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Providers who want the authority of doctors: Let them have it

WhiteCoat, MD

Health Policy

March 4, 2013

California doesn’t have enough doctors to provide healthcare to newly insured patients.

California state senator Ed Hernandez asks, “What good is it if they [state citizens] are going to have a health insurance card but no access to doctors?”

Wait. Health care insurance doesn’t mean that patients will have access to health care? Where have I heard that being said for more than 3 years?

The government is going to …

We hide behind vague words for fear of not living up to specific ones

Shara Yurkiewicz

Medical Education

March 4, 2013

“Your hands feel like velvet,” the 94-year-old woman told me as I pushed on her abdomen in the emergency department on a Friday night.

“That’s the nicest thing anyone’s said to me all day,” I told her.

“That’s pretty sad,” she said, and her abdomen quivered as she suppressed a laugh.

I walked out of the curtained room and briefly presented her findings to the resident on call. In return, he showed me …

If these are your final days, how do you want to spend them?

Jason Ryan, MD

Physician

March 4, 2013

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When I first lay eyes on Marilyn, I don’t think she will survive another week. Eighty-nine years old with short, curly gray hair, she sits in a wheelchair in the examination room. According to the nursing sheet, she weighs one-hundred and nine pounds. She wears a bulky white sweater over a gray dress that seems too big for her tiny body. Her …

Is the doctor of medicine degree vulnerable?

Jaan Sidorov, MD

Medical Education

March 3, 2013

I remember when one of my patients with coronary artery disease suggested that he be given a course of an antibiotic to lower his future risk of a heart attack. The patient quoted literature that pointed to a possible infectious link to atherosclerosis. He also was aware of the theory that aspirin’s benefit had less to do with blood thinning than reducing underlying inflammation.

Fast forward to …

Emergency medicine: What is it exactly today?

David Schlueter, MD

Physician

March 3, 2013

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I’m not old enough, in emergency medicine years, to identify with the struggle of those calling for the end of the term “ER.” The argument was about the “R” vs. the “D”: “It’s not a room!” It’s a department!” was the war cry. Then perceptions changed, battles were won, and along came the very popular TV show, “ER.” The war hawks quieted …

Office visits are essential to providing quality care

Kevin R. Campbell, MD

Physician

March 3, 2013

As I have written many times in my previous blogs, it is essential that patients and physicians partner in the management of disease. Outcomes are improved when patients are actively engaged in their own healthcare. Part of engagement involves forming a relationship with a physician through regular follow up visits. Relationships with doctors, just as with friends and spouses, evolve over time. …

A patient who’s the very reflection of our healthcare system

Kiran Raj Pandey, MD

Physician

March 3, 2013

That was Virginia’s second visit to the hospital in the ten days of the new year. It also ended up being the last.

Virginia was a patient we all knew. She came to the hospital frequently. The aphorism of our intern year was, if you had not taken care of Virginia once, you were not going to graduate out of internship. And that was hardly an exaggeration- almost no one in …

Medical students need to learn to be patients

Anonymous

Medical Education

March 3, 2013

Growing up, I rarely had a steady primary care physician. Every school-physical, immunization, sports injury, and sore throat was addressed with care and diligence at a family clinic affiliated with a major suburban hospital.

I opted to visit the clinic a few weeks ago for a minor concern but as I drove-in, I was attuned to the fact that the clinic I visit—my clinic—is a teaching site.

Before entering medical school I …

The flipped classroom might just be the future of medicine

Dr. Chris Nickson

Potpourri

March 3, 2013

Since the days of Sir William Osler, medical education has been done in much the same way by everyone everywhere. Doctors and academics slave away for hours and hours preparing lectures for students and trainees, all the while being locked away in their own isolated little silos. An anthropologist from Mars (to borrow an image from Temple Grandin made famous by Oliver Sacks) would find this remarkable. Could it really …

How do physicians cope with the emotional aspects of death?

Kevin R.R. Williams

Patient

March 2, 2013

I have the paradoxical privilege of being an emergency medical contact for dozens of people. Have you completed a healthcare medical directive with durable power of attorney? While reviewing a DPA with others, I strive to understand their choices in delicate life-or-death situations. This has me confronting death more often than many people.

They still talk to me

Triggered by seemingly insignificant events, fond memories of friends and relatives enter my mind …

5 reasons why you shouldn’t go into medical school

Brian J. Secemsky, MD

Medical Education

March 2, 2013

The gall, you might think to yourself as you click on this link in disgust.

Before you write that brutal retort which I may/may not deserve, some simple disclaimers before we tackle this subject:

This is not a ruthless attempt to crush your dreams and passions
This is not an op-ed on our current healthcare system
This is targeted towards individuals who are considering medical school in order to practice clinical medicine
This is being …
Read more…

5 reasons why you shouldn’t go into medical school

Why long term use of opioids is not the answer

Richard Juman, PsyD

Medications

March 2, 2013

In 1804, Frederich Serturner experimented with opium and created something new—morphine—named after the Greek god of sleep and dreams, Morpheus. More than 200 years later, at least 8 million Americans fall asleep at night under the influence of an opioid. Every morning, 40 of them don’t wake up.

As described in a previous article on this subject, the United States is in the grip of a prescription opioid disaster: with 2 …

Why energy drinks should be considered stimulant drugs

Kevin Pho, MD

KevinMD

March 2, 2013

A version of this column was published on February 3, 2013 in USA Today.

I’m seeing more patients than ever consume so-called “energy drinks,” a rapidly emerging class of beverage which promise to increase energy, improve alertness, and boost attention span. The energy drink business is booming, with more than $12 billion sold last year, eclipsing established beverage categories like iced tea …

Incidentalomas: The real cost of ordering tests

Edward Pullen, MD

Conditions and Diseases

March 2, 2013

I recently read a very good article in the New York Times about a patient found to have the classic incidentaloma, a small mass in the adrenal gland. This is estimated to be seen in 4% of abdominal CT scans, and is rarely serious but typically leads to recommendations for additional testing and follow up CT scans to assure that it is not either a metastatic cancer …

The baby had a seizure: Why was the mother smiling?

BirdStrike, MD

Physician

March 1, 2013

My first night shift in a stretch of 7 was almost over. It was 6:15am and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep. That never makes for a good drive home after a night shift.

“Got time to see one more?” asked Jenny the nurse.

“Do I have …

Doctors who work part time: I’m sorry that I’m ruining medicine

Fizzy, MD

Physician

March 1, 2013

I work part-time.

Some people think that women who work part-time are ruining medicine and contributing to the physician shortage. So I want to present my very reasonable list of reasons why I work part-time in a flexible job:

1. I am sick constantly. Constantly. My kids are petri dishes. And it always lasts forever. Even as I’m writing this, I’m coughing, and …

What can nurses learn from doctors?

Meaghan O'Keeffe, RN

Physician

March 1, 2013

There’s a lot nurses can learn from doctors.

There I said it.

But I’m not talking about clinical ability or medical knowledge. I’m talking about expectations. I’m talking about basic behaviors that dictate a predictable response.

Nurses don’t feel valued. Much of this is warranted, but I argue that some of it is self-inflicted. I said this once to a colleague and she responded, “But that places the blame on the nurse.”

I disagree. …

Read more…

What can nurses learn from doctors?

I tried to find peace in the loneliness that comes after a death

Sarah E. Stumbar, MD

Physician

March 1, 2013

You might be surprised to know that I’m lying here in bed still thinking of you two weeks after you’ve died.

During the month that I watched you die, I often wondered what it felt like to be you, with your deep, husky voice, rounded belly and stubborn anger. You’d once owned your own mechanic shop; now you were sitting here in a hospital bed, staring up at the medical team …

It is time for us to succeed by being the best that we can be

Jeffrey Hall Dobken, MD, MPH

Physician

March 1, 2013

According to George Orwell, “serious sport has nothing to do with fair play. It is bound up with hatred, with jealousy, with boastfulness, with disregard for all rules, and with sadistic pleasure in witnessing violence: in other words it is war minus the shooting.”

Ok … sounds pretty much like the Super Bowl, but the Tour de France? Lance Armstrong? Ergogenic aids? Cancer …

Accepting the inevitable: The last days with my Dad

Julie Saeger Nierenberg

Patient

February 28, 2013

Dad didn’t feel like dying. He felt full of life and longing to live. He had more to do, more to say, more to feel, to taste, to write, to experience. He was angry and sad, disappointed and confused, scared and brave, unaccepting and, finally, accepting.

For the past three years, I talked to him daily to be as close as I could. I listened as he told me everything he …