Being a nurse is one of the most important jobs in any society. It is also one of the most respected. Public opinion polls consistently rank nurses as the most trusted profession — usually ranking well above physicians. And it’s for good reason. Patients in hospital may forget who their doctor is, but they will rarely forget their nurse. The doctor …
Nurses are the superheroes of health care
I am wearing my favorite scrubs, the teal ones a friend gave to me while I was volunteering in the aftermath of the Haitian earthquake. My first-year classmates and I are in front of the anatomy lab, waiting to see our cadaver for the first time. Our group enters, and we stand around the blue-plastic-cloaked body for a few minutes, preparing ourselves and discussing the task at hand. My anatomy …
A therapy program for medical students
In late January, government officials announced a timeline for Medicare’s shift to paying clinicians based on quality of care rather than quantity of services. As Medicare goes, so go private insurers; this makes the agency’s move toward quality-based reimbursement nothing less than a sea change. It builds momentum for a view of health and health care that is integrated and holistic, rather than comprising discrete, disjointed episodes of treatment.
This …
Community-centered health homes: The next iteration of quality-based care
After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …
Are cardiac risk calculators accurate?
I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill. Annual sales are over $7 billion, nearly a billion more than the next runner-up.
Yes, you read that right: $30 a pill. A little more …
What does it mean to live in the age of Abilify?
A couple of years ago, I asked a friend of mine how she met her husband. It was at a bar, and when she asked his occupation he replied, “I work for the city.” She took that to mean he was a construction worker. They began dating and quickly fell in love. Much to her surprise about a month into their …
8 reasons why you should marry a female physician
In news to absolutely no one with an iota of common sense, the purported physician shortage isn’t actually one of numbers, but rather a problem of distribution. Per this article by in the Washington Post:
Critics of doctor shortage projections have argued for years that the problem is actually poor distribution of physicians, with too many clustered in urban and affluent areas and too few in poor and rural areas.
Doctors prefer to …
The physician distribution problem shouldn’t be a surprise
Dwight Frost had all the risk factors, plus he had already had a stroke several years ago. His blood sugars were too high, his lipid profile was near the top of the class, he still smoked a cigar now and then, and his blood pressure hovered around 200. He also seemed a little vague about which medications he actually took and which ones he didn’t.
He spoke rapidly with a slight …
What this patient needs for a normal blood pressure
I understand that there is a difference between perception and reality. I also get that the kind of people one meets on a tropical vacation in the middle of March are of a certain economic and sociopolitical status.
Nonetheless, I am amazed at how history seems to repeat itself. Year after year, while sitting in the shade and relaxing by the pool, …
Our health system is changing, and it’s a damn shame
I walked into room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a …
A thank you to a mother and son in the ER
American physicians have had it. We are retiring early, cutting back, changing careers, and moping in to work in astounding numbers. The typical pep talks, whether given aloud by medical directors and administrators or consisting of internal dialog occurring in the physician’s mind, are not working anymore. “You have it better than most people.” “You are still making good money.” “Your …
This is why physicians are burning out
Thomas Hobbes described life as pitifully “nasty, brutish, and short.” Thanks to the free market and the state, life is no longer a Hobbesian nightmare. But death has become nasty, brutish, and long.
Surgeon and writer, Atul Gawande, explores the medicalization of aging and death in Being Mortal. Gawande points to a glaring deficiency in medical education. Taught to save lives and fight death, doctors don’t bow out gracefully and say enough …
The vexing problem of dying for the medical profession
Health care in the U.S. continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the health care landscape because it has awakened the health care consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41 percent of all firms (32 percent of large employers, 61 percent of small …
Patient experience builds brand equity
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Members of Congress and the news media have a bad habit of referring to efforts to stop Medicare from arbitrarily cutting payments to physicians for taking care of their patients as the “doc fix.” Typical is this story from CNN — “Bipartisan Love: Boehner, Pelosi strike deal to kick doc fix” — that reported on the release yesterday of an agreement between the two leaders on a bill to repeal …
Stop calling SGR repeal the doc fix. It’s about fixing Medicare.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman comes to the office for advice regarding maintaining bone health. She has no history of fracture. The patient recently had a lumpectomy and radiation therapy to treat breast cancer, is currently taking tamoxifen, and will begin taking an aromatase inhibitor in 2 months. She underwent menopause at age 52 …
MKSAP: 54-year-old woman asking advice about bone health
Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.”
Thousands of people have …
Heart-wrenching photo of a doctor crying goes viral. Here’s why.
As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some point, sent the patients home. This simple formula was the business model for hospitals, and it worked well.
Same with the doctors. The hospital would pretty much let us do what …
Why you should help your local hospital improve
The mortality from colorectal cancer has decreased substantially in the U.S. during the past decade. While some of the improvement is due to better cancer treatment and reduced risk factors, the largest proportion is thought due to screening. The concept that early detection saves lives has now become well recognized. The harms of screening — particularly among individuals with limited life expectancy — are less well appreciated.
Royce et al. recently published a …
Colorectal cancer screening in the elderly: Can we stop the train?
Right now, there are two patients in every room. One is made with flesh, bones, and blood. One is made with a monitor, a mouse, and a keyboard.
Both demand my time.
Both demand my concentration.
A little over two weeks ago I wrote the short story “Please Choose One.” I posted it online. The response it generated exceeded anything I …
To health IT: You are the ones who can save us
In mid-January, a patient called me from her pharmacy, frantic. Her asthma inhalers came to $168 — a sum that she hadn’t been prepared for. But she can’t live without those inhalers, so she withdrew cash from her meager savings account and skipped her blood pressure pills for that month.
This is such a familiar story by now that it hardly makes …
The ethics and money in medicine
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