A friend was working an overnight shift in the ER for one of her mandatory rotations, so I popped in to observe. The ER was surprisingly quiet. A classmate was also observing that night, and like me, he was standing around, bored. We spotted an electrocardiogram (EKG) readout lying on a desk where a resident was working, and we asked him …
The strong tradition of mentorship is unique to medicine
When I completed my internal medicine residency, my fellow trainees knew I was headed for a rural practice in Vermont. Much to my surprise, they gave me a traditional doctor’s black bag – a beautiful leather bag with pockets inside for instruments, tongue depressors, syringes, prescription pads, and all my tools. It was an extraordinarily meaningful gift that acknowledged a launch …
2 ways technology will improve patient care
How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system.
-Rick Scott, Governor of Florida
Former CEO, Hospital Corporation of America
The Washington Post recently reported that health plan lobbyists, charts at the ready, are working to convince legislators that unreasonable health care costs are everyone else’s fault. Karen Ignagni, the Executive Director of America’s Health Insurance Plans (AHIP) declared: “If you’re …
Health plans need to take more responsibility for rising costs
My first encounter with a children’s hospital was as a first grader in 1980, when my 5-year-old cousin was diagnosed with cancer. Although her family was challenged to afford her cancer treatments, St. Jude Children’s Hospital in Memphis welcomed her and treated her cancer into remission. I remember my parents saying, “Everybody in that hospital loves children. No child is turned away.”
In 1997, walking into the Children’s Hospital of Alabama …
Hospitals must keep their doors open to all types of sick children
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old woman is evaluated for a 4-week history of wheals, characterized by a burning sensation without pruritus. Each individual lesion persists for 48 hours and slowly resolves, leaving a bruise. Current medications are diphenhydramine, hydroxyzine, cetirizine, and oral contraceptives. The patient’s mother has systemic lupus erythematosus.
On physical examination, vital signs are normal. She …
MKSAP: 27-year-old woman is evaluated for a 4-week history of wheals
The ultimate cure to the perversions inherent in U.S. health system economics is cracking the risk code – optimizing the financial risk allocation for any given disease across payer, health system, physician and patient. After years of payer and more recently health system effort, the heat is increasing on doctors and patients.
Despite vigorous effort on wellness and prevention, it’s fair to say the industry has so far missed the mark …
Patients need pay for performance too
Every once in a while a topic comes up that takes me back to the origins of this blog. At its core, DrJohnM aims to merge the worlds of athletics, health and medicine. The glue, the secret sauce, is mastery of the obvious.
As an athlete and doctor, I get to see how both plans parallel each other.
Katie Compton is an American …
What good coaching has to do with medicine
Add to the growing list of reasons antibiotics might not be good for you and your children: a recent study showing a statistical link between early ear infections and inflammatory bowel disease (IBD).
Researchers in the UK analyzed data from about a million children, looking specifically at the 750 who developed IBD (Crohn’s disease and ulcerative colitis, mostly.) They then compared the kids with IBD to children without …
The link between early ear infections and inflammatory bowel disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year history of type 2 diabetes mellitus.
Her blood glucose level on arrival at the ICU is 289 mg/dL (16.0 mmol/L). Although no longer on a cardiopulmonary bypass pump, she remains intubated …
MKSAP: 67-year-old woman is transferred to the ICU
He used to be a boxer.
Those days were long-gone, though.
Now he was a shell of his former self.
The hands that formerly knocked opponents to the mat were now contracted and full of arthritis. Dementia had taken away his ability to tell the stories about his career. Metastatic lung cancer ravaged his body. Multiple bed sores ate away at his sacrum and …
One fight that the patient wished he could lose
The blogosphere is alive with the sound of Silver — Nate Silver, that is, the head of what should be called the FiveThirtyEight Modeling Agency. Silver constructs statistical models to calculate the probability of electoral outcomes. Though he hasn’t shared his model yet, the results fit his model very well.
Is that the point? Statistical models can be constructed to serve various …
Would Nate Silver make a good doctor?
Wrinkles are bad.
So are small breasts.
Also crow’s feet and age spots.
Jiggly arms and muffin tops.
Don’t forget untrimmed pubic hair.
This tirade isn’t limited to women.
Guys, are your muscles ripped?
Chest gleamingly hair-free?
Male member sufficiently enhanced?
On a regular basis, I see 9 to 11 year-old girls who tell me that they’re cutting back on what they eat because they’re “fat.” While I’m examining them, …
We need to change the definition of beauty
I pick up a Glock semiautomatic, the model used in the Virginia Tech massacre. I need to hold it, to feel it, to rub my finger across the trigger.
I don’t fear death. Raised in a morgue, I worked with my dad, the city medical examiner. As a kid, I watched autopsies and talked to dead people and made up heroic stories …
It’s easier to get an assault weapon than a doctor
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The Institute of Medicine’s Rosenthal Lecture this past December addressed pop culture images of death with an eye toward understanding how “attitudes towards the end of life inform and shape our cultural repertoire” and helping “overcome the emotional obstacles that inhibit us” from dealing properly with the end of life, said IOM president Dr. Harvey Fineberg. The panelists were Dr. Kathleen Foley, a neurologist and palliative care specialist; Jay Clayton, …
Pop culture and the sanitized images of death
Happy New Year! It’s 2013! Time for us to embark on ambitious health and fitness resolutions we have no intention of keeping past March!
Here to assist us with our resolutions are a collection of fitness devices and apps that will help track our heart rate, sleep cycles, calories burned, steps walked, mood and much more. Data from these devices can …
Patients who self track their data: Curb your enthusiasm
Today’s medical students will care for tomorrow’s patients, and future physicians need to be prepared to thrive in a rapidly changing health care environment. Future physicians will need to be able to navigate new and increasingly complicated health information technologies, understand and use advances in personalized medicine and many will need to know how to lead accountable care organizations.
Gaps between …
AMA: Accelerating change in medical education
My favorite day of the year is December 26th. All work done, house a mess but, who cares – the kids are happy. No dinner to make. There’s enough left-over turkey for the apocalypse. I was sitting by the fire, new book in one hand, glass of Prosecco in the other. I never sit and haven’t read much this year so you’ll forgive me that I did not at first …
Doctors should never treat their families: Easier said than done
I live in Louisville, KY, which is the epicenter for heart disease in the United States. My state ranks 49th out of 50 states for heart attack mortality. This is a complex issue with many contributing factors, including access to care, patient education, health insurance, cooperation between EMS and hospitals, among others. The thing is: heart disease is our number one …
Allowing EMTs to perform an ECG should not be controversial
When someone is arguing that our health system needs an overhaul, one of the most common reasons they cite is because it is “built on a flawed foundation of fee for service.” Of course we blame fee-for-service reimbursement for the rampant overtesting, overtreating, and fragmentation (among other things) in our health system, but this doesn’t mean that it is inherently bad, and here’s why.
First, a little contextualization will help. Fee …
Is our system built upon a flawed foundation of fee for service?
A few years ago, I was sued. Yes indeed, I can now shout it from the rooftops. I know what it feels like to sit in the fire and burn into ashes of self-doubt, regret and emptiness; staring into the soulless, Cyclopean eye of a deposition camera, recounting my sins, defending my pride. I know what it’s like to live with fear, up close and personal. And I know what …
I was sued and lived to tell the tale
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