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Hospice care for the transgendered patient

Physician

July 17, 2013

Hospice faces numerous societal obstacles in providing care for transgender patients. I recently witnessed a striking example of this in our local community hospice. An elderly individual assigned female at birth (MTF) was suffering from metastatic cancer. Chemotherapy had proven ineffective and had left her profoundly weak and infirm. With no connection to her family, she had only a few friends to rely on, but even they were only available …

How big data is affecting medical judgment

Wes Fisher, MD

Physician

July 17, 2013

Decisions in medicine are supposed to rest on concrete observations and hard evidence.

Often, hard evidence does not exist or when it does, it isn’t used. Why is this?

Concrete observations, too, are increasingly missed as we stare at computer screens longer and patients less. Yet we persist. Why?

This is our reality now, our evolving medical world.

But if we stop and think about it, medicine, by definition, is a world of technological …

Doctors should give patients their damn data

Zackary Berger, MD, PhD

Physician

July 16, 2013

There are plenty of books out there to teach us how to boldly and proudly advocate for ourselves in the doctor’s office. Doctors have held the reins too long, goes the …

Protecting us from the terrors of unhealthy lifestyles

Margalit Gur-Arie

Health Policy

July 16, 2013

If a mosquito lands on someone’s head and you hit the mosquito with a shovel, is the death of the guy under the mosquito considered an unintended consequence?

So now we know that the government of the United States of America is spying on its own citizens, not specifically on any one in particular, but massively and indiscriminately collecting troves of data on all American people. All perfectly legal, …

After attending a medical graduation, a new sense of optimism

Steven Reznick, MD

Medical Education

July 16, 2013

I recently attended the University of Miami Miller School of Medicine graduation for the class of 2013. It had special meaning for me since this was the last group of students at the University of Miami Miller School of Medicine-Charles M. Schmidt Florida Atlantic University (FAU) joint venture to pass through my tutelage prior to the Boca Raton program becoming solely an FAU program.

One of the graduates visited my office …

Sedasys for anesthesia: Can a machine guide sedation?

Karen S. Sibert, MD

Physician

July 16, 2013

Movie buffs and science fiction fans certainly remember HAL, the computer in 1968’s hit movie “2001: A Space Odyssey”. Considered one of the greatest villains in film history, HAL was capable of reasoning and language processing to assist the astronauts on their space mission. Ultimately, however, HAL decided that its best course of action was to kill all the astronauts. “I am …

Do corporate wellness programs work?

Trudy Lieberman

Health Policy

July 15, 2013

On a recent trip to Lincoln, NE, I visited Lincoln Industries, a company that makes chrome trims for Harley-Davidson motorcycles. I was curious about the firm’s award-winning wellness program, especially since more employers are penalizing workers by making them pay more for their health insurance if they fail to meet certain health goals.

At the heart of Lincoln Industries’ wellness program is its Platinum Scorecard, which awards points to workers who …

Read more…

Do corporate wellness programs work?

Radiation exposure is related to the rise of a lawsuit culture

Dr. Charles

Physician

July 15, 2013

A study published in the British Medical Journal highlights the importance of carefully choosing which children should receive diagnostic CT scans. As a diagnostic test, CT scans utilize ionizing radiation that can cause cellular DNA damage, increasing the risk of cancer. Children who received a CT scan were 25% more likely to develop a cancer in 10 years after radiation exposure, according to a study of 11 …

Judiciously order CT scans to protect our children

Wendy Sue Swanson, MD

Physician

July 15, 2013

A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990′s and early 2000′s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate that for every 4 million pediatric CT scans preformed annually, some 4800 children will go on to develop cancer as a result. Like many studies published this decade, the …

Are physicians still responsible for mistakes in health care?

James C. Salwitz, MD

Physician

July 14, 2013

Who is responsible for mistakes in health care? Who should take credit for success or blame for failure? Most families, patients and obviously the courts, hold the doctor responsible. It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect. However, is this changing because of the Internet and big data?

In 2013, most patients have spent hours on the Internet …

How to know whether alternative medicine is safe

Juliet K. Mavromatis, MD

Medications

July 14, 2013

Recently a patient of mine brought in a bottle given to her by her acupuncturist. She had turned to acupuncture with my encouragement after traditional medicine fell short at addressing her chronic pain. Indeed, there is data to support the efficacy of acupuncture in the management of chronic pain. I was encouraged to hear that this treatment, often labeled as “alternative,” seemed to be helping her substantially.

However, my patient’s questions …

Caught in the sandwich generation: An excerpt from Mother Daughter Me

Katie Hafner

Patient

July 14, 2013

In 2009, at age 51, journalist Katie Hafner invited her elderly mother to move from San Diego to San Francisco and live with her and her 16-year-old daughter. Brilliant and funny, Hafner’s mother had also been a divorced alcoholic who lost custody of Hafner and her older sister when they were young …

One source of information that never feels overwhelming

Suzanne Koven, MD

Physician

July 14, 2013

A fascinating op-ed piece by Brigham and Women’s physician and Harvard Medical School professor Jerry Avorn appeared on June 11th in the New York Times. It’s called “Healing the Overwhelmed Physician.” What the ‘overwhelmed physician” about whom Dr. Avorn writes is overwhelmed by may surprise you.

It surprised me.

Looking at the title of the piece, I thought it might be about the emotional toll of practicing medicine, which may contribute …

Allowing patients to define a medical adverse event

Doug Farrago, MD

Physician

July 13, 2013

Patients do need the power to complain about bad doctors and, trust me, there are some bad doctors out there. That being said, the other way for patients to get some retribution is to stop seeing that doctor. Word of mouth will spread, like any other business, and that doctor’s business goes under.

Right now, state boards allow patients to complain about anything and they have to investigate that complaint. …

An ovary removed instead of an inflamed appendix: What happened?

Skeptical Scalpel, MD

Physician

July 13, 2013

On June 10, 2013 a 32-year-old pregnant woman was reported to have died after having an ovary removed instead of her inflamed appendix. As the infected appendix festered, she became septic and succumbed to multiple organ failure. This tragedy occurred in the UK in late 2011, but has just come to light.

How could this have happened?

Let me count the ways.

The surgery was performed by two trainee surgeons. Their …

What medicine has taught me about children

Edwin Leap, MD

Physician

July 13, 2013

I’ve learned a few things about children over the years. While most have come from raising children, the rest have come from caring for them as patients. Knowing children, knowing their hearts and their ways, gives me great joy. I like to think that as I know them better, I become more like them, and while my time on earth may not be any longer for it, it may be …

Finding and keeping great front office staff

Rosemarie Nelson

Physician

July 13, 2013

Your front office staff are the face of your practice — an expression of your practice’s philosophy, attitude, and values. So it should be a top priority to hire and retain top-quality people to fill such roles as receptionists, phone operators, medical secretaries, and transcriptionists.

But it can be a challenge to keep these people and keep their morale high because these positions often include high levels of stress for low …

MKSAP: 38-year-old woman with fatigue and dyspnea on exertion

mksap

Conditions and Diseases

July 13, 2013

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

A 38-year-old woman is evaluated for a 6-month history of progressive fatigue and dyspnea on exertion. Over the past 2 years she has noted episodes of hand swelling, joint pain, blue color change of her fingers with cold exposure, and difficulty swallowing. She takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), …

MKSAP: 26-year-old man with fever and lower abdominal pain

mksap

Conditions and Diseases

July 13, 2013

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

A 26-year-old man is evaluated for a 3-day history of fever, lower abdominal pain, tenesmus, hematochezia, and watery diarrhea. Seven months ago, he underwent a cadaveric kidney transplantation. At the time of transplantation, the transplant donor was seropositive for cytomegalovirus, and the patient was seronegative for this virus. Current medications are tacrolimus, mycophenolate …

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