Lately, my virtual inbox in our electronic medical record has seen a surge in requests for prescriptions for the vaccine against herpes zoster, shingles. This has made me think a lot about our responsibility as physicians to inform patients about the evidence behind our recommendations – but who informs the patients when doctors are kept out of the loop or put under …
Many medical interventions are 50/50: Who informs the patient?
I recently tweeted about Danielle Ofri’s important piece, The Doctor Will See Your Electronic Medical Record Now. I like the piece, and especially like some of the quotes, but still I believe the problem needs an expanded take.
Context represents the major advantage of 38 years experience as a physician. Over time, one sees trends come and go. Hopefully one can see the strengths of the “good old days” and …
We need to reassess the patient note
The thing about science: it’s not a body of knowledge, or a list of facts. It’s a method. It’s looking at natural things, explaining them, and testing ideas to see if they’re right. More experiments (and better experiments) on more ideas leads to improved understanding and better ways to predict and influence what happens.
But science doesn’t go in a straight line. Not every study is valid, and not every idea …
How should doctors and patients look critically at medical decisions?
It was the beginning of my third year of medical school. I had just started my first clinical rotation. My very first patient was Ray, a middle-aged man with pancreatitis.
I presented his case to the team. “What are Ranson’s criteria?” the attending physician asked.
My mind went blank. “Uh, I’m not sure,” I said.
“Next time, you’d better be sure,” the attending said. He turned to my colleague, who promptly gave the …
Patients: Insist on being an equal and active partner in your care
I just left the most unusual conference I have ever attended. First, it was small: 25 invited participants. Second, it was all women. Third, it was all women who have done amazing things …make that “trailblazing things.” They were journalists at major news outlets, retired military officers from the highest ranks, senior leaders (in some cases, the most senior leader) at major federal and state health care agencies, Fortune 500 companies, large …
The broken window theory in health: Examples of graffiti we can fix
An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.
Do I really need an MRI? Do I really need blood work? This often? Should I avoid talking to my doctor and jump right to tests?
Americans love technology, whether it’s carrying the latest iPhone or buying the newest flat-screen TV with 3D technology. …
Should I avoid talking to my doctor and jump right to tests?
It happened to me again.
This morning I got another email from one of our physician practices:
“Our early morning patient was late today because she Googled our office and it gave her the wrong directions/location. Help!”
This is not a one-time thing. Over the last seven months that I’ve been in my new position (and the four years prior at my old position), I …
Fix Google Maps before patients start dying
In early December 2012, I experienced two life-altering events. First, on December 5, Sadie, my first grandchild, was born. Second, on December 8, I suffered a myocardial infarction. All things considered, I was extremely fortunate. Because I received outstanding care almost immediately, I survived the heart attack. But that night, as I lay in bed in the coronary care unit after undergoing an angioplasty and the placement of a drug-eluting …
Many physicians view retirement as a kind of failure
Technology in medicine advances at a rapid pace. In the US today most patients have access to mobile phones, smartphones and tablets. Medical device makers continue to innovate and create ways in which these technologies can be used by patients and physicians to monitor complex biologic machinery such as implantable cardiac defibrillators (ICDs) and pacemakers at home — without the need for …
Does home monitoring make a difference in cost and outcomes?
I remember when we dragged ourselves to the large lecture hall every morning, backpacks slung over our shoulders and cups of coffee in our hands. Six to eight hours of lectures awaited us.
I remember where we all sat in that lecture hall. I remember the future ophthalmologist who sat behind me and made snarky comments while certain professors gave their lectures facing the chalkboard. I remember students sitting six rows …
My classmates now look mature, which means I must look that way too
Simply not factual. That’s really all that needs to be said in response to Michael Edwards’ opinion piece entitled “Vaccine Side Effects and Why You Shouldn’t Vaccinate” published in Organic Lifestyle Magazine recently. This is clearly a non-peer reviewed, non-fact-checked online publication that Mr. Edwards edits and owns.
That being said, Edwards’ piece is so egregious I’m unable to hold my breath. Although I’m no watchdog, the dangerous writing demands physician attention partly …
Dangerous online writing demands physician attention
Do not now look for the answers … At present you need to live the question. Perhaps you will gradually, without even noticing it, find yourself experiencing the answer.
-Rainer Maria Rilke
Two men, Ted and Ron, were long-term professional colleagues. I do not believe that they were particularly close, but they had been acquainted during their working lives. Each had retired.
In what was a remarkable coincidence, both men were diagnosed with …
When surgeons and patients don’t tolerate ambiguity very well
As a medical educator in a hospital setting, I often tell first-year medical students about disparities in health care and about the vastly different quality of care that hospitals deliver, depending on their resources.
I tell my students how important it is to advocate for patients, to learn to navigate the healthcare system and to work respectfully with health professionals in order to get optimal care for your patients.
When my own …
With my son hospitalized, an opportunity to apply my teachings
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A newspaper story recently caught my eye when it headlined: “Senators Revive Push for End-of-Life-Care Planning.” It reported on new legislation making the rounds in Washington to address care planning for those with advanced illnesses.
You remember “end of life care planning,” don’t you? It was part of the Affordable Care Act debate several years ago, and quickly became translated intoRead more…
Make the difficult journey of cancer patients a bit easier
A version of this column was published in USA Today on July 3, 2013.
One recent day in my primary care clinic, I had a full schedule and was unable to see a patient for her cough. She instead sought medical care at a local drugstore, where she was treated for bronchitis. Normally housed in pharmacies and department stores like Target or Walmart, …
Drug store retail clinics for primary care? Not so fast
A guest column by the American Medical Association, exclusive to KevinMD.com.
Prescription drug abuse has reached crisis levels: overdoses and deaths from opioid analgesics have more than quadrupled in the U.S. since 1999. At the same time, a great deal of human pain and suffering remains inadequately treated. In fact, according to the Institute of Medicine, at least 100 million Americans suffer from …
AMA: Effective pain management with prevention of prescription drug abuse
Elton John had it right: “It’s sad, so sad. Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.”
Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?
Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double shift, …
After a medical mistake, an apology is both simple and difficult
The intestines, particularly the large intestine, are teeming with bacteria. They are piled on each other as dense as the above photomicrograph shows. The huge majority of them are what we call friendly bacteria: they live inside us, feeding off the rich stew of food we eat, but cause no disease. In fact, their presence is important to our health because they crowd out bacteria that cause disease — the …
C difficile in children: Do probiotics help?
One of the things I enjoy as an academic oncologist is the opportunity to teach. I like having students, residents, and fellows in my clinic and the opportunity for them to see what oncology is and what we do; how we “marry” the art and science of medicine in our routine care of patients with cancer.
For several years, I’ve co-directed an …
Inspiring a new generation of oncologists
We have done it. We have decreased the increase in the cost of health care. Let us explain. For three decades (1980-2009), the cost of health care has been increasing each year at an average rate of 7.4 percent — double the rate of inflation. However, over the past three years, the increase in health care expenditure has remained at a low 3.1 percent.
Is this decline …
The blueprint for decreasing the cost of health care
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