You get a terrible headache. What do you do next? Take ibuprofen and try to sleep it off? Call your primary care physician (PCP) for an appointment? Dial 911 for an ambulance to take you to the emergency department (ED)? What if that headache comes with a cough and shaking chills?
Would an ad influence your decision?
I came across this image …
Would an ad influence your decision to go to the ER?
In late fall of 2011, I was tired of medicine. While seeing patients was still enjoyable, I felt underappreciated in my employment and frustrated by the endless BS that I dealt with — new laws undermining the trust my patients place in me, increasing requirements from insurance companies for ordering tests or medications, more forms to sign, less time with patients, a cumbersome EHR to learn, more non-CME education requirements …
How social media recharged this physician
“What’s the most important finding on this chest x-ray?”
There he was, standing before 5 ICU residents, each peering at a chest film on displayed on the over-sized computer screen.
“Um, the pleural effusion?” whimpered a third-year resident.
“No!” barked the attending.
The others, standing dumbfounded in front of the computer display, searching for another finding but finding none, stood silently.
“Come on, folks! Look!”
And try as they may, no one saw it.
“The name, folks, …
Medical residents expect the data to be fed to them
It had all been so easy when Jim was still around. Lisa’s ex-husband had many shortcomings, but being a critical care specialist sure came in handy. Any time her mom or dad had a health crisis, he was right there in the middle of it: advocating, interpreting, breaking down the complexities into easily digestible morsels of information. But then Lisa’s father died, and the emotional and physical stress brought the unstable union …
If only the patient had an advocate
Since an iron lung costs quite a few dollars, the prevention of polio cannot make sense. Right? If that one has you scratching your head, with a “say what?” dangling from your lip, we are on the same page. Let’s populate it accordingly. Of course prevention can save dollars. But that will only be the case when what we refer to as “prevention” really makes sense.
Prevention isn’t about saving money: It’s about saving lives
Predatory Publishers, Batman! The news out of Gotham City (New York Times) tells a tale of deception and woe. “Pseudo-academia?” How can open access to information be a bad thing, and why does Nature call some of these journals “The Dark Side of Publishing”?
What is Open Access?
Open Access is a movement encouraging free and unrestricted access to published material. The movement takes many forms, from …
Your librarian can protect you against predatory publishers
New York City’s Health and Hospitals Corporation (HHC), which runs 11 hospitals in four of the five boroughs of New York, is negotiating a new deal with the union representing some 3,300 salaried physicians. The corporation wants to base MD pay raises on 13 quality indicators.
The New York Times article that broke the story does not list all of the indicators but mentioned the following: how well patients …
The problem of basing physician pay on quality indicators
A guest column by the American Medical Association, exclusive to KevinMD.com.
While the patient populations of individual physician practices vary greatly, nearly all physicians – regardless of practice location or specialty – see patients who have diabetes or cardiovascular disease or are at risk for developing them. Because cardiovascular disease accounts for one third of all deaths in the U.S., and 100 million …
AMA: A new initiative to improve health outcomes
Think of the last few times you watched a popular movie that involved any kind of sex scene? Not as in pornographic sex, but as in two characters ended up in bed together and had, ahem, conjugal relations.
In how many of those scenes did either participant make mention of a condom before the act?
We face a public health crisis of sexually transmitted …
Hollywood needs to make condoms sexy
Growing up, I am sure you heard many “why” questions, such as: “Why is your room so messy?” and “Why didn’t you eat your vegetables?” I am quite certain those questions made you feel defensive. Patients also feel defensive when we ask them ”why” questions. In other words, “why” questions set people off. These types of questions can turn a usually-friendly patient into an angry nightmare.
Here is an example. Your …
Stop asking why and strengthen your relationships with patients
The story of the surrogate offered $10,000 to have an abortion by the couple who were paying her to carry their pregnancy has been making the rounds. If you don’t know the details, let me catch you up
Surrogate parents must discuss abortion with their surrogate
An article from Sweden was recently published showing that in a very large group of women, over 60,000 of them, followed for 19 years as part of an also very interesting study of the effectiveness of mammograms, women who get more calcium, in their diet or as supplements, had a higher risk of dying of anything, but especially of heart attacks. It is …
A high calcium diet and calcium supplementation: Is it bad for you?
“I HEAR THEM! THEY ARE CALLING ME A CHEAP PROSTITUTE!”
Her shouting is like a gas: It completely fills the space, regardless of the size of the container. The sound originates deep in her abdomen and bellows from her mouth before reverberating throughout the room.
“THESE DISGUSTING MEN,” she shouts, “KEEP CALLING ME A WHORE! I AM NOT A WHORE!”
Her wrinkled hands flecked with liver spots loosely hold a fashion magazine open. …
The other people in the waiting room
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When the American College of Emergency Physicians (ACEP) decided not to join the Choosing Wisely campaign, I was among those who expressed disappointment with this decision, in part because I have long been a proponent of efforts to encourage more cost-effective care in the ED. In fact I had already independently done a significant amount of work in the development of such strategies.
I recognized that there were legitimate concerns …
Choosing Wisely: Less dogmatic language is needed
The practice of medicine is based on a solid fund of knowledge and a physician’s ability to quickly assimilate and organize information during a patient encounter. However, the process of making a diagnosis and formulating a treatment plan is not always straightforward. Often, what separates the truly exceptional physicians from the rest is the ability to attack problems from alternative angles–more simply put, creativity.
Traditionally, medical education is centered around science. …
Promoting creativity in medical education
This question was what drove me to graduate school for an MPH degree a few years ago. I was finishing up my family medicine residency at, arguably, one of the top residency programs in the nation. I had been well trained in both medical science and doctor-patient relationship skills. Yet my patients still consistently did not adhere to my advice.
I was not disappointed in my MPH studies. It turns out …
Why don’t our patients do what we tell them?
Where did the medical community get the idea that Vioxx, Trovan and Baycol were safe and the benefits of Prempro, Neurontin and bisphosphonates outweighed their risks? From research published in medical journals written by drug companies or drug-company funded authors.
Scratch the surface of many blockbuster drugs that went on to be discredited, or even withdrawn as risks emerged, and an elaborate “publication plan” emerges, developed by …
Planting drug industry-funded papers in medical journals
Having married parents is good for children. That’s why the American Academy of Pediatrics (AAP) thinks that same-sex couples should be able to marry.
In a policy statement, that’s exactly what they said. It’s going to put the AAP in the middle of controversy–but it was the right thing to do for children.
There are currently almost 2 million children being raised by gay and lesbian parents in the United States. And …
Same-sex couples should be able to marry: Why the AAP got involved
What does the 21st century physician look like?
I’ll admit that the question on the face of it struck me as a bit absurd, especially when juxtaposed with the term “tomorrow’s doctor.”
Tomorrow’s doctor needs to be doing a much better job of dealing with today’s medical challenges, because they will all be still here tomorrow. (Duh!) And the day after tomorrow.
(As for the 21st century in general, given the speed at …
The skills that tomorrow’s doctors will need
One of the toughest parts of treating patients is managing their expectations. We wish that everyone could enjoy a perfect recovery with complete healing, but the medical profession is imperfect and life is unfair. Some folks cruise by decade after decade without a scratch, while others sag under the weight of chronic illnesses.
Accepting reasonable expectations can change the game for patients and their families. If the patient’s expectations exceed what …
Accepting reasonable expectations is a gamechanger for patients
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