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Atul Gawande provides clues on how to change doctor behavior

Kevin Pho, MD

KevinMD

August 13, 2013

We’re spending an inordinate amount of time and effort trying to convince doctors to change the way they practice.

Most recently, for instance, a study came out saying that doctors aren’t following back pain guidelines. Or from a broader perspective, consider the Choosing Wisely campaign, which lists scores of tests and treatments that are ordered too frequently.

Various carrots and sticks have been used to steer …

Hallways are no places for psychiatric evaluations

Greg Smith, MD

Physician

August 13, 2013

A commenter recently asked the other day about staging patients, especially mental health patients, in the hallways. This is sometimes done, along with triage and initial assessments, because of the very real lack of appropriate space in a busy, full emergency room. What do I mean by this?

Well, as any of you know who have ever been to the ED for anything at all, once you get through the front …

How do I live longer? Here are 10 ways backed by evidence

Alex Lickerman, MD

Conditions and Diseases

August 12, 2013

Patients often come to me seeking advice about what they can do to live longer. The number of things that have been proven to extend life, however, remains shockingly small. What follows are things that have enough support in the scientific literature that I generally recommend them (though the strength of the evidence varies even with these):

Take simvastatin (brand name Zocor). That is, if you have coronary artery disease. (This is one of …
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How do I live longer? Here are 10 ways backed by evidence

Parenting and families: Are we focusing on the wrong debate?

Claire McCarthy, MD

Physician

August 12, 2013

We have got to stop talking about stay-at-home vs. working mothers as if it were some sort of debate, as if it were the central issue of parenting and families. It’s not.

I am really annoyed by an installment in The Debate, a blog on Huffington Post in which Lisa Heffernan says that she regrets being a stay-at-home mom. She laments her loss of income (which she clearly didn’t need), and that …

Should intern boot camps be mandatory after medical school?

Skeptical Scalpel, MD

Medical Education

August 12, 2013

A concept that has been percolating in the medical literature boiled over into the mainstream as the New York Times published this story, “Chicago’s Intern ‘Boot Camp’ is a rehearsal for life or death medical issues.”

The article describes a new internal medicine intern having to deal with a simulated patient who is critically ill and has alarms going off.

Another intern had to tell a “patient” played by an actor …

How an iPhone improved patient care in the ICU

Iltifat Husain, MD

Health Technology

August 12, 2013

At iMedicalApps we have traditionally expounded on how smart phones can help us with patient care in regards to providing Physician centric tools at bedside. These range from drug reference tools to various clinical algorithm medical apps.

But there are also non-traditional methods where smartphones enable us to improve patient care at the bedside. These are subtle, but can be equally or more powerful.

When I was working in the ICU recently, there were …

Fish oil and prostate cancer: Go beyond the headlines

David L. Katz, MD

Conditions and Diseases

August 12, 2013

I suppose it may help diffuse any relevant tensions to get the punch line out of the way: I have a prostate, and in the context of my mostly-plant diet, will continue to eat fish and take a daily omega-3 supplement (krill oil in my case). We will, as well, continue using various omega-3 supplements in varying doses for specific therapeutic purposes in my clinic.

And now, let’s turn to the …

Thousands of dollars are put at risk with a single click of a button

Wes Fisher, MD

Health Policy

August 12, 2013

There is so much entropy in health care right now. So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock. Shock at prices, shock at waiting times, shock that doctors don’t know how to increase referrals, shock that doctors aren’t doing more to help. What gives?

In triage, you don’t spend time with the expectant.

Doctors are keeping their heads down. They are still seeing patients. They …

We face an epidemic of excessive busyness

Suzanne Koven, MD

Conditions and Diseases

August 11, 2013

In the past few years, I’ve observed an epidemic of sorts: patient after patient suffering from the same condition. The symptoms of this condition include fatigue, irritability, insomnia, anxiety, headaches, heartburn, bowel disturbances, back pain, and weight gain. There are no blood tests or x-rays diagnostic of this condition, and yet it’s easy to recognize. The condition is excessive busyness. It’s one with which, as a fellow sufferer, I empathize …

Boston hospitals go Epic: Hear from a holdout

John Halamka, MD

Health Technology

August 11, 2013

In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic. Boston Medical Center is replacing Eclipsys (Allscripts) with Epic. Lahey Clinic is replacing Meditech/Allscripts with Epic. Cambridge Health Alliance and Atrius already run Epic. Rumors abound that others are in Eastern Massachusetts are considering Epic. Why has Epic gained such momentum over the past few years?

Watching the implementations around me, …

Observation status: How Medicare’s solution could make things worse

Robert Wachter, MD

Health Policy

August 11, 2013

There are tens of thousands of policies in Medicare’s policy manual, which makes for stiff competition for the “Most Maddening” award. But my vote goes to the policy around “observation status,” which is crazy-making for patients, administrators, and physicians.

“Obs status” began life as Medicare’s way of characterizing those patients who needed a little more time after their ED stay to sort out whether they truly needed admission. In many hospitals, …

The first time a patient asked me how I was

Jennifer Stella, MD

Physician

August 11, 2013

It was the third year of medical school. Month two. First afternoon of my primary care clinic, first patient. I felt overwhelmed and unprepared until I saw the brief chart note for F. He’d had a positive tuberculosis test for an employment physical, with a follow-up negative chest x-ray, but he was required to be on intensive, two-drug treatment for six months to prevent developing the condition. This was the …

Medical malpractice claims drag on too long

Peter Ubel, MD

Physician

August 11, 2013

I am very fortunate to have never been sued. That is not necessarily because of my amazing ability as a physician. I always practiced in Veterans Affairs medical centers, where my status as a federal employee meant I would not get sued by my patients. I also had an incredibly appreciative patient population.

But I know that most of my physician peers have been sued, successfully or unsuccessfully, at least once …

MKSAP: 19-year-old woman with progressively worsening diarrhea

mksap

Conditions and Diseases

August 11, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 19-year-old woman is evaluated for a 3-month history of progressively worsening diarrhea, abdominal pain, and weight loss. Her brother was diagnosed with Crohn disease at age 16 years.

On physical examination, temperature is 37.4 °C (99.3 °F), blood pressure is 110/65 mm Hg, pulse rate is 90/min, and respiration rate is 20/min. Abdominal examination …

Physician contracts and the female doctor

Linda Brodsky, MD

Physician

August 10, 2013

The healthcare workplace is undergoing profound changes. Where once a letter and a handshake were enough to create a life-long working relationship between colleagues, now the multiple work settings and relationships create many possibilities. Understanding not only how to get into the relationship, but also what might happen when you need to leave or are forced out of a relationship is critical.

True case report:

A woman internist arrives at work one …

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Physician contracts and the female doctor

Why a Miracle Whip advertisement is offensive

Dr. Charles

Physician

August 10, 2013

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I happened to see this Miracle Whip advertisement in a magazine left open by a patient in our waiting room, and I really found it offensive. Let’s dissect the ways in which this advertisement sullies the notion of food, and examine how far the concept of Miracle Whip strays from real food that should be enjoyed.

At the top of the page it …

More health information is not necessarily better

Jessie Gruman, PhD

Patient

August 10, 2013

Have you ever felt that claims about the effects of our access to new and more health information overshoot the mark? For example, you may be searching for help in understanding some ambiguous findings from diagnostic tests. Perhaps you think you are having troubling side effects from your new medication but then it may just be a reaction to something you ate last night. You may be hunting high and …

The demand apathy that doctors increasingly face

Jordan Grumet, MD

Physician

August 10, 2013

Monday afternoons are always the same. I pick up the kids from their grandparents. We drive home with their backpacks and a carton of home made food. We park in the garage, and carry all the contents of the car into the house. As the kids unload, I push the recycle container to the front for street pickup the next day.

Occasionally, I stop and socialize. Yesterday, I waited at the edge …

The very best physicians do not judge their patients

James C. Salwitz, MD

Physician

August 10, 2013

It occurs to me there are several keys to being an excellent physician. One must love science, enjoy hard work, have the courage to make tough decisions, carry a modicum of intelligence and suffer angst at receiving 94% on an organic chemistry test. In addition, the very best physicians, those we admire and to whom we flock, have a secret weapon. They do not care.

I do not mean that they …

MKSAP: 58-year old woman with fatigue and weight loss

mksap

Conditions and Diseases

August 10, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes no prescription medication, but she does take a daily over-the-counter multivitamin and a calcium supplement. She has a 50-pack-year smoking history.

Physical examination reveals a lethargic, ill-appearing woman. Temperature is 37.3 …