Of all the complex, costly, and downright intimidating issues in U.S. healthcare today, Super Storm Sandy tops my list as the scariest.
Even though hospitals from the Carolinas to Maine deployed their emergency plans and had extra providers on site to deal with the expected influx of patients, those in the hardest hit areas couldn’t withstand such a powerful storm surge.
Like many …
Hurricane Sandy’s profound impact on population health
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman comes to the office for a follow-up evaluation. She has had type 2 diabetes mellitus for the past 13 years and has experienced two early-morning hypoglycemic episodes in the past 3 months.
Although her self-monitoring of fasting blood glucose levels over the past …
MKSAP: 68-year-old woman with type 2 diabetes mellitus
Accepting a promotion in the workplace is never easy task. One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.
Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner …
Doctors: How to improve your workplace relationship with nurses
The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so. There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain. Many of us opposed the bill, and there certainly are negatives. Like it or not, it is time to “get over it,” and not a second later than now. …
How Obamacare will create a new normal for medicine
I want to tell you a story about dying that ended up being a story about living.
A few years ago, I was an eager-beaver third-year medical student, and relished the opportunity to finally work on the wards. One of my patients was Mr. Taylor, a middle-aged man with pancreatic cancer—a disease that, of course, carries a bleak prognosis. He was emaciated, …
A story about dying that ended up being a story about living
Outrage #1: Wasting time of skilled caregivers. Everyday skilled nurses and physicians’ assistants waste hours of time on the telephone either getting approval for medications that we prescribe for our patients or trying to fight a rejection for a medication we requested.
Outrage #2: Choosing a medication for cost, not effectiveness. A child cannot breathe because the acid and other nasty stomach …
4 reasons why doctors should be outraged
This is the question I get asked the most: “So Doc, how do I know that this is working?” Sometimes my patients come to me with visible or palpable disease—something on the skin that they can see fading away, an enlarged lymph node in the neck that shrinks visibly during treatment, a lump or a bump that disappears, much to the gratification of both patient and doctor. But most of …
How do you know if cancer treatment is working?
An excerpt from Pet Goats and Pap Smears.
I’ve been practicing medicine nearly twenty years, but I’m still a doctor-in-training. Every patient who passes through my life teaches me something. Now doctors-in-training follow me around, but I think I learn more from my students than they do from me.
Today Brooke is here. She is two years away from applying to medical school. She has a degree in natural …
Patients don’t care what you know until they know that you care
Waking before dawn, I scurry into the study. Sitting in front of the computer, I wiggle the mouse, bringing the screen to life. Hesitantly, I call up the site for the major local newspaper. Since being notified by my attorneys one week prior that a reporter was hunting me down for comment, I am on heightened alert. Every day spent awaiting a story that could potentially decimate my life.
The home …
Waiting for a story that could potentially decimate my life
I was skeptical about the iPad Mini. I’ve used my Retina display iPad (3rd generation) for the past six months and been satisfied with the experience.
I’ve used it in the hospital setting during rounds, and even while talking to patients in the ER. I’m able to easily pull up Epic’s EMR using the Citrix app, and I can easily store the iPad …
Why the iPad Mini is the tablet physicians have been waiting for
I have a lovely pen. It’s a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice.
It’s a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window …
My experience with a scribe in the emergency department
One of the greatest risks I faced from surgery to repair a macular hole in my eye was from a hospital acquired infection. But when I tried to find data on the performance of various hospitals in New York City, there were no ratings for Manhattan Eye, Ear & Throat where I would have my surgery. My doctor had moved from a prestigious New York City hospital to Manhattan Eye, …
Patient safety requires a commitment from top management
Most modern American are familiar with the classic political novel, Atlas Shrugged. Love or hate it, the novel had a great impact on political thinking in the West. If you haven’t read it, or aren’t familiar, one of the fundamental questions author Ayn Rand asks is this: what if the producers and innovators of society simply stopped trying? What if they …
If Atlas shrugs off healthcare, it will be a dark day
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I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want …
Physicians must innovate to meet the needs of patients
In our practice, doctors have the option to administer influenza vaccines right in the exam room. The truth is, giving the flu shot only takes a couple of seconds. The syringes are pre-filled, so all you have to do is pop on a needle, swipe the patient’s upper arm with an alcohol pad, and jab.
It’s the conversation that precedes the flu shot that takes time.
Take yesterday. A very intelligent middle-aged …
The conversation that takes place before the flu shot
I strolled into our noon-daily resident conference, a little late, my free burrito in hand, and noticed that “cost awareness” was the topic. The conference seemed to have the same format as our other lectures: an attending was presenting a clinical case and asking us what steps we could take to best diagnose and manage the patient. The case seemed straightforward enough—a 65-year-old healthy Caucasian gentleman with right-sided chest pain—and …
Cost should no longer be a dirty word in medicine
Healthy patients think that they are not at risk for serious medical problems. Though maintaining a healthy weight, exercising regularly, not smoking, and eating plenty of vegetables and fruits while limiting meat, fat, and fast foods does decrease the risk of developing diabetes, high blood pressure, heart disease, and cancer, it doesn’t completely eliminate it. The chance is there, just a …
Healthy patients always make the same error
Parents worry when their children do not eat vegetables.
And, I understand why.
Parents know that vegetables are an important part of a healthy diet, and get frustrated when they are consistently left on their child’s plate.
The result? Parental “veggie-stress.”
Although veggie-stress begins at the family dinner table, it can be amplified by the rather faddish way parents talk about poor vegetable eaters within playgroups. Conversations among parents can …
Your child hates vegetables: 3 tips from a pediatrician
“Doctor’s office; please hold.”
You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on that below.) We are also in the middle of a communication revolution. There are now so many other …
The telephone is obsolete: How my patients contact me today
I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There …
10 advances that have changed medicine forever
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