Here’s a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps.
I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at …
Apps used to monitor blood pressure need better design
Readers have contacted me about a recent study that links acetaminophen use in pregnancy to the later development of ADHD in children. Is Tylenol yet another thing pregnant women need to avoid?
The study, titled “Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders” was published this month in JAMA Pediatrics. Dutch researchers looked at about 60,000 children born from 1996-2002. Their parents have been filling out questionnaires and …
Is acetaminophen taken during pregnancy associated with ADHD?
I recently spoke to a quality measures development organization and it got me thinking — what makes a good doctor, and how do we measure it?
In thinking about this, I reflected on how far we have come on quality measurement. A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or …
Can we measure what it takes to be a good doctor?
Malcolm Gladwell thinks we should tell people whats it’s really like to be a doctor. And by God I have invested the last seven years in doing just that. I have written countless blogs, given lectures, and traveled to Ireland. I have coined the term Caring 2.0 to describe the bidirectional flow of empathy. Patients will tell us what it is like to suffer with disease, and we …
Assure patients that we are on their side
Should medical school be shortened to three years?
I say, “no.”
Here’s why.
There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase — residency training.
I do not see how medical students can choose a career path before they have …
Don’t shorten medical school: Shorten undergraduate training instead
For years internationalists have being trying to make the argument to ordinary Americans that foreign policy matters — that we must contend with complex issues overseas like countering terrorism while also focusing resources and energies on economic issues at home. We have posed it as a trade-off.
We are making the foreign affairs case the wrong way. Rather than argue the positive merits of trade or the negative repercussions of unchecked …
Cancer is an international war and peace issue
I have a confession.
It is a secret I have held for more than 10 years and it is a lesson I have learned from other women.
As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise …
New feminism is about women, work, and the will to be authentic
Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients.
But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, …
They used to tell us, as physicians, that “if it isn’t on the chart, it didn’t happen.” We could protest all day, to billing companies, insurers or attorneys, “I did that. It’s assumed. I always do the same thing every time.” But they would retort, “nope, it’s not in the chart.” So we learned to detail everything, every time, every movement. Every consideration and justification. The idea being, our ‘thought process’ …
If it’s not in the computer, you didn’t order it
There’s a bit of buzz in the news recently over President Obama’s nominee for surgeon general, Dr. Vivek Murthy.
It’s worth pausing here to note the last truly consequential surgeon general: Dr. C Everett Koop single-handedly carried out the entirety of the Reagan Administration’s AIDS response (to be clear — this is true because of how little the Reagan administration did, not because of how much Koop did); fought hard …
The surgeon general nominee: Both the NRA and Vivek Murthy are wrong
Clinical medical research — finding out which treatments help and which ones don’t (or even make the situation worse) — is tough research to do. In the laboratory a scientist can control conditions so that only one thing is different between the control and the experimental groups. This isolates the effect of the particular thing and one can see if there is any difference in outcomes depending upon what is …
A case where a meta-analysis can help
“I walked in a person, and out a cancer patient,” my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine — the side on the exam table or gurney, as opposed to the one standing over it. As a physician I was used to the latter. This is my family’s story in our new position, and how the cost of medical care has impacted …
A struggle against cancer becomes a financial worry
The field of nephrology is in a workforce crisis. We as a subspecialty have witnessed a steady decline in the number of applicants perusing nephrology fellowship over the last several years. In fact, fewer than 100 US medical school applicants participated in the 2014 nephrology fellowship match. This is a sobering statistic as 403 nephrology slots were available in this year’s …
NephMadness 2014: Let’s reinvigorate nephrology
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Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way …
A 10-step process to finding a good doctor
Next in a series.
As a general rule, PCPs like people. This was true of them long before they started medical school and it will have only blossomed further during training. Ask PCPs, as I have with in depth interviews, and they will tell you that certain types of individuals are drawn to primary care careers.
They like to converse with people. They enjoy getting to know about a person — …
What are the characteristics of a good primary care physician?
“Medication mishaps cause a huge number of hospitalizations and in fact the majority of hospital readmissions. Making more time for visits with aging and complex patients is critical to avoid mishaps of poor communication and rushed decisions. A dose of ‘slow medicine’ may get us to our goal of system sustainability faster,” writes colleague and fellow blogger Dr. David Moen.
Dr. Moen distills Dr. Dennis McCullough’s ideas about slow medicine down …
How to make practicing slow medicine a reality
When I was in medical school, our nutrition researchers taught us that vitamins didn’t do much good and only made expensive urine (where the water soluble ones end up). We did learn about the classic vitamin deficiencies like scurvy, beriberi, rickets, etc. But the evidence that healthy people should take vitamins was marginal at best.
Is our search for immortality the reason that we turn to the pill or potion? Do …
Vitamin and mineral supplements for healthy individuals don’t work
My home hospital is small. In a town of just over 20,000 people, this hospital has 25 beds and is designated “critical access” by Medicare because it is felt to be necessary to the health care of the community. Critical access is a designation which was introduced in 1997 when modernization of Medicare payment systems threatened to close a large proportion of hospitals in small communities which were unable to …
The whole critical access system needs to be reconsidered
Have you ever had a conversation that rattles around in your head for days? Maybe, it changed what you thought you knew about the world. Perhaps the ideas or comments did not make any sense. I had a discussion last week and it seemed that logic stood on its head. The means was defined by the end, with no connection to the beginning, or more exactly, the tail wagged the …
When insurers dictate medical decisions
I like a lot of things about Facebook. It allows me to see pictures and video of my nephews and niece and of friends’ children, it quickly lets me know when something big (either happy or sad) is going on in people’s lives, it lets me know what people are thinking about, and it gives me the opportunity to share my own news, thoughts, pictures, or occasional videos with others.
But as much as …
A doctor’s visit is not a social media situation
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