I am sure Oprah had spectacular ratings for her Lance Armstrong interview and so, in the spirit of truth-telling, I have another mea culpa show for Ms. Winfrey to consider: vaccine safety.
Until Jenny McCarthy got major air time the link between vaccines and autism was relatively fringe. But with Oprah in September of 2007 McCarthy, and by extension Andrew Wakefield, the erroneous link …
Oprah should devote a show to vaccine safety
A sample agenda as the consulting psychiatrist with a homeless outreach team:
8:17am. Arrive at the office, which is in a tall building that is a short walk from the New York Stock Exchange. Speak with the case managers and social workers about who should be seen that day.
8:55am. Walk with a case manager to the ferry terminal meet Paul (note: all patients described here are composites of people I have …
One day of a psychiatrist with a homeless outreach team
I was startled awake at 3:40 am by a loudspeaker blaring “Code Blue … Code Blue.”
As the hospital’s newly hired chaplain intern, I’d been sleeping in the overnight room. Stumbling out of bed and groggily changing out of my pajamas, I made sure to put on my hospital badge.
I made my way to the hospital’s “Z” building, where the ICU was located, and took the elevator to the fourth floor. …
Juan Gonzales, (not his real name), is a somewhat demented elderly Hispanic male, who I met last week in an intensive care unit. He spoke little English, and I spoke limited Spanish. His devoted family was at the bedside, and fortunately his daughter was able to provide some history. He was admitted with palpitations and dizziness and atrial fibrillation with a rapid response.
His family had just moved him from Miami, …
Cookbook medicine can make doctors clinically lazy
I’m told every doctor has their list of unsolved patient mysteries. Those patients where something terribly awful or something miraculous happens for which you lay awake at night trying to understand. The nature of doctors is to want solve problems and figure out medical mysteries in sleuth-like Sherlock Holmes fashion. It’s these unsolved mysteries that you remember as they perplex you for days, weeks, possibly years after.
For me, it happened …
The fine line between compassion and detachment
By the time I met her, Ms. Jacob had been in the hospital for 202 days, 15 hours, and 38 minutes. 39 minutes. 40 minutes.
Starting work on a floor that prided itself on delivering comprehensive, efficient care, I studied the computer monitor describing patient lengths of stay, wondering why this woman had been here 25 times longer than the average patient – …
The cost of caring for undocumented immigrants is often ignored
When I first decided to pursue a career as a physician scientist by enrolling in the medical scientist training program, my goals seemed very clear; to bring what I learned at the bench to the bedside. Today, as a junior faculty member in a department of pediatrics who spends most of my time in the lab, this now clichéd phrase continues to echo in my mind. Yet, I am concerned …
In defense of basic science: The need for translational research
There are surprising misconceptions about what family physicians actually do in practice.
Americans maintain a fond respect for the classic image of the family physician, making house calls with black handbag in tow. They admire the Marcus Welbys of the world. While this classic image is endearing, it should not be confused with the 21st century family doctor. The modern family physician is trained to engage in the adaptable world of health …
You may be surprised at what family physicians do
I was startled to learn, when interviewing medical school applicants, that tagging along with a physician, or “shadowing,” is a common practice among high school and college students these days. Yes, I did say students as young as high schoolers.
Shadowing provides a way for students to observe at first hand what it is like to be a physician, and helps them decide whether the career will suit them. Medical school …
Is physician shadowing harmful for patients?
When the Lexington, Kentucky VA Medical Center pioneered the “disclosure and offer” risk management strategy in 1987, it sought to make patients whole without the need to litigate. As part of this process, before meeting with injured patients, VA risk managers contacted the patient and recommended they seek their own legal counsel who they were welcome to bring to the meeting. The VA viewed this as a necessary step for …
Disclosure and offer: Who protects the patient’s interests?
It can be difficult to keep up with the jargon, countless proposals and complicated policies that surround the debate over Medicare reform. Whether you are discussing premium support, changing the eligibility age or Medicare for All, there is one relatively simple concept that patients should make a point to pay attention to – one that directly impacts them – and is the …
Medicare patients should care about the way we pay providers
Health and health care are hot topics lately, and not just for journalists and bloggers debating Obamacare. Suddenly – or so it seems; in fact the trend has been building for years – people from all walks of life want to read about medicine.
Within medicine, a majority of journals now have essay, viewpoint, or perspectives sections. Not only are such sections frequently …
Medical journals that accept stories and essays from physicians
As trauma surgeons we often have to disassociate ourselves from the stories that surround our patients so that we can focus on their life-threatening injuries. It’s also how I personally cope with the devastating injuries to the patient and the aftermath left for the family. Sometimes, though, I am caught off guard and my defenses aren’t strong enough.
A middle-aged man was brought in one evening after being hit while riding …
When doctors dissociate themselves from the stories of their patients
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The electronic medical record (EMR)’s promised contribution to health care cost savings got a second look recently, and the results were poor at best. But what I found interesting was the “second look” was from the same organization that did the first look: the corporately-funded, non-profit think-tank called the RAND Corporation.
From their second and more recent report:
A team of RAND Corporation researchers projected in 2005 that rapid …
When EMR interactions trump patient care
Colorado and Washington state have legalized the recreational use of marijuana. I thought this would take longer to legislate, especially with the recent backlash from the federal government about medical marijuana. Eighteen states (including California, Alaska, Vermont and Oregon) allow marijuana to be used for medical reasons, but have restrictions on which conditions can be treated with it, which don’t necessarily correlate …
What are the health risks of marijuana legalization?
Am I an apologist for the pharmaceutical companies? I don’t think so, but others may disagree based on some sympathetic Whistleblower posts that have appeared in this blog. It is without question that the drug companies have been demonized and portrayed as rapacious gangs of greed who seek profit over all. Haven’t you come across the pejorative term, Big Pharma? Linguistical note: …
Big Pharma: There is nothing evil about making money
Of the 2.7 trillion dollars that will be spent on health care in these United States in 2012, more than $600 billion will be wasted. Excess testing and procedures, inflated charges, archaic business models, futile end-of-life care and exploding drug costs are some of many reasons. Predicted 25 years ago this crisis has been the focus of extensive academic analysis. It is reasonable to assume that with the primary goal …
Learning about costs: A gross failure in medical education
It’s not only about smoking cessation.
As I entered the examination room, J.L., a new patient here for a well visit, was sitting comfortably on the examination table. In his mid thirties, tall, slim and with an athletic build, he had a relaxed, easygoing air about him.
Before entering the room, I had quickly scanned his chart, and noted that in the pre-examination questionnaire, …
Why physicians should look beyond smoking cessation
Ok, I’ll admit it: I had no idea. I thought that the whining and griping by other doctors about EMR was just petulance by a group of people who like to be in charge and who resist change. I thought that they were struggling because of their lack of insight into the real benefits of digital records, instead focusing on their insignificant …
Patients don’t matter as much as payment in our system
Over the past decade, there has been yet another debate about whether pay-for-performance, the notion that the amount you get paid is tied to some measure of how you perform, “works” or not. It’s a silly debate, with proponents pointing to the logic that “you get what you pay for” and critics arguing that the evidence is not very encouraging. Both sides …
One way to think correctly about P4P programs
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