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End of life discussions require all hands on deck

Physician

April 16, 2013

When I attended the Association of Health Care Journalists (AHCJ) conference in Boston recently, discussion swirled on the topics of unsustainable costs of care, doctors’ incentives under traditional payment models to order more tests and treatments, and the struggles of patients’ family members to avoid unwanted care at the end of life. That Sunday night, I was back at my day job (so to speak) in …

How the nanny state mentality hurts public health

Sherry Pagoto, PhD

Conditions and Diseases

April 16, 2013

tanning salon

When my daughter was born, I hired a nanny. Her name was Kelly. She was great, a savior. She collaborated with me in running the household, enforcing the rules of the home. She even had a set of her own rules. I learned from her and her rules because she had more experience tending children than me. She wasn’t a dictator, …

What happened in the wake of 9/11 saved lives in Boston

Miranda Fielding, MD

Physician

April 16, 2013

Today the road all runners come,
Shoulder high we bring you home
And set you at your threshold down
Townsman of a stiller town.
-A.E Housman

As the afternoon’s events unfolded, I sat glued to my computer screen between patients. My life has really been a tale of three cities—Houston, Boston and San Diego. Boston was where I did my residency training, met my husband, had my three children and my first “real” jobs. I …

After the Boston Marathon, we are just like the rest of the world

Natasha Deonarain, MD, MBA

Physician

April 16, 2013

A few years ago my best friend ran the Boston Marathon. She came back glowing, proud that she’d qualified, amazed by the crowds and energized by the feeling of community. Never once did she think that she could have died from a bomb exploding at the finish line.

America seems to be facing tragedy after tragedy. From the Aurora shootings, to Sandy Hook Elementary, to the Boston Marathon bombings, each time …

We should tell our medical histories to our children

Dr. Charles

Physician

April 16, 2013

There was an article in the New York Times recently about the importance of cultivating a family narrative to instill a sense of identity, control, and resilience in children. The more children know about their family story, the better equipped they are to handle stresses that would shake their foundation. Is it possible that, in the realm of personal health and well being, the cultivation of an …

Boston rises in the wake of tragedy

Kevin Pho, MD

KevinMD

April 15, 2013

boston marathon explosion

“Daddy, a bomb blew up in Boston!”

That was how my 4-year old greeted me when I came home this evening.

Of course, I already knew about the horrific attacks during the Boston Marathon, first on Twitter, then realizing the gravity of the event as mainstream media caught up.

I practice in Nashua, NH, which is about 45 minutes north of Boston. But …

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Boston rises in the wake of tragedy

Prevent physician burnout with these 2 mobile apps

Dike Drummond, MD

Health Technology

April 15, 2013

Forget Angry Birds and other mobile apps that do a great job of helping you waste time. And set aside for now the apps that help you find information and practice clinical medicine more efficiently. It was only a matter of time before mobile apps would be developed that can actually help you prevent physician burnout.

Here are my two favorite free mobile apps to help you lower stress and create …

The fallout of chance medical findings

Kevin R. Campbell, MD

Physician

April 15, 2013

I can remember making rounds with a seasoned surgical attending in medical school. In typical fashion, surgical rounds were a lot like the military. The “General” (attending physician) at the front, always commanding respect (and often fear) followed by the chief resident, junior residents, interns and finally medical students. Cases were presented, statuses were updated and plans were formulated. Then came the barrage of medical fact questions–mostly directed at the …

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The fallout of chance medical findings

Hospitals are still awful: The movement toward patient centered care

Janice Boughton, MD

Physician

April 15, 2013

First a disclaimer: People often receive compassionate, considerate and effective care at hospitals. They have countless interactions which impart the miracle of human caring and enrich their lives. It is also institutionally prevalent to have haphazard care with poor communication, near misses and avoidable misery.

I have been working at a university hospital emergency room as part of a mini-fellowship in bedside ultrasound. It is the first time I have spent …

Medicine and climate change have common elements

Michael Kirsch, MD

Physician

April 15, 2013

On the morning that I began this post, I read in our local newspaper that Tennessee is soon expected to have a law that would permit public school teachers to offer views on climate change and evolution that are counter to orthodox doctrine on these subjects.

No, I don’t think that creationism is science and it should not be disguised as such. Global warming, or climate change, however, is more nuanced. …

The rise of ultimatums in medicine: Do they work?

Katie Noorbakhsh, MD

Physician

April 15, 2013

Has anyone else noticed the growing presence of ultimatums in medicine today?

The New England Journal of Medicine published a discussion of the ethics of not hiring smokers. My hospital adopted this policy six months ago, and they are not alone. There is a tobacco blood test that new employees have to pass. If they fail, they can look for a job elsewhere. I do not know the exact details, but …

No one asks oncologists how they feel

James C. Salwitz, MD

Physician

April 15, 2013

I was watching a macho shoot-em-up movie the other day; the type where everyone shoots everyone and in the final scene, the dirty blood-stained hero rides homeward on a helicopter or maybe a horse, into a red sunrise or sunset. He stares blankly, focused on nothing, focused on everything, his look reflecting the turmoil of what he has seen, done and lost. The hero’s grease-smeared face shows the understanding that …

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No one asks oncologists how they feel

8 surprising thoughts about patient wait times

Adam Banks

Physician

April 14, 2013

Every one of us feels a high level of anxiety when we are made to wait. In grocery stores, we jockey back and forth to the line we perceive is moving the fastest and easily get frustrated when we choose the “wrong” line. When driving, we will swerve across multiple lanes of traffic to avoid a line at a toll booth or …

A more sustainable model of palliative care

Deep J. Shah

Physician

April 14, 2013

During morning rounds on my sub-internship, we always spoke softly about TG. There was never any good news. The 56-year-old writer’s lifelong battle with substance abuse was coming to an end – her heart, liver, and kidney were slowly failing. But TG’s devoted husband was in denial. And behind the scenes, we were struggling, too. The patient needed pain control, symptom management, and psychiatric support among other things. At this …

The flat and shrinking medical world

Mark J. Rosen, MD

Medical Education

April 14, 2013

Columbus gets the credit, but in 240 BC, Eratosthenes of Cyrene discovered that the earth was round. In 1990, the Hubbell telescope proved that the universe is expanding. In the 21st century we know that the world is round but with the Internet and smart phones, it feels small and flat. With ease of travel and technology, all aspects of modern life have changed, including medical science, practice, and education.

The …

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The flat and shrinking medical world

The largest barrier to achieving humanistic nirvana in medical care

Larry Istrail, MD

Physician

April 14, 2013

The dictionary defines humanism as “a system of thought that centers on humans and their values, capacities, and worth.” No sector of the economy comprehends this definition better than a small business. In a sea of competition, the small business whose primary focus strays from its customer’s best interests will surely sink. Those with business experience will undoubtedly attest that, whether in a hair salon or restaurant, a happy customer …

With health reform, flexibility is important

Rob Burnside

Patient

April 13, 2013

Flexibility is important these days, perhaps more than ever before. I’m reminded of this almost every time I order lunch at a fast food joint: “I’d like a double cheeseburger, please, with ketchup only.” “You mean ‘only ketchup,’ don’t you?” “Okay, a double cheeseburger with only ketchup.” “Right, got it, coming up!”

So many changes on the medical care horizon and everyone speaking a slightly different language — it’s bound to …

America’s health system is dangerously out of balance

Brian Klepper, PhD

Health Policy

April 13, 2013

For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives except going without or going broke.

Steven Brill’s recent cover story clearly detailed the predatory health care pricing that has been ruinous for many rank-and-file Americans. In Brill’s report, a key mechanism, …

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