Our fascination with Ebola exposes a double standard

Conditions and Diseases
December 29, 2014

Since Ebola was first discovered in 1976, there have been an estimated 16 to 22 recorded outbreaks. In August, the World Health Organization designated the most recent outbreak a global emergency.

Ebola is a deadly infection and the scope of the current epidemic in West Africa is unprecedented. More than 17,000 people have contracted Ebola virus disease (EVD) with more than 6,000 estimated deaths.

Many in the health care field have criticized the response of world …

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Our fascination with Ebola exposes a double standard

A New Year’s resolution for physicians: Listen to your inner voice

Physician
December 29, 2014

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Exactly one year ago, I abruptly fell off my professional trajectory. I lost the battle I was fighting — trying to bring new and fresh ideas and a measure of fairness and accountability into a dictatorial academic establishment — and, pretty much, lost the war. The year that followed was a spectacular ride, filled with new ideas, meeting great people, creating business ventures …

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A New Year’s resolution for physicians: Listen to your inner voice

How physicians and psychologists agree to torture others

Physician
December 29, 2014

Atul Gawande posted a series of tweets, based on findings in the Senate CIA torture report, about the significant role physicians and psychologists played in torture. He comments, “But the worst for me is to see the details of how doctors, psychologists, and others sworn to aid human beings made the torture possible.”

Agreed. Upon reading how these professionals used their knowledge to torture their fellow human beings I felt disappointed, …

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How physicians and psychologists agree to torture others

Family medicine residencies should be 7 years. Here’s why.

Medical Education
December 28, 2014

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I’m on my family medicine rotation right now.  One of my preceptors is about 80 years old and went through medical school in the 1960s.  He is still sharp as a tack; he used to do C-sections, hernia repairs, appendectomies, fracture repairs and get this — emergency burr holes for subdural hematomas (a.k.a. neurosurgery).  He stopped around 1997, mostly because he …

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Family medicine residencies should be 7 years. Here’s why.

Who needs doctors at all if care is reduced to point and click?

Physician
December 28, 2014

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As I watch the business world’s fascination with the electronic medical record (EMR) and all of the big data that it accumulates, I see more and more processes codified and treatment pathways carefully honed. Only one small thing remains until the computer can tell doctors how to behave based on the developed algorithms: To turn free text in the patient chart …

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Who needs doctors at all if care is reduced to point and click?

Bureaucrats think a doctor is a doctor. They’re wrong.

Physician
December 28, 2014

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I am a foreign born, foreign trained doctor, serving many patients from an ethnic minority, whose native language I never mastered.

So, perhaps I am in a position to reflect a little on the modern notion that health care is a standardized service, which can be equally well provided by anyone, from anywhere, with any kind of medical degree and postgraduate training.

1. …

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Bureaucrats think a doctor is a doctor. They’re wrong.

MKSAP: 32-year-old woman with systemic lupus erythematosus

Conditions and Diseases
December 28, 2014

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

A 32-year-old woman is evaluated as a new patient. She is planning to attempt conception with her partner. She has a history of systemic lupus erythematosus complicated by chronic kidney disease that has been inactive for several years off of treatment. She has had borderline blood pressure elevations since the …

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MKSAP: 32-year-old woman with systemic lupus erythematosus

Information without communication is uninformative

Physician
December 27, 2014

Information is everything, communication is the key.

Recently, we were contacted by the medical director of a subspecialist fellow’s practice at one of our affiliated hospitals.

She wanted to discuss ways to improve communication between our practices, and expressed considerable frustration about the information received in consultation requests from the providers in our practice sending patients their way.

She noted that they had “read-only” access to our electronic health record (through an information-sharing …

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Information without communication is uninformative

5 ways to improve patient engagement in hospitals

Physician
December 27, 2014

Improving patient engagement is a subject that’s being talked about in hospital boardrooms across the country. It’s become the in-fashion political buzz phrase. Certainly sounds very well and good, but what exactly does it mean?

Likely different things to different people depending on what angle they approach it — all the way from a care assistant up to the hospital CEO. In a nutshell, it’s all about allowing the patient to …

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5 ways to improve patient engagement in hospitals

Is reactive scheduling for hospitalists a good idea?

Physician
December 27, 2014

My earliest memories of medicine take me back to dinner table conversations with my mother, who is a physician. She would share with us her daily stories, telling us about patients she took care of in her clinics and in the hospital. As an internist, she often found herself traveling between many locations. I grew up knowing this to be medicine. As I have progressed in my career as a …

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Is reactive scheduling for hospitalists a good idea?

Can shared accountability improve performance measures?

Physician
December 27, 2014

There are plenty of good reasons why thoughtful physicians are often unhappy with the current approach to measuring the quality of care they provide. Some, of course, object to the whole notion of quality measurement, but I believe they are in a shrinking minority clinging to an anachronistic mental model in which each physician defines for himself what constitutes high quality care. I have addressed this previously. But even those, …

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Can shared accountability improve performance measures?

From medical student to patient, in a matter of minutes

Medical Education
December 26, 2014

As part of the second-year clinical skills course, each member of my class is required to complete two 8-hour emergency department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the …

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From medical student to patient, in a matter of minutes

Red light, green light: How nutritional labels can mislead

Conditions and Diseases
December 26, 2014

So many foods beckoning us from the grocery store shelves — but which ones are healthy for us to consume? We could study nutritional facts labels, but that feels as challenging as the math portion of the SAT, with so much numerical information to process. The label tells us how many calories are in the food in question — how many grams of protein, how many grams of fat, and …

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Red light, green light: How nutritional labels can mislead

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What happens to medical notes today’s EMRs

Health Technology
December 26, 2014

I once wrote about the communication difficulties caused by electronic medical records systems. The response on Twitter ranged from sentiments including everything from “right on, sister” to “greedy doctors are only complaining about EMRs because of their price tag.” The disconnect between policy wonk’s (and EMR vendor’s) belief in the transformative power of EMRs and exasperated clinician users of these products is jaw-dropping. Physicians are often labeled as obstinate dinosaurs, blocking progress, while policy wonks …

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What happens to medical notes today’s EMRs

Hysterectomy for chronic pelvic pain: 7 questions to ask

Conditions and Diseases
December 26, 2014

Chronic pelvic pain (CPP, pain in the pelvis that is present for more than 2 weeks a month and has been there for more than 6 months) affects 15 percent of women and accounts for upwards of $2 billion a year in direct medical costs. To say it is a significant health burden is a gross underestimate at best. My entire practice is devoted to the treatment of pelvic pain …

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Hysterectomy for chronic pelvic pain: 7 questions to ask

Hardly anyone is opening their own practice anymore. Why?

Physician
December 25, 2014

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Young doctors are often progressive thinkers who like to support small businesses, buy locally grown produce from food shares, shop from individual merchants on Etsy, and never be seen in any chain store larger than Trader Joe’s. It seems every industry is recognizing the benefits of the personal service of a small business.

Decades ago, the majority of physicians owned their own …

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Hardly anyone is opening their own practice anymore. Why?

The people who will cure cancer are the patients

Conditions and Diseases
December 25, 2014

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Sometimes I tell people I’m learning how to treat cancer, and their first question is ‘why haven’t we cured cancer yet?’

We will.  It’s coming.

In medicine, we’re much better at treating infections than cancer, but it wasn’t always that way:

  • We didn’t know washing your hands before delivering a baby was safer for women until 1847.
  • The concept of a germ was proposed in 1870.
  • The first Read more…

The people who will cure cancer are the patients

How many doctors does it take to read a hospital bill?

Physician
December 25, 2014

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Traveling to another country can be daunting. So when a friend of mine hosted a Russian college-aged student named Anna for a year so she could take English classes, I agreed to help out if she ever needed to navigate the American medical system. Anna had insurance provided through her program, and she was in good health, so I wasn’t too …

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How many doctors does it take to read a hospital bill?

Competition helped innovate computers: Can it do the same for health care?

Health Technology
December 24, 2014

My lifetime has spanned many of the important developments in the Age of Computers. Back in 1969 when I entered college, I was a frequent visitor to the Kiewit Computing Center, the lair of a GE-635 computer that filled several rooms. Students had access to the computer via noisy teletypes and a multiuser operating system known as Dartmouth Time Sharing. We wrote simple programs in BASIC, a language created by two of …

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Competition helped innovate computers: Can it do the same for health care?

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