It occurs to me that I talk to my patients more about death and dying, than about sex. It is not that I lack interest or an appreciation of the importance of intimacy, but like most physicians I fall into the trap of fighting the dread disease, instead of focusing on the wonders and power of wellness. Still, we do not rise each morning planning for our demise, rather we …
The importance of sex in the midst of a cancer diagnosis
From gas stations to grocery stores, slender cylinders of nicotine “e-juice” seem to be available everywhere. On my drive to work, in fact, 2 new e-cigarette shops have opened their doors in just the last 3 months. So I was not surprised to read a recent report suggesting a rise in the number of teens trying e-cigs.
E-cigarettes deliver nicotine by heating nicotine-containing fluid into a vapor that is …
What a doctor learned from a visit to an e-cigarette store
The use of standardized or simulated patients (SPs) in medical education for the teaching and assessment of clinical skills has enormously expanded the opportunities for medical students and residents to develop and practice their skills in challenging and high-risk clinical situations without any risk to patients.
While many use these two terms interchangeably, most medical educators define a simulated patient as an individual who is trained to act as a real patient in order to …
Using simulated patients in medical education
I hear it over and over again.
From a nurse, “She can’t have povidone prep, she has a shellfish allergy.”
From the patient, “I can’t have the contrast because I’m allergic to iodine and shellfish.”
The list of allergies placed in the chart by a doctor, “Radiocontrast. Iodine. Shellfish.”
It’s not the fault of the patients who are typically repeating the medical misinformation they have been given. However, the medical professionals who perpetuate the …
I have a shellfish allergy. Can I have contrast?
The most commonly heard comment in healthcare these days is that we have to move from paying for volume to paying for value. While it may sound trite, it also turns out to be pretty true. Right now, most healthcare services are paid for on a fee-for-service basis — with little regard for the quality of that service. We clearly need to move towards value-based payments (sometimes referred to as …
Do safety net hospitals get penalized under new payment models?
Leana Wen’s Who’s My Doctor? campaign is an important step to help health care. She endorses a total transparency manifesto where physicians can describe their sources of revenue and other potential conflicts of interest. It’s an effort to build trust.
We can’t fix health care without patients’ help. A quick look at the numbers for chronic disease are compelling enough– half of Americans have at least one chronic disease, …
We can’t treat patients if they don’t trust us
The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for the delivery of care in the United States. It is, however, anything but comprehensive in scope, and the coverage has primarily focused on crashing websites, politics, calls for resignations, and …
Is health care a right or a business? It’s time to make a choice
I lost another patient to hospice last week.
She was 49-years-old. Three years ago, she was diagnosed with stage 3 cervical cancer. She was treated with surgery and chemotherapy and went into remission and stayed there until she died. After the chemotherapy, she stayed anemic. She was weak, didn’t take care of her insulin properly and didn’t eat. Her kidneys slowly lost function because of her noncompliance, her HgA1c climbed to …
Despite the current outcry over Healthcare.gov, Obamacare will soon bring 30 million Americans healthcare coverage. But if the website to signup may have lacked adequate planning, is our infrastructure for primary care ready? With some estimating a current shortage of 20,000 doctors, legions of new patients will add stress to an already crippled system. As a junior medical resident managing my own panel of outpatients at our local VA hospital, …
The key to saving primary care
Over the past 300 years, the peer review process has played an integral role in scientific publishing. If you don’t happen to spend your time injecting laboratory mice with toxic chemicals and submitting your results to the New England Journal of Medicine, here’s how it typically works: A manuscript is submitted to a journal using an online manager, after which editors screen the paper and decide whether it merits further consideration. At …
The problem with peer review in scientific publishing
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 33-year-old woman is evaluated for a 5-week history of whitish spots in the mouth and the back of the throat and discomfort with swallowing solid foods. This is her first episode of these symptoms. She has had no mouth pain, trouble ingesting liquids or pills, nausea, vomiting, diarrhea, fever, chills, sweats, …
MKSAP: 33-year-old woman with whitish spots in the mouth and throat
When I patronize a restaurant, I am fully aware that the restaurant staff’s goal is to serve me quickly and efficiently with few (or no) mistakes. Regardless of how ravishingly starved I feel, my severe hunger pangs do not propel me to the front of the line, nor do they make me more of a priority than another customer, no matter how much I moan and cry in agony. If …
The complexity of making health care a right
For at least two decades doctors, caregivers, the people they care for, and advocates have deplored the term patient or have been exposed to the arguments of those who deplore it. “Patient” has few defenders in an age in which Western consumers of health care insist on an equal voice in the management of their afflictions, and loathe ceding all power to those who are dispensing relief. This blog recently …
4 linguistic reasons to leave patient alone
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As a family doctor based in Brooklyn, New York, who has served the needs of my community since completing residency in 1982, I find myself with a unique privilege and opportunity to observe disease and wellness, the effects of lifestyle, policy and the collective efforts of myself and others, as we attempt to keep our patients well and affect the statistical bottom line. I’m typing this as I also think …
Diabetes: More than a word, much more than a diagnosis
Recently I was asked to intervene on behalf of a patient who, trapped by circumstance, was paying off an enormous bill for a lithotripsy procedure. What I uncovered wasn’t news, but it drove home how egregious the current system can be, why it so badly needs to be fixed, and how the Affordable Care Act (ACA) helps move us in the right direction.
The patient had health insurance through her husband’s …
Stop pursuing self-pay patients as a windfall opportunity
As a psychiatrist who is passionate about integrative mental health treatments, I was excited to spend five days recently in St. Petersburg, Florida for the annual conference of the American Board of Integrative and Holistic Medicine.
At the conference, I learned that even more than I previously realized, our ecosystem and environment have a profound effect on our happiness and wellness, and can either give us easy access to good food …
Should we consider an integrative psychiatry model?
Women in the Bronx get sick.
Pregnant women in the Bronx get really sick.
The patients of the Bronx live in a hard place that has some of the poorest zip codes in the United States. And if there’s anything I’ve learned from my medical training as a fellow at Montefiore — and now as an attending in maternal-fetal medicine — it’s that poverty can make you sick, not just theoretically, or …
Much is being made of the meaningful use requirement to use secure online messaging to communicate with patients about relevant health information. The new Stage 2 measure requires that more than 5% of unique patients seen by the eligible professional during the reporting period were sent a secure message using the electronic messaging function of certified EHR technology.
But to meet that goal, we have to get our patient population engaged …
How to improve patient engagement
How do we keep the well people well while managing the devil out of the 1%?
This is one of our most complex and challenging questions, and there is no simple answer — but we needn’t look far to see that progress is being made.
Judging from the unprecedented groundswell of interest in health and wellness — and the corresponding emergence of a “wellbeing economy” — I think it’s fair to say …
Health and wellness: We need to broaden our perspective
Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient’s chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he …
Patients must be given the results of their tests
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