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E-cigarettes are an emerging threat to children

Medications

June 29, 2014

There is a new emerging health threat to our children: nicotine poisoning.

The number of nicotine exposures in children reported to the National Poison Data System has more than tripled in the last year.

Here’s the fact every parent should know: 1 tablespoon of nicotine oil can be lethal to a 60-pound child!

When doctors were campaigning against tobacco companies through public health legislation, we did not foresee a resultant new market for …

5 messages you should say about your health

Danea Horn

Patient

June 28, 2014

We tell ourselves many things about our health each day, every day, all day long. The vast majority are unintentional, uninspired and blunt. A particularly sinful dessert brings admonishment, “You should not have eaten that.” Panting after two flights of stairs call for an exasperated, “I am out of shape!” Receiving a diagnosis prompts mental overdrive of “What if I don’t survive this?” thoughts.

Learning my diagnosis of chronic kidney disease …

16 questions to ask when choosing a hospice

Naomi Naierman, MPA and Marsha Nelson, ACSW, MBA

Patient

June 28, 2014

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Hospice is a set of services that we all may need someday — if not for ourselves, for our parents. While death is not an option for any of us, we do have choices about the services we use at the end of life. Hospice is undoubtedly the best option in the last months of life because it offers a whole …

Obesity is a disease: Does that change the way doctors practice?

Josh Umbehr, MD

Conditions and Diseases

June 28, 2014

Recently, someone asked me on Twitter, “Has the change in classification of obesity as a disease affected how you treat patients presenting w/ the disease?”

The classification change in question is regarding the American Medical Association’s declaration that obesity is a disease rather than a comorbidity factor.

This change in classification affected 78 million American adults and 12 million children. The new status for obesity means that this is now considered a medical condition …

Physicians must embrace EMRs on their terms

Michael Chen, MD

Health Technology

June 28, 2014

A pivotal moment in the U.S. health care system is taking shape. Physicians across the U.S. are wondering what their role will be in this new health care landscape that is being shaped by legislation (from the Affordable Care Act and from meaningful use), by social media, and by technology advancements.

It’s an existential moment. Physicians are wondering if we are knaves, pawns, or knights in this chess game called the …

MKSAP: 35-year-old woman with new-onset thrombocytopenia

mksap

Conditions and Diseases

June 28, 2014

A 35-year-old woman is evaluated for new-onset thrombocytopenia. She is gravida 1 at 36 weeks’ gestation. Her pregnancy has been otherwise uncomplicated. She takes only a prenatal vitamin.

On physical examination, temperature is normal, blood pressure is 110/65 mm Hg, pulse rate is 110/min, and respiration rate is 22/min. There are no ecchymoses or petechiae. Abdominal examination discloses no right upper quadrant pain. She has a gravid uterus. Neurologic examination is …

Why do we think more care is better for us?

Robert Pearl, MD

Health Policy

June 27, 2014

The U.S. spends nearly $3 trillion a year on health care, significantly more than any other nation.

In fact, America’s annual health care spending is greater than the total gross domestic product (GDP) of every other country except China, Germany and Japan.

Yet our measurable health outcomes — from infant mortality to life expectancy — aren’t any better than nations spending much less.

I’ve written about this paradox before, pointing to a few …

What does it take for a cancer researcher to know cancer?

Kenneth Lin, MD

Physician

June 27, 2014

In my line of work, it’s not uncommon for a civil debate about the evidence for a cancer screening test (such as the PSA test for prostate cancer) to rapidly degenerate into the other person questioning my motives or suggesting that the real reason I oppose disseminating or requiring insurers to pay for a test is because I secretly want patients to suffer lingering and painful deaths. (“He obviously doesn’t care about …

HealthKit and the Health app: A game-changer for doctors?

Iltifat Husain, MD

Health Technology

June 27, 2014

health_hero

Several months ago I wrote about how Apple’s upcoming health app had the potential to change public health and could force physicians to adopt mobile.

Recently at WWDC Apple affirmed the rumors when announcing iOS 8, stating the new operating system would have a Health app, and a cloud platform HealthKit.

HealthKit is the developer platform and will be able to collect/aggregate information …

A love-hate relationship with practice guidelines

Ira Nash, MD

Physician

June 27, 2014

I have a love-hate relationship with practice guidelines. Love because it is often helpful to refer to a set of evidence-based recommendations as part of clinical decision-making; hate because of all of the shortcomings of the guidelines themselves, as well as the evidence upon which they are based.

A recent piece in JAMA and the editorial that Read more…

A love-hate relationship with practice guidelines

The night when I entered the cult of medicine

David G. Thoele, MD

Medical Education

June 27, 2014

I was on the cusp of my first year in medical school, and time was running out. Classes started in two weeks. I needed a place to live: Ideally someplace cheap, not too far from school.

There was an opening at Phi Chi medical fraternity, a large brick house of faded elegance located less than a block from my classes at the University of Minnesota. At $75 a month for a …

Labels leave an indelible mark on children

Courtney Schmidt, PharmD

Conditions and Diseases

June 26, 2014

As a parent, my words to and about my child will probably be one of the single most influential aspects of their development. Children learn to see themselves through their parents’ eyes, and what we tell them they are, they are likely to become. The labels we place on them often tend to be a self-fulfilling prophecy.

I’ve seen this play out in my own life and in the lives of …

You’re doing it wrong: The Paleo diet

David L. Katz, MD

Conditions and Diseases

June 26, 2014

Go ahead, eat more meat, butter and cheese. Let me know how it turns out for you. I certainly won’t be joining you, despite the current popularity of the proposition.

For one thing, there is no case — none — that eating more meat, butter and cheese would be good for us. Rather, the case is advanced these days — Read more…

You’re doing it wrong: The Paleo diet

A perfect thank you note to an oncologist

James C. Salwitz, MD

Physician

June 26, 2014

I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery. The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa …

The effect of dropping doctors from Medicare Advantage plans

Shirie Leng, MD

Health Policy

June 26, 2014

We all want the advantage. We put our kids in special preschools so they have the advantage. We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told. Poor people are “disadvantaged.” Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get disadvantaged starting September 1.

UnitedHealthcare (UHC) will be Read more…

The effect of dropping doctors from Medicare Advantage plans

The bus driver and the destiny of the children in the bus

Jordan Grumet, MD

Physician

June 26, 2014

It was a sunny spring day as the bus turned the corner. It was a yellow school bus filled with young children jumping up and down in their seats. It was an average day in an average school year. Nothing about it stood out. Let’s take a closer look.

The boy sitting in the front of the bus holding tightly to his lunch box is named William. His clothes are tattered …

Young children are silenced by psychiatric medication

Claudia M. Gold, MD

Physician

June 26, 2014

Tom Insel, director of the National Institute of Mental Health (NIMH) in his recent blog post, “Are Children Overmedicated?” seems to suggest that perhaps more medication is in order. Comparing mental illness in children to food allergies, he dismisses the “usual” explanations given for the increase prescribing of medication. In his view these explanations are; blaming psychiatrists who are too busy to provide therapy, parents who are too busy to provide …

Emergency physicians are blamed for a broken health system

BirdStrike, MD

Physician

June 25, 2014

In an article entitled, ”Why the ER admits too many patients,” Dr. Michael Kirsch tries to explain that emergency department admissions are inflated due to emergency physicians acting in their own self-interest. Many emergency physicians have read this and taken offense, feeling that his assertions point unfair blame on them for a significant portion of excesses in medical care and costs. I share this visceral reaction in part, but …

Medicine isn’t about pleasing all of the people all the time

Starla Fitch, MD

Physician

June 25, 2014

From the moment some patients arrive in your office, nothing seems to suit them:

Your parking lot charges too much.
Your front desk staff has too many forms for them to complete.
Your waiting room magazines are too old.
The temperature in your exam room is too cold.

So why are some patients so grumpy?

I believe many patients come to us with a wall of fear around themselves. They are worried about the outcome of their …

After giving birth, the small sting that hurt the most

Laurie Filipelli

Patient

June 25, 2014

My second miscarriage started in a Starbucks bathroom, and I couldn’t have felt more alone. Where to go from there? I drove home, took as much ibuprofen as I could stomach, and resolved to quit my stressful teaching job.

I found a new position at a nonprofit, training writers to teach in public schools. My husband, who’d always been an entrepreneur, continued to lead a startup that encouraged girls to dream …

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