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Change the warfare metaphors when it comes to illness

Rob A. Ruff

Patient

April 12, 2013

The metaphor we use, almost universally, to describe the experience of illness is that of warfare. Someone diagnosed with cancer is said to be “battling” cancer (as if the diagnosis itself implies a fight). Family members often say that their hospitalized loved one is a “fighter” who “will never give up” or surrender. Doctors refer to the most potent antibiotics as “big guns” that are prescribed to “kill the bugs” …

The patient experience can be dehumanizing

Joyce Ho, MD

Physician

April 12, 2013

Being a clinical student is not a walk in the park. When we get together for “Reflections on Clerkship” days every two months in our small groups, students let the floodgates open about the hardships they have been facing on rotations. I am no exception. Transitioning to a strict schedule in the hierarchical world of academic medicine has been no small feat. In fact I was planning earlier this morning …

The male gynecologist: Tips to connect with female patients

Suzanne Hall, MD

Physician

April 12, 2013

With all due respect to the many caring, compassionate, and skilled male OB/GYN physicians out there, we’d be amiss in ignoring the research showing a near majority of younger women preferring a female gynecologist. Some call this reverse discrimination in gynecology. I’d more simply call it patient preference. The bigger question is, “Where does this leave the male gynecologist?”, especially in a current marketing climate promoting the “female only” OB/GYN …

Walgreens moves into primary care, and it’s our own damn fault

Kevin Pho, MD

KevinMD

April 12, 2013

walgreens

Will your next primary care appointment be at a drugstore?

Yes, if Walgreens can help it.

It was recently announced that the drug chain will have its nurse practitioners and physician assistants begin to diagnose and manage chronic conditions, such as hypertension and diabetes.

“We’re not trying to take over primary care, but we think we can help support physicians and transform …

Increasing the role of nurse practitioners in the inpatient setting

Gene Uzawa Dorio, MD

Physician

April 12, 2013

We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this …

Beauty in surgery: Traction and counter-traction

Sid Schwab, MD

Physician

April 11, 2013

Next in a continuing series.

Traction and counter-traction: along with maintaining excellent exposure, that is one of the fundamental principles of operating. It’s Newtonian: equal and opposite. In nearly all forms of surgical dissection, there’s a need for some pull in the opposing direction: tissues that are a little stretched-out, that are under some tension, fall open more easily when dissected. Plus, it’s a form of stabilization, another obligatory …

Tiger Woods and the pre-med gunner mentality

Ryan Gray, MD

Medical Education

April 11, 2013

tiger woods

What can Tiger Woods teach us about pre-med competition and the medical school gunner mentality? A lot.

I was recently watching Tiger’s latest win, his 76th win on the PGA. Tiger was dominating the competition, not unlike your classmate in your organic chemistry or biochemistry class that just crushes every test and sets the curve for everybody else.

What was different about this …

Sharing my loss helped a patient’s loss

Paul Rousseau, MD

Physician

April 11, 2013

“I want everything done. Please, Dr. Rousseau, do everything. We have two children–they can’t be without their father. Do you understand? Do what it takes to keep him alive!”

Angie, a petite woman with long blonde hair, fixes me with piercing blue eyes. Her husband, Joe, fifty-two, has scleroderma, an autoimmune disease. In its most devastating form, it hardens the skin and destroys the kidneys, heart and lungs.

Joe is dying of …

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Sharing my loss helped a patient’s loss

Patients who are in denial may be doing themselves harm

Miranda Fielding, MD

Physician

April 11, 2013

If you desire healing,
let yourself fall ill
let yourself fall ill.
–Rumi

Yesterday I saw a patient—an 80 year old woman with metastatic cancer involving her bones. She had near complete replacement of her twelfth thoracic vertebra by tumor, and also significant destruction of her fourth and fifth lumbar vertebrae, demonstrated by PET-CT scan and bone scan.

She had so much pain in her legs that it was difficult to walk. In …

Why this doctor is compelled to write

Davis Liu, MD

Physician

April 11, 2013

As a doctor, I am compelled to write because of what I know is occurring with alarming frequency in our country. Americans are skipping needed and recommended care that could save their lives and allow them to live to their fullest. Patients are more distracted, as life is more complicated and busier than ever. Households have both parents working, sometimes two jobs, just to make ends meet. They easily would …

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Why this doctor is compelled to write

Roger Ebert did not lose his battle with cancer

Michael A. Wosnick, PhD

Conditions and Diseases

April 11, 2013

I was very saddened to learn of the death of Roger Ebert. I, like so many around the world, was impressed and inspired at how he handled himself in the aftermath of his cancer surgery years ago that left him disabled and disfigured and unable to eat, drink or speak. And yet, despite his struggles he remained a dominant force in film …

The New York Times gets it wrong on health IT

Robert Wachter, MD

Health Technology

April 11, 2013

I’m well aware that a good fraction of the people in this country spend their lives furious at the New York Times. I am not one of them. I love the Grey Lady; it would be high on my list of things to bring to a desert island. But every now and then, the paper screws up, and it did so in a big way in its …

A memorable introduction to the family

StorytellERdoc, MD

Physician

April 10, 2013

Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share …

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A memorable introduction to the family

The elective induction of labor is no longer sustainable

Vivian E. von Gruenigen, MD

Conditions and Diseases

April 10, 2013

Why do some obstetricians, midwives and family physicians electively induce labor? The answer is long and politically infused. Nevertheless, it includes patient desires, physician convenience and the acceptance of induction as a form of labor.

The induction of labor is the use of medicine or other methods to initiate uterine contractions. If performed for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix ought …

Successfully starting a direct pay practice: Trickle up economics

Rob Lamberts, MD

Physician

April 10, 2013

It’s been a month since I started my new practice. We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending. The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead. My admitted ineptitude at financial complexity has forced me to simplify our …

Quality healthcare isn’t just about clicks and lists

John Mandrola, MD

Physician

April 10, 2013

My hospital has just weathered an impressive upswing in patient volume. The house was full for weeks. The experience highlights an important aspect about quality care–an obvious one that doesn’t always make headlines.

What I notice when the hospital gets full is that patients are sent to units that they don’t normally go to. For instance, at my hospital, like yours probably as well, there are numerous different types of heart …

When photographs transform relationships with patients

Suzanne Koven, MD

Physician

April 10, 2013

When I entered the exam room I found my patient, a woman in her 80s who’d come in for a routine visit, holding a photograph. “I need to show you something,” she said. Some patients bring me photos at every visit–usually their kids’ or grandkids’ annual school pictures, or smartphone shots of a wedding or christening–but she never had before. I wondered what it might be.

She laid the photo on …

There is no such thing as minor anesthesia

Karen S. Sibert, MD

Medications

April 10, 2013

It’s a nightmare that doesn’t end for the family of 24-year-old Marek Lapinski, who suffered cardiac arrest recently during the removal of two wisdom teeth in a southern California oral surgery clinic. The former college football player had no known health problems prior to the surgery, but died three days later in a hospital intensive care unit.

While the circumstances of Mr. Lapinski’s death are still being investigated, the case highlights …

The real reason to be cautious about Z-Paks and azithromycin

Albert Fuchs, MD

Medications

April 10, 2013

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.

What’s the hubbub about?

Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …

Medical educators: Take charge and help deflate medical bills

Neel Shah, MD, Christopher Moriates, MD, and Vineet Arora, MD

Potpourri

April 10, 2013

At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring the problem is not new.

In 1975, the …

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