Jess, like many parents, has been hearing conflicting information about what crying can do to your baby.
She wrote: “So, my husband and I accidentally let our kiddo (5.5 months) cry it out. So of course, I’m spending all sorts of time on Google finding out that I’ve caused long-term damage to my son and he’ll be more likely to get ADHD and …
Letting your infant cry it out: Will it hurt your baby?
I recently spoke at a symposium on nutrition and public health at the Tuck School of Business at my alma mater in beautiful Hanover, N.H., Dartmouth College. Among others on the panel with me was Richard Starmann, the former head of corporate communications for McDonald’s. Those with even a modest number of Katz-column frequent flyer miles can readily guess how often he and I agreed.
One point Mr. Starmann made, more …
Fixing obesity is not complicated
If you have been paying attention to US healthcare policy debates lately, you know that hospitals have a price problem. Walk across the street from one hospital to a competitor hospital, and you could easily find yourself facing a $30,000 increase in your medical bills. At one extreme for instance recent information shows that replacing your hip with a surgical implant might cost anywhere from $5000 to …
How Obamacare will largely eliminate price variations
As I began logging on to my third different hospital EHR (electronic health record) recently, I contemplated how much more of this I could take. Being less than a year from planned retirement, the nuances of learning a new EHR and CPOE (computerized physician order entry) system is not fun. Furthermore, every hour I spend learning a new and unique system is …
User friendly recording of data often seems like an EHR afterthought
To resuscitate or not to resuscitate, that is the question. Whether ’tis nobler to beat the heck out of a person on his or her way out in the hope of saving his or her one precious life, or to allow death to proceed at its own pace with expectation of a peaceful passing.
The United States has come a long way in the last 2 decades since 1991 when the …
Improving informed consent for resuscitation without playing God
In the business of medicine, one of the brightest hopes is the potential for re-optimizing our spend around what patients want. That’s important because decades of research in the field of shared decision making have shown that when there’s a range of options to treat a condition, informed patients choose less spending and less invasive treatment.
That’s a good thing.
Unfortunately, the University of Chicago …
Does shared decision making really increase health costs?
Look at this sample question from the American College of Cardiology self-assessment. Tell me whether you see the problem. (It came in a mass advertisement-email, so I don’t think it is a secret.)
Sample question
A 75-year-old woman is referred to you with a murmur. She has had the murmur for many years and has been followed by her primary care doctor. Recently she has noted increasing symptoms of shortness of …
Cardiologists should lead the way in shared decision making
One reason is to apply an extra “facility fee” to patients’ bills.
Another reason is that primary care docs generate a ton of money for the hospital. A new survey was sent to hospital chief financial officers across the nation and based on data submitted by 102 facilities, it found that PCPs generate more annual revenue than specialists do.
PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a …
Why do hospitals buy primary care practices?
For most of our patients, the student run homeless clinic is the last stop in a long, fruitless search for healthcare in the city of New Orleans. Recently, an insulin-dependent diabetic came in who had his insulin pump stolen, an unfortunate side-effect of homelessness. The physician prescribed a 150 dollar-per-month supply of insulin—far out of our price range—not knowing how much insulin costs. This was in addition to a sixty-dollar …
One expensive patient can prevent treating a dozen others
A few months ago marked the 20th anniversary of the launch of evidence based medicine (EBM). Now seems a good time for a retrospective. After twenty years what does EBM mean? Where has it taken us? What are the distortions and unintended consequences? You might be surprised.
What I intend to do is start with a little of the history of EBM, talk about the essential notion as originally conceived by …
Where has evidence based medicine taken us in 20 years?
Social media has opened a whole new world for patients. Now, information about disease is readily accessible and available to everyone. Certainly, there are issues with reliability and accuracy of internet sources and this can create uneasiness and misunderstanding for both physician and patient.
However, the internet can also provide many new therapeutic possibilities. In particular, online support groups, twitter chats and blogging can provide a positive outlet for patients suffering …
4 reasons why patients should blog
As a third-year med student, I was doing an ER shift when the call came through our dispatch: 56-year-old man, status epilepticus, being flown in from Yosemite, 10 minutes out. I watched the residents snap into a semi-ordered chaos. Ten crucial minutes. Prepping the trauma bay. Anticipating acute management, who was going to do it, half-tying the yellow paper gowns. Anyone who had looked tired didn’t anymore.
We raced in the …
Doctors think about their patients all the time after they leave
Google Glass will be like the Segway. It’s really cool but it will have only a few practical uses and won’t be a paradigm shifter. Segway never won widespread acceptance in a culture dominated by cars and Google Glass is unlikely to win over people who prefer to wear their smart phones on the waist instead of on their face.
Still, …
How doctors will use Google Glass
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During my ambulatory care rotation, I got the opportunity to tag along with my attending on a house call to a geriatric couple. The husband, “Joe,” had recently been in the hospital for severe respiratory illness. His wife, “Sally,” had recently fallen and broken her hip and was recovering from a hip replacement.
While my attending checked on Sally, he advised me to talk to Joe. We chatted a while about …
Why medical residents should do house calls
It is near impossible to escape the commanding news headlines: The horrific details that are emerging about the years of violent captivity of three women in a home in Ohio; The fifteen year old Californian teenager who was allegedly sexually assaulted by three boys and then committed suicide last September.
And, internationally, the tragic case of a 23 year old woman who was gang raped and beaten to …
Violence against women is a serious public health problem
Students wishing to go to medical school — premedical students — have gone through pretty much the same process for nearly a century. The requirements have some variability according to the whims of particular medical schools, but in general a person wishing to go to medical school needs a four year collage degree, during which he or she has completed two years of chemistry (including organic chemistry), a year of …
Let’s change the way we select medical students
You’ve heard all of the advice about backing up your computer regularly, making sure that you have your passwords stored in a safe place, protecting yourself against digital identity theft, but what does that have to do with providing care for a person with special needs?
Let’s count the ways.
First: Resources. Much of the information you need is online, and your personalized data may be password-protected. Anyone who has ever been …
Why caregivers should care about digital backups
The Atlantic this week published a provocative article entitled “The Robot Will See You Now.” Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care. In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?”
The IT version of health includes continuous medical monitoring (i.e. your watch will …
Will patients trade human imperfection for computerized perfection?
Every primary care doctor has had the experience of listening to a very depressed patient explain that things are hopeless, that chronic medical problems or financial setbacks or family conflicts have pushed the patient past his ability to cope, that he can’t imagine how things could ever get better, that he would be better off dead.
Unfortunately, suicide in the United States is increasingly common. An article in …
Suicide in baby boomers: Convince them that hope is not lost
Everyone is talking about health care costs these days. The presentations usually start with a chart of rising health care expenditures, the tip of the line pointing skywards. Next come exhaustive (and exhausting) tables, more charts, all punctuated with a final shrug of uncertainty from the speaker: What is the solution to rising costs? Of course, there is not just one.
But in the morass of data, we can lose the …
Address the financial burden of medical treatment
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