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Disciplined physician communication saves lives

Val Jones, MD

Medical Education

November 14, 2014

I have spent many blog hours bemoaning the inadequate communication going on in hospitals today. Thanks to authors of a new study published in the New England Journal of Medicine, I have more objective data for my ranting. A prospective intervention study conducted at 9 academic children’s hospitals (and involving 10,740 patients over 18 months) revealed that requiring resident physicians to adopt a formal handoff process at shift change resulted in a 30 percent …

What primary care can learn from the financial service industry

Tom Valenti

Health Policy

November 14, 2014

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Man looks into the Abyss, and there’s nothin’ staring back at him. At that moment, man finds his character, and that’s what keeps him out of the Abyss.
– Lou Mannheim (Hal Holbrook) in the movie, Wall Street

We hear reform ideas all the time: Primary care physicians need to work at the top of license, physicians need to work in teams, health …

How Dr. Alzheimer discovered a disease in a mental asylum

Rod Tanchanco, MD

Conditions and Diseases

November 14, 2014

Carl didn’t know what was happening to his wife. The German railway clerk from Morfelder Landstasse and his wife Auguste had been happily married for twenty-eight years. They had one daughter, Thekla, and their marriage had always been harmonious — that is, until one Spring day in 1901 when Auguste suddenly exhibited signs of jealousy.

Auguste accused Carl of going for a walk with a female neighbor, and since then, she …

Patients should not have to advocate for their own safety

Marc-David Munk, MD

Health Policy

November 14, 2014

Last year the New York Times reported that the aviation industry had become so safe that one could fly every day for 123,000 years before dying in an aviation crash.

I wish we could say the same for the U.S. health care system. Nationally, problems with health care quality (doing too much, doing the wrong things, and doing too little when indicated) are pretty clear. The bigger problem is that the progress …

Oncologists have one of the lowest burnout rates. Why?

James C. Salwitz, MD

Physician

November 14, 2014

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The alarm clock’s blast brings hours of work, running from task to task, always pushing toward the next turn. In moments of failure, the waves of complexity and anxiety batter and you question each stroke. Then you fly downhill, easy breeze in your face, as success urges you on. After the finish, the parking lot empties, the lights go out, and …

The reading gap: Too small to fail or too big to care?

Claire McCarthy, MD

Physician

November 14, 2014

At the national conference of the American Academy of Pediatrics (AAP), I got to hear Hillary Clinton talk about the AAP’s partnership with her Too Small to Fail campaign. It made me happy — and sad.

The partnership is a great idea. It’s all about improving early childhood literacy, which is way more crucial than most people realize. It’s not just about an income gap when we talk …

Physician suicide 101: Secrets, lies and solutions

Pamela Wible, MD

Physician

November 13, 2014

This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC.

Why did you go to medical school?

I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction …

Why do drugs cost so much?

Janice Boughton, MD

Medications

November 12, 2014

Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. …

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Why do drugs cost so much?

Anesthesiologists have to start to truly care for patients

Shirie Leng, MD

Physician

November 12, 2014

Anesthesiology used to be a job that was attractive for people who don’t like patients very much. The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done. Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the …

When patients seek a second opinion: It’s not about you

Don S. Dizon, MD

Physician

November 12, 2014

I remember when I first started in oncology; I had joined the faculty at Brown three years after fellowship and was seeing a patient* with newly diagnosed breast cancer. She was in her 40s, an advertising executive, married, with two small kids. The diagnosis was unexpected (as it usually is), with a lump found while showering. She had come …

The ethics of researching Ebola

Ruth Macklin, PhD

Conditions and Diseases

November 12, 2014

As we learn of new suspected cases of Ebola infection in the United States, causing worries among the population and renewed efforts by the Centers for Disease Control and Prevention to contain the epidemic.

A student in the postgraduate course in research ethics that I teach at Albert Einstein College of Medicine recently asked whether we could discuss the Ebola epidemic in class. Because I had prepared the syllabus for the course months ago, I hadn’t …

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The ethics of researching Ebola

Giving extremists a fake psychiatric diagnosis

Allen Frances, MD

Conditions and Diseases

November 11, 2014

Every time there is a terrorist act or a mass murder, reporters start calling with questions on the psychiatric diagnosis of the perp. The default position seems to be that every religious extremist or political fanatic or mass murderer must be crazy. How else to account for their weird behavior?

Naming a diagnosis somehow satisfies a deep human need to explain what otherwise seems an unexplainable act. But names can only …

It’s time to tell fast medicine to slow down

Richard Gunderman, MD, PhD

Physician

November 11, 2014

Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …

Money has always been and will always be a big part of medicine

Edwin Leap, MD

Health Policy

November 11, 2014

Medicine is not about money, except when it is.

When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor’s offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the …

When you can’t share experience: The power of listening

Abigail Schildcrout, MD

Physician

November 11, 2014

I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.

I have a different thought.

Although every experience …

Fall in love with medicine again

Starla Fitch, MD

Physician

November 11, 2014

An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine.

A doctor’s self-worth can be tied up with a lot of issues.

How well can we make a diagnosis?

How elegantly can we perform the surgery?

How happy are our patients? Our staffs? Our families?

How many articles have we had published or how many lectures have we given?

The list goes on and on, doesn’t it?

For me, …

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Fall in love with medicine again

Building a better EMR. Read how one doctor is doing it.

Rob Lamberts, MD

Health Technology

November 11, 2014

The documentation I get from everyone is terrible. Seldom does it tell me what I actually want to know, and if there is useful information it is buried in an avalanche of yada yada. The main reason for this is that documentation is driven by our ridiculous payment system, which requires us to follow arcane rules to generate notes that justify the obscure codes we submit for money from the …

Ask for a generic: The sticker shock of brand name drugs

Brandon Kopper

Medications

November 10, 2014

I am currently a pharmacy student, and although I have not yet dispensed a medication, I had my first experience concerning the cost of care a few months ago. My ear hurt very badly when I woke up in the morning, and being that I had to go to work later that evening, I decided to go to the local clinic in order to get my ear treated.

The physician was …

Cognitive behavioral therapy: Why parents should be involved

Claudia M. Gold, MD

Conditions and Diseases

November 10, 2014

While studying for my recertification exam as required by the American Board of Pediatrics, I came across this question:

A 7-year-old girl is having difficulty establishing relationships with other children despite repeated opportunities to do so. The girl prefers to stay near her mother or her teacher and will avoid other children. She sometimes cries and can be difficult to calm down after being dropped off at school, so her mother frequently remains …

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Cognitive behavioral therapy: Why parents should be involved

When the patient treats the doctor

Wes Fisher, MD

Physician

November 10, 2014

Another day, another pacemaker, at least so it seemed at first.

The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were all recent memories. He laid there, smiling, knowing he’d made the right decision after years of struggling with his arrhythmia in other ways. His heart was showing signs of slight weakening and …

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When the patient treats the doctor

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