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The two towers of medicine. Which one will you choose?

Health Policy

March 1, 2015

Come, let us build ourselves a city, with a tower that reaches to the heavens, so that we may make a name for ourselves.
– Genesis 11:4

With these words, so begins the biblical story of The Tower of Babel. The tale was written, at least in part, to explain the origin of different languages. Essentially, a group of earth’s early inhabitants started to build a tower to the sky in order …

The measles outbreak and vaccines: We need civil discourse

Janice Boughton, MD

Medications

March 1, 2015

There has been an outbreak of measles, a vaccine preventable disease, along with an outbreak of people yelling at each other. There have been angry exchanges between people who would like all children vaccinated according to the recommended guidelines and people who support the rights of parents to choose which vaccines to give their children, if any, and when to give them. There has been much focus on the assertion, …

Is a doctor allowed to become sick?

Mimi Emig, MD

Physician

March 1, 2015

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I awoke one Saturday morning to a terribly familiar feeling — a tight, barky cough, fast breathing, severe shortness of breath and burning in my chest. Another severe asthma attack. I knew I was in trouble.

Twenty-three years ago, when I was an internal medicine resident, I went to be evaluated for recurrent pneumonia. I wound up being diagnosed with cough variant …

Read more…

Is a doctor allowed to become sick?

Health care or abuse: Which are you receiving?

Pamela Wible, MD

Physician

March 1, 2015

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A physician in Texas posts this photo on Facebook. Caption: “My schedule one morning in January 2014. Never again …”

Yay! Another physician breaks free from assembly-line medicine.

High-overhead, high-volume offices sacrifice the sacred physicians-patient relationship and perpetuate a disease-billing management system. This is not health care. It’s abuse.

Patients: Avoid clinics with 10-minute slots. Go for docs who offer 30 to 60-minute appointments. Physicians: …

It’s the year 2015: Why are we still debating vaccines?

Rebecca Weintraub, MD

Medications

February 28, 2015

Recently, as I juggled work, family and shoveling, I prepared a lecture on promoting equity in health delivery. My first slide is a picture of the Ebola virus, and as of this morning, my last slide is a map of the ongoing measles outbreak. That’s because this week, we’ve heard a clear public health message from both President Obama and Surgeon General Vivek Murthy: Vaccines are safe and effective.

Why is this …

Today’s EMRs: Extra work with uncertain benefits

Hans Duvefelt, MD

Health Technology

February 28, 2015

The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab.

Printing a requisition from our EMR is a multi-step process that involves …

Ask for Dilaudid, get Dilaudid. No questions asked.

GomerBlog

Medications

February 28, 2015

A local hospital is trying a new, controversial but more efficient approach to medical care. “We have changed our guidelines, if you want Dilaudid you get Dilaudid, if you want Valium, you get Valium. No questions asked,” CEO Michael Shoemaker told reporters Wednesday.

In what experts are calling pure genius, emergency …

Herbal supplements: What are you really taking?

Michael Kirsch, MD

Medications

February 28, 2015

Many of my patients are taking herbal supplements, or so they think. This herbal and health supplements industry likely is envied by traditional pharmaceutical companies. The latter has to spend zillions of dollars proving safety and efficacy to the Food and Drug Administration (FDA). Many of these drugs are cast aside during the approval process or afterwards when serious side effects become known, or a new medicine is proved safer …

MKSAP: 23-year-old woman with stiffness and achiness of the hands

mksap

Conditions and Diseases

February 28, 2015

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

A 23-year-old woman is evaluated for a 1-year history of morning stiffness and achiness of the hands as well as Raynaud phenomenon. Two months ago, she experienced a sun-induced rash on the chest and back and patches of discoloration on the hands.

On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure …

Why don’t some parents believe the safety of vaccines?

Vamsi Aribindi, MD

Medications

February 27, 2015

As a medical student, I strongly support vaccination. It works, it’s safe, and it doesn’t cause autism. But I also understand why many parents don’t believe me and the medical community when we beg them to vaccinate their kids.

Medicine has come a long way from “do no harm.” Now we talk about risks and benefits: and none of our tests, medicines, or procedures are without risks. Increasingly, pharmaceutical companies have …

Reduce allergy costs for patients with simple solutions

Jennifer Menjivar

Medications

February 27, 2015

I grew up most of my life avoiding doctors and hospital visits. I never fancied getting shots or blood draws as a child, and without health insurance; I didn’t have much of a choice. This lack of access is what drew me to volunteer at the county hospital I was born at. Every Wednesday morning, I would report to the pediatric asthma allergy clinic at San Francisco General Hospital. Most …

What cancer denial has to do with global warming

James C. Salwitz, MD

Conditions and Diseases

February 27, 2015

Cancer patients depend on denial. Without its protection, we would be overwhelmed by terror. Denial filters and slows bad news, so we can digest reality in the merciful morsels; thus, we cope. Without denial, we would shut down, withdraw, and lose hope; healing would not be possible. However, if we do not move beyond denial, accept the diagnosis and loss, make a plan, we die.

Allen, a 43-year-old man, came to …

The medical truth behind #TheDress. And yes, it makes sense.

Steve Christiansen, MD

Conditions and Diseases

February 27, 2015

My mother-in-law texted me about The Dress, random friends are blowing up my inbox, and the nurses in the emergency department were huddled around the computer at 2 a.m. debating the color of the dress. Everyone in the world seems to be wondering what color the dress really is and why.

The best way to find the answer to such questions is to find …

On vaccines: Don’t forget the rights of children

Roy Benaroch, MD

Conditions and Diseases

February 27, 2015

Some people who argue against vaccinations claim that vaccine policies infringe on their “rights” — their rights, as parents, to make medical decisions for their children. It’s a scary, misleading, and chilling message. We need to be careful about where one person’s rights end and the next person’s rights begin. We need to remember that children (their children, and your children too) have rights of their own.

For example, Dr. Bob …

Secrets that your doctors are dying to tell you

Jamie Coleman, MD

Physician

February 27, 2015

I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues.

We are in debt. I mean, real debt. We are in debt. I mean, real debt. It actually costs most of us almost 1 million dollars to become your doctor.

It has taken us a long time to get here.

Let’s do some …

Patients are not customers. Here are 6 reasons why.

Shirie Leng, MD

Physician

February 27, 2015

Recently I wrote about the problems with maintenance of certification requirements. One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.” Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because …

Read more…

Patients are not customers. Here are 6 reasons why.

Stop the arranged marriages between patient and provider

P. J. Parmar, MD

Physician

February 26, 2015

Assigning patients to doctors. Who still does this?

We don’t assign hungry people to restaurants, hairy people to barbers, or passengers to airlines. Even State Farm allows me to choose between Maaco or my local chop shop every time I crash my car. We do assign kids to teachers, but still, I don’t need too many analogies to tell me that assigning …

Politicians and dense breasts: Here are 2 questions to ask

Jeffrey Parks, MD

Conditions and Diseases

February 26, 2015

Recently, Ohio became the 20th state to pass a law mandating that hospitals and clinics performing mammography screening to notify a patient in writing if results suggest something known as “dense breast tissue.” Standard mammography creates a 2-D image of breast tissue. In general, this is sufficient for screening purposes. However, especially in younger patients, the presence of dense breast parenchyma can lead to higher false negative readings and …

Help patients make better decisions about lung cancer screening

Michael J. Barry, MD

Conditions and Diseases

February 26, 2015

The high cost of health care in the United States in part relates to how clinicians are paid. Performing expensive and often risky procedures simply pays better than engaging patients in a shared decision-making conversation. Shared decision-making (SDM) is a process where clinicians and patients educate each other about treatment options, risks and benefits, and preferences, and then they decide on the best approach together. Patient decision aids can assist …

What is true maintenance of medical knowledge?

Robert Centor, MD

Physician

February 26, 2015

Maintenance is the process of maintaining or preserving someone or something, or the state of being maintained.

Our certification documents that we have trained (in my case in internal medicine) and that we can pass a test on the breadth of internal medicine knowledge. We accept that the ABIM has developed a test the evaluates our entire exposure to the many diseases and treatments that reflect our patients.

The idea of maintenance of …

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