One of the true joys of being a primary care doctor is partnering and educating patients to make the best decision for themselves and their families. Though they may not always agree with what I have to say, at least I know I’ve done my best to give them the information they need to be informed. What follows are common conversations I …
Answers to common vaccine questions from patients
I have long been a proponent of proven technology in the digital health space. Probably the most obvious reason is to dispel the generalized notion that these technologies are flimsy. The HHS Text4HealthTask Force has endorsed clinical studies in its recommendations. There certainly have been studies performed. One interesting one, the final report of The National Mobile Health Worker Project of the …
5 reasons why mobile technology needs clinical trials
The bacteria that live in our healthy guts are a garden of cooperating and competing species that help to determine our intestinal health. When we take antibiotics, we kill countless bystander bacteria in our guts and sometimes develop changes in our digestion which can be severe. Clostridium difficile infection is one of these conditions, a superinfection with a bacterium which is pretty resistant to antibiotics and causes infection of the …
Clostridium difficile: A fecal transplant when all else fails
Sometimes, I feel like I belong in law enforcement. There was a time in my life that I seriously considered a career where I would haul in the bad guys and make society a better place. Of course, every American male youngster fantasized that he would one day drive the Aston Martin, get the girl, defuse the bomb, and sip on a …
Law enforcement and medicine: The ties that bind both professions
Sometimes, angry patients and dissident doctors and nurses warn us about the impending patient revolution – how health care is so unsafe, of such poor quality and so expensive for us patients that we are soon going to rise up out of our beds, go to our windows and, in unison, holler, “I’m mad as hell and I’m not going to take it anymore!”
We’ll riot in the streets, …
Outrage: The crisis in patient safety
Trying to figure out what is going on with health care costs is like Alice’s adventures in Wonderland, things are just getting curiouser and curiouser. To illustrate: which of the following statements do you think are correct?
1. It’s been 50 years since health care costs increased this slowly.
2. The U.S. spends more on healthcare than any other country but our health is …
Do we really know what is going on with health care spending?
For most people, anesthesia is one of the more mysterious branches of medicine. What we do for patients is done, generally, when they are asleep. You the patient don’t exactly know what we are going to do, or how it’s done, but you put yourselves in our hands willingly. It’s sort of a weird relationship we have with other humans. We have done our job right if our patients don’t …
What are the different types of anesthesia?
I was recently speaking to the clinical leaders of a mid-sized hospital, and a senior administrator posed the question, “should we require our doctors and nurses to get flu shots?” The answer, I said, is yes, and it isn’t just to prevent the flu. It’s to get into the habit of making our folks do the right thing when it comes to patient safety.
Preventing the flu is very important. In …
Why doctors and nurses should be required to have flu shots
One of the first posts I wrote was a about how pharmaceutical reps provide lunch for physicians while presenting information about a medication that they are promoting. The post, and others like it, have generated visceral reactions on the part of the public. A similar article to the one that I wrote prompted comments like “Get over yourself and buy your own lunch” and “I’m certainly glad …
Should medical school deans have ties to pharma?
To treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.
Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, …
What is observation care? Clearing up common misperceptions
The implementation of the electronic medical record (EMR) in American medicine gained a powerful foothold in medical care with the passage of the American Reinvestment and Recovery Act (ARRA) in 2009. With the passage of this act came the promise of improved efficiencies, safety and ultimately reduced cost delivery for health care. Also, some $18 billion dollars in financial incentives were offered to physicians …
The ethics of EMR: How unproven technology affects patients
It’s Friday afternoon and I check the day’s schedule. A name jumps out at me and I groan a little and worry — what am I going to say to someone I’ve treated for twenty years, who’s my age and just been admitted to hospice care? If this is goodbye, how do I as a physician, who is more than an acquaintance but not quite a friend, handle this appointment?
All …
Saying goodbye: Seeing a patient just admitted to hospice care
Complications from my cancer sent me to the hospital again recently. The news that I was in trouble came unexpectedly from my oncologist’s office Thanksgiving eve, following a routine blood test. “Your liver numbers are out of whack.” My response was “Really?” as if I’d been notified that my driver’s license had expired.
I was diagnosed with a blocked bile duct and I …
Experiencing the revolving door of physicians in the hospital
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“Lance Armstrong is a bad guy who has done some very good things.”
These are the words of a sports radio personality I listened to yesterday. He was obviously commenting on the confession (to my pal Oprah) by Armstrong about his use of performance enhancing drugs. The sportscaster, along with many I heard talk on the subject, were not as upset by the …
Is Lance Armstrong really a bad guy?
Mexican medical residents have been submerged in a bygone system for decades. More than 100 work hours a week, scanty pay and psychological warfare are the everyday burden for residents in our country. You can read more about the working conditions of Mexican residents in my guest post, “The life of a medical resident in Mexico.”
Gradual progress is being made thanks to 30 years of pushing …
A view from Mexico: Reforming resident work hours
Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.
It doesn’t matter who’s doing the quacking. A quack is a quack, even if …
Behind the fetish of vitamin B12 shots
There’s been a lot of talk over the last year or so about the benefits (and some drawbacks) of physicians using social media. Social media use by physicians has become so widespread here in Canada that the Canadian Medical Association has actually developed guidelines to help physicians understand the rules of engagement on the web. But while there has been a lot of attention paid to physicians and social media, …
3 reasons why patients should use social media
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 …
The irony and the agony of our prescription opioid problem
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. …
Drug interactions and the problem with default settings
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 …
What you can learn from the flu epidemic: Get vaccinated earlier
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