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Force feeding in Guantanamo: Why doctors shouldn’t participate

Physician

October 3, 2013

Nearly every physician regards himself as an ethical practitioner. Nearly none of us are, at least not fully. There is no bright line that separates ethical from improper behavior. Indeed, it is because the boundary is fuzzy that ethicists and the rest of us wrestle with contentious controversies. It is, therefore, expected that ethicists are divided on many issues, much as the U.S. Supreme Court is often split in its …

6 thoughts after testifying at a medical malpractice trial

Robert Centor, MD

Physician

October 3, 2013

A few weeks ago I was an expert witness in a malpractice trial. In this post I will use generalities and specifically not reveal any details of the patient or the court case. I first became involved in this process several years ago. My involvement included a deposition, reviewing medical records, reviewing other expert depositions, discussing the patient’s most unfortunate story with lawyers for two different defendants, and finally testifying. …

Preventing disease is a problem for the health industry

Rob Lamberts, MD

Physician

October 3, 2013

“Daddy?”

“Yes, Jonathan?”

“Sometimes my leg hurts.”

“Yes?”

“Why does it hurt?”

“Uh, that’s a tough question. Does it hurt a lot?”

“No, just every once in a while.”

“OK, and where does it hurt.”

He gives an expression of disbelief at the stupidity of the question. ”My leg!”

“Where on your leg?”

“I don’t know,” patience now growing thin. ”I just want to know what’s causing it.”

“Well, Jonathan, it doesn’t work that way. My main job is to make …

How to ensure you receive the right amount of care

Leana Wen, MD

Physician

October 3, 2013

In a recent blog post, I discussed the harms of a new epidemic: too much medical care. We also don’t want the opposite. In fact, much of the driving force leading to overdiagnosis and overtreatment is this fear of rationing.

So what can you do to ensure that you obtain just the right amount of care?

It isn’t easy — if it were, if there an algorithm that would give …

Real patient engagement depends on defining it correctly

Leslie Kernisan, MD, MPH

Physician

October 3, 2013

What is patient engagement?

Everyone agrees that it’s a good thing, and that we healthcare providers should be fostering it.

How to do so, however, depends on just what you believe patient engagement means.

As Dan Munro recently pointed out, the term “patient engagement” is a hot buzz phrase, and — in the best tradition of such phrases — it’s amorphous enough and appealing enough to mean just about anything.

Provided …

Why I stopped working with mail order pharmacies

Deep Ramachandran, MD

Medications

October 2, 2013

Mail order pharmacies like Express Scripts and Medco have become increasingly prominent players in health care. But these companies are a lot more than simply mail order pharmacies, they are in fact a new generation of pharmacy benefit managers (PBMs). PBMs are essentially middle-men between insurance and pharmacy, with companies like Express Scripts merging the dual functions of a PBM and pharmacist into one. PBMs manage and administer medication benefits …

Why the despicable deserve the best care possible

Greg Smith, MD

Physician

October 2, 2013

I received a very intriguing question the other day.

“What happens when someone despicable, someone who has committed some horrible act or made some terrible decision, comes in for evaluation or treatment and you have to see them?”

I have been asked to see child molesters of the worst kind, men (usually) who have done things so vile to children that it would make your stomach turn to hear about them. Having …

Social support matters in cancer survival

Suzanne Koven, MD

Conditions and Diseases

October 2, 2013

A study by researchers at Brigham and Women’s Hospital and Dana Farber Cancer Institute published in the Journal of Clinical Oncology confirms what primary care doctors already know: marriage is often, but not always, good for your health. The study found that among more than a million people with common cancers such as colon, lung, breast and prostate, those who were married were more likely to be diagnosed early and stick …

Fighting the patient-computer attention war

Sharon Parish, MD

Health Technology

October 2, 2013

I recently supervised a new intern as she conducted a patient interview. Following procedure, the intern reviewed the patient’s electronic medical record (EMR) and checked his lab results. She noticed that his cholesterol was high, and he told her that he had stopped taking his atorvastatin due to a recent trip to the Dominican Republic.

“It’s no problem,” my intern replied. “We’ll get you back on the medication.” She began to …

The OR is not a good place for a prank

Skeptical Scalpel, MD

Social Media in Medicine

October 2, 2013

An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.

According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”

And if that wasn’t bad enough, a “nursing attendant” took a photograph.

The patient, who said she had to quit her job …

Read more…

The OR is not a good place for a prank

4 myths and truths about milk

Naline Lai, MD and Julie Kardos, MD

Conditions and Diseases

October 2, 2013

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We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents.

Myth #1: Don’t give milk to a child with a fever; the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable …

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4 myths and truths about milk

Why solutions to mental health continue to evade us

Edwin Leap, MD

Physician

October 1, 2013

Another tragedy, another tragic series of errors, another avalanche of debriefings and politicization, and in Washington, DC, there are 12 more dead. What can we say about this? It seems that the standard commentary fails. Aaron Alexis was not an angry white man, nor a conservative. He carried no assault rifle and he had a secret security clearance. He doesn’t seem to have been motivated by race. He was a …

Why physicians will never learn to like EMRs

Margalit Gur-Arie

Health Technology

October 1, 2013

EMRs are not designed for patient care. Is there anyone working in health IT who can honestly say that he or she never heard this statement being made hundreds or thousands of times? Is there any clinician actually working with patients and EMRs who can state that such thought never crossed his or her mind? This includes health IT evangelists and physicians spearheading IT initiatives at the most excellent of …

Doctors can learn from how nurses provide care

Kevin R. Campbell, MD

Physician

October 1, 2013

In today’s health care environment, we are all driven to see more patients in less time and do more with less support. Obviously most of this is financially motivated — the delivery of medical care had unfortunately become more of a business than an art. As more physician groups are now owned by hospital systems, the “bean counters” and administrators are now …

Money driven care punishes both the rich and poor

James C. Salwitz, MD

Physician

October 1, 2013

Recently I met the husband of a patient with a diagnosis of advanced lung cancer. Even though she was young and had been healthy, the disease spread to her bones. I outlined treatment for this incurable illness: choices, goals and side effects. This was a very tough meeting, because by the end we had to discuss time as measured by dollars.

The particular challenge was that this family had health insurance …

Nonsensical recommendations from specialist physicians

Lucy Hornstein, MD

Physician

October 1, 2013

Recommendations. Specialists are full of recommendations. Sometimes they’re helpful, even lifesaving. Other times, not so much. I try to make a point of calling ahead and letting them know about special circumstances, but it’s tough getting past their nurses. Then again, even when I do get through to them, I’m never sure I’m getting through to them, if you know what I mean.

Specialist’s recommendation (ortho, seen for fracture):

Frequent falls resulting …

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Nonsensical recommendations from specialist physicians

The promise and the peril of big data in health care

J. Leonard Lichtenfeld, MD

Health Technology

October 1, 2013

There was a memorable scene in the movie “The Graduate” from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: “plastics.”

Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central …

6 tips for women physicians just starting internship

Linda Brodsky, MD

Medical Education

September 30, 2013

My introduction to internship was during my hooding ceremony at graduation when the revered Dr. David Wagner hooded me and told me that internship was a time to become “intimate with disease and the suffering caused.”

“You will live with it so that it becomes so much a part of you that you instinctively know what to do, what to expect, even without sleep, food or outside contact.”

Filled up with this …

Leadership and management define the core of emergency medicine

Anoop Kumar, MD

Physician

September 30, 2013

History’s great achievers — a Napoléon, a da Vinci, a Mozart — have always managed themselves. That, in large measure, is what makes them great achievers.

These are the words of Peter F. Drucker, father of modern management theory. They are especially relevant to emergency medicine today. The founders of our specialty and the wave of emergency physicians that followed them have carved us a unique position in the house of …

Technology alone won’t solve the suffering in our world

James Marroquin, MD

Physician

September 30, 2013

I recently attended a meeting in which a public intellectual spoke with boundless enthusiasm about the wonderful future medical technology will inevitably deliver to human beings.

His lecture went something like this: “Since the dawn of civilization, we humans have sought to transcend the limits of our condition. While we’ve long worked at this enterprise of empowerment, the arrival of the scientific method has radically accelerated the pace of change. With …

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