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Why do vaccines in particular give parents concern?

Medications

April 11, 2014

I’ve been involved in several boisterous Twitter debates about vaccines, at least to the extent that one can debate using snippets of 140 characters or less. I’ve also been a “super moderator” at a very large Internet message board for many years and have seen my share of passionate vaccine debates there. I’ve been a pediatrician for over 30 years and trained in the subspecialty of pediatric infectious diseases before I went …

The palliative care discussion starts in the emergency department

David Klein, MD

Physician

April 10, 2014

During a recent lunch with my daughter, a senior at the University of Maryland, she shared her frustration with a question she often receives: “So, what are your plans for next year?” She commented that while her life experiences through present day have been memorable, each stage has been predictable. Now, for the first time, she has more questions than answers. This ambivalence — this fear of what’s ahead — …

How an email list changed a man’s life forever

Lucy Hornstein, MD

Physician

April 10, 2014

The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food.

He lived alone, hated his job, saw few people, had no friends — so he told me at every visit. His visits …

What if medical records worked like Wikipedia?

Nick Dawson

Health Technology

April 10, 2014

I’ve been thinking about EMRs, electronic medical records, lately. It’s a subject, despite some professional experience, I don’t feel particularly close to. In fact, if anything, they are a source of consternation. As an industry insider, I see them as an expensive albatross around our collective neck. As a human centered design adviser, I see them as an encumbrance for both providers and patients. And, as a patient I see …

How wearables can objectively track outcomes in patients

Jesse Slade Shantz, MD, MBA

Health Technology

April 10, 2014

There are few certainties in medicine. But treating rotator cuff injuries has revealed one to me: People with rotator cuff tears don’t sleep well. If you want a glimpse into the life-altering symptoms of shoulder pain, just ask one of these patients how many times a night he or she wakes up with pain. Hearing the answer, it’s easy to see that improving the ability to sleep through the …

We are turning childhood into an illness

Allen Frances, MD

Medications

April 10, 2014

The statistics tell us that our children are getting sicker and sicker. Attention deficit hyperactivity disorder (ADHD) has more than tripled in just 20 years: It is now diagnosed in 11 percent of all kids, and in an astounding 20 percent of teenage boys. Autism is also on a rapid rise. The latest reported rate suggests that it occurs in one in every 68 kids — 20 years ago it …

Doing a lot more than the doctoring than bargained for

Hans Duvefelt, MD

Physician

April 9, 2014

The horse that came into my life has made me think about many things from a different perspective. I have learned about the horse’s subtle ways of communicating, her extrasensory (compared to our own) perception, and her instincts of flight. I have also become more aware of the energy I bring to my relationship with her. With no learned tricks or horse management skills, I have established a way of …

Water births should be treated as a medical intervention

Jennifer Gunter, MD

Conditions and Diseases

April 9, 2014

The joint statement on laboring in water and delivering in water (the latter also known as immersion births) from the American Academy Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists (ACOG) is making the rounds. I’ve linked to the full statement above, but in essence it says that some women find laboring in water helpful for pain relief (in the first stage of labor it reduces the need for …

Do patients care about how much money their doctors make?

Trudy Lieberman

Health Policy

April 9, 2014

I am all for transparency when it comes to health care. So when Medicare announced that it would tell the public how much doctors are paid to treat Medicare patients, my first thought was “hooray.” Another victory for consumer information.

Then I began to think about this in more depth. The Centers for Medicare and Medicaid Services (CMS), in response to a ruling in a federal case …

Do rural provider bonus payments do more good than harm?

Peter Ubel, MD

Health Policy

April 9, 2014

If you live in the rural U.S., you probably face relatively limited access to the wonders of American health care. There won’t be as many physicians per capita offering you their services. This paucity of health care professionals will be especially stark for subspecialty care. There are not many ENT specialists opening up shops in rural Texas when they can find jobs in Houston or San Antonio.

This undersupply of physicians …

What health care can learn from Katz’s Delicatessen

Margalit Gur-Arie

Health Technology

April 9, 2014

Katz's_Delicatessen

Sometime during the last year of the second millennium, I wrote my last letter in response to the last letter I have ever received. It’s been email ever since. I don’t recall making a conscious decision to stop writing letters. It just happened. I cannot pinpoint the exact date when my work memos, agendas, proposals and various notes, disappeared from my desk …

The Heartbleed bug compromises EHRs: Physicians and patients beware

Rigel Hope

Health Technology

April 9, 2014

Technology finds its way into our lives not so much in big flashy ways as little ones. Oh, I can do this a little bit faster now, isn’t that cool? Wow, isn’t this convenient? Oh, isn’t this a huge risk to my privacy?

Oftentimes, when I start talking about Linux or scripting or the command line or any number of tech subjects that seem increasingly esoteric, I get blank stares from …

The alarming decline of internal medicine recertification pass rates

Kevin Pho, MD

KevinMD

April 9, 2014

Let’s talk internal medicine maintenance of certification (MOC).

I recertified back in 2011, and it was an onerous process capped off with a challenging exam. Thankfully I passed, and I’m good until 2022.

Since then, the American Board of Internal Medicine has made maintenance of certification a more “continuous” process, and is sparking some outcry among physicians. Wes Fisher has multiple posts …

Why the future of health care can be found in the Cayman Islands

Robert Pearl, MD

Health Policy

April 9, 2014

The Cayman Islands are nestled in the Caribbean Sea some 430 miles south of Miami. The three-island cluster is known for its inviting coral-sand beaches, laid-back island culture and tax-free status.

While it lures many tourists and big banks, it’s not the first place you’d expect to find the future of American health care. That may change soon.

Last month, I flew to the Caymans to moderate an afternoon-long panel on delivering …

A cancer story that defied the odds

James C. Salwitz, MD

Conditions and Diseases

April 8, 2014

Sometimes it seems that life is unfair and the odds are stacked incredibly against us. More than 1 in 3 persons will get cancer. The chance of survival if you get lung, pancreatic or brain tumors is pathetically small. The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers.

However, there are remarkable stories of hope. Here …

Read more…

A cancer story that defied the odds

Explain the reasoning behind new prescriptions

Val Jones, MD

Medications

April 8, 2014

A Canadian study published in the Annals of Internal Medicine suggests that about one third of new prescriptions (written by primary care physicians) are never filled. Over 15,000 patients were followed from 2006 to 2009. Prescription and patient characteristics were analyzed, though patients were not directly interviewed about their rationale for not filling their prescriptions.

In short, patients were less likely to fill a prescription if the treatment was expensive, but certain …

Good psychotherapy eventually ends

Steven Reidbord, MD

Physician

April 8, 2014

Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave. This isn’t completely unfounded: There are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad. The patient’s chief complaint, i.e., the ostensible reason for coming, often gives way to more troubling underlying conflicts and concerns that might never appear in …

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Good psychotherapy eventually ends

We must place a higher value on discharge paperwork

Suneel Dhand, MD

Physician

April 8, 2014

The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20% for Medicare patients, there is an increasingly urgent need to focus on this transition of care point. Discharging a patient is, by its very …

What goes through a surgeon’s mind after a complication

Sid Schwab, MD

Physician

April 8, 2014

One of the hardest things about being a surgeon is the inevitability of complications. It’s true for any doctor; but with surgery, it’s as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big …

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