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The winds of change are blowing us out of the hospital

Physician

May 25, 2013

The sweat coalesced on my forehead. I leaned forward to push the weight of my body into the wheel chair. I was terrified. Behind me strode the baffled parents with their arms full of coats and scarves. The young boy shrunk into the chair and balanced his IV’ed arm on the rest, trying not to disrupt the tubing that had been so painfully inserted.

I was lost. A week into my rotation as a volunteer …

Who should be able to certify medical necessity?

Marjorie Stiegler, MD

Physician

May 25, 2013

These days, there is a lot of talk about expanding scopes of practice for the group of folks who used to be called physician extenders and then midlevel providers and more recently non-physician providers, many of whom are now getting degrees with the title “doctor” incorporated.

While it seems to vary, these folks may include nurses, physician assistants (one day to be called physician associates perhaps), pharmacists, and more. Lots …

Creating value for others boost to our happiness

Alex Lickerman, MD

Conditions and Diseases

May 25, 2013

The set-point theory of happiness suggests that our level of subjective well-being is determined primarily by heredity and by personality traits ingrained in us early in life and as a result remains relatively constant throughout our lives. Our level of happiness may change transiently in response to life events, but then almost always returns to its baseline level as we habituate to those events and their consequences over time. Habituation, …

Professionalism is not a stable trait

Patti M. Thorn, PhD

Physician

May 25, 2013

In my work as an academic medicine education specialist, and, perhaps more importantly, in my experience as a patient, I have observed time and time again a common scenario. I call it the grumpy physician trickle down scenario.

Here is how it plays out. A physician, likely good-hearted, well-intentioned, competent, and compassionate, develops frustration with system operations (scheduling, inefficiencies, miscommunication, the list goes on). The physician internalizes the frustration, perhaps believing …

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Professionalism is not a stable trait

Address the disease of residency work hours

Joyce Ho, MD

Medical Education

May 25, 2013

I knew from the beginning that residency would be one of the biggest challenges in a career in medicine and reading Dr. Pauline Chen’s article, “The Impossible Workload for Doctors in Training,” put into mathematical terms what I had been sensing all along.

In what other profession do you go through four years of undergrad and four years of $60k/year medical school, only to end up working 100 hour weeks for …

The dark side of social marketing to physicians

Hans Duvefelt, MD

Physician

May 24, 2013

As a Swede, I know all about socialized medicine. I grew up with it and I learned my trade in it. I worked under budget constraints, treatment protocols and formularies in the late 70′s and early 80′s while American doctors were essentially practicing the way they wanted here.

I remember one of my surprises when I arrived in this country: I had learned in medical school that trimethoprim-sulfa was the drug …

Think of a soda ban like seatbelts

Claire McCarthy, MD

Physician

May 24, 2013

soda

I’m sad that a New York judge struck down the 16-ounce size limit for sodas and some other sweet drinks. I think Mayor Bloomberg had the right idea.

I get that whole personal freedom argument (although the court just said that it was arbitrary and out of Bloomberg’s purview), that this was a “nanny state” idea. But honestly, when it comes to obesity, …

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Think of a soda ban like seatbelts

What is the excuse for not taking action on Alzheimer’s?

Alexander Halperin, DDS

Conditions and Diseases

May 24, 2013

Having early-stage Alzheimer’s, I get extraordinarily sentimental when I hear the words of songs when I go for early morning walks with my headphones on.

Yesterday morning, I heard the song, “Memories,” and some of the lyrics hit my heart, soul and mind. I looked up the lyrics on the Web: “Daylight (and the sun was about to rise soon after at that time), I must wait for the sunrise, I …

A proton therapy center opens: A radiation oncologist reflects

Miranda Fielding, MD

Conditions and Diseases

May 24, 2013

When I was a radiation oncology resident in Boston in the early 80’s, a few brilliant minds in physics and medicine came up with the notion that it would be a good idea to treat certain cancers with a beam of protons. Protons are the positively charged particles which are created with a hydrogen atom is split into its component parts, a proton and an electron. When accelerated towards a …

English is the second language of medical documentation

Yul Ejnes, MD

Health Technology

May 24, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

English is the international language of medicine, according to many. Regardless of whether that is true, what is becoming increasingly clear is that English is the second language of medical documentation. For those of you who blame EHRs for this, the replacement of English by something else started …

Don’t call me a health care consumer

Jessie Gruman, PhD

Patient

May 24, 2013

The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services. But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service. Two phrases commonly used to describe us …

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Don’t call me a health care consumer

Transitional care programs are ripe for innovation

Michael Cetta, MD

Health Policy

May 23, 2013

Right now hospitals around the country are being asked to reckon with some stark realities regarding readmissions. $17 billion a year is spent on readmissions for Medicare patients alone, and 75% of those readmissions are considered to be preventable. Of all Medicare patients who are admitted to a hospital, 18 percent will be readmitted in 30 days and of those, 50 percent will not have seen a primary care physician …

Family medicine residents need to learn reproductive healthcare

Alison Block, MD

Medical Education

May 23, 2013

Jennifer was one of my first patients as a new doctor, and she came to see me about an unintended pregnancy. A single mom to a rambunctious 5-year-old girl, Jennifer was struggling economically and battling depression. We talked about the options available to her: continuing the pregnancy and preparing to parent another child, offering the baby for adoption or having an abortion. She chose to continue with the pregnancy, and …

It’s time to treat mental illness in the ER with dignity

Greg Smith, MD

Physician

May 23, 2013

We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at them, and not think that they are stupid, crazy, or horrible. A tall order, granted, given that we hear stories that sometimes border on the unimaginable, bizarre and otherworldly. This …

The impact of outdated communications technologies in healthcare

Sean Kelly, MD

Health Technology

May 23, 2013

As a physician, I experience first-hand the impact that internal communication at a hospital—both good and bad—has on patient care.

If I am able to quickly access clinical systems, analyze patient information and collaborate with colleagues, I can diagnose and interact with the patient much more efficiently and effectively. Conversely, breakdowns and inefficiencies in the communications process can inhibit the delivery of quality patient care by bogging down workflows, creating delays …

Practice hassles are threatening our profession

Robert Centor, MD

Physician

May 23, 2013

Do you know anyone who has tried to find an internist recently? Good luck. Internists are either overflowing with patients, switching to retainer medicine, switching to hospital medicine or quitting. Internists are frustrated, burned out, and unhappy with the external transformation of our wonderful profession.

We spend 20 years in school, and then 3 years of residency training. We learned to think and apply our cognitive expertise to the diagnosis and …

Finding a doctor online and researching your physician on the Internet

Kevin Pho, MD

KevinMD

May 23, 2013

Part of the KevinMD toolkit series.

“How can I find a doctor online?”

A seemingly simple question, but patients are often confronted with too much information on the Internet, with variable quality.

Finding a doctor a similar to completing a puzzle. Like puzzle pieces, there are many resources available, including word of mouth, hospitals, insurance companies, and physician rating sites.

Don’t …

Is drug resistant bacteria a major public health issue?

Colin Son, MD

Conditions and Diseases

May 23, 2013

Infectious disease is the most hyperbolic of all medical fields, at least when the media gets ahold of such.

Right now we are to fear a new avian influenza virus. Previously there was another avian influenza strain whose outbreak threatened the world and of course SARS and, more distantly, the ebola virus and the threat of bioterrorism. And on the …

When patients rely on financial assistance programs for drugs

Nancy Meredith

Medications

May 22, 2013

I had been laid off a few months when my ulcerative colitis kicked in, and my doctor and I struggled to get it under control. After trying a variety of medicines, my health continued to deteriorate and I agreed to take Remicade.

Remicade is a potent drug, administered through an IV infusion at the oncology center that comes with a whole host of potential side effects. The dosage requires an initial …

Why banning curbside consults may not be the answer

Robert Wachter, MD

Physician

May 22, 2013

Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge conversations that aren’t about sports, Wall Street, or ObamaCare.

Consultants hate being asked clinical questions out of context; they know that they may give incorrect advice if the underlying facts and assumptions aren’t right (the old garbage in, …

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