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Which drugs are on formulary? A little help, please.

Medications

February 23, 2015

The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed.

Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives.

Then there are several cumbersome explanations about the appeal …

Primary care physicians: Fight for your value

Margalit Gur-Arie

Health Policy

February 22, 2015

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear to …

5 tips for travelling with your CPAP

Deep Ramachandran, MD

Conditions and Diseases

February 22, 2015

Sleep apnea is a condition that afflicts millions of people. There are two types of sleep apnea: central, and obstructive. Obstructive is by far the most common, and is usually what is referred to when people talk about sleep apnea. Obstructive sleep apnea occurs when, during sleep, the airway passages in the throat close and block the movement of air. Common symptoms are snoring, gasping during sleep, sleepiness during the day, …

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5 tips for travelling with your CPAP

What do patients really want from doctors?

Pamela Wible, MD

Physician

February 22, 2015

pamela wible
Ever wonder what patients really want from doctors?

Is it the fancy buildings with marble fountains?

Is it the board certifications and diplomas on the wall?

Is it the expert medical jargon and starched white coats?

Nope. None of the above.

Listen up, docs: Patients just want the real you. Ya know — you. The competent and caring you who really listens with compassion. The real you …

We have the power to prevent disease. But we’re not using it.

Brad Wright, PhD

Conditions and Diseases

February 22, 2015

We all know them. We see them on TV. We read about them in the paper. And, with the explosion of social media, you hear about it from people you know. If you have a Facebook account with a sizable enough network of friends, you’ve probably seen at least one negative comment about vaccines. On one end of the spectrum, there are the seemingly innocent people who claim that they …

Emerging health care models for innovators

James Maskell

Health Technology

February 21, 2015

As our medical system attempts to evolve to better deal with the modern epidemics of lifestyle-driven chronic disease, much time and attention is being placed on the clinical models for prevention. Rightly so, and various viable models are popping up with names like lifestyle medicine, preventative medicine, and functional medicine.

But one area that is hardly addressed is the payment structure and business model of the practices. Are there structures that …

The measles outbreak: Let’s look at the bigger picture

Claudia M. Gold, MD

Conditions and Diseases

February 21, 2015

As the measles outbreak gathers worrisome steam in parallel to the explosion of passionate rants both pro and anti-vaccination, I find myself wondering; what is this really about? Rather than get bogged down in the myriad of issues on either side- though at the outset I will say that as a pediatrician I unequivocally recommend vaccination; I will aim to look at the bigger picture.

Is this issue really about trying …

A tale of two strep throats: Retail clinic vs. PCP

Leslie Kernisan, MD, MPH

Conditions and Diseases

February 21, 2015

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Six years ago, just after arriving in Baltimore for a winter conference, I fell sick with fever and a bad sore throat.

After a night of feeling awful, I went looking for help. I found it at a Minute Clinic in a CVS near the hotel. I was seen right away by a friendly NP, who did a rapid strep test …

Let’s break the association of palliative care as hospice

Don S. Dizon, MD

Physician

February 21, 2015

Mom. Dad.

Happy. Sad.

Friend. Trust.

I remember playing this game. A friend would say one thing, and then I would say the first thing that came to my mind. For some reason, it would pass the time. I remember how some words would spark an emotion or a memory. Sometimes happy, sometimes not so happy. But, playing that game was one of …

When should parents be vaccinated against measles?

Natasha Burgert, MD

Conditions and Diseases

February 20, 2015

“Nervous.”

I’ve heard that word a lot lately. It keeps falling from the mouths of my families in clinic, landing on the floor with a silent thud.

I mean, we have a right to be. We should be. It is one of the most infectious diseases on the planet, today about 400 people worldwide will have died of it, and the number of infected people in the U.S. is climbing.

Do you want a doctor or a demotivated test-taking machine?

Shirie Leng, MD

Medical Education

February 20, 2015

Last week, my best friend took the recertification exam in anesthesia, the so-called MOCA exam. Like a good doobie, she paid her $2,100, paid her nanny extra so she could study, took a day off in which she missed the funeral of a friend’s husband, and took the test. Wow, she must be the most awesome, most well-read, most skilled, most …

I am proud of our society. We provide care to everyone.

Michael Joel Pottash, MD, MPH

Physician

February 20, 2015

She is always a difficult admission. The long chart review. The vague complaints. The entitled attitude. The misdirection. These are expected. As is the cake at her bedside after a diabetic crisis. The two-liter soda after an emergent fluid dialysis. The urine toxicology was positive for cocaine. The staff knows her well. I know her well. I give her the attention, kindness and empathy that I give to every patient. …

No, you don’t need a vagina facial

Jennifer Gunter, MD

Conditions and Diseases

February 20, 2015

I saw this little news item from Shape Magazine about “vagina facials.”

First of all, the post means vulva. The vagina is inside and the vulva is the outside (where your underwear touches your skin). The vestibule is in between.

This what Shape Magazine had to say about it:

Created by Lisa Palmer, the facial came about after she “looked downstairs” and realized her …

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No, you don’t need a vagina facial

How to make a great first impression with patients

Edward Leigh

Patient

February 20, 2015

You don’t have a second chance to make a great first impression.

If twenty random numbers were read aloud, most people would remember the first few numbers and the last few numbers. We tend to remember beginnings and endings. It is the same with patients; they tend to recall what they hear at the beginning and …

Does Tamiflu work and what are the side effects?

Janice Boughton, MD

Medications

February 20, 2015

The flu season has really gotten into gear now with 46 of our 50 states reporting widespread influenza activity as of January 3, 2015. Influenza is a virus that infects the respiratory tract, causing sore throat, runny nose, fever, and cough. Rarely people with the flu will have nausea, vomiting and diarrhea, but this is not “stomach flu” which is a term some of us use to describe any one …

The power of expensive placebos

Albert Fuchs, MD

Medications

February 19, 2015

The power of placebos has long been known. People who believe that they are taking an effective drug frequently feel better. In fact, prior to the discovery of penicillin, it is likely that the placebo effect accounted for much of the benefit of medical care.

A study published in the journal Neurology makes an interesting connection between the magnitude of the placebo effect and the medication’s perceived price.

The study enrolled 12 …

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The power of expensive placebos

How the advent of propofol changed the meaning of the term “sedation”

Karen S. Sibert, MD

Medications

February 19, 2015

“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!”

We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, …

Driving advice from a trauma surgeon

Jamie Coleman, MD

Conditions and Diseases

February 19, 2015

No one ever wants to meet me. Well, at least inside of a hospital. If you are meeting me in a hospital, it is likely because you have been stabbed, shot, assaulted, or in a car accident. Although the only advice I have about avoiding the first three mechanisms of injury is to stay away from “two dudes” and not try to sell …

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Driving advice from a trauma surgeon

The misguided case against the annual physical

David L. Katz, MD

Physician

February 19, 2015

Recently in the New York Times, Dr. Ezekiel Emanuel suggested that this year’s resolution might be to abandon the ritual of your annual physical. The title of his column, perhaps chosen by an editor to maximize glibness and thus provocation was: “Skip Your Annual Physical.”

But permit me to suggest you don’t commit to that just yet. The annual physical exam warrants some more examination, a defense to follow its prosecution.

Dr. …

Want to know why your doctor is late? Read this.

Sanaz Majd, MD

Physician

February 19, 2015

One of my biggest pet peeves in life is tardiness. I hate it when other people are late. It’s as if they are not respecting my time. But you know what? I hate being late myself even more. In fact, I cringe at the thought. Conscientious, successful people are on time.

Always.

So you can imagine that nothing irks me more than being …