Why the days of the stethoscope are numbered

Health Technology
March 24, 2014

The stethoscope has been a symbol of the medical profession for two centuries. Dr. René Laennec probably had no idea how his idea would take off when he first invented the simple wooden tube in Paris back in 1816. After a few modifications over the course of the next several decades, it evolved into what we know today.

A central part of the physical examination, the stethoscope currently gives doctors priceless information about the cardiac and …

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Why the days of the stethoscope are numbered

What Sweden can teach us about primary care

Health Policy
March 24, 2014

Fulfilling every stereotype, I sat at my grandparents’ house in southern Sweden, sipping elderberry juice out of an IKEA glass and eating meatballs with lingonberry jam. It was Christmas Eve, and I was enjoying a getaway from the rigors of medical school. However, it wasn’t a complete escape, as my grandparents loved talking about medicine and the differences between health care in the United States and Sweden.

In this particular conversation, …

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What Sweden can teach us about primary care

Help people understand what it is really like to be a physician

Physician
March 24, 2014

In a recent article, Malcolm Gladwell dissected and diagnosed American health care.

Throughout our interview, he tackled controversial topics from the Affordable Care Act and medical malpractice to the contrasting Canadian health care system and much more. I expected him to dive deep below the surface and provide new and intriguing perspectives. He didn’t disappoint.

But it was his closing comment that caught me off guard. When I asked Gladwell …

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Help people understand what it is really like to be a physician

7 tips for becoming a savvy digital parent

Social Media in Medicine
March 24, 2014

As a pediatrician, I encourage families to search online for health advice. Yet how you search and where you click matters. Tips for you and your time with “Dr. Google” or “Surgeon Bing.”

The Pew Internet Project’s research finds that over 70% of Internet users in the United States say they have looked online for health information in the last year. Furthermore, most health information seekers (ie freaked out parents …

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7 tips for becoming a savvy digital parent

Everybody judges in the exam room

Medical Education
March 23, 2014

As a medical student, I am being taught not to judge patients. If a patient tells me that he has smoked cigarettes for forty years of his life despite the protests of his wife, I am supposed to nod my head understandingly without showing my inherent disapproval. If a patient tells me that she has given her husband genital herpes because she is cheating on him, I am not supposed …

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Everybody judges in the exam room

Is it any wonder why young doctors shun primary care?

Physician
March 23, 2014

With the announcement out of Washington about the 2015 budget, much has been made about the apparent presence of significant support for the development of more primary care practitioners in the years ahead.

This support includes programs aimed to encourage medical students and residents to choose primary care as a profession, including loan forgiveness packages.

Response in the press has already raised issues with this, suggesting that this move would do little …

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Is it any wonder why young doctors shun primary care?

How to answer difficult vaccine questions from parents

Conditions and Diseases
March 23, 2014

A recent blog comes to the conclusion that non-vaccinating parents believe their pediatrician “would have to be staggeringly incompetent, negligent or malicious to keep administering (vaccines).”  Using this as the premise, this pediatrician goes on to say that these patients should be dismissed from our practices.

First off, these parents don’t think we’re the enemy.  The reason they bring their kids to see …

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How to answer difficult vaccine questions from parents

Why medical schools discourage entrepreneurs

Medical Education
March 23, 2014

As a medical student looking to explore entrepreneurship, I quickly came across Shiv Gaglani’s October 2013 article in Entrepreneur, entitled “Why Medical Schools are Pumping Out Entrepreneurs,” in which he the highlights similarities and differences he sees between medical students and entrepreneurs. I was struck by his proposed differences — he does not share his take on their origins, so I have come to delineate my own view.

Medical students …

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Why medical schools discourage entrepreneurs

Baseball players’ heads finally getting the attention they deserve

Conditions and Diseases
March 23, 2014

The smell of the grass, the crack of the bat and the roar of the crowd … baseball season is back. As spring training gets into full swing, a new Major League baseball rule takes effect. Though contact will still be allowed at home plate, base runners will no longer be allowed to intentionally run into a catcher.

The rule is intended to protect players from injuries, especially head injuries. Concussions …

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Baseball players’ heads finally getting the attention they deserve

What is an autoinflammatory disease?

Conditions and Diseases
March 23, 2014

During our weekly physician conference,  I discussed a patient with a suspected autoinflammatory disease.  An elderly male, he had a history of recurrent fevers, hives, and elevated inflammatory markers, which had gone untreated for many years.  Eventually, he developed renal amyloidosis, and was finally referred to rheumatology clinic for further evaluation.  Although he had many of the classic signs and symptoms of an autoinflammatory disease, his physicians had not recognized …

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What is an autoinflammatory disease?

Physicians specializing in the patient experience

Physician
March 22, 2014

Imagine — where would elective surgery be today if patients still worried about operating rooms exploding or developing liver and kidney failure from anesthesia?

Having major surgery would be a very different experience without anesthesia.  Before the advent of safe anesthesia techniques, the world of surgery was basically limited to amputations and other attempts at life-saving maneuvers.  Dr. Bigelow’s publication describing the safe administration of ether changed everything, and the New …

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Physicians specializing in the patient experience

Patient experience is not to be confused with patient happiness

Physician
March 22, 2014

I hear providers groan when we talk about the patient experience and some even tell me that they have no impact on the patient experience, that’s an administration problem. Nothing is further from the truth. If you interact with patients, you influence the patient experience.

Some providers think a full waiting room is a measure of patient satisfaction. Actually, it’s a measure of how long patients will tolerate a long waiting …

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Patient experience is not to be confused with patient happiness

Antibiotic overuse: The role of infectious disease specialists

Medications
March 22, 2014

The CDC’s report on the overuse of antibiotics raises concerns that the infectious disease community has been aware of for decades. Unfortunately, systemic action to address these concerns is hindered by misperceptions about antibiotic therapy: that it is safe, inexpensive, easy to prescribe, and that early administration is the best approach.

At first blush, antibiotic therapy appears to be safe. But there can be dangerous complications to its use. Clostridium …

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Antibiotic overuse: The role of infectious disease specialists

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What does it mean for a patient to be undermedicated?

Conditions and Diseases
March 22, 2014

A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety.  He shared this story with a smile, as we’ve never discussed adding medication to his productive weekly sessions that focus on anxiety and interpersonal conflicts.  Indeed, …

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What does it mean for a patient to be undermedicated?

Patient satisfaction: Hospitals are not like car dealerships

Physician
March 22, 2014

Recently, I attended what may have been my last quarterly medical staff meeting at my local hospital — ever. (I am retiring from medicine in ten weeks.) I certainly wasn’t there for the food, although the fare was much better than the daily servings in the doctors’ lounge. Part of the night’s agenda was a rousing talk by the hospital’s new chief medical officer (CMO). A retired surgeon, the CMO …

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Patient satisfaction: Hospitals are not like car dealerships

MKSAP: 59-year-old woman with type 2 diabetes mellitus and hyperlipidemia

Conditions and Diseases
March 22, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well. Medications are metformin, atorvastatin, and aspirin.

Physical examination findings and vital signs are normal. BMI is 27.

Laboratory studies reveal a serum creatinine level of 0.9 mg/dL (79.6 µmol/L), an …

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MKSAP: 59-year-old woman with type 2 diabetes mellitus and hyperlipidemia

Perverse incentives push physicians to order ineffective tests

Physician
March 21, 2014

When I meet a new patient, I’m frequently astounded by the health care he has received. I’ve met patients with absolutely no cardiac symptoms who have been receiving EKGs every six months for years. I’ve had patients brag to me about their annual executive physicals in which myriad tests including treadmill stress tests and chest x-rays were routinely performed. Patients get head-to-toe CT scans under the mistaken hope that they …

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Perverse incentives push physicians to order ineffective tests

An infant made my medical training feel worthwhile

Physician
March 21, 2014

As an intern in the neonatal intensive-care unit (NICU), I am one of several doctors who rarely see or touch the tiny patients we treat. We sit in a back room off a distant hallway, far removed from the babies, reviewing lab results and blood gases on the computer. Much of the time I feel like the Wizard of Oz, controlling a marvelous machine from behind a curtain.

The only uninterrupted …

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An infant made my medical training feel worthwhile

Weighing a patient offers a treasure trove of information

Physician
March 21, 2014

As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come …

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Weighing a patient offers a treasure trove of information

Mal de debarquement: Vertigo and dizziness after a cruise

Conditions and Diseases
March 21, 2014

I have a patient with very unusual visual symptoms and sense of imbalance that has persisted for more than a year.  She describes very unusual and concerning symptoms including true diplopia, a sense of major visual disturbances like the floor buckling in her visual fields, vertigo, severe sense of imbalance and swaying, headache, memory fog and concentration difficulty.

Of note is that her symptoms seemed to start after a cruise.  I …

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Mal de debarquement: Vertigo and dizziness after a cruise

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