Fact: Doctors want to help people.
Fact: Some people take advantage of doctors.
A doctor in Oregon shares this case:
I had an old man with cancer. He kept complaining of pain as I was increasing his opiate pain medication, Oxycontin. I was at, I forget, about 40mg four times a day or some fairly substantial dose. I ran a urine drug test. Negative …
Why doctors treat patients as drug addicts
Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this subtle premise before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act.
My question, however, is simple. Where is the evidence that …
Why more health insurance isn’t necessarily better
Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly, about half occur in women who were using contraception at the time of conception. That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using …
Increasing the use of long-acting reversible contraception
A recent editorial in the New England Journal of Medicine lauded, albeit cautiously, point-of-care ultrasound that has risen to such an extent that it is now becoming an integral part of medical education.
Could the availability of ultrasound revolutionize clinical medicine in much the same way Laennec’s stethoscope broke the acoustic barrier?
Certainly this possibility can’t be ruled out. But I am not so sanguine. One thing I’m sure about: Indiscriminate …
Forget ultrasound: Do a proper history and physical instead
With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers.
And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.)
It is far …
A framework for evidence-based debate of contentious health issues
There are words in many languages that have no good English equivalent. During my work in Haiti, I’ve noticed my Haitian colleagues on occasion exhaling a phrase — “tet chaje” — which literally means “head charged.” More accurately, it describes a sense of being overwhelmed or conveying disbelief or frustration. Based on my limited experiences in the field, I can only begin to imagine the burnout that local providers face …
There can be no global health without local staff
It was only a matter of time before the name Dr. Stanislaw Burzynski would grab the attention of the family of McKenzie Lowe, a 12-year-old from Hudson, N.H., with that most damning of diagnoses, a diffuse intrinsic pontine glioma, an inoperable brain tumor with a median survival of less than a year.
Like McKenzie, my own daughter was 12-years-old with a recurring brain tumor that had started to metastasize and …
Should doctors tell parents of terminal children to quit pursuing quackery?
A version of column was published on March 5, 2014 in the New York Times’ Room for Debate blog.
To remedy our fragmented health system, reformers want to consolidate health care. President Obama, for instance, has praised integrated health systems like the Mayo Clinic as a model for national reform. To that end, the Affordable Care Act drives more hospitals to become more Mayo-like by purchasing physician practices. Today, about 39% …
Growing hospital networks create a tension for health reformers
American consumers value the freedom to comparison shop. We like to survey a variety of options and select “the one” that what we really want. If we want triple-ply, select-a-size paper towels with a blue shepherdess imprinted on them, then we expect to be able to find them in aisle 9. Deny us options and we’ll take our business elsewhere.
When it comes to health care, though, endless options may not …
Can narrow networks increase health care quality?
Many times I have heard physicians and other providers lament that the outcomes for their patients would be so much better if they could “get them to listen and follow instructions.” They understand that they can be most effective in treating patients if the patients would follow all of their directions.
Do the physicians’ or care providers’ responsibilities end with this wish? Can physicians do more than just hope and pray …
Providers should be active in helping patients follow directions
For 11 years, Congress has failed to reform the Medicare physician payment system, and appears prepared yet again (for the 17th time) to fall back on another one-year patch for the unpopular sustainable growth-rate (SGR) formula to avoid a 24% cut in payments to doctors. As House minority leader Nancy Pelosi said recently, “Instead of reforming the Medicare physician payment system, Congress seems intent on imposing yet another round of arbitrary …
I had never seen my young cousin sit so still.
“What did you do?” my aunt wondered, amazed that her hyperactive 12-year-old had been transfixed for nearly an hour. “Were you two playing video games?”
“Actually we were just talking about some of the things I learned in medical school. He’s really interested,” I told her. Indeed, he hadn’t even touched one of the delicious samosas we were eating. Every time he …
In medical school, sometimes you have to curb your enthusiasm
Michelle Obama refers to childhood obesity as the tobacco of the 21st century. I agree. Obesity is quickly overtaking smoking as the nation’s No. 1 killer.
As a pediatrician who sees firsthand the impact of overweight and obese children, we need to have conversations with our patient families that focus on obesity as a clinical issue.
Right now, this isn’t happening. The rate of missed diagnosis for childhood obesity is over 95 percent, …
Clinical obesity, not morbid: A plea to change the diagnosis
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There is a JAMA article out that is very telling: Medical Conspiracy Theories and Health Behaviors in the United States. It is a must-read article for anyone who wonders why the public does not seem to advocate for themselves when it comes to their medical care in the US.
The first theory studied in the article states that the FDA is purposely preventing the public from getting natural cures …
Why so many Americans believe in health care conspiracy theories
There are reports from across the country regarding severe influenza in young people. In addition to mechanical ventilation, many are requiring extracorporeal membrane oxygenation (ECMO). Given the severity of illness and the presence of multiple organ dysfunction, relying on an oral antiviral for influenza therapy seems unwise. However, at this point, the only option for intravenous therapy is IV zanamivir, which is not approved by the FDA, but available on …
Doctors didn’t sign up to fill out forms
The Centers for Medicare and Medicaid Services released a massive amount of information regarding how much money it paid out to individual doctors. For the policy nerds out there, here is the original data. For everyone else, here is a simple way to look up how much your own doctor made. I decided to search for myself in the database …
How much Medicare pays doctors requires context
Lying in a hospital bed, my seriously obese patient can barely see her swollen and odorous right foot over her abdominal fat. The foot is soon to be amputated, the result of an untreatable infection exacerbated by diabetes and kidney failure, which developed in part because of obesity.
Her two children, ages 6 and 12, hover from the hospital bed to the couch. In between, the bedside table is strewed with …
Doctors struggle to treat childhood obesity
It’s rare for doctors to turn out en masse for a public protest. But that’s what happened at “Doccupy” in Contra Costa County, California in 2012. A group of safety net physicians testified before county supervisors — in what they only half-jokingly called “Doccupy” — that the cumbersome move to electronic health records (EHRs) had taken an enormous toll on patient care. The doctors saw half their usual number of patients. …
Electronic medical records: Questions journalists should ask
I’m back at it again, talking about my continued love/hate relationship with EMRs. From my conversations with doctors at different hospitals in our region, it seems that most docs appear to be falling into the “hate” column. Meanwhile, I’m still chugging along with the EHR that’s been installed in my office. And while it works just fine for the needs of a 3 physician single-specialty outpatient practice, it’s hardly the …
The population health benefits of EMR implementation done right
The New England Journal of Medicine recently published an article by David Reuben, MD and Mary Tinetti, MD, both academic gerontologists, about patients who are unable to stay out of the hospital. The two physicians study the problems of old people, and are of the opinion that most of these “hospital dependent” patients are elderly. Certainly some of them are, but in my experience a surprising number are just chronically ill, …
Some people will be hospital-dependent despite our best efforts
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