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The transition from chief resident to attending

Medical Education

January 28, 2014

During my year as a chief resident, I have the privilege to attend on the general medicine service for 8 weeks. I recently completed 4 weeks and, as expected, found myself in an entirely new realm of patient care and accountability. I would be remiss without recalling a few of the pivotal lessons and poignant moments that stand out.

Transitioning from resident to attending inevitably results in greater scrutiny. Despite my best …

Seat belts, brakes and tires: A vaccine story

Roy Benaroch, MD

Conditions and Diseases

January 28, 2014

Ron was puzzled. He had been a mechanic for many years, and had known Ms. McCarthy through two previous vehicles. But what could he say to a request like this?

“I don’t see why you wouldn’t want to do it this way. What’s the harm?” The mother of two seemed sincere and earnest. Ron knew she wanted to take good care of her car, and the kids who rode with her …

The truth about juicing

Keith-Thomas Ayoob, EdD, RD

Conditions and Diseases

January 28, 2014

Eating takes a lot of work. That “food coma” many lapse into after the big Thanksgiving meal is largely due not to the turkey, but to overeating. The caloric onslaught unleashes a cascade that sends a rush of blood to the gastrointestinal tract to help us digest, leaving less blood circulating elsewhere.

It’s estimated that up to 10 percent of our calories go …

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The truth about juicing

The toxicity of Medicaid

Edwin Leap, MD

Physician

January 28, 2014

I have noticed over the years that physicians who write about medicine, particularly for the general public, are limited to very specific discussions. For instance, it is perfectly acceptable to write about the plight of the poor and uninsured. It is always reasonable to advocate for a single payer system. It is perfectly acceptable to discuss how one downsized in order to make less and “give back” more. And it …

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The toxicity of Medicaid

People with overt disabilities: Are we more forgiving of their behavior?

Maria Yang, MD

Physician

January 27, 2014

Everyone noticed him before we boarded the plane. He asked the airline representative at least three times to confirm that he had a seat. He looked like an adult, but the tone of his voice was that of a child.

“Yes, you have a seat, Michael. It’s 7B.”

Grey cargo pants covered his short legs. The sleeves of his striped polo shirt collected below his elbows, making his arms look even shorter …

Should we follow a Mediterranean diet?

Val Jones, MD

Conditions and Diseases

January 27, 2014

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We’ve known for quite some time that weight loss can reduce the risk of developing insulin resistance and type 2 diabetes. However, a healthy diet alone (without weight loss) may also help to reduce risk. In a recent Spanish study (published in the Annals of Internal Medicine), 3,541 men and women ages 55-80 at risk for diabetes were followed for …

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Should we follow a Mediterranean diet?

Skin cancers are never truly benign

J. Leonard Lichtenfeld, MD

Conditions and Diseases

January 27, 2014

I spent 4 hours on New Year’s Eve sitting in the surgeon’s chair getting a skin cancer taken off my nose. Nothing about the experience fits the “benign” label so many professionals, including yours truly, have used: routine; easy to treat; nothing to worry about. Friends, after this experience, which left me looking like a tall, white-haired Rudolph the …

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Skin cancers are never truly benign

Money is only a microcosm of physician burnout

Sid Schwab, MD

Physician

January 27, 2014

The medical director of my clinic once gave me a book on burnout. I never read it. Didn’t have the time or energy.

Because a young reader considering a career in surgery referred to stories he’s heard of depressed and disappointed surgeons and asked for my thoughts, I’ll try to address it. Parenthetically, I’ve heard from more than a few readers that my blog and/or book has inspired them to consider …

What medical training can learn from placebo research

Karan Chhabra

Medical Education

January 27, 2014

Placebos work. This isn’t news. The term “placebo” was coined 60 years ago to describe how one-third of people respond to pills without any active drug in them. Twenty-five years later, we learned how they work: through endorphins produced by the body that work just like morphine. Today placebos are everywhere: from mothers kissing boo-boos to international drug trials.

A recent paper, though, shows that all placebos aren’t created equal. As expected, …

Be emotionally intimate with your patients

Pamela Wible, MD

Physician

January 27, 2014

A new patient calls for an appointment. I ask, “What would you like to come in for?”

“Depression. Two weeks ago my doctor put me on antidepressants.”

“Why don’t you see your current doctor?” I ask.

“I feel weird discussing my emotions with someone who doesn’t have any.”

When doctors are fully present, vulnerable — even emotional, patients are more likely to be honest, transparent, …

Doctors should ask about financial safety

Susan M. Reverby, PhD

Patient

January 26, 2014

In most states, doctors are mandated to ask their patients if they feel physically “safe at home.” With an aging population, perhaps another question should be added: are you financially safe?

Two examples suggest the problem.

“Trudy” had always managed her financial matters, even complex transactions. Aging, however, had made her short-term memory a bit more problematic and her focus diminished by TIAs. Even though her daughter shared responsibility on some of …

Existing for others is not enough

C. Elizabeth Modelewski

Patient

January 26, 2014

A frequent response to those contemplating suicide is to remember friends and loved ones, how much one is needed and how much one would be missed. Some people have a sense this statement is true and that the depressive emotions are inaccurate, so seeking therapy, medication, or riding out the episode will result in returning to whatever emotional mode is typical. Others don’t believe this sentiment, and they potentially live …

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Existing for others is not enough

How to stand out as a medical school applicant

Anonymous

Medical Education

January 26, 2014

It’s 11:00 a.m. when we finish listening to a somewhat pointless series of talks from various medical school administrators on interview day — one on financial aid, one on the medical curriculum, another on the school’s student organizations. It’s time for the medical school tour. All the applicants rise from their seats in unison, button their suit jackets, pat down any newly …

Take the time to understand the business of medicine

Sidney Christiansen, MD

Physician

January 26, 2014

A Catholic nun, who was the administrator of a small hospital once summed up for me the role business plays in patient care: “No money, no mission.”

In order for a practice to be successful, it must be run with healthy business principles in place. But the truth is that few physicians have any training in or knowledge about the business aspects of running a practice. A satisfying and successful career …

Does your joint replacement have a warranty?

Brian Hatten, MD

Physician

January 26, 2014

Should joint replacement manufactures provide a warranty for their products? It seems pretty logical since most consumer products come with some sort of warranty these days. Basic warranties are almost universally provided and the market for extended warranties is increasingly popular.

Take for instance my recent upgrade to the new iPhone 5s. At the time of purchase, the AT&T store suggested their extended …

Tips to manage your seasonal allergies

James Marroquin, MD

Conditions and Diseases

January 26, 2014

Unlike some of my classmates in medical school, diseases themselves are not something I often feel a passion to study. I find philosophy, theology, politics, literature, history, psychology, and so many other subjects much more interesting. But when I see a person suffering and looking for answers and relief, I am motivated to learn all that I can to help.

So while the topic of allergies is not something that really …

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Tips to manage your seasonal allergies

The FDA and 23andMe puts a libertarian in a dilemma

Dr. Saurabh Jha

Conditions and Diseases

January 25, 2014

An advantage astrologers have over genetic testing is that the prediction of astrologers are personally verifiable. An astrologer once emphatically stated that I had no chance of a career in international cricket or Bollywood. So far both claims have turned out to be remarkably accurate.

How does one personally verify a “12.5%” increased chance of lung cancer, the sort of number the vendor for genetic testing 23andMe produces? If one develops …

Why psychiatrists don’t take insurance

Dinah Miller, MD

Physician

January 25, 2014

In 2007, I wrote a post called “Why Shrinks Don’t Take Insurance.” The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased. Many other doctors don’t take insurance now, though psychiatry remains the number one specialty where doctors don’t participate in health insurance plans. This is an updated version of that same post.

Many psychiatrists in private practice don’t …

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Why psychiatrists don’t take insurance

7 wishes that I hope come true for those with health problems

Toni Bernhard, JD

Patient

January 25, 2014

As we reflect on the year that’s passing, it’s not unusual to formulate wishes and resolutions for the new year. I’m not much for resolutions anymore, but I do have hopes and wishes for me and for my readers.

Of course, my first wish is that those of you who suffer from chronic illness — including chronic pain — have your health restored. I know that, for some, this is a …

How the Affordable Care Act will affect emergency department payments

Cedric Dark, MD, MPH

Health Policy

January 25, 2014

A recent article in the Annals of Emergency Medicine analyzed the revenue increases due to emergency physicians for services delivered to currently uninsured individuals when they begin to receive coverage (via either Medicaid or private plans) under the Affordable Care Act.

The authors analyzed payments for outpatient emergency department (ED) visits using the Medical Expenditure Panel Survey from 2005-2010. They looked into characteristics of charges and payments for the following groups: …

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