Those of you who have followed our blog for the past few years probably know that one of my favorite topics in infection prevention is the role of clothing in transmission of pathogens. But I’m also fascinated by the sociologic aspects of clothing in medicine, which is usually framed around questions of professionalism (for example, is a doctor in a white coat more “professional” than a doctor …
Doctors: It’s ok to shed the white coat and tie
Direct-to-consumer genetic testing is increasingly available to the general public. Reduced cost and ease of testing make this service easy and seemingly harmless. For less than $100 and without even having your blood drawn (a saliva sample is sufficient), a private company promises to provide you with information about your ancestry and your health.
However, undergoing genetic testing of any kind is not a trivial decision. It is not like having …
Be careful when ordering your own genetic tests
I recently presented Yale Surgical Grand Rounds focused on “Cost and Quality in Cancer Care.” Amidst the talks in Washington regarding our unsustainable health care spending, and provisions of the Affordable Care Act rapidly taking hold, it seemed appropriate to start to critically evaluate how we spend our health care dollar and the value we receive in return. The data are …
It’s our duty as physicians to avoid needless tests
According to a new report from Cegedim Strategic Data, DTC promotional spending declined 22% versus last year. In fact they reported that “spending in nearly every channel saw decline year over year in 2012, the only exception being direct mail, which continued an upward trend. Here are the reasons why I expect DTC marketing to continue to decline in 2013.
1. Most big brands …
7 reasons why DTC drug marketing will decline in 2013
A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.
–Wayne Gretzky
Recently, I attended an end-of-year review with one of our hospital partner’s executive team. We reviewed our performance for the past year, and discussed mutually strategic goals and how to improve upon our excellent service. As part of the conversation turned …
Make small bets during the era of health reform
Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.
Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …
Clinical pearls that you don’t learn during medical training
My office consultation for the 50 year-old woman was her complaint of chest pain. I could not help but glance at her insurance and it was for Medicare. I have always been fascinated with what types of disability people have which qualifies them for Medicare and SSD, (Social Security Disability), before the usual age of 65. To say that I have observed bizarre and inequitable awards would be a gross …
Why I’m skeptical of the growing number of disability beneficiaries
I believe the role that God plays in our lives is often magnified during times of great suffering. How we perceive that role is a question of faith, often strong and steadfast in some, especially my patients, but sometimes unreliable and inconvenient to others, like myself, on a journey of understanding and acceptance.
During the terminal stages of my grandmother’s colon cancer, I recall her saying, “Je pense que le Bon …
A frequent witness to the power of faith
The problem of medical resident work-hours has vexed medical educators for decades. The traditional model of sleep-deprived residents led to highly publicized medical mistakes, most famously the Libby Zion case in 1984.
Nobody wants tired doctors caring for them.
In response, various restrictions have been placed on how many hours medical residents are allowed to work. Since 2011, for instance, medical residents were …
Solving the issue of tired doctors: My radical idea
There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so.
Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.
My focus today is more, well, literary.
I know the word “literary” often …
Where can doctors publish literary writing?
Wrong site surgery is never acceptable. A surgeon ought never to find himself in a situation where he has to inform the family that he just operated on the wrong body part. It is embarrassing, unprofessional, and an egregious violation of the patient/physician covenant.
That being said, we have allowed this issue to be defined entirely in terms of “systems management”. And hence the …
How diminishing returns may render the surgical timeout ineffective
During the last year I have been paying particular attention to lesser known and under appreciated miracles in medicine. It is a mystery why miracles of any sort would be under appreciated, but it is so very human to ignore things in plain sight which disrupt our deeply held belief systems or even are simply not what we are looking for.
For those readers who don’t believe that they could actually ignore something …
3 scientific breakthroughs plagued by uncoolness
I just took step three of the national board exams – the final in a series that all U.S. physicians must pass to practice medicine unsupervised. The two day exam, composed of multiple choice questions and simulated patient cases requiring free-text answers, brought up subjects that we haven’t thought about since medical school (Sick children? Terrifying.) The test also shed some light into how doctors think under pressure and why reigning …
Do board exams teach doctors to overtest?
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In the satirical novel The House of God, author Samuel Shem writes about experiences as a medical student at Harvard. In the novel, many famous quotations are used that have been passed on from generation after generation of medical students and residents. Some slang terminology is also referenced and characters are created to illustrate the qualities of certain types of students.
One particular student that is found in every medical school …
Should medical schools find a way to fail gunners?
An excerpt from Pet Goats and Pap Smears.
Phoning isn’t an option. Nor is e-mail. So I write a letter to the head elder, asking that the Amish community meet with me. He agrees.
Today is the day. I accompany Steve, the hospital CEO, to an Upper Midwest town so tiny that the post office is inside the grocery store. On the third floor of a local bank, we …
The first meeting with a group of Amish patients
I am a physician who writes and I think that more of my colleagues should do so. Not because, we are such skilled wordsmiths or understand plot and characterization. We don’t. But, we confront the human condition every day. We see pain and struggle and fear and rebirth. We have much to share.
Beyond my own profession, I think everyone should write, because everyone has something important to say and to …
Why more physicians should write
Do they need a PET scan to confirm the presence or absence of amyloid plaque?
More importantly, would doing such PET scans make meaningful impacts on patients’ health?
Those are the questions that a Medicare expert panel recently considered, and their impression, after carefully reviewing lots of high-quality research, is that we don’t yet have evidence supporting the benefit of using the PET scans. Unsurprisingly, some experts disagree, including a working group …
Should Medicare cover PET scans for the diagnosis of dementia?
I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …
Why coroners should fill out death certificates
The following is an exclusive excerpt adapted from #1 New York Times best selling authors Chip and Dan Heath’s new book Decisive: How to Make Better Choices in Life and Work, which was released on March 26, 2013. Click here to order.
One …
How a smart process helped Kaiser Permanente save lives
Every once in a while a news item becomes so big that a threshold is reached. Thinking people must weigh in.
When the US Supreme Court hears two cases involving the rights and treatment of individuals who are lesbian, gay, bisexual or transgender, there is a lot at stake. Our country faces a really important test.
It’s not so much about the specific legal issues, though they are not insignificant. Much more …
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