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Let’s stop worrying about what we call obesity

Conditions and Diseases

July 30, 2013

Should we call obesity a disease—or a condition?

This is a question that has become really controversial. This week, the Council on Science and Public Health of the American Medical Association (AMA) put out a report saying that obesity shouldn’t be classified as a disease. The next day, the AMA’s House of Delegates disagreed, saying it should be.

You know what I think? I don’t care.

It’s not that I don’t care about obesity. I passionately …

What doctors wear: Do we care too much?

Edmund Kwok, MD

Physician

July 30, 2013

What would you prefer your doctor to be wearing when examining and treating you or your loved ones? Most would likely reply with something along the lines of “it doesn’t really matter, as long as they are competent and do a good job.“

Except it does matter, apparently. So much so that there have been hospital/nation-wide policies surrounding the issue, and a recent surge in …

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What doctors wear: Do we care too much?

Lessons learned from a family meeting

Don S. Dizon, MD

Physician

July 29, 2013

Recently, my family experienced the loss of someone very dear- Uncle Peter. Peter was an ex-Marine, father of three men, and patriarch of my spouse’s family; not to mention, husband to my wonderful and artistic Aunt Helene. He had been admitted to an outside hospital with leg ischemia and was transferred to a tertiary facility. Unfortunately, things did not turn out …

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Lessons learned from a family meeting

Secrecy shrouds the prescribing habits of doctors

Tracy Weber and Charles Ornstein

Medications

July 29, 2013

You’re searching for a new primary care physician or a specialist. Is there a way you can know whether the doctor is more partial to expensive, brand-name drugs than his peers?

Or say you’ve got to find a nursing home for a loved one. Wouldn’t you want to know if the staff doctor regularly prescribes drugs known to be risky for seniors or …

The bar for becoming a stool donor just got higher

Michael Edmond, MD, MPH

Conditions and Diseases

July 29, 2013

Recently, I have spent a lot of time talking to patients, trying to explain why I’ve had to cancel their upcoming fecal transplant. The FDA has ruled that stool is an investigational new drug (IND), which now imposes a huge bureaucratic hurdle to getting a much needed therapy for patients with recurrent or intractable C. difficile infection.

Even before the FDA did this, there were already hurdles for patients who are really suffering …

Medical students: How to survive the 21st century medical school

Maureen Miller, MD, MPH

Medical Education

July 29, 2013

Congratulations on your admission to medical school! Your white coat ceremony is coming, and it’ll be grand. Your orientation leaders will suggest study skills, where to find scrubs and the best cheap supplements. Maybe more enlightened members of the faculty will remind you that medicine is really about the patients. If your parents are physicians, as so many medical students’ parents are—mine are not—they will reminisce about their own days …

Treating the psychiatric patient in the ED: 3 changes I’d like to see

Greg Smith, MD

Physician

July 29, 2013

“Most EDs do not have separate secure areas in which psychiatric patients can be held. They typically don’t have a psychiatrist immediately available to evaluate the patient and provide guidance on management, and they do not have extra nursing staff to monitor often unpredictable patients.”

This was a comment on one of my blog posts.

Well, we have been talking about the way psychiatric patients get to the ED …

Break the cycle of event centered care

Fred N. Pelzman, MD

Health Policy

July 28, 2013

Creating a patient-centered medical home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right.

We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path …

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Break the cycle of event centered care

The benefit of a public health degree in medical education

Joshua St. Louis

Medical Education

July 28, 2013

On a rotation in internal medicine last year during my third year of medical school, I spent several days watching the residents work to optimize a homeless patient’s insulin regimen. They were understandably concerned with his diabetes medications because he had been admitted in a diabetic coma, but the real reason for the coma, as far as I could see, had nothing to do with his medication regimen and everything …

Reflecting on DNR/DNI after being a code team leader

Robert Glass, MD

Physician

July 28, 2013

“Got a new admission for you. 93-year-old male with end stage kidney disease on dialysis, coronary artery disease, hypertension, diabetes, peripheral vascular disease here after being found unresponsive. Oh by the way, I think he’s DNR/DNI.”

It’s like music to the ears of any medicine resident. I’m still not entirely sure why this phrase brings such relief, but I’m in my last year of residency and still exhale a little bit …

Turning health care into a giant used car lot

Naomi Freundlich

Health Policy

July 28, 2013

I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing with delight once I’m gone, thinking, “I really pulled one over on that rube!”

And so it has come as somewhat of a shock to me that medical care has become …

Why more medical information does not lead to better health

Beth Waldron

Patient

July 28, 2013

As the director of a health education program at a public university, my work is predicated upon the belief that greater knowledge is the key to improving health outcomes. If patients and healthcare professionals simply had better access to the latest information on a particular medical topic—if they simply knew more about a diagnosis, treatment, or prevention strategy—then we’d surely see improved health outcomes.

I have come to realize this assumption is wrong. …

Suicide in female physicians: Recognize, respond, reconsider

Linda Brodsky, MD

Physician

July 28, 2013

More people are dying because they commit suicide than in motor vehicle accidents this year. The number of suicides is rapidly approaching the number of deaths from breast cancer. The trend upward has been noted for the past decade.

Physicians are the professional group with the highest rate of suicide. And studies have estimated that women physicians have as much as an eight fold rate of suicide compared to their male colleagues. Is …

How to aggressively pursue population health

David B. Nash, MD, MBA

Health Policy

July 27, 2013

A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert.

It strikes me that, in order to answer the Affordable Care Act’s call for us to aggressively pursue population health, we must first understand what the recipe calls for.

Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the …

Patients and clinicians don’t have the same goals in mind

Jessie Gruman, PhD

Patient

July 27, 2013

What we look for when we participate actively in our health care differs from what our clinicians, employers and health plans believe will result when we shift from being passive to active participants.

We don’t have the same goals in mind. Does this matter?

Ask patients who use the phrases “patient engagement,” “patient participation” or “patient empowerment” about their goals and we talk about having some measure of control over our health …

In medicine, trust needs to be built in a matter of minutes

Scott Finkelstein, MD

Physician

July 27, 2013

I was a very shy child. I never felt comfortable speaking up, especially in groups or in new situations. When asked a question in class, my heart raced, my eyes teared up, and I felt sweaty. As I grew up, these physical reactions subsided as I learned to internalize and manage this fear. But at that time, I could not have imagined that my professional career would depend upon my …

The unwritten contract: Cancer cannot be beaten any other way

James C. Salwitz, MD

Physician

July 27, 2013

I had a patient this week that really screwed up his medical care when he experienced a predicted side effect of curative chemotherapy. Despite clear instructions and access to every number my partners, my staff and I have, including office, triage, cell, and answering service, he did not reach out. Day-by-day he lay in bed, as he grew weaker and multiple systems failed. No one contacted me. Finally, he sent …

Haunted by an autism diagnosis: A sense of closure after 20 years

Lisa Shulman, MD

Conditions and Diseases

July 27, 2013

I believe most physicians have cases that haunt them, often patients whose treatment courses do not go ideally and who leave a mark on the physician, altering the way he or she practices ever after. When the physician is a surgeon, it might be a patient who died on the table. For a hematologist, it might be a patient with cancer who could not be cured. For a developmental pediatrician, …

Why you should never order a herpes IgM blood test

Jennifer Gunter, MD

Conditions and Diseases

July 27, 2013

Routine screening blood tests for herpes are not recommended by the Centers for Disease Control. When I say routine screening I mean a scenario such as, “I want to get checked for everything, ok?”

Blood tests for herpes do have a place in specific clinical situations, but that’s for another post.

But say you did get a herpes blood test (even though it’s not recommended many people seem to get it done) …