I just finished reading Neil Gaiman’s fascinating novel, Gods of America. I first learned about his work by watching the movie Stardust, then reading the novel.
One of the themes of Gods of America is that the deities of the old world came to America in the hearts of their followers, but over time lose their followers and thus their power. A war is arranged between the …
We worship at the feet of pain and pills
I enthusiastically shared the news of the American Academy of Pediatrics (AAP)’s same-sex marriage endorsement with my medical school classmates yesterday. I even publicly posted the AAP’s article – the sole public posting on my private Facebook page – because to me, the strong endorsement of equal rights by an organization of 60,000 pediatricians seemed enormously important for my colleagues and for our world.
I was disheartened to read the viral …
Let us signal that we accept and support same-sex marriage
Before patients can become savvy consumers of healthcare, they need information about their healthcare choices. Too often, such information is nearly impossible to get, especially when it requires doctors to give patients useful statistics about things like treatment side effects.
Since publishing Critical Decisions this fall, I have received a number of emails from readers who have recognized their own medical histories in the pages of my book. I received …
Just sign here: That isn’t real informed consent
After graduating from college I had the opportunity to spend two years working at the Institute of Medicine on a variety of health care improvement topics. When it came time to apply to medical school I noticed an odd dissonance—the challenges I had been grappling with at the IOM were not manifest in most medical school curricula. I knew that multidisciplinary teams …
The physician’s role in cost containment is absent during training
Tuesday morning, eight o’clock, and I have seven things to do. Check vitals, change a dressing, get a patient out of bed, send another to the operating room. Review lab results, give medications, start a blood transfusion.
I have six patients, and they have an average of five morning medications each. I make three trips to the med room for supplies, two trips to the pantry for fresh water.
Mrs. Napoli has …
It happened, of all times, when I was in the car driving the kids to violin practice. My pager buzzed with a message from one of the medical floors. I waited till the car was parked, and dutifully pecked the numbers on my cell phone.
Hello doctor, we have your patient, can you please put admitting orders into EPIC?
I, of course, like most doctors, wasn’t sitting by my phone waiting at a computer terminal. …
Our most scarce health resources are asked to carry the largest load
A recent meta-analysis published in the American Journal of Clinical Nutrition suggests that coenzyme Q10 is of benefit in congestive heart failure. For those who like the idea that food and nutrients can be excellent medicine, this paper is interesting at the very least. But there is a case to be made that it is far more than that. There is a case to be made …
The resurrection of coenzyme Q10: It’s all about the money
As undoubtedly you’ve heard by now, there’s another person cured of HIV out there — this time, it’s a baby born to an HIV-infected mother.
Here’s the story: The mother didn’t know she was HIV positive until delivery, and the baby was found to be infected by both HIV DNA and RNA right at birth. The doctors started combination antiretroviral therapy approximately one day later, essentially as soon as the results …
Baby cured of HIV: What’s the real story?
Even as social media use among physicians gains popularity, I continue to hear doubts echoing from my fellow medical students, residents, and attendings, particularly about the use of Twitter.
Many of them ask how using Twitter has benefited me, and my answer almost always makes them stop and think.
My life has been enriched by the network of intelligent and forward-thinking people I have connected with …
Twitter makes me a better doctor: 4 reasons why I use Twitter
Recently, my family and the hospital care team have been guided by my father’s healthcare proxy to avoid painful, invasive, or aggressive care at time when his multiple medical issues have combined to make his health decline irreversible.
The healthcare proxy was extremely clear and enabled us to finalize the do not resuscitate and do not intubate orders. We agreed to stop monitoring and stop all medications except …
Comfort care goes beyond DNR orders
For those who haven’t been following, earlier this month, Dr. Carol Warfield, a Harvard doctor and chief of anesthesia at Beth Israel Deaconess Medical Center was awarded a settlement of $7 million dollars for gender discrimination. It was a massive settlement to be sure, certainly one of the largest ever for a gender discrimination case.
But the large dollar figure is not the real story here. The real story is found in …
Gender discrimination in medicine: The 5 miracles of Carol Warfield
Think you know something about oncology? Ok then, pop quiz: If you are giving chemotherapy to a patient who does not have cancer, how can you tell if it works? Ridiculous question? Not at all. The answer to that question is; “hopefully, we will never know,” and it is at the core of modern cancer care.
In the 1960s, breast cancer surgeons had a serious problem. They were doing large complex …
How can you tell if adjuvant chemotherapy works?
Be empowered. Get informed. Be engaged. Get involved. We’re exhorted to help make our medical decisions, to speak up, to ask questions, to say how we feel. But if we’re going to get the hang of being engaged patients, we could use a way to practice our role in the privacy of our own homes.
Well, read on my fellow patient. I give …
Practice being an engaged patient: Choose your own adventure
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A presentation to patients is an excellent tool to communicate your message. However, the material must be presented in an effective and powerful manner. These tips will help you deliver dazzling presentations.
1. Know your audience. Sounds obvious, but unfortunately I have seen many presentations delivered to patient groups that were full of medical jargon and complex slides. Think about how people speak …
7 tips to improve your patient presentations
My phone rang a few weeks ago, the morning of January 26th. It was my brother saying “Mom has cancer in her spine. I’m bringing her to the hospital this afternoon. They’re operating Monday.”
I threw my stuff in my suitcase, jumped in the car and drove back home from the conference that moments before had seemed so important.
But before I left, I spoke at length with the orthopedist who’d delivered …
What can you say to the people who saved your mother’s life?
Most professional business enterprises nationwide understand that they could never expect to compete in the marketplace if they shut down their phones 20 – 25% of important business hours every day. Yet that is exactly what your medical practice is doing if you are shutting your phones down for a “lunch break”.
You might be wondering how important can this really be for a medical practice? Can’t patients just wait an …
8 reasons why your practice needs to stay open during lunch
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old woman is hospitalized for a 2-day history of fever and chills and a 1-day history of hypotension and dyspnea. Medical history is significant for adenocarcinoma of the colon diagnosed 3 weeks ago for which she had a partial colectomy. Her course was complicated by the development of a polymicrobial intra-abdominal abscess. After …
MKSAP: 64-year-old woman with fever and chills
The big news at HIMSS13 was the unveiling of CommonWell (Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth) to “get the ball rolling” on data exchange across disparate technologies. The shame is that another program with opaque governance by the largest incumbents in health IT is being passed off as progress. The missed opportunity is to answer the call for patient engagement and the frustrations of physicians with EHRs …
Will CommonWell solve one of the biggest problems in health IT?
I am embarrassed. I am a specialist taking care of patients with inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis. I spend more than half of my time at work related to research regarding the benefits and risks of treatment options for these diseases. Specifically, I aim to translate the vast medical literature published on this topic into tools for patients (and their parents) to help them better …
Why is cost so obscure in healthcare?
Let me tell you about this fabulous new test – it’s far better than the old tests, I’ve got a decade’s worth of research publications to show you, plus it’s a floor wax and a dessert topping.
Who am I? Why, I’m simply an academic clinician, advocating for this test because it’s the next great thing to help us tailor treatments to patients. Does it matter that I’m on the unofficial …
The filtering of medical evidence has clearly failed
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