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Doing more than necessary in medicine is the opposite of safe

Conditions and Diseases

August 23, 2013

In case you missed it, former President George W. Bush had a stent placed in one of the arteries that feeds his heart.

The 67-year-old came through the procedure with flying colors, we are told. Stents are tiny metal mesh tubes that get inserted into clogged arteries, essentially to prop them open.

Bush, heretofore thought to be in excellent shape, seems an unlikely candidate for the procedure. We hear tale of him riding his …

Putting the fear of God into people is bad medicine

Jennifer Gunter, MD

Conditions and Diseases

August 23, 2013

Emily Oster has a book coming out entitled Take Back Your Pregnancy. In preparation for the book launch, as most authors do, she wrote a nice piece in the Wall Street Journal about decision-making, risks, and how some of what OB/GYNs recommend during pregnancy isn’t always evidence based.

In particular, she mentions listeria, a bacteria that is a food borne illness with potentially devastating outcomes during pregnancy. Osher quotes the risk …

The decision to end a treatment is as important as the one to start it

Allen Frances, MD

Medications

August 22, 2013

We have become a pill popping society. It makes absolutely no sense that 20 percent of our population regularly uses a psychotropic medicine and that the United States has more deaths each year from overdose with prescription drugs than from street drugs.

The causes of excessive medication use are numerous — the diagnostic system is too loose; some doctors are trigger happy in. their prescribing habits; the drug companies have sold …

Doctor, if this were your child, what would you do?

Robert Truog, MD

Physician

August 22, 2013

Doctors are often asked what treatment options they would opt for if their patient was their own child.

Perhaps the most gratifying question I am ever asked as a pediatrician is, “Doctor, if this were your child, what would you do?” So often today, being a physician can feel like being a technician — parents come in believing they already know their child’s diagnosis from their Internet search. They know what …

How dieting endangers our children

David L. Katz, MD

Conditions and Diseases

August 22, 2013

Imagine a family — or for that matter, any number of families — in which everyone is hungry, thin as a rail, struggling to get enough to eat, and prone to starvation. Imagine the familial skin tautly stretched over protuberant ribs.

Now imagine that Mom — it could just as well be Dad, but we have data to suggest it is, indeed, more likely to be Mom — gazes dolefully at …

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How dieting endangers our children

We offer patients too many unproven treatments at too much expense

Peter Ubel, MD

Conditions and Diseases

August 22, 2013

pfo occluder

Ten years ago, my tennis partner suffered a stroke. He was a sixty-year-old at the time, working to move up into the top ten players in his age group. In the country! You could not have found a healthier sixty-year-old. He played tennis three-plus hours a day, scampering across the court like a hyperactive adolescent. In other words, he was not …

Doctors are conflicted about sharing discharge summaries with patients

Ishani Ganguli, MD

Physician

August 22, 2013

Whether it lasted hours or months, every hospital stay is chronicled in that one final document: the proverbial baton passed from a patient’s hospital doctor to his primary care provider better known as a discharge summary.

This report has always been available to patients after they fill out a decent amount of paperwork. In mid-July, Massachusetts General Hospital began sharing discharge summaries with all patients through an online portal. The move …

We have the potential to have the best health care system in the world

Aaron E. Carroll, MD

Health Policy

August 22, 2013

Every once in a while, I’m forced to engage the health care system in a more personal way. Yesterday was one of those days. First, one of my children (who shall remain nameless), decided to take a stroll in the mulch on Monday without any shoes. He managed to lodge an enormous splinter in his foot which I couldn’t get out. By the time I saw it that night, it …

The challenge of using health IT more effectively

Ashish Jha, MD, MPH

Health Technology

August 21, 2013

Just a little over four years ago, President Obama, in his inaugural address, challenged us a nation to “wield technology’s wonders to raise health care’s quality and lower its costs.” This was an awe-inspiring, “we will go to the moon” moment for the healthcare delivery system. But the next thought that ran through the minds of so many of us who work on health IT issues was this: how were we …

The physicians to solve the doctor shortage are already here

Karan Chhabra

Health Policy

August 21, 2013

Catherine Rampell recently wrote up an often-overlooked aspect to the doctor shortage debate:

Thousands of foreign-trained immigrant physicians are living in the United States with lifesaving skills that are going unused because they stumbled over one of the many hurdles in the path toward becoming a licensed doctor here.

The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most …

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The physicians to solve the doctor shortage are already here

We need to start a revolution in surgical education

Leo Gordon, MD

Medical Education

August 21, 2013

A few months ago I read an essay by Dr. Herbert Fred of Houston, Texas. After reading his essay, “Medical Education on the Brink,” I was inspired to start a revolution in surgical education.

His essay ends with the following recommendation:

“…raise the bar of performance in all training programs to a distinctly higher level, with excellence as the perpetual goal.”

As the Fourth of July approached, I began to …

AAFP: What does it mean to be a family physician?

Reid Blackwelder, MD

Physician

August 21, 2013

Paul Simmons’s recent post highlights the challenges family physicians face, both in practicing the full scope of family medicine and how we communicate about our profession. I couldn’t agree more that we must raise awareness about what it means to be a family physician and fight to ensure we can practice to the fullest extent of our credentials. Family physicians care for both genders and all ages. Our …

Pathologists welcome the opportunity for more direct patient care

Michael Misialek, MD

Physician

August 21, 2013

“How much time do I have?” was the first question Mrs. C asked.

She had called me in a panic. Earlier in the week, I had diagnosed her with breast cancer. She called me after learning the bad news from her radiologist. A whirlwind of appointments with oncology, surgery, and radiation oncology ensued, overwhelming her with information.

I knew her case — these cells and her pathology — well, having just presented …

A medical student’s lesson in cultural understanding

Natalie Wilcox

Medical Education

August 20, 2013

The presence of strong, independent women has been a constant throughout my life. Friends, teachers, mentors, aunts, cousins, and grandmothers have all helped shape my firm belief that gender need not be a hindrance and can indeed become a source of pride. Yet the most influential and compelling woman will always be my mom, and for me, no story of admirable females can go without mention of her.

On a rainy …

5 ways Google Glass can be used in a hospital

John Halamka, MD

Health Technology

August 20, 2013

I recently had the opportunity to test Google Glass.

It’s basically an Android smartphone (without the cellular transmitter) capable of running Android apps, built into a pair of glasses. The small prism “screen” displays video at half HD resolution. The sound features use bone conduction, so only the wearer can hear audio output. It has a motion sensitive accelerometer for gestural commands. …

How fear affects cancer survivorship

Jessie Gruman, PhD

Patient

August 20, 2013

A recent Wall Street Journal article about how post-traumatic stress syndrome can be caused by cancer and stroke brought to mind the variety of responses many people experience in response to cancer diagnosis and treatment. The lingering intensity of those responses – physical, psychological, social and behavioral – can affect whether and how we attend to the tasks of survivorship; that is, monitoring and addressing the unique health challenges that follow treatment …

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How fear affects cancer survivorship

The complicated existential dilemma of living with cancer

Don S. Dizon, MD

Physician

August 20, 2013

Maybe I should’ve noticed how she looked. “She” was a new patient, Louise*, and she had been diagnosed with stage IV cervical cancer. Only in her 40s, the diagnosis had hit her extremely hard. At her first meeting, she wanted the “truth,” and I had told her what I felt to be most relevant — that her cancer had spread, that …

When evaluating mental health patients, go beyond snap decisions

Greg Smith, MD

Conditions and Diseases

August 20, 2013

It is tempting to use our sense of sight to make snap judgments about people, places and things.

Think about it. When you walk into a restaurant, if you see a sparkling clean dining room, you probably assume that the kitchen looks the same and that the food will be prepared in a clean, safe environment. When you see a well-dressed pilot and crew walking onto an airplane that has been …

Why does Ezekiel Emanuel have such a low opinion of physicians?

Jordan Grumet, MD

Health Policy

August 20, 2013

A study in JAMA suggested that physicians feel that other players (lawyers, insurance companies, hospitals, etc.) are more responsible than doctors for reducing healthcare costs. Furthermore, they are hesitant to promote reforms that eliminate the current fee for service payment system.

Although I would bet the no one would be surprised by these findings, a scathing editorial by Ezekiel Emanuel and Andrew Steinmetz caught my eye. Before I get …

George W. Bush’s angioplasty: Did he receive the best care?

Albert Fuchs, MD

Conditions and Diseases

August 19, 2013

Former president George W. Bush underwent an angioplasty recently, and the details sparked a public debate about the controversies of heart disease treatments.

His spokesman stated that he underwent a routine physical exam and had no symptoms of heart disease. A stress test showed EKG changes and a CT angiogram found a blocked artery. He was transferred to another hospital and underwent an …

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