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Rural medicine in India: What American health care can learn

Roheet Kakaday

Medical Education

October 27, 2012

Many premeds take time during their undergraduate careers to volunteer abroad. Popular destinations include Mexico, various Central and Southern American countries, and Africa. These are great opportunities to discover more about underserved care and, more importantly, what you are made of. I just thought I would share my reflections on volunteering abroad during college. Hopefully, you can glean something from them.

In the backcountry of India, in the state of Maharashtra, …

Give life a chance to amaze you with what’s possible

Susan Biali Haas, MD

Physician

October 27, 2012

It’s natural: when you see someone doing something you long to do, you automatically search for reasons to justify why they’re doing it and you’re not. Maybe they had encouraging supportive parents and yours belittled you. Maybe they got their start at a younger age and it’s probably too late for you now. Maybe they got a great education, or were blessed with more opportunities in life.

My coaching clients won’t …

Give patients the pros and cons of treatment options

Barbara Bronson Gray, RN

Patient

October 27, 2012

If you or someone you love is considering surgery or an intensive treatment, it really pays to be sure you understand the pros and cons.

While that seems like common sense, millions of people say “yes” without learning all the facts.

Some simply rely on the trust they have in their physician. Others assume the known benefits and risks are too complicated to fully understand. And some people just want to get …

Healthier menus without restrictive legislation

Sherry Pagoto, PhD

Physician

October 27, 2012

The recent New York City law restricting portion sizes of sugary beverages offered in restaurants has stirred much controversy among policy makers, scientists, the media and consumers. Opponents support the freedom of choice in selecting beverage portions and contend there is insufficient evidence that legislation will change behavior or body weight. Proponents contend that something should be done to reduce the ever-expanding receptacles in which sugar-laden beverages …

From surgeon to management: Was my decision selfish?

Richard Patterson, MD

Physician

October 26, 2012

She was in her late thirties when her medical oncologist asked me to see her. Five years before, one of our community surgeons had removed part of her colon for cancer. She also had a recognized, single metastatic tumor in her liver at the time of that original surgery.

The contemporary standard of practice was to treat for a prescribed period of time with chemotherapy and then re-evaluate for the appearance …

The iron triangle of health care is not law, but an observation

Davis Liu, MD

Health Policy

October 26, 2012

A recent commentary in the Journal of the American Medical Association titled, “The Iron Triangle of Health Care: Access, Cost, and Quality” reflected that any health care system can only optimize two of the three elements – quality, access, cost. A health care system which provides the finest quality and best access cannot do so without raising costs to unaffordable levels. An inexpensive health care system available to …

Ways to improve influenza immunization rates

William Schaffner, MD

Conditions and Diseases

October 26, 2012

With the 2012-13 influenza season underway, I want to remind my colleagues that while influenza vaccination has been around for 60 years, the times are changing, and physicians need to change too. We now have newer vaccine options targeting specific populations that were not available just a decade ago.

Alas, many providers have not taken advantage of these options that 1) potentially offer better protection for patients aged 65+ and 2) …

Rural medicine is the most stimulating kind of primary care

Hans Duvefelt, MD

Physician

October 26, 2012

A lot of people, many of them medical students, think that rural doctors don’t get to see many interesting cases.

The opposite is true; if you are the only doctor within a wide radius, people will come to you for help, rather than try to pick the appropriate out-of-town specialist to diagnose their problem. In this state with widespread physician shortages most specialists won’t even see self-referred patients.

Sir William Osler wrote: …

Oral board exams: A window into how you behave in the operating room

Felicity Billings, MD

Physician

October 26, 2012

When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.

But instead, there …

Why healthcare is a boon for private equity

Kiran Raj Pandey, MD

Health Policy

October 25, 2012

The New York Times recently did an expose on hospital overbilling by a group of cardiologists at some hospitals owned by the Hospital Corporation of America (HCA). Immediately after a few days, a rather gloating article about how HCA had become the poster boy of Wall Street with its double digit growth strategy appeared. If the first story had not raised enough doubt about the …

How to steel myself against this profession I have chosen

Shara Yurkiewicz

Medical Education

October 25, 2012

An elderly man startles awake after a man in a white coat touches his shoulder. He looks around and sees three other white-coated people standing around his bed.

“Sir? Good afternoon, sir. How are you?” says the man who touched the patient’s shoulder.

“Oh, I’m fine.” He’s perfectly calm.

“I know this is a silly question,” continues the man, “but do you know where you are right now?”

“Of course, of course. I’m at …

A physician removed from the reality of acute care

Colin Son, MD

Physician

October 25, 2012

I’ve written about trying to communicate acuity to families. Maybe that needs to be expanded to encompass the same to other physicians.

To be fair I’m sure some of this, perhaps much of it, rests solely on my shoulders. Recognizing that I’m still going to make an accusation that talking life and death with families and patients is a skill not fostered in many providers. More accurately for this anecdote, and …

Hospitals need evidence based design

Joe Flower

Health Policy

October 25, 2012

It was some doctor show on cable: Nurse McCarthy bustles into the hospital room, says “Good morning!” brightly, and crosses the brilliantly polished linoleum floor to the window. Humming to herself, she sweeps open the curtains to the view of the brick wall across the airshaft, then goes to the patient on the right and checks his dressing, clucking and offering encouragement. After a few moments she does the same …

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Hospitals need evidence based design

My feelings of superiority were replaced by a sense of kinship

Shumon Dhar

Medical Education

October 25, 2012

In the summer of my first year of college, I did an internship as a nursing attendant in a rehab hospital’s stroke unit.

As a premed student, I had little idea of what it meant to be a physician. But that didn’t stop me from feeling slightly superior to others who weren’t on the same path. Although I didn’t know how to take someone’s blood pressure, I often treated friends to …

Why doctors shouldn’t treat their family and friends

Janice Boughton, MD

Physician

October 24, 2012

It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?

In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to …

Why doctors don’t like to go to doctors

bongi, MD

Physician

October 24, 2012

Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …

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Why doctors don’t like to go to doctors

Is customer satisfaction in healthcare a gateway to corruption?

Edwin Leap, MD

Physician

October 24, 2012

Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad.

I’d be interested to know how customer satisfaction played out in my home. “Kids, now you’ve had a week of school-work. Please fill out the attached survey …

Frustrations with the health care system drove me to a big change

Rob Lamberts, MD

Physician

October 24, 2012

After 18 years in private practice, many good, some not, I am making a very big change. I am leaving my practice.

No, this isn’t my ironic way of saying that I am going to change the way I see my practice; I am really quitting my job. The stresses and pressures of our current health care system become heavier, and heavier, making it increasingly difficult to practice medicine in a way …

Why venture capitalists shouldn’t try to solve health care

Margalit Gur-Arie

Health Technology

October 24, 2012

I recently wrote a post about the clueless, but endearing, enthusiasm of technology people as applied to solving the health care problem.

Dr. Davis Liu published a post describing the vision of Vinod Khosla, the famed venture capital maven, of replacing doctors with machines. It turns out that Mr. Khosla wrote a series of three articles at the beginning of the year …

Preparing for your doctor’s visit: 10 things to always bring

Leana Wen, MD

Patient

October 23, 2012

Most patients I see are surprised to find out that there’s something they should have brought to their doctor’s visit. Granted, I’m an emergency physician, and many of my patients come to me in emergency situations that they can’t plan for. However, most people have some heads-up for going to their doctor. Certainly if you’re going to your annual check-up or a routine appointment, you should bring these items with …

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