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In a financial squeeze, a way forward for academic cardiologists

Wes Fisher, MD

Physician

August 21, 2012

If you want to succeed in academic cardiology, get a federal grant for research.

Better yet: get a few well-paid industry grants, too.

These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking because grants are harder to come by and money from their academic center is getting tight. For instance, the National Heart, Lung and Blood Institute (NHLBI) of the NIH no longer accepts investigator-initiated innovative …

We need a doctor-family partnership on the Internet

Claire McCarthy, MD

Physician

August 20, 2012

In early 1996, I sat down at my computer looking for help.

My third child, 2 months old, had just been diagnosed with a severe brain malformation called lissencephaly. He won’t be normal, the doctors said grimly. His life will be shorter, we were told. He will have seizures and other problems, they said, but it’s hard for us to say what or how bad those problems will be. We were …

Why brain tumors are my least favorite cancer

James C. Salwitz, MD

Conditions and Diseases

August 20, 2012

If I had to choose my “least favorite” cancer, it would be brain tumors. This malady is not only challenging to treat, but it attacks in such a personal and disturbing way. It is hard enough to fight a complex disease, but to do it when the ability to focus and understand is disrupted by brain injury is a terrible curse. Still we have learned a lot and therapy is …

My mother couldn’t advocate for herself when she needed it the most

Leana Wen, MD

Physician

August 20, 2012

My mother is my role model and my inspiration for what I do every day. She was diagnosed with breast cancer when she was in her forties, and fought it courageously for seven years until she passed away in 2010.

There are so many stories I can tell about my mother and her battle with cancer. Let me start with just one. Whenever she’d go to her oncologist, she would go …

Don’t accept advice from physicians until they understand your values

Peter Ubel, MD

Physician

August 20, 2012

Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense? But do you know what your oncologist cares about, and can you be sure her recommendations map onto your own treatment preferences?

A recent study lead by Michael Kozminski (I was senior author) shows that American oncologists downplay the value of treatments that improve quality of life, …

Googling cancer information: Tips from a cancer survivor

Andrew Griffith

Patient

August 19, 2012

When I got my phone call with the diagnosis of mantle cell lymphoma (MCL), my instinct, like so many of us, was to Google. Today, 3 years later, I have learned about what to look for, what to avoid, and how to manage my natural wish to know as much as possible.

The following are suggestions to help others faced with a cancer diagnosis.

Google wisely. Google (and Wikipedia) are a reflex. …

What can basketball teach us about health policy?

Andrew Boozary, MD, MPP

Health Policy

August 19, 2012

Basketball imposed my first patient experience in the American health care system. A loose ball and flying elbow saw me to an x-ray machine and a consult with a respected surgeon in New York City. The wait at the hospital was long. CNN blazed through the speakers and the only reading material was a sea of People magazine. For hours, I found myself in a blinking contest between Blitzer or Kardashian.

Once in …

3 simple games to lower doctor stress and prevent burnout

Dike Drummond, MD

Physician

August 19, 2012

Burnout is a constant threat for physicians. Research consistently shows an average of 1 in 3 doctors suffering from symptomatic burnout on any given office day. In my work with over stressed and burned out doctors, I have found that most of us work way too hard being the superhero to our staff, patients and families — and don’t have any fun at all. It doesn’t have to be …

MKSAP: 53-year-old woman with a 4 month history of tremor

mksap

Medications

August 19, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 53-year-old woman is evaluated in the office for a 4-month history of tremor. The tremor affects both upper extremities and is present “most of the time.” She has a 15-year history of type 2 diabetes mellitus; she also has a history of hypertension, gastroparesis, and chronic kidney disease. Medications are insulin glargine, insulin …

Put patients to work during their wait time

Steve Wilkins, MPH

Patient

August 18, 2012

I talk with lot of physicians about the need to improve the quality of communications between physicians and patients. Regular followers of my work will know that I am an advocate for the adoption of patient-centered communication skills by the physician and provider community.

Physicians with whom I talk seldom disagree as to the need for better physician-patient communications. They know that physician communication skills top the list of patient complaints …

Chief Justice Roberts’ health reform ruling analysis: A win-win?

David B. Nash, MD, MBA

Health Policy

August 18, 2012

The decision is in – and it is likely to have a substantial impact on this year’s elections, the Congress, the Court, the healthcare industry, and all Americans.

Of all the commentary I’ve read in the wake of the recent Supreme Court decision, Time Magazine‘s “Special Report: The Health Care Decision” struck me as the most balanced and comprehensive.

In the lead article, “Roberts Rules,” author David Von Drehle skillfully dissected the …

The largest health care fraud settlement in history: Is it big enough?

George Lundberg, MD

Medications

August 18, 2012

A law is a rule of conduct or action formally recognized as binding and enforced by a controlling authority. Law enforcement broadly refers to any system by which some members of society act in an organized manner to promote adherence to the law by discovering and punishing persons who violate the rules governing that society.

The purposes of punishment for crimes include:

1. Punishment will stop them from committing further crimes.
2. Punishment …

MKSAP: 62-year-old man with a 2 month history of progressive fatigue

mksap

Conditions and Diseases

August 18, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 62-year-old man is evaluated for a 2-month history of progressive fatigue, dyspnea on exertion, anorexia, and nausea. He has no other medical problems and takes no medications.

On physical examination, temperature is normal, blood pressure is 157/88 mm Hg, pulse rate is 86/min, and respiration rate is 22/min. BMI is 31. The conjunctivae are …

Doctors in no win situations: Damned if you do or don’t

Skeptical Scalpel, MD

Physician

August 17, 2012

Here’s a little story from the early days of my first job as a chairman of surgery.

Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger …

How to think like a doctor: Start with differential diagnosis

Suzanne Koven, MD

Conditions and Diseases

August 17, 2012

“What would you do if you were your doctor?” Mary asked me. Mary is my physical therapist and she was trying to figure out why the rehab after my shoulder surgery was progressing so slowly. A month after my operation I was still in pain and still not moving the joint well.

Without hesitation I replied: “I’d come up with a differential diagnosis.”

Differential diagnosis is a two word summary of how …

7 iPhone apps that need to be created for doctors

David Sack, MD

Health Technology

August 17, 2012

I read a few months ago that the number of available iPhone apps had exceeded a million, with new apps now appearing that are intended to help sort through the mountain of other apps. We have reached the age of meta-apps. Parenthetically, I have always loved that “meta”concept. In college, when people asked why I majored in philosophy despite the fact that I was pre-med, I explained that my intention was to become …

Helping cancer survivors fight neuropathy

Cindy Tofthagen, PhD, ARNP

Conditions and Diseases

August 16, 2012

As an oncology nurse, I see more and more people fighting—and winning—the battle against cancer these days thanks to earlier detection and a variety of new treatment approaches. But, like many healthcare professionals, I also see many cancer survivors struggle with the underappreciated long-term health effects often referred to as the “price of survival.”

Cancer-related neuropathy is a common long-term health effect impacting a third of cancer survivors. It can result …

Real health reform cannot happen without a primary care foundation

Andrew Morris-Singer, MD

Health Policy

August 16, 2012

Annie Lowrey’s July 28 article “Doctor shortage likely to worsen with health law” in the New York Times noted the growing shortage of primary care doctors particularly in economically disadvantaged communities, both in rural and inner-city America. This problem will likely get worse before it gets better as more Americans gain coverage and seek a regular source of care. As the article suggests, training more doctors and incentivizing them …

Mandating care in the ER but not payment: Why that’s a problem

Thomas Pane, MD, MBA

Physician

August 16, 2012

A recent case from Dayton, OH highlights the tangled mess of emergency department specialty coverage, federal law, and out-of-network insurance benefits. When these interact, patients, doctors, insurers and hospitals can be left frustrated and perplexed.

Here’s a brief summary.

A 6-year old boy suffered a fingertip injury and the emergency staff called the covering plastic surgeon, who repaired the injury. The surgeon, who does not participate with insurance, submitted a bill for …

Why must medical care be provided for free?

Edwin Leap, MD

Health Policy

August 16, 2012

Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …

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