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How can we improve the patient experience?

Patient

September 19, 2012

We’re a disgruntled bunch these days. We think there must be a better way to experience health care.

Doctors say they’re pressed for time, don’t make enough money, have to hassle with insurance companies and typically feel generally burned out about medicine.

Patients feel they wait too long in the waiting room, don’t get much time in the examining room to ask questions or share concerns, want to be more involved in …

The decision to have a child circumcised

Natasha Burgert, MD

Conditions and Diseases

September 19, 2012

Soon-to-be parents come to “interview” me almost every day. Typically, they come prepared with a long list of questions for a pediatrician. I answer them as best as I am able.

For parents soon-to-be-expecting sons, I am frequently asked about circumcision.

Most parents are just curious about how the procedure is technically done, when their baby can get the procedure, and …

Despite the best evidence, oncologists cannot dictate treatment

Don S. Dizon, MD

Physician

September 19, 2012

During Multidisciplinary Gynecologic Oncology Tumor Board at Massachusetts General Hospital, a case was presented of an older woman with stage IV ovarian cancer who was deemed inoperable. Following review, we recommended a course of chemotherapy.

I asked our fellow what treatment she would administer, and this sparked a discussion on how patients and providers create a treatment plan. We discussed options, …

Both sides are spewing nonsense when they talk Medicare

Bob Doherty

Health Policy

September 19, 2012

Medicare has suddenly become a centerpiece issue in the 2012 election—but not in a good way. Instead of an informed debate about Medicare’s present and future place in our health care system, the politicians have subjected us to a daily assault of nonsense over substance:

Let’s start with the nonsense accusation by Governor Romney that “There’s only one president that I know of in history that robbed Medicare, $716 billion to …

Should doctors stop prescribing inhalers for smokers?

Deep Ramachandran, MD

Medications

September 18, 2012

I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …

Physicians need to embrace change to fix health care

Eugene Spiritus, MD

Health Policy

September 18, 2012

Several interesting facts crossed my computer screen recently. The first was a Tweet by American Medical News that the first CT scan was performed on August 25th 1973. The second focused on the large number of practicing physicians who suffer from burnout, and the third was an article, which cited a talk given by Vinod Khosia in which he is quoted as saying “80 percent of doctors could …

I hope my son never asks me if he can play tackle football

Manoj Jain, MD, MPH

Conditions and Diseases

September 18, 2012

Last fall, I went with my 12-year-old son to his middle school’s opening home football game. The bleachers were lined with parents, the smell of hot dogs and nachos wafted over the field, the announcer’s voice blared, and the cheerleaders jumped out of sync.

The boys were dressed in shoulder, chest, thigh and kneepads covered with clean white numbered uniforms. They each wore a helmet that seemed to weigh more than …

What can we learn about health care from Europe?

John Mandrola, MD

Health Policy

September 18, 2012

May I tiptoe onto a ledge for a moment?

Some (just-back-from-Europe) thoughts on health care policy, perhaps?

One of the many differences between the European Society of Cardiology (ESC) Congress and a typical American cardiology meeting was the scarcity of healthcare policy sessions at the ESC. That’s hard to explain; perhaps European countries are settled on their own systems and do not wish to — or can’t — influence their neighbors.

It goes …

How can technology entrepreneurs disrupt health care?

Davis Liu, MD

Health Technology

September 17, 2012

I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.

Not surprising, the most fascinating person, …

Remember the Professionalism APGAR during times of stress

Dawn Baker, MD

Physician

September 17, 2012

What does it mean to be a professional? And how do we maintain our professionalism at a time when things such as stress, burnout, and caregiver fatigue threaten our motivation? As an anesthesiologist, the ability to remain professional in many scenarios is something I constantly strive for. Aside from how it affects my relationships with the interdisciplinary OR team, professionalism is an important attribute given that my job requires patients …

Doctors need to make room for disagreement with patients

Ishani Ganguli, MD

Physician

September 17, 2012

While our dad was in the hospital last winter, my brother shared with me his strategy for talking to the doctors we encountered – an approach honed over ten years of marriage to an internist and dozens of pediatrician visits for his two little boys. He asked smart questions that used medical terms to earn their respect, he told me. He was appropriately deferential, admitting his lack of clinical experience. …

Restless legs syndrome in children: How the kids see it

Craig Canapari, MD

Conditions and Diseases

September 17, 2012

When I was a kid, my parents used to avoid giving me Coca-Cola after lunch. Not because they were overly concerned about my health. (If they had been, my mom wouldn’t have given me milkshakes when I watched Kung Fu Theater every Sunday afternoon. But that is a different story). The reason was that I would have really severe problems falling asleep about a quarter of the time. I would …

My wish list for a perfect ACO

Keegan Duchicela, MD

Health Policy

September 16, 2012

If you believe what most people are saying about health care reform and future practice models, you or your physician, will soon be part of an accountable care organization (ACO).

Health policy experts tell us that as physicians, we’ll be embarking on a wonderful journey that bears no resemblance to the HMO/managed care heyday of the early 1990s. Of course, there’ll be similarities, like limited networks, top down implementation of health protocols, and …

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My wish list for a perfect ACO

Can I still have a bladder infection with a negative urine culture?

Jennifer Gunter, MD

Conditions and Diseases

September 16, 2012

In a word, yes.

And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture.

Let’s back up a little. These are the symptoms of a bladder infection: needing to empty your bladder a lot (urinary frequency), when you gotta go, you gotta go (urgency), pain just over the pubic bone, blood in the urine, burning when you empty your …

CT scans for lung cancer screening: Look closely at the statistics

Kenneth Lin, MD

Conditions and Diseases

September 16, 2012

Enthusiasm for lung cancer screening has never been higher, following last year’s report from the National Lung Screening Trial (NLST) that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20 percent less likely to die from lung cancer compared to a similar group that was screened with chest x-rays (a “placebo” intervention that another study found to be ineffective). My own institution, Georgetown University Hospital, was one of the …

Is there a role for the laxative free virtual colonoscopy?

Steven Reznick, MD

Conditions and Diseases

September 16, 2012

Research radiologists at the Massachusetts General Hospital in Boston evaluated the accuracy and detail of imaging the colon (a virtual colonoscopy or colonography) with no laxatives as preparation and comparing it with traditional colonoscopy. There are clear evidence based guidelines suggesting that all low-risk men and women have a screening for colon cancer with a colonoscopy at age 50. If that study is normal they are directed to repeat it …

Useful design flaws explain some hemoglobin disorders

Reflex Hammer

Conditions and Diseases

September 15, 2012

Paradoxically, some parts of our body work best when they fail under stress.

An illustrative story from my freshman year of college.

I decided to buy a wheelie chair for my (miniscule) dorm room from a student who lived 1.5 miles away. How could I transport the chair across campus when I didn’t have a car?

I didn’t feel like wasting an hour walking there and then walking the chair back. Instead, I …

Use the Janus principle in your medical practice

Neil Baum, MD

Physician

September 15, 2012

Janus is the Roman god of doors and gateways but also the god of beginnings. Interestingly, good beginnings and required for good endings. The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day. Most statues of Janus show him with two faces facing opposite directions.

The Janus principle in your medical practice is the idea of …

These are the reasons why nurse practitioners are special

Kim Sakovich, WHNP

Physician

September 15, 2012

By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?

A nurse practitioner is a registered nurse who has completed graduate-level education and advanced practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, …

How baby boomers will change end of life care

Monica Williams-Murphy, MD

Physician

September 15, 2012

The baby boomers, the largest generation in American history, are now almost all in the last third of their lives (if average life expectancy is 78). They have spent the previous, early and middle thirds of their lives transforming cultural ideas, expectations and practices (e.g with the civil rights movement, environmental movement and women’s movement, etc).

The question now is, “Will the baby boomers also transform our cultural ideas, expectations, and …