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A physician remembers his first patient of the new millennium

Physician

September 4, 2014

It was January 1, 2000, and I was an intern in emergency medicine at the University of Arkansas for Medical Sciences.

I had gone to sleep the night before listening to celebratory fireworks and congratulating myself for surviving Y2K. Now I was walking into the emergency department of our large, level 1 trauma center where I was furthering my medical training. Like most urban ERs, this one was a busy place …

Can direct primary care solve the physician shortage?

Brett Clark

Health Policy

September 4, 2014

One of my main interests in primary care is providing care to all people, regardless of their income or ability to pay. In my limited experience with health care, I have found it most rewarding to work with the underserved and underprivileged, those who do not have their own money available to allocate to health care. These patients are on Medicaid or are at the mercy of free clinics. This is why I …

Does owning cancer equipment change treatment patterns?

Robert Pearl, MD

Physician

September 4, 2014

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Today’s article follows the money trail to expose a different form of bias: the kind that takes place when doctors own their own diagnostic and therapeutic equipment.

For people living with cancer, this kind of bias can have a particularly painful impact.

Radiation therapy brings out medical bias

In the United States, cancer is the second most common cause of death, killing nearly 600,000 Americans …

One doctor’s day: Everything comes full circle eventually

Jordan Grumet, MD

Physician

September 4, 2014

Sometimes my day is like a book. The first chapter may begin in the darkness of a self imposed corner as a phone call is made. A voice, full with the thickness of slumber, answers unexpectedly.

“I think today is the day.”

No matter how many years I have been discussing death I still find myself using poor euphemisms. The bane of medical school teaching, I often struggle with the directness. “Your mother …

Beware your doctor’s knee-jerk reflex: 3 questions to ask

David L. Katz, MD

Physician

September 3, 2014

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We are, I trust, all but universally familiar with the knee-jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response.

The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet …

Will lower prices for genomic tests raise medical costs?

Peter Ubel, MD

Conditions and Diseases

September 3, 2014

The first time scientists sequenced a person’s entire genome, it took more than a decade and cost hundreds of millions of dollars. Currently, such sequencing takes less than twenty-four hours and costs less than $5,000.

To put that into perspective, Myriad Genetics charges $3,000 to test for mutations in just two genes associated with breast cancer. The days of affordable genomic sequencing are rapidly approaching. But will such testing bankrupt us?

In most consumer …

The cheapest prescription that’s most beneficial to patients

Neil Baum, MD

Physician

September 3, 2014

I see nearly 100 patients a week. Of these, easily 35% are overweight and 15-20% are obese with a BMI greater than 30. I live in New Orleans, Louisiana, which along with Mississippi has the highest rate of hypertension, diabetes mellitus, arthritis, and other diseases commonly associated with obesity. There are many explanations for the obesity academic in America but certainly poor nutrition and lack of exercise are at the …

Ebola in the United States: A reason not to panic

Manoj Jain, MD, MPH

Conditions and Diseases

September 3, 2014

If an ill patient, who unexpectedly has Ebola, landed in Memphis, it is likely that my partner or I would see him. We work as infectious disease doctors at the hospital closest to the airport.

The Ebola patient would present with fever, nausea and vomiting, indistinguishable from a flu or a viral illness that hundreds of patients present with each day at our hospitals. But over a few days of the illness, …

Upcoding in Medicare Advantage: Transparency can clean the mess

Trudy Lieberman

Health Policy

September 3, 2014

That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles even if much of the public remains unaware. Recently, two Department of Health and Human Services (HHS) researchers posted new findings on the Medicare and Medicaid Research Review, a peer-reviewed online journal supported by the Centers for Medicare and Medicaid Services (CMS), documenting how some insurance companies are overbilling the government and have been …

Set free: Thank you for the freedom to care for this sick patient

Rob Lamberts, MD

Physician

September 3, 2014

I got the following email a few weeks ago (details changed for confidentiality reasons):

Dear Sir,

I read about your unique practice online. I have an 91-year-old ambulatory father who will not go to a doctor. He definitely is not well and this is the only way I can get him the attention he needs. He is adamant about not wanting medical interventions, however he still needs to be seen …

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Set free: Thank you for the freedom to care for this sick patient

I never understood the loss of empathy during medical training. Until now.

Anonymous

Medical Education

September 2, 2014

It was 4:30 a.m., and I was on the side of the road, drenched in sweat and tears. I had finally slowed my breathing to normal. I was going to be late for rounds. No time to obsess over possible questions. No time to memorize lab values, or practice regurgitating them.

I thought of home. My family and friend, who I hadn’t …

The desire to spoon-feed medical residents today

Wes Fisher, MD

Medical Education

September 2, 2014

As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, “Where to teach?”

I do not mean to imply a geographic sense to the word “where” (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a “level.” What level do I teach our residents …

Is much of the annual physical a waste of time?

Michael Kirsch, MD

Physician

September 2, 2014

So much in medicine and in life is done out of habit. We do stuff simply because that’s the way we always did it. Repetition leads to the belief that we are doing the right thing.

In this country, we traditionally eat three meals each day. Why not four or two?

We prefer soft drinks to be served iced cold. I’ve never tried …

Don’t be stupid, and other wise words to new college students

Edwin Leap, MD

Physician

September 2, 2014

Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me to give you some wisdom.

First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for all …

Price shop your prescriptions to dramatically reduce costs

Ali Khoshnevis, MD

Medications

September 2, 2014

My brother and I, both optometrists, had a heart-to-heart discussion about the loss of one of our patients. We discovered he was not taking his medications as prescribed, which was leading to vision loss. When pressed, the patient said he had a choice of eating, supporting his family, or purchasing his medication.

He was under the impression that the $150 price for his generic Lipitor was “about the same” at any …

A bystander to the evolution of plastic surgery

Miranda Fielding, MD

Physician

September 2, 2014

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights. The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop. The tagline is as they say, priceless: “Modern medicine had to start somewhere.”

On the third episode, last Friday …

Cancer screening in the elderly: Don’t be stupid

Kenneth Lin, MD

Conditions and Diseases

September 1, 2014

The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the …

Allowing medicine to become a commodity would be a disaster

James C. Salwitz, MD

Physician

September 1, 2014

What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list? Gasoline, copying paper and paperclips? Shopping for a mobile accounting office? Nope. What these items share is that who ever makes them, wherever you buy them, they are essentially the same. They are commodities. They do not vary significantly in construction or quality. The only way to …

Employer-sponsored insurance or Medicaid? An ideological debate.

Dr. Saurabh Jha

Health Policy

September 1, 2014

The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it.

Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, …

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