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Dealing with all the behavioral conditions of unknown etiology

Conditions and Diseases

May 1, 2014

A few years ago I wrote that uncertainty is inevitable in psychiatry. We literally don’t know the pathogenesis of any psychiatric disorder. Historically, when the etiology of abnormal behavior became known, the disease was no longer considered psychiatric. Thus, neurosyphilis and myxedema went to internal medicine; seizures, multiple sclerosis, Parkinson’s, and many other formerly psychiatric conditions went to neurology; brain tumors and hemorrhages went to neurosurgery; and so forth.

This leaves psychiatry …

The promise and peril of OpenNotes

Gizabeth Shyder, MD

Health Technology

May 1, 2014

After I read this blog on OpenNotes, I struck up a discussion with a radiologist friend. We commiserate over laws and loopholes in laws that cause system abuse. I am so happy that Obama recommended to close the loophole in the Stark Law in his 2015 budget. That loophole has created some rampant abuse.

I worry about and applaud the possible effects of patients being able to read their notes online. …

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The promise and peril of OpenNotes

Why doesn’t everyone have a pocket ultrasound machine?

Janice Boughton, MD

Health Technology

May 1, 2014

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For about 2 years now a tiny ultrasound machine has been part of my standard physical exam tools as I take care of patients in the hospital and in the outpatient clinic. In November 2011, I first picked up an ultrasound transducer in a continuing medical education course on bedside ultrasound for emergency physicians. I am an internist, not an emergency physician, …

An organic effort to reboot healthcare

Zubin Damania, MD

Physician

April 30, 2014

For the better part of a decade, I practiced inpatient hospital medicine at a large academic center (the name isn’t important, but it rhymes with Afghanistan … ford).

I used to play a game with the med students and housestaff: Let’s estimate how many of our inpatients actually didn’t need hospitalization, had they simply received effective outpatient preventative care. Over the years, our totals were almost never less than 50%.

For my …

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An organic effort to reboot healthcare

Quality of life: We say it, but do we mean it?

Tamara Kile, MD

Physician

April 30, 2014

One of my most treasured stories as an ED physician belongs to a lovely couple who valued quality of life. It was a routine day in the ED when an elderly woman rolled through the ambulance doors on a cold, narrow stretcher, unaccompanied by family. She was placed in bed 5, which is where we met. She was frail and her memory was poor. The EMS run sheet reported “change …

Brevity is the soul of a good EMR note

Scott Moore, MD

Health Technology

April 30, 2014

Shakespeare said that brevity is the soul of wit. I say brevity is the soul of a good note.

As a resident back in the early 90s I would look at office notes written by older, near-retiring physicians. I’d read these one or two lines written on 3 1/2-inch note cards, turn to my fellow residents and ask, “How can someone possibly document this way?” Years later, I realize the genius, …

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Brevity is the soul of a good EMR note

Having health insurance is not the same as receiving health care

Kenneth Lin, MD

Health Policy

April 30, 2014

“Health insurance is not health care.”

That is not original. I borrowed it from Los Angeles County Department of Health Services Director Mitchell Katz’s JAMA Internal Medicine editorial about problems with ensuring access to health care for Medicaid recipients whose cheap public insurance usually doesn’t even pay doctors enough to recoup costs of care, let alone earn a living.

But somehow, during the impassioned political debates that preceded Obamacare, the botched rollout of …

A solution to ER overcrowding: Direct care

Josh Umbehr, MD

Physician

April 30, 2014

Emergency departments in U.S. hospitals see copious patients who aren’t terribly ill, but don’t have insurance and need somewhere to go. I see some of these patients when I moonlight on nights and weekends at a local county hospital. Sadly, these patients run through a gantlet of expensive tests — I’m required by protocol to administer them. The reality is that 80% of what I see in the ER is “family …

Why I love house calls

Pamela Wible, MD

Physician

April 30, 2014

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I’ve always been a people watcher. Now I get paid to spy on folks. I have to ask detailed, personal questions. Sometimes I even snoop around patients’ homes.

In the 1930s nearly half of all patient visits were house calls. Now most patients are rushed through ten-minute office visits. But if I need to know what’s going on with a patient, I …

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Why I love house calls

A few thought-provoking questions about essential oils

Justin Smith, MD

Medications

April 29, 2014

I get asked a lot about essential oils. I answer very little. Why?

The answer is simply that we don’t know much about how or if they work. Except from stories about how they have helped certain people in certain situations, no one has done a large studies to truly evaluate their effectiveness or safety.

The main explanation for why they are used is that people (parents) are simply looking for something that’s an alternative to …

The Medicare data dump: How the government gave physicians the finger

Jordan Grumet, MD

Health Policy

April 29, 2014

According to a study by Jackson Healthcare, the percentage rate of U.S. physician compensation is among the lowest of western nations. In 2011, physicians’ salaries compromised 8.6 percent of the nation’s total health care costs. This is in comparison to 15 percent in Germany, 11 percent in France, and 11.6 percent in Australia. Detractors point to the fact that although the percentages speak for themselves, if you look at …

A patient’s role in ensuring high quality colonoscopy

Douglas K. Rex, MD

Conditions and Diseases

April 29, 2014

The American Cancer Society recently released important new data showing that the rate at which people are diagnosed with colon cancer in the U.S. has dropped 30% in the last ten years for those aged 50 and older. Much of this decline was attributed to the widespread uptake of colonoscopy screening. Colonoscopy is the only screening test that examines the entire colon and allows removal of precancerous polyps in the …

No, bras do not cause breast cancer

Jennifer Gunter, MD

Conditions and Diseases

April 29, 2014

The myth that bras cause breast cancer is apparently coming ‘round the barn again. The latest scare-you-out-of-your-brassiere “article” claims there are “five research studies” that show a strong correlation between bra wearing and breast cancer. Well, that certainly sounds all scientific.

Why the bra hullabaloo? A couple of anthropologists wrote a whole book about their incorrect theory back in 1995, Dressed to kill: The link between breast cancer and bras. …

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No, bras do not cause breast cancer

The key to physician job satisfaction: Being valued

Lumi St. Claire, MD

Physician

April 29, 2014

It’s been almost two years since returned to medicine after a three-year hiatus from practice. I recently finished the longest week of work I have had since starting this job. I had a family emergency and a conference all converge around the same week, and ended up cramming two makeup days into an already full schedule. It was long. It was incredibly tiring. I was very glad when I finally …

A toxic environment for delivering health care

Hans Duvefelt, MD

Health Policy

April 29, 2014

A long time ago, when I worked in Sweden’s socialized health care system, there were no incentives to see more patients. In the hospital and in the outpatient offices there were scheduled coffee breaks at 10 and at 3 o’clock, lunch was an hour, and everyone left on the dot at five. On call work was reimbursed as time off. Any extra income would have been taxed at the prevailing …

A mentor who opened my heart and eyes to the need for compassion

James C. Salwitz, MD

Physician

April 28, 2014

As I look back, I remember teachers. One taught to be compulsive and complete. Another, calm and humor in the face of chaos. Another believed in me and thereby taught me to believe in myself. One made me write and rewrite. Above all, there was a mentor who opened my heart and eyes to the need for compassion. That special teacher was Dr. Black.

Tuesday afternoon, 8:30am, July 12, 1966: Dr. …

Why I work at the fringe

Maria Yang, MD

Physician

April 28, 2014

This article is making the rounds among physicians on Twitter. Much of the information in the article, unfortunately, is accurate.

For some of the reasons stated there, I left the “traditional” health care system and pursued work at the “fringe.”

Part of this is due to my clinical interests: I like working at the intersections of different fields. For example, I like the intersection of psychiatry and hospital medicine, which is called Read more…

Why I work at the fringe

Why patients cannot afford to have asthma or gout

Deceased, MD

Medications

April 28, 2014

It is noteworthy how certain vital and effective generic drugs for common diseases have become exorbitantly expensive. We are use to new pharmaceutical brands costing a small fortune. But generics, one of which goes back to use in Egyptian times? Really? Allopurinol and asthma inhalers that are cheap but effective medications have become unaffordable to those that need it the most: Simply stated, those that can’t breathe and those that …

We shouldn’t focus exclusively on patient satisfaction

Richard Young, MD

Health Policy

April 28, 2014

“Patient-centered.”

It sounds so right, doesn’t it? Right up there with mothers and apple pie. If only family medicine were so simple.

A report by ABC News told the story of a doctor at a VA hospital in Kansas City who claims she was forced to leave her job because she tried to limit prescriptions for opioid pain medications to reasonable amounts. Patients complained, so she was canned.

She claimed that some patients …

The Maryland approach to controlling health costs

Pascal Crosley, DO

Health Policy

April 28, 2014

We needed to move away from a fee-for-service-driven health care system, where the incentive was to do more to be paid more, and instead move to a system where the incentives are aligned to what we all feel needs to be done.
– Carmela Coyle, CEO, Maryland Hospital Association

Since 1977, Maryland’s unique all-payer system has succeeded in keeping health care costs relatively low. Now the state is embarking on a …