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The Match: A testament to the genius of central planning

Medical Education

July 12, 2014

My father who was a junior doctor in Britain’s National Health Service (NHS) in the seventies would have been grateful for the match scheme, an algorithm that places medical students in residency programs in the U.S. The training in the NHS was unstructured. Physicians carved their own training by joining a patchwork of hospital positions in disparate places.

Over a few years we lived in Yorkshire, East Anglia, Wales, East London …

Are we relying too much on gadgetry to improve ourselves?

James Aw, MD

Health Technology

July 12, 2014

Apple announced the company is working on a new app, called Health, that allows a user to store in one place all aspects of their health data, from heart rate to blood sugar levels, cholesterol measures and calories burned. The Health app, Apple says, will enable an exercise app to determine the number of calories you consume a day — and, in turn, how hard you have to exercise to burn …

A medical student speaks up and saves a life

Andrew Ho, MD

Medical Education

July 12, 2014

Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms.

The patient …

Why we’re not ready to embrace Eastern medicine

Armaan Rowther

Medications

July 12, 2014

“The Eastern medicine revolution?”

These were the words emblazoned across the screen behind Dr. David L. Katz, founding director of the Yale-Griffin Prevention Research Center, as he discussed the growing popularity of holistic integrative medicine on a recent edition of the Katie Couric Show.

The conversation centered on the opening of Cleveland Clinic’s Chinese herb therapy ward in January of this year, the first of its kind at a major U.S. hospital. Dr. …

MKSAP: 64-year-old man with knee osteoarthritis

mksap

Medications

July 12, 2014

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

A 64-year-old man is evaluated for a 2-year history of knee osteoarthritis. He has bilateral knee pain that worsens with walking. He has tried topical therapies, physical therapy, and acetaminophen, none of which has provided relief. The patient also has peripheral vascular disease, hyperlipidemia, and hypertension. Medications are hydrochlorothiazide, pravastatin, and a …

How physicians can retire the right way

David Mann, MD

Physician

July 11, 2014

To paraphrase General MacArthur, old doctors never retire, they just fade away. Despite having greater than average financial resources and more burdensome than average work load, many doctors seem to have a hard time knowing when it is time to call it quits. I know doctors who continue to practice into their 70s and 80s. Some continue to work until the day they die. Why is this?

I think that some …

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How physicians can retire the right way

Trivializing violence against women

Jennifer Gunter, MD

Physician

July 11, 2014

George Will continues with his assertion that it is mathematically impossible for 1 in 5 women to have been sexually assaulted while in college. He calls the statistics “insupportable” and when he replied to Senators Blumenthal, Feinstein, Baldwin, and Casey he chided them to temper their “rhetoric” about the “scourge of sexual assault.” But it’s not just the statistics that appear to bother Mr. Will as he also …

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Trivializing violence against women

Medicine is like blackjack: Physicians need to count cards

Thomas D. Guastavino, MD

Physician

July 11, 2014

shutterstock_191107415

In the game of blackjack, players will attempt to increase their odds of winning by using the frowned upon method of counting cards. The basic principle is to add or subtract points to the cards dealt under the belief that the cards remaining in the deck are more or less likely to give the player a winning hand. Not a guarantee, of …

Parenting a child with autism

Kathleen O’Grady

Patient

July 11, 2014

It was an ordinary summer day. People were milling on the main thoroughfare, bikes zig-zagging through traffic, cafés and pubs spilling onto the sidewalk, patrons sipping their way through a lazy Friday afternoon.

We were ordinary that day too. Just another family, managing the hectic jumble of kids’ lessons, bills, our careers, endless streams of birthday parties, too little sleep and the occasional date night out.

But it was all shattered with …

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Parenting a child with autism

Recognizing and treating self-injurious behaviors in teens

Susie Raskin, LMHC

Conditions and Diseases

July 11, 2014

“Is it weird that I cut myself on purpose?”

A 14-year-old girl from a local middle school asked me this question at work last week. In my years as a Teen Xpress counselor, I have been asked about self-injurious behaviors many times.

They ask:

“What is it about?”

“Isn’t it just a way to get attention?”

“Why would someone do that?”

“Are they trying to kill themselves?”

It’s not only teens that ask about self-injury. I’ve …

Dense breasts on mammogram? Don’t be afraid.

Margaret Polaneczky, MD

Conditions and Diseases

July 10, 2014

Only in America can we find a way to scare the bejesus out of a woman with normal breasts and a normal mammogram. Because that’s exactly what happened when New York Times reporter Roni Caryn Rabin read her entirely normal mammogram results letter: “A sentence in the fourth paragraph grabbed me by the throat. ‘Your breast tissue is dense.'”

I can’t really blame Rabin for being afraid. The information about breast density in …

Doctors must discuss the cost of care with their patients

Peter Ubel, MD

Health Policy

July 10, 2014

I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with …

3 ways patients can help reduce wait times

Justin Smith, MD

Physician

July 10, 2014

Before you jump all over me, I have already outlined why I think we (doctors and medical offices) are the biggest part of the wait time problem. But, patients can help. Here are 3 ways you can help avoid long wait times at the doctor’s office.

1. Don’t request peak times during the day. Every office has busier times and not as busy times throughout the day. If you don’t know …

5 things medicine can learn from veterinary care

Suneel Dhand, MD

Physician

July 10, 2014

Over the last few years I’ve had numerous encounters with vets and vet hospitals. Domino, the dog that we had since I was in medical school, was sadly very sick. He was a Jack Russell-Corgi cross, black and white, with the loveliest sweetest nature. He lived till almost 13-years-old, bringing an immense amount of joy to our whole family. Sadly, he passed away last summer. My parents felt a huge …

Why are doctors still prescribing Zetia?

Janice Boughton, MD

Medications

July 10, 2014

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.

This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …

Learning about human nature after a cancer diagnosis

Elana Miller, MD

Conditions and Diseases

July 10, 2014

Recently, in front of my family, friends, colleagues, and teachers, I accepted my diploma during the graduation ceremony for the UCLA psychiatry residency program.

While it wasn’t my real diploma — it’s been months since I’ve been able to work, so when I’m better I need to go back and finish some requirements — my residency program coordinator put together an awesome fake diploma so I would have something to pick …

The clear, killing acid of modern life

Greg Smith, MD

Physician

July 9, 2014

Floor technician.

Environmental technician.

Life coach.

Investment and retirement strategist.

Facility safety coordinator.

Interventional cardiologist.

Cardiothoracic and vascular surgeon.

Neurodevelopmental psychologist.

Are we hiding behind out words? Worse yet, are we afraid to be who we really are?

Maintenance man.

Trash man.

Knowledgeable and experienced friend.

Salesman.

Security guard.

Doctor.

Psychologist.

I see it every day. Someone comes to me for a run-of-the-mill mental health problem, absolutely nothing to be ashamed of, and asks for help. For whatever reason, when we get to the social history …

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The clear, killing acid of modern life

The effort it takes to become an engaged patient

Jessie Gruman, PhD

Patient

July 9, 2014

Heard these?

Media-fueled flip-flops and research breakthroughs on lifestyle and health behaviors are wearing down my usual patience with …

Learning from and living the triathlon lifestyle

Susanna Carter, MD

Physician

July 9, 2014

During my third year of residency I trained for and completed an Ironman triathlon. I’ve discovered, despite its growing popularity, many people have no idea what a triathlon is and often nod at me in hesitant approval when I talk about this particular passion of mine. An Ironman triathlon is a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run, completed in succession, all in one day.

And it happens …

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