This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school.
A bit of background for non-medical readers. Informed consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient. For example, before a patient is cut …
Informed consent: Can patients ever truly be informed?
“Plank? Is that a board?” asked my patient. I had been encouraging her to start doing exercises to strengthen her core in order to stabilize and support her back. My hope was that over time, these exercises would lessen the need for pain medicine. There are times for words and there are times for action. So I got down on the …
Motivate patients to exercise more and eat less
I received my new thinner bigger iPhone. Within a few days, news reports highlighted how new iPhone 6 owners accidentally bent the latest Apple iteration of the modern smartphone. A blogger bent an iPhone 6 Plus with his bare hands. This story, the subsequent fallout, and response has learnings for doctors and health care on the challenges facing the vaccination “debate.”
The best launch in iPhone history with roughly 10 million smartphones shipped …
What the iPhone 6 bendgate can teach us about vaccines
A medical student recently asked my advice on her decision to pursue a career in dermatology. It was about 25 years ago when my own parents encouraged me to pursue this specialty. What was their deal? Perhaps, they anticipated future developments in the field and were hoping for free Botox treatments? As readers know, I rejected the rarefied world of pustules and itchy skin rashes for the glamor of hemorrhoids, …
Should medical students consider lifestyle when choosing a specialty?
My student’s voice trembled as she answered my question. “How do you think you’ve done so far?” I’d asked her. We’d been together on the general medicine inpatient ward for two weeks — the midpoint of the rotation — and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance …
How to give feedback to medical students
There he sat, hunched over with rugged, muscular arms stretched across his abdomen, his weary eyes stealing hopeful glances from behind an otherwise steely facade. Mr. J was a 53-year-old Latino agricultural laborer with a history of H. pylori who presented at our student-run free clinic with persistent abdominal pain, unchanged from his multiple previous visits. As I learned more about Mr. J and his story, I realized that treating …
How the costs of care impacted H. pylori treatment
There is a lot of talk about why the man diagnosed with Ebola at Texas Health Presbyterian Hospital was sent home from the emergency room not having been tested for Ebola despite telling the triage nurse he had been in Liberia.
Because they let him go, he came in to contact with up to 20 people including a handful of school aged children. …
The Ebola outbreak: Don’t blame the nurse
I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned at a local restaurant.
The telephone rang with the caller ID identifying a call on my office work line.
“Hello this is the emergency department, please hold on for Dr. S.” …
Physicians don’t take the time to communicate with their colleagues
Since 1996, 21 states have approved the legalization of marijuana for medical use. More recently, Washington and Colorado have legalized the use of recreational marijuana, with California and Oregon not far behind. The health risks associated with marijuana have been well documented in a number of studies, but these are secondary to the much greater mortality risk associated with an increased prevalence of the drug: driving under the influence.
As is …
Marijuana and motor vehicle safety: An impending public health dilemma
Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits.
Unfortunately, too many Americans lack easy access to primary care. Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. …
3 ways to improve primary care access
The ALS wave has finished sweeping the nation, resulting in a flood of over $100 million raised to fight a devastating disease which is actually quite rare. Now that gallons of ice water have drenched American’s bikinis and trunks, we should be asking ourselves two questions. First, does everyone really understand more about the disease now that the challenge is over? Second, and more importantly, what lessons can we learn …
Apply the lessons learned from the ice bucket challenge
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications …
MKSAP: 59-year-old woman with pain of the right foot
A colleague at a hospital-based health system recently told me about physician alignment initiatives his employer was introducing. These included co-management deals (where doctors get per patient incentives for on-time discharges, and high quality scores) and new salary models that adjusted based on various metrics. At the same time, he noted, his hospital was laying off clerks, leaving him spending hours on clerical tasks …
How to improve doctor-administrator relations
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Should we be worried about Ebola? That’s the question on the minds of many Americans given the first documented case on U.S. soil. And now there is a second possible case, someone having contact with Thomas Duncan, the first U.S. case of Ebola.
Thomas Frieden, director of the Centers for Disease Control and Prevention reassures us, “I have no doubt that we’ll stop this in its tracks in the U.S.” President Obama also told …
Ebola: Is it time for travel restrictions?
The unexpected death of Joan Rivers at 81 years of age occurred during a routine outpatient procedure at an accredited doctor-owned surgery center. Although there are few confirmed reports of what actually occurred, what we do know is that media-fed information can resonate amongst the general public — and our patients. Concerns have been raised about the outpatient setting, patient selection, and types of surgeries that are performed.
As a result, the responsibility …
Examining the safety of outpatient surgery centers
Dr. Danielle Ofri has an important piece in the New York Times: “The Physical Exam as Refuge.” As an outpatient physician, she makes the case that the physical examination provides a special time for the physician to focus entirely on the patient. Is examination time the refuge for the harried physician, and the opportunity to engage the patient in extended conversation about their condition?
While I did outpatient medicine for …
The physical exam is still useful. Here’s how.
Twenty-five years ago, the New England Journal of Medicine issued a report on a stunning new medical discovery: Aspirin helps prevent heart attacks.
Yes, good ol’ aspirin. Known since the time of Hippocrates for its magical abilities to quell fever and pain, it took only 2,000 years for us to understand the science of it well enough to design a ‘sufficiently powered’ double-blind, placebo-controlled randomized trial on aspirin’s efficacy in preventing heart attacks. The Physicians’ …
Medical reversals: When wonder drugs become harmful
There are now so many rules and regulations in medicine that it is difficult for doctors to express any individuality. Like the burgers at McDonald’s that are constructed in such a way that they taste the same regardless of your locale, doctors are expected to behave similarly when confronted with similar circumstances. Or at least that is how the proponents of algorithmic medicine see it.
In addition, electronic health record systems create uniformity by enforcing …
Is there any room for individuality in medicine?
The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S.
We have got to get more people immunized.
Essentially all of the cases were linked to “importations,” cases brought in from other …
7 common reasons for refusing vaccines
We’re born into our bodies, and we take that for granted.
Our first job is to take a breath, something we’ll hopefully do many millions of times and never think about. That first breath changes everything: Our blood starts to flow through our heart and lungs in a different way and for the first time we taste a new world.
Before we’re born, all our needs are met via an artery and …
There’s a part of us that’s unafflictable
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