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Does the process of diseasification hold any promise in obesity?

Conditions and Diseases

September 5, 2013

In a thoughtful, measured and well-reasoned blog post, Dr. Keith Ayoob recently discussed the AMA’s decision to classify obesity as a disease. As he concluded his post, Dr. Ayoob wrote: “I don’t care how obesity is categorized. I care about what’s being done about it … We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether.” This got me thinking: …

Billing for end of life conversations needs to be an honest discussion

Shirie Leng, MD

Physician

September 5, 2013

Good old Earl Blumenauer. A bespectacled and bowtied Congressman from Oregon. He of the “death panel” proposal. Thank God he’s still here. Presuming that the crazy talk over the provision in the Affordable Care Act that would have paid doctors to discuss end-of-life issues with patients is over, he has introduced a separate bill with this provision and hopes to get it passed in the next couple of …

The primary care crisis has been legislated

Jordan Grumet, MD

Health Policy

September 5, 2013

It was the same years ago in residency. There was both a categorical and primary care residency track. Each had their own distinctive curriculum and rotation schedule. The outpatient track did more time in the clinic, the categorical more on the hospital wards. We trained side by side. We attended many of the same lectures. And our fellowship choices matched identically. In fact, most of my colleagues from the primary …

The difficult transition between the hospital and nursing home

Ken Covinsky, MD

Physician

September 5, 2013

nursing_home_abuse

Huge numbers of older persons transition from hospitals to the nursing home. Often, an older hospitalized patient needs skilled nursing care before they are ready to return home. In other cases, a nursing home patient who needed hospitalization is returning to the nursing home. Older patients and their families certainly hope that great communication between the hospital and nursing home would assure …

What health care in the United States can learn from Nepal

Brad Wright, PhD

Health Policy

September 5, 2013

Beautiful Nepal Photos (10)

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning …

Treating cancer patients puts everything else into perspective

Miranda Fielding, MD

Physician

September 5, 2013

When I was about ten years old, swimming on a Texas swim team, I remember hearing that the child of one of the local coaches had been diagnosed with leukemia. The idea of a kid dying of an untreatable disease was so foreign to me that I am sure that I have blocked out most of the details. I do know that the child died, and it didn’t take very …

10 questions to ask before anesthesia

Karen S. Sibert, MD

Physician

September 4, 2013

A guest column by the American Society of Anesthesiologists.

Not so many years ago, surgeons wouldn’t operate on patients they considered too old to tolerate the stress of anesthesia and surgery. Today, however, patients of every age — from Baby Boomers to the Greatest Generation — undergo anesthesia safely for surgery and diagnostic procedures.

Realistically, even if you believe …

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10 questions to ask before anesthesia

Are ADHD drugs responsible for mental illness in college?

Claudia M. Gold, MD

Medications

September 4, 2013

Recently, I “launched” my oldest off to college. As anticipated, it was an intense emotional experience full of joy, sadness, and many things in between. (I have to tip my hat to Beverly Beckham for her piece I was the sun, the kids were my planets that was very helpful. However, I might have written that my child was the sun, a burst of light in our household, and the experience …

Should school buses have seat belts?

Natasha Burgert, MD

Conditions and Diseases

September 4, 2013

Recently, parents all over the Kansas City area waited patiently for the news that the 6th graders were okay. Many were holding their breath.

And those of us whose children ever step foot onto a school bus, thoughts came to our brains that we don’t like to talk about.

The good news is that the kids were fine. Certainly shaken, but no critical injuries. The community is thankful …

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Should school buses have seat belts?

Hospitalizing people against their will: 4 questions to ask

Maria Yang, MD

Conditions and Diseases

September 4, 2013

Involuntary commitment refers to hospitalizing people against their will for psychiatric reasons. It is a controversial topic because this is where medicine and civil liberties intersect: Physicians have the ability to take away the rights of fellow citizens. (I suspect that few people who become psychiatrists realize that making recommendations about involuntary commitment is part of the job. I certainly did not know this. I also did not appreciate the …

Health care through the lens of a technology entrepreneur

Davis Liu, MD

Health Technology

September 4, 2013

If you want to see the future of health care, the can’t miss conference of the year is the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I had the opportunity to view health care through the lenses of technology entrepreneurs. I thought the conference was even better than the one I attended last year. Absent was the provocative rhetoric by 2012 …

How customer service mechanisms don’t exist in health care

Paul Levy

Health Policy

September 4, 2013

Now that I am a “civilian,” I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that …

Chronic Lyme symptoms after treatment deserve respect

David L. Katz, MD

Conditions and Diseases

September 3, 2013

One of the more salient and concerning items of medical news reported this past week is an analysis by the CDC indicating that there is 10 times as much Lyme disease in the U.S. as formal reporting channels suggest. Rather than the 30,000 official cases each year, which would already make Lyme the most common tick-borne illness in the country — there are roughly 300,000 cases. An increase in Lyme prevalence by …

The voices of schizophrenia: Treatment still has a long ways to go

Allen Frances, MD

Conditions and Diseases

September 3, 2013

Read the original op-ed from the TED speaker who inspired this post: “Why I Thank the Voices in My Head.”

Eleanor Langdon is an extraordinary woman who has shown remarkable grit and creativity in transforming her disturbing symptoms into useful tools. Hats off to her for finding such a fruitful path to personal recovery and for sharing her techniques and inspiring story so that others may benefit from what she has learned.

There are …

Drugs that are not FDA approved: Is there a time to prescribe them?

Juliet K. Mavromatis, MD

Medications

September 3, 2013

Here’s an interesting clinical dilemma brought to my attention by another physician.

She was asked to refill a prescription for a drug called domperidone to help a patient with lactation. Domperidone is not FDA approved in the United States for any indication. However, in Europe and in Canada it is approved as a promotility agent for patients with a condition called gastroparesis, which causes the stomach to empty very slowly and results in …

The knowledge that one wasn’t alone in an uphill fight

StorytellERdoc, MD

Physician

September 3, 2013

I smelled the patient, unfortunately, even before walking into his room to introduce myself. From the hallway, his odor of lingering stale smoke flared my nostrils, instigating childhood recollections of the wood-burning furnace at my grandmother’s home. From a distance, the scent of smoke was just that — charred-burnt air, its weight clinging to my nostrils. As I approached the patient, however, the scent of smoke smoldered my wishful memories …

What conditions are more amenable to watchful waiting?

Edward Pullen, MD

Conditions and Diseases

September 3, 2013

Watchful waiting has become a term often thought of as an alternative to surgery, radiation, or other interventions for early stage prostate cancer. Watchful waiting is actually a viable option for many other conditions too.

Most Mom’s know that tincture of time with watchful waiting lets their children have the opportunity to recover without intervention for many minor injuries and illnesses without exposing them to the risks associated with antibiotics or …

The hubris of medicine has to end

John Mandrola, MD

Physician

September 3, 2013

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

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The hubris of medicine has to end

Can telepsychiatry really work?

Greg Smith, MD

Physician

September 2, 2013

I have been asked one question about my work in telepsychiatry more that any other, hands down.

“Can you really help a mental health patient like that, through a television screen?”

The quick and dirty answer? Yes, absolutely.

The extended answer? Read on.

Psychiatry is an intensely personal specialty. It requires knowing yourself as a doctor, as a therapist, as a consultant, and as a person more than any other kind of medical practice I …

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Can telepsychiatry really work?

Your EMR is watching you

Skeptical Scalpel, MD

Health Technology

September 2, 2013

A recent article on American Medical News titled “Medical charting errors can drive patient liability suits” led with a case involving a bad outcome after coronary artery bypass surgery. The plaintiff’s attorney alleged that the doctors did not review the patient’s lab results or x-rays because they did not specific say so in the medical record.

The article quoted a defense attorney who said, “By the time [the doctors] are deposed, …

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Your EMR is watching you