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No unnecessary screening tests. Even at the cost of my online reputation.

Physician

April 8, 2015

I’ve just finished sitting through a wonderfully aptly named lecture: Probability and Statistics, in which, among other things, we learned (again) that the utility of various clinical tests depends at least as much and generally more on the patient and condition involved than on the specific test itself. From stress tests to mammograms to PSAs, the relationships of true and false positive and negatives, positive and negative predictive values all …

The Match 2015: A grim prognosis for international medical graduates

Skeptical Scalpel, MD

Medical Education

April 7, 2015

There were a lot of happy faces on March 20th as depicted in this brief video of the excitement on the campus of the University of Rochester School of Medicine. Similar scenes took place at every U.S. medical school because 93.9 percent of the 18,025 graduates of U.S. allopathic medical schools matched in a specialty.

But for the 1,093 (6.1 percent) U.S. graduates who didn’t match things were not so bright. …

Angelina Jolie’s story is one of true courage and grit

Miranda Fielding, MD

Physician

April 7, 2015

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I have always been one of Angelina Jolie’s biggest fans. The Academy of Motion Picture Arts and Sciences saw fit to reward her 1999 performance in Girl Interrupted with an Oscar, but I wasn’t well and truly smitten until the second Lara Croft Tomb Raider movie was released in 2003. In that film, Jolie, who performs her own stunts, is seen …

From an ER physician: Write your own admitting orders

Edwin Leap, MD

Physician

April 7, 2015

While working at small rural hospital I was once again faced with the emergency physician’s dilemma. Admitting a patient and being told to write holding orders. In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system. All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble …

Solving bullying: We must begin with ourselves

Ahmad Bailony, MD

Conditions and Diseases

April 7, 2015

“I want to hurt myself.”

That was the only thing written on an otherwise blank page. The other day, the mother of a bright second grader, showed me that alarming note. Apparently the boy wrote it at his school. She went on to tearfully explain that her child has constantly been bullied ever since joining the institution. Sadly, it is not uncommon to encounter such stories when your profession is …

Shift the focus from patient satisfaction to employee satisfaction

Thomas Paine, MD

Physician

April 7, 2015

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By now, everyone in health care is accustomed to the idea of patient satisfaction data and the multi-million dollar industry ($61 million in annual revenue for Press Ganey alone) which exists thanks to the health care leaders and policy makers who embrace it. Most physicians believe it is absurd to use it as a marker of quality care, but have accepted …

Projection. From an unlikely source.

Ilana Yurkiewicz

Medical Education

April 7, 2015

The patient was hacking sputum into a tissue when the resident and I entered his room.

“How long have you had that cough?”

“Oh this? As long as I can remember.”

“But it’s been worse lately?”

“Yeah.”

“Worse how?”

“More stuff coming out each time. See?”

He opens the tissue.

“How much sputum is there?”

“Sputum?”

“The stuff you cough up.”

“I don’t look that close.”

“More than two spoonfuls?”

“Oh yes. Definitely.”

“And the color?”

“White-ish.”

“Ever see any streaks of blood?”

“Never.”

“And how long have …

Read more…

Projection. From an unlikely source.

With the EMR, you have to work backwards from the superbill

Hans Duvefelt, MD

Health Technology

April 6, 2015

Sometimes, after crafting an important or complex plan of care with a patient, I say: “Let me type all this into the computer so that, in case I run into that big bull moose up on Vaillancourt Hill on my way home tonight, the next doctor who sees you will know what we were thinking today.”

Patients sometimes squirm or laugh nervously at that, but then they usually indicate understanding and …

Bill Maher: You don’t matter to doctors

Rebecca Simstein, MD

Physician

April 6, 2015

Dear Bill Maher,

I respect your First Amendment right to exercise free speech. In regards to your recent comments on doctors, however, your words don’t matter. Here’s why.

There is a concept known as the beauty of medicine; I attempt to capture it in the following paragraphs.

If you present to the emergency department with acute chest pain, we will work you up for …

Read more…

Bill Maher: You don’t matter to doctors

Medicine: A profession that saves lives but often silences death

Amy Faith Ho, MD

Physician

April 6, 2015

The sad thing is, I hardly remember the patient. Everything about her is just an overhead pediatric trauma alert followed by the flurry of cutting clothes off, throwing IV lines, and calling out our primary and secondary survey — “blown right pupil,” “unequal breath sounds,” “gross deformity to left ankle,” and then, “no pulses” — followed by the age-old barbaric resuscitation efforts that are now muscle memory to us, as …

Should home births be turned into reality TV?

Justin Morgan, MD

Physician

April 6, 2015

Lifetime has an unscripted series, Born in the Wild, which documents couples’ decisions to forgo birth in a hospital and instead give birth in nature on their own terms without assistance:

In this new series, families take one step beyond home birth and make the powerful choice to experience childbirth in the great outdoors. No inductions, no epidurals … just expectant mothers facing …

Read more…

Should home births be turned into reality TV?

Captain Sullenberger and his lessons for health care

Robert Wachter, MD

Physician

April 6, 2015

The story of Chesley “Sully” Sullenberger — the “Miracle on the Hudson” pilot — is a modern American legend. I’ve gotten to know Captain Sullenberger over the past several years, and he is a warm, caring, and thoughtful person who saw, in the aftermath of his feat, an opportunity to promote safety in many industries, including health care.

In my continuing …

Access your emergency medical identification via smartphone

Kristina Derrick, MD

Health Technology

April 5, 2015

As medical providers, we recognize the value and importance of emergency medical identification (EMI), especially for our patients who live with chronic medical conditions, such as diabetes, epilepsy, and severe allergies. Of particular concern are those who may require emergency care during a time when they are unable to communicate, but how often do we address this topic with our patients, and do they really listen?

Health care professionals have long recommended that such patients obtain emergency medical identification, such as MedicAlert jewelry (bracelet, …

Can doctors afford to ignore the changes in medical practice?

Tommy Prewitt, MD

Health Policy

April 5, 2015

As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other …

How can the health of patients coexist with patient autonomy?

Eric Mandelbaum, RN, MBA

Patient

April 5, 2015

Managing diabetes is all about control: controlling what you eat, when you eat, and the amount of insulin you give yourself. As someone with type 1 diabetes, I understand how control over one’s blood glucose levels is vital to maintaining a healthy lifestyle. When I was hospitalized due to a car accident, however, I saw how the hospital’s desire to control my care ended up costing my insurance company more …

Do not underestimate the importance of liking your peers

Val Jones, MD

Physician

April 4, 2015

As a traveling physician, I’m often asked if I have a favorite place to work. Since I have licenses in 14 states, I have an unusual vantage point from which to compare hospitals. I know that people who ask this question presume that my answer will be heavily influenced by the town where the job is located, and all the associated extra-curriculars, environmental peculiarities (ocean, mountains, desert), and potential amenities. …

Does multitasking lead to physician burnout?

Starla Fitch, MD

Physician

April 4, 2015

As with the beginning of each new year, the word “improved” gets bandied about: improved patient care, improved patient satisfaction, improved efficiency. Physicians are constantly being told to push past their burnout and embrace multitasking for the sake of improved health care delivery. Patients are told to “hurry up and wait” as they line up for health care like lemmings on the top of a cliff.

In a world in which …

My experience with an emergency airway management CME

Janice Boughton, MD

Physician

April 4, 2015

Physicians need to complete about 50 hours of some kind of continuing medical education (CME) every year. The ideal kind of class is one that we actually attend in person, with teachers who are expert in the field being taught and are somewhere near the cutting edge. CME classes are especially nice when they include something hands-on rather than just a lecture format because much of medicine is hands on …

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