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The irony and the agony of our prescription opioid problem

Medications

February 3, 2013

It’s almost unthinkable that in an era preoccupied with “evidence-based” medicine and “best practice” advice, one of the worst drug problems in the United States flows right out of our health care system. Unlike other major epidemics such as those connected to methamphetamine, crack cocaine or other illegal drugs, our prescription opioid problem is full of irony and agony, because it has been fueled, to a certain extent, by the …

Drug interactions and the problem with default settings

Bradley Evans, MD

Medications

February 2, 2013

At some hospitals, pantoprazole is not on the formulary. So, when a patient takes clopidogrel and pantoprazole, the drugs are automatically switched to clopidogrel and omeprazole. For a proton pump inhibitor (PPI), the default is omeprazole.

The Medical Letter, the FDA and UK’s National Guidelines for Stroke recommend if patients take clopidogrel and need a PPI, avoid omeprazole and use pantoprazole instead. The concern is …

What you can learn from the flu epidemic: Get vaccinated earlier

Kevin Pho, MD

KevinMD

February 2, 2013

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The following column was published on January 11, 2013 in CNN.

During the past few months, I have gently suggested to my patients that they receive the flu vaccine. Many said yes, but some declined.

Today, as I look up Google’s national flu trend map, I see nearly the entire country painted in an alarming red, signifying “intense” flu activity. According to the Centers …

Reform medical education to fix the primary care shortage

Kevin R. Campbell, MD

Medical Education

February 2, 2013

When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …

The successful physician of 2015: 5 essential traits

Linda Ireland

Physician

February 2, 2013

The health care scene is evolving. Rapidly. We all know that. Thanks to legislation, changing patient expectations and physician shortages, we are all in for a roller coaster of changes over the next few years.

But what does this mean for physicians? Plenty. Most importantly, it means physician’s roles in the health care system will change. Drastically. And that means the traits and skills you’ll need to be successful will change, too.

Some traits …

To CT scan or not: What is the ultimate goal of patients?

Erin Plute

Physician

February 1, 2013

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The patient – blue-eyed, red-haired, and healthy but worried looking – guided the doctor’s hand to just below the angle of her jaw, where a small lump was barely palpable. She had first noticed the swollen lymph node after a cold and thought nothing of it at the time. But five months later, it was still there. She knew it was nothing, …

Will improved mental healthcare be enough to curb gun violence?

Juliet K. Mavromatis, MD

Physician

February 1, 2013

For the past month I’ve been trying to formulate a blog that could capture my thoughts about mental illness and the prevention of violence. At this point my ideas are still not crystallized, but perhaps writing this will help. A few days before Christmas I received a phone call from a former patient’s mother. She called while I was at the mall with my family doing some last minute shopping—I …

The myth of the difficult patient: Blame the system instead

Heidi Roman, MD

Physician

February 1, 2013

As a pediatrician at a busy county clinic with close proximity to pediatric specialists, I care for a significant number of children with special health care needs. Instead of colds and ear infections (though there are those too), my days are often filled thinking about gastrostomy tubes, tracheostomies, and ventriculo-peritoneal shunts. I sign orders for specialty formulas and nebulizer machines. Many of my patients have thick charts and diagnoses like …

We can learn a lot by comparing guns to cars

Jennifer Gunter, MD

Physician

February 1, 2013

A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch.

And I agree. Comparing guns and cars is fair, after all they kill about …

Should doctors be required to ask patients about guns?

David Mokotoff, MD

Physician

February 1, 2013

Recently both President Obama and the AMA have called for physicians to talk with their patients about gun ownership, especially if they sense mental health issues. This request sounds innocuous enough, but let’s explore the implications and the reality here.

First I need to issue a disclaimer. I am neither a member of the NRA nor do I necessarily feel that more gun laws and bans will reduce the recent tragedies …

Anesthesia awareness: Look beyond the headlines

Karen S. Sibert, MD

Physician

January 31, 2013

Don’t be surprised if patients start asking more questions than usual about awareness under anesthesia. We can all thank a recent article in The Atlantic magazine, with a large-print headline on the cover: “Awake Under the Knife”. Written by a UCSF medical student in preclinical training, the article not only assures everyone that awareness can happen, but takes pains to point out that anesthesiologists can’t always prevent …

From Mom: Here’s what it takes to be a great doctor

Anonymous

Medical Education

January 31, 2013

My mom wrote me the following letter during my first semester in medical school. She has been a patient, and a mother/wife/sister/daughter of patients. She has been around countless doctors. Here is her take on what makes a great one.

Dear Son,

I am so very proud that you are becoming a physician and that you chose this profession, not for the prestige or the financial advantages, but because you want to …

Cancelling surgery: When the show can’t go on

Kate O'Reilley, MD

Physician

January 31, 2013

It’s showtime. No need to worry. This is just another routine performance. I can do this. All I need to do is get on stage, do my dance, and wait for the curtain to fall. Then move on to the next stage and do it all again.

The curtain opens.

My patient is wheeled into the operating room. With the help of the circulating nurse, we guide her from the hospital gurney …

Learning about human relationships and the art of medical practice

Pamela Wible, MD

Medical Education

January 31, 2013

An excerpt from Pet Goats and Pap Smears.

After two decades of formal education, today I’m finally set loose with real patients. It’the actual moment I’ve been waiting for my entire life.

We’re each assigned to a family doc for the month. I scroll down the list of third-year medical students, place my right index finger beside my name, slide …

The cost of blaming doctors for prescription drug abuse

WhiteCoat, MD

Physician

January 31, 2013

An article written by two physicians in Time questions whether we should blame doctors for the large number of chronic pain patients and the abuse of prescription pain medications.

There are two frames of reference to this article.

First, no one can argue that prescriptions for pain medications in this country are excessive. The article notes that in 2011, “enough …

Do doctors take advantage of desperate couples with infertility loans?

Peter Ubel, MD

Physician

January 30, 2013

Somewhere near where you live, a couple will discover this week that they are infertile and that if they want biological children of their own, they are going to need in vitro fertilization (or IVF). According to treatment protocol, the woman will need to take powerful medicines to ramp up her production of fertilizable eggs. One monthly cycle of this treatment will run …

Can protected naptimes reduce medical errors?

Ishani Ganguli, MD

Physician

January 30, 2013

Protected naptime is a luxury usually reserved for the under-five-year-old set. Might it also be a tool to combat our country’s astoundingly high rates of medical errors?

Trainee fatigue has been a major focus of patient safety efforts since the mid 1980’s, after 18-year-old Libby Zion died tragically from a drug interaction that may have been precipitated by residents working long hours. In 2003, the Accreditation Council for Graduate …

A doctor’s job is objectively impossible to do well

Janice Boughton, MD

Physician

January 30, 2013

Today I’ve been feeling stupid. My job absolutely requires critical, creative thinking and the ability to focus well, which was really hard today. But I don’t think I’m actually stupid. I think it has something to do with the task at hand.

So this is how today went. I think it kind of explains the stupid feeling.

My morning shift started at 7:30am in …

Quiet moments are a precious and rarely appreciated gift

Bruce Campbell, MD

Physician

January 30, 2013

How we spend our days is, of course, how we spend our lives.
-Annie Dillard

I wish I could add up all of the moments I spend waiting for things to happen.

I wait for computers to boot up. I wait for computer screens to load. I wait for programs to ask for and accept my user name and password for the umpteenth time so I can view a CT scan and then re-enter a different …