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How colonoscopies are like airline tickets

Physician

September 24, 2012

One would think that a physician who earns his living billing patients would be conversant with the prices of his services. Not this doctor. I am queried periodically by patients asking how much I charge for a colonoscopy.

Of course, every physician recognizes that this question is not phrased properly. It doesn’t matter what we charge; it’s what an insurance company determines we will be paid. I might believe that your …

When patients decide the best is not for them

James C. Salwitz, MD

Physician

September 24, 2012

I have been practicing medicine for 35 years and the great secret is that it just keeps getting better. No day goes by without an important learning moment, a unique observation or just the satisfaction of making a difference. Today I had one of those moments of revelation that will slightly change all days which follow.

Stan is a 57-year-old man with curable colon cancer who requires surgery. Unfortunately, that surgery …

Being a Good Samaritan isn’t always comfortable

Suzanne Koven, MD

Physician

September 24, 2012

On a night flight from Boston to San Francisco a voice came over the loudspeaker. “If there’s a doctor on board, would you please identify yourself by pressing your call bell?”

I reached up to hit the button, shrugging nonchalantly in response to my seat mate’s questioning look. “Duty calls,” my shrug was meant to convey.

But I didn’t feel nonchalant. What I felt was approximately two parts excitement and one part …

Why do patients often deviate from their advance directives?

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

September 24, 2012

One of the most difficult decisions that patients, families and physicians face involves end-of-life care. The advance directive or “living will” has become an accepted framework for patients to delineate their own preferences about what treatment they would or would not want when faced with a life-threatening disorder. But it was not always this way.

In the past, physicians and families often shielded those with potentially fatal illnesses from candid conversations …

Oversights contribute to a simplified view of elder care

Natasha Bhuyan, MD

Physician

September 23, 2012

On a picnic blanket at Piestewa Peak in Phoenix, AZ, Rowena passed around orange honey almonds while Barbara read an Elizabeth Chase Allen poem to us. My friend Dosia pointed out the growing audience of curious squirrels hoping we would drop a few treats. The conversation turned to favorite springtime memories; our laughter cut through the quiet of the desert. Nadine brought out a layered chocolate cake for her boyfriend …

My first day as a surgery intern

Richard Patterson, MD

Physician

September 23, 2012

Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who:

1. combine the MD with a JD or PhD;

2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums;

3. are named Michael Crichton.

Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery …

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My first day as a surgery intern

Why I love the USPSTF

George Lundberg, MD

Physician

September 23, 2012

Readers of this column will already know that I am a great fan of the United States Preventive Services Task Force (USPSTF). But they may not know how far back that fan support goes.

The USPSTF was founded in 1984 to produce evidence-based policies for preventive care. In about 1986, while editor of JAMA, I was asked to consider becoming the primary destination for the USPSTF reports, after appropriate peer review, …

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Why I love the USPSTF

How to improve communication in the medical setting

Donald Tex Bryant

Physician

September 23, 2012

“What we have here is a failure to communicate.” A famous quote from the movie Cool Hand Luke. As many know poor communication is common in healthcare.

Consider the following examples.

According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions. It was the teaching hospital for Brown University and the only Level I trauma center in southeastern …

The impact of West Nile Virus on survivors

Wendy Station

Conditions and Diseases

September 22, 2012

Since 1999, when most people in North America first heard about West Nile Virus, we’ve been measuring the impact of West Nile by looking at its fatality count. It’s time to take note of the impact on the survivors of West Nile meningitis and encephalitis.

As of August 2012, an outbreak of 1,590 cases of West Nile virus in 2012 was confirmed by the CDC. This is the highest number of …

Doctors are practicing irrational medicine at the end of life

Monica Williams-Murphy, MD

Physician

September 22, 2012

I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills …

Becoming a doctor in a family of physicians

Brian J. Secemsky, MD

Medical Education

September 22, 2012

Listen.

I know that you are in your junior year in college.

I know that you’ve picked an unsustainable, or unrealistic. major. For instance, I know that at this very moment in time you have (finally) made the revelation involving your slim-to-none chances of owning the Jets by means of your pending Sports Management degree.

I know that you are now in the throes of career-choice turmoil.

I understand that the only council you …

5 ways to help make a cancer diagnosis more manageable

Andrew Griffith

Patient

September 22, 2012

Over the past few years, I have had more than my share of navigating my way through the emotional and practical aspects of my treatment for mantle cell lymphoma. While at the back of my mind the broader questions – why me?, how long will I live? – remain, once I got over the initial anger and depression after the initial diagnosis (and after my relapse), I found these practical …

Do your homework when looking for a new doctor

Vivian E. von Gruenigen, MD

Physician

September 21, 2012

You are in charge of your own healthcare. Equally important is research that reveals that most women are in charge of their family’s health as well. But you’re not alone – you need a physician partner for you and your family, and sometimes, it can be challenging to find the right one.

I always recommend doing your homework and researching the reputation of the physicians, surgeons and nurse practitioners who will …

How to destroy health IT innovation

Douglas Perednia, MD

Health Technology

September 21, 2012

I have spent a good portion of his career working to come up with ways to make healthcare better, faster and cheaper through the appropriate use of computer and information technologies. Given the vitriol that I have periodically heaped upon many of the electronic medical record systems commonly deployed and mandated by the government, this enthusiasm for computers and telecommunications may come as a bit of a surprise to some …

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How to destroy health IT innovation

Patients need to overcome the fear of asking questions

Beth Austin

Patient

September 21, 2012

Today’s healthcare consumers are increasingly asked to take a more participatory role in their care. For many this is a daunting task – even if the patient desires being in the driver’s seat. There are a myriad of issues undermining patient-physician communication – such as time constraints, lack of comfort with the subject matter, lack of shared language, or even fear – that can make the task of …

Undermining Planned Parenthood in Texas

Elizabeth Breuer, MD

Physician

September 20, 2012

Last year, Texas legislature attempted to pass a bill that would halt all funding for the Women’s Health Program, a Medicaid associated program that provides annual exams and contraception for all reproductive age women that qualify, simply because Planned Parenthood participated in the Women’s Health Program. This puts programs such as where I work in a bind. The funding is in serious jeopardy of being eliminated completely.

According to the Texas …

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Undermining Planned Parenthood in Texas

As I reach the end of my career, I empathize more with my patients

Skeptical Scalpel, MD

Physician

September 20, 2012

As I contemplate retirement from clinical practice as a general surgeon, something I’ve been doing for over 41 years including residency, I’ve been having some unsettling thoughts.

Like many physicians, I’ve tried to stay somewhat emotionally detached from my patients. You must maintain some distance in order to be able to make tough decisions and to keep on doing surgery for so long.

I have written in a previous blog about the …

Doctors are shackled by the stigma of ignorance

Marya Zilberberg, MD, MPH

Physician

September 20, 2012

Are you familiar with the trolley problem? It is an ethics dilemma first formulated by the great Philippa Foot as a part of a series of such dilemmas. Her formulation goes roughly like this. Imagine there is a tram hurtling down a track. If it keeps going straight, it will hit and kill 5 people who are working on that track. The …

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