The paranoia surrounding hospital infection rates

Physician
December 13, 2014

No one wants a hospital-acquired infection — a wound infection, a central line infection, or any other kind.  But today, the level of concern in American hospitals about infection rates has reached a new peak — better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies.  As far as I can tell, …

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The paranoia surrounding hospital infection rates

Say happy holidays to your GI tract

Conditions and Diseases
December 13, 2014

The holiday season is well underway. This is the time of year for celebrating with family and close friends and reflecting on what is truly important to us. It can also be a  time of significant stress, inevitable over-eating and deviation from our usual routines. Essentially, the holidays can be hazardous to your health and this is particularly true when it comes to your gastrointestinal (GI) system. So what can …

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Say happy holidays to your GI tract

Physicians must be the architects of health care change

Health Policy
December 13, 2014

An excerpt  from The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield).

Myth 1: “The United States boasts the best health care in the world.”

Betsy Lehman trusted her life to the American health care system. An award-winning journalist, Lehman was a rising star at the Boston Globe, where she wrote extensively about health care issues. So when the mother of two was …

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Physicians must be the architects of health care change

MKSAP: 50-year-old man with cirrhosis

Conditions and Diseases
December 13, 2014

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

A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril.

On physical examination, temperature is 37.5 °C (99.5 °F), …

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MKSAP: 50-year-old man with cirrhosis

Medical errors: We can’t trust doctors to get it right

Physician
December 12, 2014

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“If doctors do no other good, they at least prepare their patients early for death, undermining little by little and cutting off their enjoyment of life.”

These words from Montaigne are 350 years old, but, sadly, too often they describe the results of modern medicine, particularly when it is mindlessly applied in a needlessly heroic way to the end of life.

I spend …

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Medical errors: We can’t trust doctors to get it right

You’re fine: That’s the hardest diagnosis to make

Conditions and Diseases
December 12, 2014

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A thought provoking article in the November, 2014 edition of Pediatrics highlights a growing problem with modern medicine: Just because we can make a diagnosis doesn’t mean we should.

The article, titled “Overdiagnosis: How our compulsion for diagnosis may be harming our children,” has been made available for free to everyone. It’s fairly dense and technical, but if you’ve been following this blog …

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You’re fine: That’s the hardest diagnosis to make

Here’s what genomics is all about

Medications
December 12, 2014

Personalized medicine. Predictive medicine. Targeted medicine. These are just some of the descriptors being applied to “genomic medicine,” a field of medical research generating much fanfare and hope for the future.

Genomics, according to the Centers for Disease Control and Prevention (CDC), is the study of all the genes in the human genome – that double-stranded DNA helix that defines who we are and what we’re made of. Building on classical …

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Here’s what genomics is all about

A controversial email. But not for this patient.

Physician
December 12, 2014

It’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient. The general consensus, unsurprisingly, was that the first was far too cheeky — not to mention insulting — to effectively convey the necessary information.  The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send the …

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A controversial email. But not for this patient.

Is there really a doctor shortage, and what can we do about it?

Health Policy
December 12, 2014

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There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The …

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Is there really a doctor shortage, and what can we do about it?

A doctor goes networking, and is horrified by what she finds

Physician
December 11, 2014

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I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the …

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A doctor goes networking, and is horrified by what she finds

Science bashing: The latest threat to research in America

Health Policy
December 11, 2014

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In the midst of multiple public health crises, the NIH budget is in an unprecedented period of stagnation. So why the growing chorus of voices calling to slash more science?

Senator Rand Paul recently slammed the NIH, specifically calling out a study of “origami condoms” which he says are “designed with Japanese folding paper in mind.” In fact, this research is …

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Science bashing: The latest threat to research in America

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Jonathan Gruber: What if he’s right?

Health Policy
December 11, 2014

So there is this guy from MIT or Harvard, or some other place where they teach our leaders how to lead, and his name is Jonathan Gruber. Mr. Gruber, it seems, was hired to consult with the Obama administration during the time the Affordable Care Act (ACA) was created because of his extensive expertise in designing the Massachusetts health care system. In recent weeks, people who don’t particularly like our …

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Jonathan Gruber: What if he’s right?

Obamacare: What did Jonathan Gruber really say?

Health Policy
December 11, 2014

Jonathan Gruber went from unknown to infamous in the last few weeks, a result of disparaging comments he made about the Affordable Care Act (Obamacare) and even more disparaging ones he made about the American people. According to Gruber, the Obama administration counted on “the stupidity of the American voter” to pass the bill. In fact, the Obama team’s “lack of transparency” was deliberate, because they believed the law would …

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Obamacare: What did Jonathan Gruber really say?

Medical students in the couples match: One student’s story

Medical Education
December 11, 2014

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I recently wrote about the pressure that comes with the scrutiny of residency applications and the interview process. Adding to this, many applicants apply alongside their significant other, making use of the “couples match” option. Let’s think about that: No longer do you have to stress for yourself, but now you worry for your partner too. And while your primary …

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Medical students in the couples match: One student’s story

Married to a physician: Holiday blessings in disguise

Physician
December 11, 2014

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Each year as the holidays approach, countless medical families prepare for the dreaded release of the holiday schedule. Will the physician spouse be home this year? Will the non-physician spouse be packing up three kids under the age of five and traveling across the country alone to visit family they may only see once a year? It can be stressful. It …

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Married to a physician: Holiday blessings in disguise

Health care’s future: An interview with a hospital CEO

Health Policy
December 10, 2014

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Not long ago I interviewed Dr. Todd Sorensen, the CEO of Regional West Medical Center, a 184-bed facility serving a large swath of rural western Nebraska. I’ve known Dr. Sorensen since junior high school, and we’ve kept in touch over the years to discuss the health care system from his perspective as a physician and administrator and mine as a health …

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Health care’s future: An interview with a hospital CEO

Fixing obesity: It’s a matter of changing our perspective

Conditions and Diseases
December 10, 2014

McKinsey & Company recently issued a report on effective means of fighting hyper-endemic obesity in the modern world. Among other things, they concluded that “implementing an obesity-abatement program on the required scale will not be easy.” I presume that is intended to be somber, but the magnitude of understatement makes it almost funny. And sad.

No, it will not be easy — not in the world as it is. In the world as …

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Fixing obesity: It’s a matter of changing our perspective

How to choose a good medical school: A look behind the scenes

Medical Education
December 10, 2014

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The competition to get into medical school is fierce.  The Association of American Medical Colleges just announced that this year, nearly 50,000 students applied for just over 20,000 positions at the nation’s 141 MD-granting schools — a record.  But medical schools do not have a monopoly on selectivity.  The average student applies to approximately 15 schools, and many are accepted by more …

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How to choose a good medical school: A look behind the scenes

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