I recently followed a brief spat on Twitter between a journalist and a doctor. It did not go further than a few irritable tweets, but I had to agree with the doctor’s point of view.
The journalist had written an article about the death of a South African shack fire victim, admitted to hospital with 100% burns, and the contrast in perceived care he received compared to that of a …
Why health journalists need medical training
“I gave at the office.”
I am an American taxpayer just like most of you, the audience. My tax dollars, and yours, fund the great majority of health-related research in the United States, mostly through the National Institutes of Health.
Thus, I, and you, the taxpayers, own the results of that NIH funded research. We paid for it.
Then, why, for goodness sake, do I, the owner, or my physician, another owner, have …
The public needs access to federally funded research
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old man is admitted to the hospital for a 12-hour history of bilateral lower-extremity paralysis. The patient is an injection drug user. Over the past week, he developed lower back pain, which progressed to pain and numbness radiating down both lower extremities. On the day of admission, he was unable to walk but …
MKSAP: 38-year-old man with bilateral lower extremity paralysis
E-cigarettes seem to be a very popular product these days, so I thought I’d do a bit of research to figure out what the heck an e-cigarette is and to try to answer the question, “Are e-cigarettes safe?”
It appears that the primary reason people use e-cigarettes is to avoid smoking, either as a way to get their nicotine in areas where smoking is prohibited, or as a means to try …
E-cigarettes: Are there better ways to quit smoking?
The world’s largest breast cancer charity used misleading statistics and deceptive statements about mammography to promote breast cancer awareness and screening, authors of an opinion piece asserted.
In promotional material for the 2011 Breast Cancer Awareness Month, Susan G. Komen for the Cure suggested large differences in breast cancer survival among women who undergo screening mammography and those who do not. …
Is Susan G. Komen wrong about mammograms?
Most doctors will tell you that Medicare payments to doctors haven’t increased in a decade, and that doctors are turning away Medicare patients in droves. But they would be mistaken on both counts.
An authoritative compilation of current data from the Medicare Payment Advisory Commission shows what is really happening with Medicare physician spending:
Medicare spending per beneficiary on physicians’ fee schedule services steadily increased from 2001 to 2011. In 2001, Medicare …
The truth about Medicare physician spending
The news of my wife Elaine’s primary peritoneal cancer 27 months ago began a fevered effort to learn all we could about her disease and our options. Peritoneal cancer, which is close in form and behavior to ovarian, is rooted in the abdominal lining. “Gold standard” treatments notwithstanding, the prognosis isn’t good. After a 12-36 month remission in which tumors are inactive, the disease generally returns, and a high percentage …
Genomic medicine: How it can help cancer patients
Steve is lying almost flat in the hospital room, an IV attached to his arm. I am happy to see he is more comfortable, last night’s crisis has passed. He smiles as I enter and walk to his side. I touch his hand as I sit down on the pressed clean blanket. And then … a shrill loud wail breaks the silence … lights flash above his bed … fear …
Well meaning improvements can hurt critical healing relationships
All too often the most powerful illusions seduce us through truthful whisperings. Let’s start with an obvious truth: Living a long and happy life after a cancer diagnosis is better than living a short miserable one.
Given a choice between receiving a diagnosis of metastatic cancer—an incurable life-ending-it’s-already-spread-to-your-brain neoplasm—versus the diagnosis of a localized, snip-it-out-and-it’s-done tumor: Who wouldn’t choose the latter?
And yet this simple truth causes doctors to embrace unproven screening …
Many doctors fail to understand the math of cancer prevention
This past July marked the 16th anniversary of the installation of our electronic medical record.
Yup. I am that weird.
Over the first 10-14 years of my run as doctor uber-nerd, I believed that widespread adoption of EHR would be one of main things to drive efficiency in health care. I told anyone I could corner about our drive to improve the quality of our care, while keeping our cash-flow out of …
My dream of universal acceptance of EHR has turned sour
The majority of killers involved in recent mass shootings had encounters with the mental healthcare system before they committed their acts of violence, with some even being legally compelled to seek help.
Few seemed surprised when it came out over the weekend that James Holmes, 24, who allegedly killed 12 and wounded 58 others at a movie theater shooting in Aurora, …
Involuntary commitment for James Holmes: Is his psychiatrist to blame?
A few days ago, I received a question that stopped me in my tracks. I was giving a talk to a local church group on the importance of patient advocacy, and most everyone was nodding. Yes, doctors don’t always listen — let’s do something about it! Yes, we need to control of our health.
Then someone raised her name. Her name is Susan, and she is the owner of a mom-and-pop grocery in …
Improving medical care needs to involve the doctor
As doctors in training, we learn to think in patterns of symptoms and can often use “clinical judgement” to fit a patient’s presenting symptoms into a diagnosis. This generally works well, until we are presented with an unfamiliar pattern. For example, in the early 80’s I saw a 60 year old shoe salesman with fatigue and a low grade fever. He had general malaise and some muscle weakness. His exam …
The questions in medicine never change, but sometimes the answers do
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The headline called it “the new” science behind America’s deadliest diseases. Wall Street Journal reporter Laura Landro was talking about inflammation and its role in causing human disease.
Now, you all know my reaction when a prestigious newspaper features a founding principle of this blog. Well, let’s just say it felt awfully nice.
A brief Mandrola review of inflammation is in order.
First, acute inflammation is normal, and required for life. …
Fat cells are factories of inflammation
I love being a medicine attending in the summer. It’s often more intense work since everyone’s in a new role. Bright, fresh interns. Excited new residents. And the medical students – the new third-year students who have toiled in the classroom finally get to focus on patient care.
Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it’s a …
Being a ward attending: A job I am so lucky to have
If we want to fight childhood obesity, we need to get kids moving.
Sounds incredibly obvious. And that was my reaction when I first read the study just released in the journal Pediatrics—in it, the authors said that high school students were less likely to be overweight or obese if they played at least two sports during the school year, or if they walked or biked to school. Really? Next we …
When it comes to exercise, stating the obvious is really important
I knew it would happen sooner or later, and earlier this week it finally did.
In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and heart attack were now instantly available on the Internet. While we performed …
The upside of hospital rankings far outweighs the downside
In the debate over health care reform the issue of choice is often brought up. I’m not referring to a women’s right to choose or the birth control controversies but the simple idea of individuals being able to choose their health plan or physician.
However most physicians would probably agree that for much of health care, especially unexpected and sudden illnesses, the idea of choice is an illusion. Patients rarely choose …
A physician has difficulty choosing a primary care doctor
“The plural of anecdote is not data.”
A recent lead editorial in the Sunday edition of the New York Times was entitled “A Formula for Cutting Health Costs” and contained the byline “Alaska natives have something to teach doctors and patients in the rest of the world.”
I read the editorial with interest, hoping that a new perspective, vision, idea, or insight would be mentioned that would provide a sustainable cost solution …
Mainstream media’s sinister undertone against doctors
Media outlets are reporting the results of a small, but very important study regarding a new treatment for Alzheimer’s Disease. Most Americans are familiar with Alzheimer’s because it is so common (President Reagan had it), so devastating, and without a cure. This new study gives hope to people who have or are at risk for the disease.
Recently at the Alzheimer’s Association International Conference 2012 in Vancouver, researchers presented the …
IVIG for Alzerheimer’s: Cost is a barrier
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