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Is autism diagnosed more frequently? Making sense of a recent study.

Conditions and Diseases

April 4, 2014

Headlines soared recently with the CDC report that the number of children with autism diagnoses had increased by 30% in the past 2 years.

“Reality is there are many children who are having serious struggles because they can’t communicate well and have a hard time being with people,” Dr. Chuck Cowan clearly stated to me this morning. Like a bell on a quiet night, I feel parents need to hear this most: …

Frustrations of the primary care physician should be a wakeup call

Stephen C. Schimpff, MD

Physician

April 4, 2014

Next in a series.

Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the …

Sharing secrets with my grandmother

Maria Gervits, MD

Physician

April 4, 2014

“I feel bad …” Amy whispered, then paused.

I’m a family medicine resident, and I was doing my gynecology rotation, which involved spending a few days at a Planned Parenthood facility. This was my first day. I’d been assigned a patient to shadow: a young woman named Amy, who was here to have a first-trimester abortion.

I’m a fan of Planned Parenthood’s work providing high quality, affordable contraceptive and gynecological care. In …

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Sharing secrets with my grandmother

Is what we know about dietary fats wrong?

Albert Fuchs, MD

Conditions and Diseases

April 3, 2014

Most humans have spent most of human history nearly starving to death. So it’s no surprise that we spend a lot of time thinking about food. And it’s no surprise that food has acquired cultural, social, and religious significance in almost every society. Because food is so important, and because it’s nearly impossible for us not to ascribe powerful effects to anything important to us, every society imbues special health …

4 reasons why patients may become angry

Arshya Vahabzadeh, MD

Physician

April 3, 2014

Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face.

The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several …

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4 reasons why patients may become angry

Problems with the proposed solutions to the primary care shortage

Kenneth Lin, MD

Health Policy

April 3, 2014

Projecting future physician workforce needs is a challenging calculation that must take multiple variables into account to avoid missing its mark. In the mid-1990s, the American Medical Association confidently predicted that the penetration of managed care would lead to a large “physician surplus” and convinced Congress to cap the number of graduate medical education (GME) positions subsidized by the Medicare program.

Two decades later, there is a widespread consensus that the U.S. is …

Introducing yourself to patients is a patient safety issue

Peter Pronovost, MD, PhD

Physician

April 3, 2014

One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine — putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle …

The shocking ingredient in natural medicine

Pamela Wible, MD

Medications

April 3, 2014

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So you think your medicine is natural. Ever wonder what’s inside? A product can be labeled “natural” if the main ingredient is from an animal, plant, or mineral. Arsenic, horse urine, and cow brain are natural. But are they natural for you? Here are four drugs whose origins may surprise you.

Insulin was discovered in 1922. Until the 1980s, all insulin was …

We have a physician utilization problem

Christine A. Sinsky, MD

Physician

April 2, 2014

Do we really have a looming physician shortage? We may, but even more acutely I believe we have a physician utilization problem, most particularly in primary care. After shadowing approximately 50 primary care physicians across the country and engaging physicians in conversation during 150 or so presentations on improving the delivery model of care, my observation is that 70-80% of the PCPs work output is direct waste: computer order entry, prescription processing, composing the billing …

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We have a physician utilization problem

When childbirth becomes a financial stress

Ashley Lane

Patient

April 2, 2014

On December 31, 2011 right before midnight, I took the test of excitement and new beginnings and found out that I was pregnant. While this news was joyous in nature, it was soon marred by uncertainty and harsh reality.

After my test, I followed up with a doctor’s visit a month later, as was expected, and soon learned that the cost for this bundle of joy would be around $12,000 to …

Measuring Obamacare’s success: Are enough people getting coverage?

Robert Laszewski

Health Policy

April 2, 2014

Health insurance reform was long overdue. But did it need to be done the way the architects of the Affordable Care Act did it?

Obamacare was enacted, and the private health insurance market fundamentally changed, so that we could cover millions of people who previously couldn’t get coverage.

Are enough people getting coverage who didn’t have it before to justify the sacrifices the people who were already covered — in the individual, …

Do call centers send too many children to the emergency department?

Christopher Johnson, MD

Physician

April 2, 2014

A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make live easier for the doctor; having somebody screen the calls, answer easy questions, and only call you …

An ICU physician’s work is never done

Harlan R. Weinberg, MD

Physician

April 2, 2014

If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the …

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An ICU physician’s work is never done

Would you admit this patient into hospice?

James C. Salwitz, MD

Conditions and Diseases

April 2, 2014

Allow me to describe a recent case and ask your opinion. Today, you are the intake nurse at hospice and you are asked to evaluate Stan. This gentleman has incurable cancer, but treatment would probably prolong his survival. However, Stan has refused that treatment and been referred to you. It is your job to decide if he is “hospice appropriate.”

Why has Stan refused therapy? It is not that he denies …

Understand the consequences of preventable infectious diseases

Robert Pearl, MD

Conditions and Diseases

April 1, 2014

There is nothing more disheartening for a physician than watching a patient die from a preventable cause. And, of course, the loss for the family involved is unimaginable.

But it’s important, especially for parents, to understand the potential consequences of preventable, infectious diseases.

Here’s a scenario doctors across the country are witnessing first-hand: A 2-year-old girl develops what seems like a cold. Over the next several days, her breathing rate increases. At …

Developing bedside manner comes from understanding who the patient is

Robert Centor, MD

Physician

April 1, 2014

Over the years I have strived to develop my bedside manner. On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection. This commentary may convince some readers that I have the answers, but I do not. Sometimes I do very well, but sometimes my skills fall short. I do try to connect with patients and families, and give them confidence, …

The rise of ADHD diagnoses in young mothers

Claudia M. Gold, MD

Conditions and Diseases

April 1, 2014

“I know its my ADHD acting up,” a mother of three young children recently said to me as an explanation for her inability to recall a particular piece of information. My observation, in the setting of mybehavioral pediatrics practice, of increasing numbers of mothers of young children being diagnosed with ADHD is in keeping with a recent report from Express Scripts. This report, based on pharmacy claims data, showed a 53% rise in writing of prescriptions for ADHD in …

Negative results from clinical trials need to be reported

Kevin R. Campbell, MD

Medications

April 1, 2014

Research and development is critical to battling disease. Now, more than ever, technology can rapidly impact a patient and their disease process in a very positive way. The process of developing a new drug or device is expensive and can be very time consuming. As government funding for projects continues to decline, more funding is coming from private sponsorship according to a recent New York Times piece.

Another critical source of …

Powerless to treat a complicated cancer case in Kenya

Bruce Campbell, MD

Conditions and Diseases

April 1, 2014

I was working side-by-side with a Kenyan ENT doctor at his hospital in Eldoret, Kenya. My wife, Kathi, and I were part of a team of head and neck surgeons organized by Indiana University spending two weeks working with Kenyan ENT surgeons to help them build confidence to perform operations independently. In rapid sequence, we were seeing dozens of patients who had signed up to be examined and hoping to …

Why are doctors crazy enough to accept health care’s status quo?

Davis Liu, MD

Health Policy

April 1, 2014

We believe integrated will triumph fragmented every time.
-Steve Jobs

Two articles recently got my attention. The first was an interview by Dr. Robert Pearl, CEO of the Permanente Medical Group with my favorite author and thinker Malcolm Gladwell. On Pearl’s blog, he answered Gladwell’s request to tell people what is was like to be a doctor.

The second was a NPR article, “When Facts Are Scarce, ER Doctor Turns …