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How scut work has changed for today’s generation of doctors

Physician

December 27, 2013

When I was an acting medicine intern in Manhattan’s Bellevue Hospital at the turn of the century, all employees who provided the hospital’s “ancillary services” went home between the hours of 5pm and 8am. It was the job of the on-call interns to fill in. If a patient needed a stat blood draw or IV line replacement in the middle of the night, his nurse paged the intern to do it. If …

5 universal problems hospitals need to solve

Suneel Dhand, MD

Physician

December 27, 2013

As health reform sets in, hospitals are gearing up for many challenges. While some of these are new to the health industry, several are against the backdrop of old problems that have plagued us for decades. Speaking as a doctor who has worked in a number of different hospitals up and down the east coast, I would like to identify 5 of these that I believe are fairly universal.

1. Medication …

The challenges and rewards of rural medicine

Janice Boughton, MD

Physician

December 27, 2013

Rural medicine, I guess, can be defined as health care that happens in places that aren’t big cities or referral centers. The vast majority of the populated earth’s crust that has any health care at all is served by rural practitioners. I have done a little bit of rural medicine in Haiti, in Mexico and now a bit more in South Sudan. I have also worked in a rural health …

These are the people who work in a hospital

Maria Yang, MD

Physician

December 26, 2013

Who works at a hospital? (Again, just indulge me for now.)

Doctors. If you’re a patient at a teaching hospital, this includes medical students (people in school to become doctors), interns and residents (people who have earned the title of “doctor”, but who are still learning their craft), and attendings (people who have completed their formal training as physicians). If you’re not at a teaching hospital, it’s less likely you’ll see medical …

How should personal genetic tests be regulated?

Ruth Macklin, PhD

Conditions and Diseases

December 26, 2013

Many people have heard of the company 23andMe; hundreds of thousands throughout the world have used the company’s Personal Genome Service (PGS), which provides a report that offers detailed information about an individual’s DNA. For $99, a consumer receives a test-tube kit from the company, fills the tube with saliva and sends it back. The company then performs a DNA analysis and provides information about the person’s health risks, ancestry …

The gamification of medical training

Vincent Stevenson

Health Technology

December 26, 2013

Video games evoke several connotations. They are regarded as childish, escapist, and time wasters that prompt isolation and bad habits. Video games are even blamed for violence and other ills of society. In actuality, many serious scientists have convincingly argued that video games not only have acquired an undeserved reputation, but they are actually potent and effective tools for science education.

Features of video games inherently support scientific learning

While it may …

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The gamification of medical training

10 reasons to like the bills that repeal the SGR

Bob Doherty

Health Policy

December 26, 2013

At a time when Republicans and Democrats, House and Senate, can’t seem to agree on anything, Medicare physician payment reform is the exception to the rule. Recently, the House Ways and Means and Senate Finance committees reported out nearly identical bills to repeal the Medicare SGR formula and begin to move Medicare more rapidly toward paying physicians based on quality improvement activities — the closest Congress has ever gotten to …

When children are abused by foster parents

S. Terez Malka, MD

Physician

December 26, 2013

I click open the x-ray viewer. After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam. Yet I audibly gasp as the chest x-ray loads. The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes. I begin to count the fractured ribs — 1, …

Nonsensical rules are binding the hands of caregivers

Jordan Grumet, MD

Physician

December 26, 2013

Why must everything be so difficult?

Soni pushed her mother quickly into the building from the parking lot, she wore a strained look on her face. The wheelchair appeared preposterously large for the aged figure cowering under the haggle of blankets. They were enjoying the brisk air, taking a walk around the facility, when the elderly woman called out. Her lips curled and she moaned deeply.

Now Soni’s mother had stopped talking …

Sometimes we give pain instead of hope

James C. Salwitz, MD

Physician

December 25, 2013

One of the most satisfying sports is to make ourselves feel better by degrading another. What better way to make up for our own inadequacy, then to shove someone else’s face in theirs? We see this at work, in our families, in politics and in almost every type of social interaction. Nonetheless, it is particularly painful and tragic when we project our own fear and frailty onto someone that is …

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Sometimes we give pain instead of hope

Restricting resident work hours decreases deliberate practice

Robert Centor, MD

Medical Education

December 25, 2013

Pauline Chen has once again written a brilliant piece in the New York Times: Are Today’s New Surgeons Unprepared? While many comments miss her underlying question, her exposition makes the problem clear.

How do we gain expertise? Current theory supports the idea of deliberate practice. How do we conceptualize deliberate practice? Start with a sports analogy. You are trying to learn to make a 6 foot putt. …

3 questions doctors should ask themselves in 2014

Natasha Deonarain, MD, MBA

Health Policy

December 25, 2013

Next year will be a landmark year for America. Since our Great Recession and its far-reaching effects on the economy, housing markets, jobs, relationships, personal savings, spreading wealth, increasing poverty, divided politics and collapsing health care system, America seems to be purging a lot of karma.

Doctors play a huge role, allowing themselves to become puppets pulled by the purse strings of politicians, conglomerates and a divided country gone wild.

As we …

Can defensive medicine ever be stopped?

Skeptical Scalpel, MD

Physician

December 25, 2013

You may have missed this when it first appeared.

Experts from Harvard and the University of Southern California say assumptions made by some analysts that defensive medicine is not an important facet of the high cost of health care may be wrong.

Those assumptions were based on data showing that malpractice reforms instituted in some states did little to reduce health care spending.

According to the report from the National Center for Policy …

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Can defensive medicine ever be stopped?

How to talk to a child with autism

Kathleen O’Grady

Conditions and Diseases

December 25, 2013

The holiday season means most of us will be socializing with colleagues and neighbors, friends and family. Chances are good this circle of friendly acquaintances and loved ones will include a child with autism.

Why? An estimated 1 in 88 children are now diagnosed with the neurological disorder, with a four times prevalence for boys. Among other challenges, those with autism often have difficulties with social communication (be it verbally or …

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How to talk to a child with autism

Merry Christmas, American health care!

Margalit Gur-Arie

Health Policy

December 25, 2013

It’s that time of year when the OECD publishes its “Health at a Glance” comparative health indicators, and The Commonwealth Fund follows with an international survey of health care related activities. A cursory review of these documents always ends up with the customary assessment of American health care: much more expensive than all others, wasteful and inefficient.

But this is the month of December, and health care workers are people too, …

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Merry Christmas, American health care!

Treat your child’s fever before the doctor’s appointment

Natasha Burgert, MD

Conditions and Diseases

December 24, 2013

It’s the beginning of cold and flu season. That means a lot of kiddos, big and small, are coming to the office with fever.

As docs, we know that fevers can freak moms and dads out. Kids look pretty awful when their temperature climbs, and it is understandable that parents want to bring them to the office for an evaluation.

In the exam room, I often hear worried parents …

Waking up from cardiac arrest

David Sack, MD

Physician

December 24, 2013

I nearly died a month ago on a treadmill halfway through a stress test.

The short story is this: I had just gone to bed and was about to go to sleep when I started to have some chest pain that I told myself was just my usual heartburn, only worse. As a gastroenterologist, I knew better. It was bad enough that I couldn’t go to sleep. After two sleepless hours …

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Waking up from cardiac arrest

Overdiagnosis: When health services harm more than help

Charles Wright, MD

Physician

December 24, 2013

“First, do no harm,” as suggested by Hippocrates, is a vital principle that should always guide physicians, but they are also well aware that in modern health care, whether in the form of drugs, operations, radiotherapy or any other form of treatment, there is always the possibility of causing harm to their patients. All drugs have potential adverse side effects and all surgery carries risk. Doctors and patients need to …

Could we exhale, my children and I?

Pam Kress-Dunn

Patient

December 24, 2013

When he was five, my son Daniel went through a rough patch with his asthma. Both he and his sister Allison had been diagnosed the year before, when we were living in Colorado. I never knew if it was the fault of the pollution that too often smeared our view of the mountains, or my then-husband’s two-pack-daily cigarette habit. Or was it the unspoken shriek of anxiety?

After I divorced my …

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Could we exhale, my children and I?

In the wake of Trayvon: A pediatric resident’s search for answers

Kendra McDow, MD, MPH

Physician

December 24, 2013

I heard the verdict in my car, driving from my birth home, Washington, DC to my new home, Baltimore, MD. I was stunned, my mouth agape and my mind muddled.

Not guilty.

Thoughts raced that hot July night, but mostly I cried and prayed. That Sunday morning I awoke with some clarity, but more sadness and more determination to try to fix this perceived wrong. Reaching out for stability and peace that …

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