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As journals proliferate, so do authors

Medical Education

February 14, 2014

New journals are appearing almost every day. Does anyone read them? Journals keep popping up because of the need for faculty to publish. Another reason could be that publishers, particularly those who charge authors fees for publishing, are in the business of making money.

Authoring journal articles is not only enhancing to one’s CV (the old “publish or perish” cliché), it is required by residency review committees as evidence of “scholarly …

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As journals proliferate, so do authors

The wisdom of Dr. Bernard Lown and sick patients with chronic diseases

Janice Boughton, MD

Physician

February 14, 2014

I have been doing admitting shifts at a large hospital, as hospitalist. It is flu season, so volumes are large. Even people without the flu are sick. It often happens that way. And they are so very sick!

The thing about the very sick patients I see is that they are generally what might be called medical “train wrecks.” They are very sick because they have had interventions over the years …

Fortification masks our deplorable dietary circumstances

David L. Katz, MD

Conditions and Diseases

February 14, 2014

A paper published in the Journal of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) highlights the importance of nutrient fortification to the diets of our children. The researchers used data from the National Health and Nutrition Examination Survey to determine the sources of micronutrients in the diets of over 7,000 kids ages 2 to 18, and assessed overall dietary intake in this cohort assembled …

Obamacare is considering extending individual health insurance policies

Robert Laszewski

Health Policy

February 14, 2014

Is Obamacare unraveling?

Rumors have been circulating in the marketplace all week that the administration was thinking of extending the individual health insurance policies that Obamacare was supposed to have cancelled for as much as three more years.

Those rumors have now come out into the open with Tom Murphy’s AP story that began running recently.

That the administration might extend these polices shouldn’t come as a shock. My sense has always been that at …

One cardiologist on CVS and cigarettes: Let’s not fall for the spin

Wes Fisher, MD

Physician

February 14, 2014

By now the world has heard the remarkable news. CVS Caremark will no longer be selling its tobacco products in any of its stores. Locked and loaded with the news, the American Heart Association, American College of Cardiologists, local public health experts, Phillip Morris, and even the former-smoking president of the United States was quick to applaud the news by publishing press releases.

But when press releases and major announcements of …

Health reform: Forward progress or a temporary dislocation?

Kenneth Lin, MD

Health Policy

February 13, 2014

A little over a month ago, my family of five moved to a more spacious and modern house in the same neighborhood. I’m slowly getting adjusted to our new place — the locations of the light switches, how to operate the refrigerator’s automatic ice maker, which cycle to choose among the dozen different options displayed on our high-end washing machine. It still takes me a few minutes longer to get …

A 2 question strategy to assess the worth of medical tests

Michael Kirsch, MD

Conditions and Diseases

February 13, 2014

In the medical world, when a physician, a scientist, a hospital, a drug company or a panel of experts issues a report, the games begin. If one agrees with the statement or benefits from it, then the report is heralded as breakthrough brilliance.

If, however, the report suggests a new medical pathway that diminishes your relevance or reimbursement, then the report and its authors are regarded as misguided. Yes, I am …

A cancer patient return visit after 20 years

Miranda Fielding, MD

Physician

February 13, 2014

A couple of weeks ago my nurse came to me with a request for a consultation. Since our schedule has been packed full lately, she’s been asking me where I can squeeze patients in.

She said, “I’m not sure about this one — he says you treated him twenty years ago and he wants to see you. But there is no new pathology so I don’t know how urgent it is.”

I …

Why monetary carrots and sticks are detrimental to health care

angienadia, MD

Physician

February 13, 2014

In describing why Cooper Union, a unique college that offers absolutely free education to students, would effectively die if it starts charging tuition, Kevin Slavin wrote:

For many of us, Cooper wasn’t even the cheapest way to go to school…So the question is: why did we go? We went not because of the financial value of free–that is, zero tuition–but rather, because of the academic value of free. At Cooper Union …

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Why monetary carrots and sticks are detrimental to health care

Does Obamacare really kill jobs?

Brad Wright, PhD

Health Policy

February 12, 2014

A primary criticism of the Affordable Care Act is that it creates incentives for employers to hire fewer full-time employees. One of the House’s attempts to repeal the ACA even referenced it as the “job-killing healthcare law.” It’s true that there are some provisions in the ACA that employers may exploit in order to minimize the cost of doing business.

At the same time, it’s also true that the ACA protects …

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Does Obamacare really kill jobs?

I am in a long term relationship with my patients

Lucy Hornstein, MD

Physician

February 12, 2014

“Do you mind telling your legions how long you intend to work?”

Certainly. The short answer is, “Indefinitely.”

The more detailed answer (technically, the answer to “Why do you answer that way?”) has two parts.

First, I love what I do. Just about every part of it. I love it. I wake up eager to get to work each morning. Being continuously on call is an opportunity, not a chore. I love my …

Why your doctor isn’t prescribing medical marijuana yet

Suzanne Koven, MD

Medications

February 12, 2014

Now that medical marijuana is legal in Massachusetts and licenses have been awarded for the first twenty dispensaries across the state, you’d guess that my practice is busily preparing to meet the demands of patients seeking marijuana prescriptions for several debilitating conditions including chemotherapy-related nausea and AIDS-related weight loss.

You’d guess wrong.

Since Massachusetts voters approved legalization of marijuana in 2012 I’ve received no special training (required for physicians to certify patients as eligible …

Long term care insurance: The premium catch

Ken Covinsky, MD

Physician

February 12, 2014

Consider this scenario.

You are getting older, and are concerned about the costs of nursing homes and long term care. So, you decide to get expensive long term care insurance to protect your family from these costs. The policy will pay some of the cost of long term care if you develop cognitive or physical disability. All you have to do is keep making payments on the policy until you have …

My cancer has been knocked into oblivion

Elana Miller, MD

Conditions and Diseases

February 12, 2014

elanahappy

From the beginning, there were so many signs that my cancer didn’t have a chance.

First, there was the rock-hard lymph node above my collarbone that disappeared with one night of steroids, even before I started chemotherapy.

Then, there was the chest x-ray done only a few days after starting my first round of chemo. It’s not pretty, and you can see that the …

Mammograms: Breast cancer screening as an individual patient decision

Kevin Pho, MD

KevinMD

February 12, 2014

In a major cancer screening development, a study from the British Medical Journal found that an annual screening mammography didn’t result in a mortality benefit:

Women screened annually by mammography for 5 years had had a breast cancer mortality hazard of 1.05 compared with the control group during the screening period. During follow-up for a mean of 22 years, the mammography group …

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Mammograms: Breast cancer screening as an individual patient decision

Everyone should have a pleasant mammogram experience

Abigail Schildcrout, MD

Physician

February 12, 2014

This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.

In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in …

Don’t take patients’ patience for granted

Maria Yang, MD

Physician

February 11, 2014

When I was a resident one of my attendings said, “You know why patients are called ‘patients’? It’s because they have a lot of patience. For us.”

Patients in hospitals do a lot of waiting. They wait for physicians. They wait for nurses. They wait to use the bathroom. They wait to undergo procedures. They wait for their IVs to stop beeping. They wait for the person next door to stop …

When medical wishes are respected

Kelly McCutcheon Adams, MSW

Patient

February 11, 2014

In 2005, my husband and I bought a small farmhouse in northern New England next door to Tom and Sally.

They were in their early seventies, married nearly fifty years, with a large family. Tom’s grandfather had built a farmhouse in 1900 on the family’s small pig farm. In the 1970s, Tom and Sally had parceled off the land and built a modern house for themselves, a stone’s throw from the …

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When medical wishes are respected

Fix primary care with technology and anesthesia

Luis Collar, MD

Health Policy

February 11, 2014

Trauma surgeons earn their patients’ respect every day, acting decisively in the face of calamity and uncertainty, heroically beating back death with steel blades and iron wills. Primary care physicians, however, have traditionally been at a relative disadvantage with regard to public opinion. After all, reconciling medication lists, reviewing lab results, and discussing health behaviors simply aren’t as exciting. In fairness, though, surgeons have always had one other advantage: anesthesia. …

Analyzing the Jahi McMath case

Christopher Johnson, MD

Conditions and Diseases

February 11, 2014

The recent tragedy of Jahi McMath, the 13-year-old girl who died following complications of tonsillectomy and adenoidectomy, has focused many people on the question of brain death. Although I have no more details about this case than anyone else reading the news, I am quite familiar with the sort of things that happened to this unfortunate child. As many of you know, her family does not believe she …

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Analyzing the Jahi McMath case

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