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Do we have too many hospital beds?

Health Policy

June 16, 2012

Stranded capital is a new term, a derivation of the term stranded costs that emerged from the deregulation of electric companies. It refers to “the existing investments in infrastructure for the incumbent utility which may become redundant in a competitive environment.” Many academic medical centers are weighing the importance of meeting current demand while considering the risk that, in a future competitive environment, dramatic declines could occur in the need …

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Do we have too many hospital beds?

Physician ratings can help identify missed opportunities

Sandra O. Gold, EdD

Patient

June 16, 2012

Mirrors reflect, and give us pause for reflection. Not always eagerly sought after or welcome, this reflection does not always reinforce the image one has of oneself. For a physician, publicly-posted patient ratings that contradict the doctor’s perception of his or her standard of care can be jarring.

Through “How Does Your Doctor Compare?”, the physician practice rating collaboration between Massachusetts Health Quality Partners (MHQP) and Consumer Reports, patients can access …

MKSAP: 62-year-old man with enlargement of the hand joints

mksap

Conditions and Diseases

June 16, 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 two-year history of enlargement and discomfort of the metacarpophalangeal joints of both hands. He works as a bank manager and leads a sedentary lifestyle. He does not have morning stiffness. He was diagnosed with type 2 diabetes mellitus three …

Clinician researchers meet the physician scientists

Vinay Prasad, MD

Physician

June 15, 2012

Recently our department of medicine grand rounds was on the subject of asthma. It began with a clinical vignette about a child with asthma, lasting three minutes, and, was followed by 47 more of intracellular cascades. The talk was like many others this year, and the speaker, who was introduced as a physician scientist, lived up to the part.

As someone who works in an academic hospital, I know many physician-scientists. …

Banning large sugar sweetened drinks is a start

Mandy Huggins, MD

Conditions and Diseases

June 15, 2012

In an effort to combat obesity and all the health problems that are associated with it, New York mayor Michael Bloomberg recently announced a plan to ban the sale of sugar-sweetened drinks to 16 ounces or less. It also includes a $200 fine to vendors who violate it. If passed, the ban could take place as early as next March. The ban would not include diet drinks, juice-based drinks, or …

Both patients and physicians need to communicate in the exam room

Beth Austin

Patient

June 15, 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 relishes the role. 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 being an empowered patient …

Should doctors really want ideal patients?

Maurice Bernstein, MD

Physician

June 15, 2012

What do you think is the physician-view of an “ideal patient”?

Well, as physicians, though we would like to think of caring for an ideal patient, we have to face the reality that this would rarely happen. You see, the ideal patient would be one who, first of all, bears many of the views and goals of the physician. As physicians, we really can’t believe that we will be so lucky. …

Is CT lung cancer screening worth it?

Deep Ramachandran, MD

Conditions and Diseases

June 14, 2012

In 2011 The National Cancer Institute published results from their study of low dose CT lung cancer screening of individuals identified as at risk for lung cancer. The investigators enrolled those between 55 to 74 years of age who had at least 30 pack years of smoking under their belt (number of packs per day multiplied by number of years smoked). These people were then randomly assigned to either a …

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Is CT lung cancer screening worth it?

Medical students need guides during their clinical years

Thomas Doran

Medical Education

June 14, 2012

Before I started medical school I thought it would be phenomenal to become a doctor. What could be more amazing than to possess a thorough, complete and intimate understanding of the human mechanism? I came to medical school to learn physiology and pathology in their entirety. I could not imagine a more valuable understanding than to fully know the secrets of the human body, what befalls it and how to …

Primary care physicians are negatively portrayed in the media

Trishul Reddy, MD

Physician

June 14, 2012

Does it really make sense for a neurosurgeon to be quoted in a news story about a new treatment for diabetes or prevention of obesity? Some news reporters think so, leaving primary care physicians frustrated at the media’s lack of understanding about the wide range of expertise they practice on a daily basis. In both news and entertainment media, seeking out and representing primary care expertise seems to be the …

The secrets to a fulfilling medical practice are often paradoxical

Robin Youngson, MD

Physician

June 14, 2012

“Great interview, darling, but there’s one question you didn’t quite answer.”

My wife is my best coach. She thought the question about a busy orthopedic surgeon not having time to relate to his patients deserved a better response.

My interviewer, a psychiatrist, said he once accompanied a surgeon friend on his Saturday morning round of post-op cases. On the drive home, he challenged his friend with the observation that many of the …

Burdening families with CPR decisions in the face of futility is cruel

Monica Williams-Murphy, MD

Physician

June 13, 2012

Those who know and work with me have heard me state without hesitation that it’s morally wrong to do CPR on 90-year old great grandmas. So, it was with great relief that I read the “Do Not Offer CPR” option in a recent JAMA article urging a revision of our present approach to the use of CPR for those who are unarguably at the end of life.

This is a change …

Communication skills are lacking in health care today

Satyam H. Veean

Medical Education

June 13, 2012

Take a look around you. What do you see? Babies playing with gadgets, four year olds playing with cell phones, and teenagers and adults playing with iPads or typing away on their personal computers. With the exponential increases in technology, specifically the digitalization of communication, in the past decade, our citizens have moved to the point of paying more attention to our devices than to each other.

As we begin to …

Always remember why you are a doctor

Don S. Dizon, MD

Physician

June 13, 2012

I was recently asked to speak at hematology-oncology Grand Rounds at Rhode Island Hospital. Instead of my usual topics on gynecologic cancers or sexual health, my colleague, MaryAnn Fenton, had asked me to speak to them about promotion in academics. I was both touched and taken aback that I was now in a position to give that kind of advice. …

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Always remember why you are a doctor

Our health problems will remain, despite how the Supreme Court rules

Ricky Choi, MD

Health Policy

June 13, 2012

I was recently honored to attend a discussion at the White House, convened by Health and Human Services Secretary Kathleen Sebelius. It was one of those rare “clear my schedule immediately” invitations; I thank my patients and family for allowing me to take this last minute trip.

Physician leaders from around the country were invited to the White House for a dialogue with lead government health officials (specifically administrators from the …

Long waits to access primary care are avoidable

David Margolius, MD

Physician

June 12, 2012

“Cheers!” “To good health,” my girlfriend and I toasted in the living room of our apartment joined by my parents on speakerphone.

It had been 12 years since my last radiation treatment—my last treatment for Hodgkin’s Lymphoma. Tonight was the anniversary of my remission, and in the case of Hodgkin’s—a cancer with an exceedingly low relapse rate—tonight was my anniversary of being cured.

I kissed my girlfriend goodbye and tread the dark …

Why isn’t shared decision making standard practice?

Patricia Salber, MD

Physician

June 12, 2012

Pretty much everyone chats up shared decision making these days. And that is good. It seems intuitive that people (patients) who are knowledgeable about their condition and buy in and/or help to shape the treatment plan are more likely to follow it.

Here is an example from my seatmate on today’s flight from SFO to our nation’s capitol. Her son, let’s call him Alex, is a teen with cystic fibrosis (CF). …

The selfless people in medicine are the people a patient never sees

Ryan Stewart, DO

Physician

June 12, 2012

It’s been two days now since I basked in the glory. I still find myself floating above the ground. I can still feel the weight of the heavy gown and the velvet tam. I can feel the tickle of the tassel on my ear. My eyes fill with tears at the thought of my classmates – those who toiled alongside me – experiencing the same emotions. The reminders of our …

Physician disrespect impedes patient safety

Jessie Gruman, PhD

Patient

June 12, 2012

“I just love working here!” my nurse told me. “We have great supervision, I have wonderful colleagues – we all help each other in an emergency. The doctors are really responsive and I feel like I am doing important work. I thought I would only stay for a year because oncology is so hard, but I’ve been here ten and I still love it.”

This is what we want to hear …

Patients must speak up at the doctor’s office

Kevin R. Campbell, MD

Physician

June 11, 2012

While reading the New York Times I stumbled upon an article by Pauline Chen addressing issues with doctor patient communication.

In the article, Dr. Chen describes a highly educated, articulate patient who was unwilling to speak up and discuss care related issues with her doctor. The reasons given for not wanting to speak up included not wanting to anger the physician and not giving the perception of questioning judgement.

I immediately began …

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