Why are we shortening medical degrees?
The four-year medical degree has been the mainstay of U.S. medical schools for more than a century, following the publication of the Flexner report in 1910. Prior to this, there was little standardization about what a medical degree could or should look like. Medical school education was subsequently standardized to two years of academic study, followed …
Shortening medical school: Is that a good idea?
I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second career path, I have been planning my career in hospital medicine since the beginning of my residency training.
The things that drew me …
A day in the life of a hospitalist
Dr. Peterson, the radiation oncologist, gets right to the point.
“The medical center’s tumor board has concluded that your cancer is inoperable, incurable and untreatable,” he says flatly. “Any chemotherapy or radiation treatments would be palliative in nature.”
He begins explaining the reasons behind the board’s verdict, but everything he’s saying washes out. My mind stopped working as soon as I heard the words “incurable” and “palliative.” I am sliding into shock.
Dr. …
When discussing cancer treatment, the approach matters
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 76-year-old woman is evaluated for a 1-day history of headache, left eye pain, nausea and vomiting, seeing halos around lights, and decreased visual acuity of the left eye. She has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Medications are metformin, digoxin, metoprolol, hydrochlorothiazide, and warfarin.
On physical examination, temperature is 36.8 …
MKSAP: 76-year-old woman with a headache
Value.
A simple word with lots of meanings, all of which depend on the context of the moment. Value in health care — especially in cancer care — is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person’s value is clearly another person’s concern.
At the crux …
What is value in cancer care? It depends.
Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other health care facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work …
Hospital credentialing is one giant mess
I find myself in a unique position. I recently retired as an orthopedic surgeon and my wife and I moved out of my practice area. At the same time, my wife was diagnosed and started treatment for breast cancer. So I got opportunity to interact with the health care system both as a provider and as a family member of a patient receiving long-term care first from providers I knew …
When going “by the book” hurts patients
Establishing a digital presence is rapidly becoming a necessity for health care professionals, medical practices, and institutions. Yet something that often gets obscured in the discussion is the fact that at its heart, digital media is about people.
As such, it’s about relationships, and it’s about communication, and increasingly, your digital footprint means educating, engaging and growing your audience.
When you do this in a way that authentically reflects you and your …
Physicians: Make your online presence a social one
I stared down at the tired, deteriorating woman sprawled across a bariatric bed before me. A breathing tube was in her throat while multiple catheters pierced her arms and neck, pouring powerful medications directly into her veins. Among several functions, these infusions would maintain her blood pressure high enough to keep her organs alive. This was my initial, visual impression of a patient I was responsible for during my first …
How antibiotics are killing us and the new ones can’t come fast enough
This year’s flu vaccine, as you likely know, is taking a drubbing. The contention is that CDC flubbed, and didn’t get quite the right flu strains in the mix. That is apparently true, although more the “fault” of the influenza virus and its natively wily ways, than of the CDC. Either way, the drubbing is disproportionate to any flubbing.
The drubbing occurs in …
The flu vaccine is imperfect, but please get it anyways
We all have prejudices. We have racial prejudices. Religious prejudices. Gender prejudices. Occupational prejudices. Age prejudices. Weight prejudices. Height prejudices. We prejudge based on hair style. Language. Accent. Clothing. Shoes. Attractiveness. Tattoos. Names. Jewelry. Family. Hobbies. Cars. Schools. Type of home. Music. Where a person lives. What type of work a person does. What a person reads. Talents. Disabilities. Physique. Medical history. Injuries. Opinions or assessments by others.
No one is …
Don’t let our desire to be respected get in the way of our oaths
It took me until 2010 to buy an iPhone and in just a few years, I’ve become so dependent on it, without fail, I will always make a U-turn to make sure it’s with me — my smartphone is essentially a new limb for me.
I know I’m not alone.
Most did not predict the rocket speed adoption and transformative power of modern smartphones when the iPhone launched in 2007. But, in …
What could a digital future look like in health care?
Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010. Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act. Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure.
But is consolidation the clear-cut answer?
Here are 4 reasons bigger actually may not be better for all hospitals:
1. Disparate …
Hospital consolidation: 4 reasons why bigger isn’t better
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There’s been a lot of talk recently about low morale and disgruntlement among doctors. A recent article on focused on a list of reasons when doctors know it’s time to quit. I found the article a bit sad and unfortunate, but I’m sure the feelings behind it were sincere.
Another excellent article in the Wall Street Journal last week extensively discussed the factors behind …
Don’t quit medicine. Here are 5 reasons why.
I admittedly spent a good portion of the fourth year of medical school dreading internship. A year where I was expected to suddenly be a doctor and to have all the answers. A year where I would work long hours and carry several pagers at one time. I come to you in blog form to inform you of some of the …
Don’t dread internship: 5 truths from a first-year intern
It is estimated that approximately 14 percent of U.S. physicians in training are depressed and another 10 percent experience suicidal ideation. Some 400 U.S. physicians take their own lives each year. Hampering efforts to deal with such problems is the stigma associated with them. I knew a top medical student who was reluctant to seek mental health care in part because …
I do not know about you, but I get confused about the Heisenberg uncertainty principle. Asked for a definition, I usually say something about how when you try to measure something, you change it, therefore one can never be complete or exact in measurement. However, that is wrong. The uncertainty principle has nothing to do with the effects of measurement, but rather its limits. If you measure one thing, such …
When the patient’s touch alters the doctor
In the giddy days after the passage of ACA, I was chatting with a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; “Healthcare post-Obamacare” or “Radiology in the new era.” Talks warning us that we were exiting the …
Health reform and Gruber: We want simple solutions to complex problems
She was absolutely perfect. She had ten perfect fingers and ten perfect toes. Her eyes were wide and curious and drew you in fondly. She was absolutely perfect everywhere — everywhere except for her nose and mouth. She was born in 1959 with a unilateral complete cheiloschisis and palatoschisis, more commonly known as a cleft lip and palate. Where her perfect, beautiful nose should have been was an empty, gaping …
When it comes to health care, I finally understand how beautiful banality can be
Old age is no place for sissies.
-Bette Davis
“I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!”
She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had …
Tongue cancer in an elderly patient: Thinking of my grandmother
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