectomy, bilateral neck dissection, with metastases to the lung, status post thoracotomy, currently undergoing chemotherapy who is being admitted for a for first-time seizure. Patient is a transfer from Riker’s Island.”

Prisoners are a common occurrence in Bellevue Hospital. This, however, was my first prisoner-patient. The hyphenation both as I write this now and as it formed as a concept in …

Physicians are the Rosetta Stone for patients

Anthony Oliva, DO

Physician

April 17, 2015

About a year ago, there was a great commercial that depicted the slowing of time as a free-falling, but worry-free, James Franco uses his smartphone to chart a safe landing on the billowy awning of a restaurant dozens of stories below. There probably isn’t a single person who hasn’t, at one point or another, wished she or he could control time in order to navigate a better outcome. And doctors …

How are drug companies making millions from generic drugs?

Peter Ubel, MD

Medications

April 17, 2015

It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. …

The metaphors of illness

Amrapali Maitra

Medical Education

April 17, 2015

In India, when the first heavy droplets of rain meet dry earth it releases a particular kind of smell: a dampness arising from sizzling soil that in Bengal we call shnoda gondho. It is raining on the second day we go to visit my grandfather in the hospital.

He has been readmitted to the hospital, after spending a week recovering at home from a hospitalization for rib fractures and bleeding into his …

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The metaphors of illness

What does real meaningful use of an electronic record look like? Not like this.

Rob Lamberts, MD

Health Technology

April 17, 2015

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I drank the Kool-Aid early. We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling. While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my road to Damascus.

Within a year of implementation, our practice became one of the top installations for our vendor.
Within two years, …
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What does real meaningful use of an electronic record look like? Not like this.

My first experience administering injections

Heather Alva

Medical Education

April 16, 2015

My first experience administering injections involved sitting in an ICU room, ten years old, drinking bitter diet Shasta colas and watching thrillers from the 90s starring Sandra Bullock. The nurses started me on oranges. Easy as pie — I could stab away, practicing insulin injections with saline and fruit. The oranges practically squealed with delight upon puncture, rewarding me with the scent of citrus and a plume of juice — …

Medicine should never be about accepting the status quo

Fay Burekhovich

Medical Education

April 16, 2015

It was the boy who was unable to speak who ended up teaching me the most.

I was seeing patients in the epilepsy clinic during my neurology rotation. The attending physician with whom I was working, an internationally renowned pediatric epilepsy specialist with a penchant for attracting exceedingly complex cases, wanted me to observe the end of a patient session with one of the child neurology fellows.

I entered the patient’s room …

When examining patients, don’t forget about the feet

Lori Weisenfeld, DPM

Conditions and Diseases

April 16, 2015

When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in …

Delivering bad news shouldn’t be easy

Albert Fuchs, MD

Physician

April 16, 2015

Delivering bad news is part of my job, an important part.

It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that’s very true. But even in the best of times, it’s a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and …

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Delivering bad news shouldn’t be easy

Should there be zero tolerance for depression in the cockpit?

Rocky Jedick, MD, MBA

Conditions and Diseases

April 16, 2015

The recent Germanwings tragedy has called commercial aviation’s concept of fitness for flight into question. Although the official mishap investigation has not yet concluded, available information at the time of this writing points to an intentional crashing of the plane by the 27-year-old co-pilot, Andreas Lubitz.

Reports from the co-pilot’s medical records allege he had previously experienced episodes of depression and carried diagnoses for other psychosomatic disorders. Antidepressants and torn medical memorandums stating that …

The SGR is dead! Hooray?

Shadowfax, MD

Health Policy

April 16, 2015

Yeah, it happened. The SGR is finally dead. Hooray! Sort of.

I mean, it’s great and all that — we’ll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we’ll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we’ll no longer have to waste our lobbying time and effort …

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The SGR is dead! Hooray?

SGR repeal and MACRA: Here’s why it’s remarkable

Bob Doherty

Health Policy

April 16, 2015

The 92-8 vote in the United States Senate to join the House in passing the Medicare Access and CHIP Reauthorization Act (MACRA), H.R. 2, represents a remarkable milestone for the Medicare program, and for ACP advocacy on behalf of internists and patients.

It is remarkable not only because it eliminates the failed Medicare SGR — how often does Congress admit it made a mistake, and then correct it? — but because it …

Let’s clear up the confusion about what a physical is

Lucy Hornstein, MD

Physician

April 16, 2015

Dear patients,

First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service: trust me, it’s not “free”) has probably motivated more of you to call. That’s OK. But sometimes it seems that your …