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2 ways to improve doctors: feedback and reflection

Physician

August 28, 2014

In medical school I used to ask myself, “When will I feel like a real doctor?” During intern year, I asked the same question. Now as a new faculty member who has completed medical school, a family medicine residency and a teaching fellowship, I still find myself asking that same question.

As primary care doctors, we are trained to churn out differential diagnoses. We must avoid premature closure or incorrectly assuming …

How much health care data is mined without your knowledge?

Martine Ehrenclou, MA

Health Technology

August 28, 2014

The Business Insider article, “Senator Warns Fitbit is a Privacy Nightmare and Could be Tracking Your Movements,” reports that Senator Chuck Schumer called for federal protections to prevent companies like Fitbit from collecting, sharing and selling consumer data to health insurers, employers and others. Fitbit, like Nike+FuelBand and Jawbone, sells wearable trackers that monitor sleep, health functions and physical activity.

Senator Schumer accused FitBit and Smartphone apps of sharing …

Medicare’s trust fund has been extended. Big deal.

Tanya Feke, MD

Health Policy

August 28, 2014

The Medicare trust fund has been extended to 2030, 4 years longer than projections made just one year ago. This sounds like wonderful news until you take a closer look. The fine print reveals that this is little more than campaign rhetoric. Four years in the grand scheme means little when you look at the real numbers.

More baby boomers approach eligibility age every day. In 2012, there were 50.8 million …

High-yield and protected time: A medical student’s take

Hamsika Chandrasekar

Medical Education

August 28, 2014

Learning in medical school often feels like learning a completely new language. There are numerous acronyms (OPQRST, CAGE) and molecules (IL-1, TGF-beta) and more. But most striking to me are two particularly ubiquitous buzzwords: “high-yield” and “protected time.”

I feel like I heard both these terms — and particularly the former — thrown around every single week of this past school year. High-yield has been used to refer to, as you …

Hospitals are taking a page from the big pharma playbook

Trudy Lieberman

Health Policy

August 28, 2014

I recently wrote about a hospital system in Colorado that had discovered a way to cross market its more profitable emergency room services if a patient first came to its urgent care center. Pretty clever! Then recently I came across another health care marketing trick close to home and just as sly. As I sat on a New York subway one sizzler of a day, an ad for an ice cream …

Lying to receive pain medications hurts patients in true pain

Kenneth Lin, MD

Conditions and Diseases

August 28, 2014

My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they …

Why can’t an EHR fit into a mobile device?

David Mann, MD

Health Technology

August 27, 2014

It’s been a while since my last rant about electronic health records (EHRs), so let’s remedy that right now. EHRs in their current iteration are — how to put this delicately? — an unmitigated disaster. Nevertheless, much of the criticism of EHRs, including mine, has been in the destructive category. What about some constructive criticism? How could EHR software be made better?

I am not …

7 assumptions about end of life care

Lizzy Miles, MSW

Conditions and Diseases

August 27, 2014

The worst thing anyone ever said to me was, “You think you know everything, but let me tell you: You don’t know jack!” I was six weeks into my social work internship at a hospice and it was my student supervisor who decided I needed an attitude adjustment. Needless to say, I didn’t stay there. I was angry and hurt for a long time but now I’ve come to realize …

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7 assumptions about end of life care

This is what lifelong learning in medicine should look like

Wes Fisher, MD

Physician

August 27, 2014

He left a little early to stop by the cath lab to see his patient before her procedure. Cordial “hellos,” “good mornings,” and “any last questions?” were mentioned before she signed her consent. The team was working feverishly to prepare her for her procedure. “Have you met the anesthesiologist yet?” was next, and almost on cue, the anesthesiologist arrived and took over for a bit.

He hurried upstairs to the conference …

On the first day of school, a letter to my child’s teacher

Courtney Schmidt, PharmD

Patient

August 27, 2014

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I don’t know you and you don’t know me, but today you become one of the most important people in my life. You are the one. The one who I’ve entrusted to take care of my girl in my absence. The one who I’ve tasked with teaching her things that I cannot. The one who will make an indelible mark on her …

The epidemic of physician burnout is heartbreaking

Samantha Meltzer-Brody, MD, MPH

Physician

August 27, 2014

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Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.

The burned-out physician is …

My new practice saves lives

Rob Lamberts, MD

Physician

August 26, 2014

Oh yeah. Hot dang. All right. Groovy.

Boom goes the dynamite.

I had a very great day yesterday.

I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don’t. Each person I saw gave me a clear view of how the practice I’ve been building over the past 18 months is making a difference. A big, big difference.

The first patient was a guy who is …

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My new practice saves lives

The consequences of prohibiting physicians’ free speech

Michael Kirsch, MD

Physician

August 26, 2014

I’m all for free speech and I’m very hostile to censorship. The response to ugly speech is not censorship, but is rebuttal speech. Of course, there’s a lot of speech out there that should never be uttered. Indecent and rude speech is constitutionally protected, but is usually a poor choice. We have the right to make speech that is wrong.

I relish my free speech in the office with patients. I …

Sleep apnea in children: A primer from a pediatric intensivist

Christopher Johnson, MD

Conditions and Diseases

August 26, 2014

Earlier this year a child died following a surgical procedure in California for a condition called obstructive sleep apnea. The case generated a great deal of concern among parents about both this condition and the surgery often done to treat it. I wrote a post myself about it at the time. I still get questions about it because I care for quite a few children immediately after they have had …

A life lesson in cost-awareness of medical care

Christi Lucus, RN

Patient

August 26, 2014

It was July 2012 and I was pregnant with my third child. As an experienced mother and labor and delivery nurse, I felt very comfortable at 29-weeks gestation and anticipated the usual course of pregnancy. However, at 30 weeks, I started battling with preterm labor issues. This eventually led to the early delivery of my son, a four week and stay in the NICU, and a life lesson in cost-awareness …

Introduce our patients to mentors

Heather Alva

Physician

August 26, 2014

A resident once offered me this piece of advice: Find mentors whom you admire. Not just for their rapport with patients, but also for their lifestyle, their hours and their family life. Make goals that you know to be realistic because someone has already accomplished them.

My question now: Why stop there? Why not share that ounce of brilliant advice with our patients? Why don’t we link older, successful patients with diabetes …

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Introduce our patients to mentors

Solving the mid-level dilemma: Call them what they really are

Jim Pagano, MD

Physician

August 26, 2014

Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: “Stop calling nurse practitioners mid-level providers.” So do I, though my reasons are a bit different. In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know …

DNR/DNI: More code than status

Dan Chen, MD

Physician

August 25, 2014

“If a tree falls in a forest and no one is around to hear it, does it make a sound?”

Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …

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DNR/DNI: More code than status

When medications devalue the opportunity to listen

Claudia M. Gold, MD

Conditions and Diseases

August 25, 2014

When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s. As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly …

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