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I’m addicted to prescribing pain medications

Anonymous

Physician

April 25, 2013

Hi. I’m a 44-year old emergency physician. And I’m an addict.

My addiction came to light when my Press Ganey scores plummeted after I started to stand up to the chronic pain and frequent ER patients.

The fact that I have an addiction was reaffirmed when I went to my state’s Prescription Drug Abuse Summit. When I saw so many professionals from varying fields (medicine, law enforcement, pharmacy, education) assembled, I realized …

12 tips to stay safe in hospitals

Leana Wen, MD

Physician

April 25, 2013

Hospitals can save you, but they can also harm you. So how can you stay safe in hospitals? Follow these 12 life-saving tips:

1. Never go alone. Always bring someone else—a trusted family member or friend—with you. That person will be your primary advocate, and can serve as an extra set of eyes and ears to help make sure you are safe. (This tip applies to routine doctors’ appointments too; always …

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12 tips to stay safe in hospitals

Is outsourcing medical diagnoses a good idea?

Joyce Ho, MD

Health Policy

April 25, 2013

I’m sure that many of you have read the New York Times post titled “Job Prospects are Dimming for Radiology Trainees.”

I don’t know about you, but this article made me feel more than ever that in order to choose the right specialty, you have to predict the future of the field. Don’t choose a field that’s going to be heavily affected …

Human nature prevents any cost savings at the end of the life

Steven Reznick, MD

Health Policy

April 25, 2013

We are frequently reminded by the General Accounting Office and CMS that a great proportion of Medicare health costs are incurred in the last three months of a patient’s life. Health care policy experts have tried to reduce these costs by encouraging end of life planning. Living wills, health care directives and the availability of hospice and palliative services will not put a dent in these costs because of human …

Building a true collaborative health record: Ask your patients

Rob Lamberts, MD

Physician

April 25, 2013

I’ve been going about this all wrong.

It’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the “collaborative record” that is wrong. It’s the fact that I am doing this without my most important resource: my patients.

I realized this while driving in to work this past week. My first patient was …

Lean in: The subtle complexity of having it all in medicine

Genevieve M. Boland, MD

Physician

April 24, 2013

As an intellectual female surgeon, I have always resented being pinned down by my gender. Throughout medical school, I refused to join “Women’s Societies”. I felt that these were excuses for disillusioned women to get together and complain that the reason they were not succeeding was their gender. I, on the other hand, did not feel limited by my gender nor did I hide it. Instead, I relished it. I …

Patient engagement: What doctors can learn from teachers

James Dominic O’Brien

Patient

April 24, 2013

As of late, patient engagement has been laudably deemed a “miracle drug,” a silver bullet slicing through the tangled morass that is our American healthcare system. The comparison may be hyperbole, but the potential impact of patient engagement does have merit. With engaged patients, medical problems can be diagnosed swiftly and treated with higher success rates. Illness can be prevented and emergency department usage can be abated. Care can be …

Why violence is an infectious disease

Courtney Schmidt, PharmD

Patient

April 24, 2013

Newtown. Aurora. Oak Creek.

A year ago, I’d never even heard of these places, and now those names are permanently imbedded in my mind along with the graphic images of suffering and death.

And now, people are finally talking about it. What can we do to prevent these tragedies? How can we protect our society from senseless bloodshed? I can’t help but think, though, that all of the arguing over guns misses …

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Why violence is an infectious disease

The state of online doctor ratings: It’s still early

David Williams

Physician

April 24, 2013

A front-page Boston Globe article on a neurosurgeon suing a caregiver for a harsh blog post is exciting but unrepresentative of the overall state of online doctor reviews. However it caused me to take another look at online physician ratings from the perspective of someone trying to find a doctor.

Conclusion: we are still in the early days and there is plenty of opportunity for better, more useful information. …

My hope for the upcoming generation of physicians

Karen S. Sibert, MD

Physician

April 24, 2013

My son has been accepted into medical school, we learned last week, and I must say I’m about as happy a mother and a physician as you could find anywhere. For everything that’s wrong with the American healthcare system today, medicine is a wonderful profession and it’s still the greatest honor in the world for a patient to have faith in your skills and care.

It will be interesting to see …

Why are some generic drugs so expensive?

Leslie Ramirez, MD

Medications

April 23, 2013

Two of the biggest -selling prescriptions of all time, Plavix, an anti-platelet medication, and Lipitor, a cholesterol lowering medicine, have been available in generic form since May 2012 and November 2011, respectively. However, most retail pharmacies are still charging patients $100-$200 monthly for these medications. Why? And what does this market oddity say about our chances of lowering healthcare costs in the United States?

Patients are used to paying a high …

The hidden curriculum in medical school

Ken Noguchi

Medical Education

April 23, 2013

As a first year medical student, one of our many responsibilities is to shadow a nurse once a month to gain an appreciation for their job. On one such shift, I asked my nurse-preceptor his greatest complaint about doctors. I expected to hear something about respecting nurses, or spending more time listening to the patients. Instead, I heard this:

“I wish doctors would communicate better with each other.”

Doctors are notorious for …

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The hidden curriculum in medical school

Primary care has lost its self-esteem

Michael Chen, MD

Health Policy

April 23, 2013

Several months ago, as I was in the last few months of my private practice, I watched the Joy Luck Club with my wife. I had seen the movie many times before, but somehow at that moment in time, when I was grieving for my practice and my profession, I began to have some startling clarity.

Specifically, I was particularly struck by this dialogue:

I tell you the story because I was raised …

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Primary care has lost its self-esteem

Can physicians really stop the actions of reckless caregivers?

Sherry Gorman, MD

Physician

April 23, 2013

In 2010, a surgical scrub technician named Kristen Parker was sentenced to thirty years in federal prison after allegedly diverting fentanyl from operating rooms, injecting herself with the powerful intravenous narcotic, refilling the contaminated syringes with saline, and replacing them to be used on patients. She was infected with hepatitis C, and her drug diversions infected over two dozen patients in the Denver area.

In 2012, David Kwiatkowski, also positive for …

Consider the quality of our caring, not just the quality of our care

Shanna K. Patterson, MD

Physician

April 22, 2013

I have kept some of my books from medical school displayed on the shelf, including suggested contemplative readings meant to tenderly inculcate students with a sense of compassion.

Like so many fledglings, we soar off into our chosen paths. Many new realities and considerations take hold. I shall refer to these as the “business, logistics and politics” of medicine. How can we ensure that we are adhering to the standards of …

I am called before the inquisition board: Welcome to modern medicine

David Gelber, MD

Physician

April 22, 2013

Today I had the displeasure of sitting in judgment before a modern inquisition at one of the hospitals I attend. Although the grand inquisitor lacked the trappings of a monsignor or bishop, and without a physical executioner in the room, I was subjected to round after round of questions regarding my apparent disregard for system wide medical and post surgical protocols. Such protocols have been adopted by CMS (which oversees …

How my geriatric practice works

Leslie Kernisan, MD, MPH

Physician

April 22, 2013

A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.

I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our …

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How my geriatric practice works

Are the days of screening colonoscopies numbered?

Michael Kirsch, MD

Physician

April 22, 2013

The medical arena, like society at large, is permeated with self-interest. This reality makes me very skeptical that comparative effectiveness research, which I support, will get airborne. In medicine, every heath care reform, new medicine, new medical device or revised medical guideline is at some constituency’s expense. Recognizing and dismantling conflicts of interests is one of our greatest challenges and threats.

When I …

As an oncologist, I hate running late

James C. Salwitz, MD

Physician

April 22, 2013

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day. However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve. I really hate it when patients are late.

Now, I have to admit this is a unique …

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As an oncologist, I hate running late

The role of remote patient monitoring in mobile health

David Lee Scher, MD

Health Technology

April 21, 2013

As defined in Wikipedia, remote patient monitoring (RPM) is: “a technology to enable monitoring of patients outside of conventional clinical settings (e.g. in the home), which may increase access to care and decrease healthcare delivery costs.”

I was a pioneer adopter of RPM as a beta site for Medtronic’s Carelink wireless system which monitors implantable cardiac rhythm devices (defibrillators and pacemakers). RPM has gained significant attention because of recently mandated penalties …

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