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Create peace and dignity at the end of life

Physician

May 31, 2012

Never heard of the 90-80 dilemma? That’s because I have just coined the phrase. You see, tied into soaring healthcare costs in this country, is another humanitarian crisis of massive proportions.

A huge gap exists between what Americans want for end-of-life care and what they actually receive. 90% of people wish to die at home, yet nearly 80% of us actually die in institutions (hospitals and nursing homes.)

So, how did we …

Shared decision making is a necessary concept in modern patient care

Shabbir Hossain, MD

Physician

May 31, 2012

There’s nothing better than sitting down with a patient, going though an entire visit, and collaborating on a well thought out plan that meets everyone’s expectations.

Shared decision making is a wonderful and necessary concept in modern patient care. Paternalistic attitudes are fading away in the medical community as the next generations of doctors continue to get educated on how to manage patients who are very knowledgeable and yearn to be …

Is a good patient simply one who never complains or disagrees?

Suzanne Koven, MD

Physician

May 31, 2012

I’m currently having a chance to do one of my least favorite things: be a patient. And the whole time, I’m missing no opportunity to declare what a bad patient I am. “I’m sorry I’m such a bad patient,” I said to the phlebotomist when I winced as she drew my blood. “I know I’m a bad patient,” I said to the x-ray technician who re-positioned my fractured arm. “We …

How we need to take risk to reduce risk in hospitals

Richard Corder

Physician

May 31, 2012

The show-stopping line from the Hans Christian Anderson’s 1837 fairytale is actually, “But he has nothing on!”

A brave, young, clear thinking boy in the crowd is the only person confident enough to say what he thinks and speak up. Perhaps even more simply, the young voice in the crowd has not had the life experience that often builds (and rewards) the filters of loyalty, flattery and only saying and thinking …

Young physicians will become the champions of technology

David Lee Scher, MD

Health Technology

May 30, 2012

“Generation C” has recently been defined by Nielsen as adults between 18 and 34 years old, who are entrenched in digital technologies.

They are indeed the connected generation and use technology by choice in all facets of life. It is part of their fabric. Those entering the field of medicine would logically desire and expect to carry that over to their professional lives. However, there are multiple barriers to the continuity …

Autism is a social justice problem

Claire McCarthy, MD

Conditions and Diseases

May 30, 2012

A child with autism is more likely to do well if his mother is white and educated.

This is the message of a study just released in the journal Pediatrics, and it’s something we need to pay attention to—now.

Researchers from Columbia University wanted to find out what happens to children with autism over time. So they looked at the records of more than 6,000 children with autism who were enrolled …

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Autism is a social justice problem

Isn’t caring for your child worth as much as caring for your parents?

Nilesh Kalyanaraman, MD

Health Policy

May 30, 2012

I love it when I see Medicaid patients on my schedule for the day. Working at a community health center, our doors are open to all people, regardless of their ability to pay. It’s hard to run a medical office when you get $20 for a visit, which is what our uninsured patients pay. So when a patient has Medicaid we know we’ll get paid a decent reimbursement for that …

The power of words in cancer care

Don S. Dizon, MD

Physician

May 30, 2012

In oncology, there are certain words and phrases that (no matter how carefully said) suck the air out of a room, like “you have cancer,” “you’ve recurred,” “incurable,” “terminal,” and “hospice.” Such phrases require careful consideration before they are spoken, and most (if not all) oncologists understand the power of these words, and use them carefully. However, there are others that can …

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The power of words in cancer care

When the homeless disappear

Maria Yang, MD

Physician

May 29, 2012

Two weeks had passed before I learned what happened.

I hadn’t seen him in several months. At our last meeting, the trees were full of red and orange leaves. He, as usual, was not interested in talking to me. He was sitting in front of a closed shop.

“Hi. How are you?”

“Fine.”

People in the neighborhood took care of him. Surrounding him were several plastic bags holding neatly stacked styrofoam containers filled with soup. …

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When the homeless disappear

A radical transformation in healthcare decision making is needed

Marya Zilberberg, MD, MPH

Physician

May 29, 2012

I love when an article I read first thing in the morning gets me to think about itself all through my morning chores and then erupts into a blog post. So it was with this little gem in the statistical publication Significance. The author suggests making gambling safer by placing realistic odds estimates right on the poker machines in casinos. He even goes through the generation of the odds of …

Listening is what a patient needs most

Anonymous

Medical Education

May 29, 2012

Hard time is here
And ev’rywhere you go
Hard times is harder
Than th’ever been befo’

The opening lines of a century-old Delta blues song rings out among the stars and the dark of a rural Virginia night. I sit tenuously awake atop an old wooden stump in front of a farmhouse, where four minds sleep peacefully inside. It is 3:00 am. From the window, I hear the sound of the needle dragging …

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Listening is what a patient needs most

A population health approach to wellness

David B. Nash, MD, MBA

Health Policy

May 28, 2012

FACT: Four determinants of health account for 40% of all deaths in the U.S. – smoking, unhealthy diet, physical inactivity, and alcohol use.

FACT: A mere 3% of Americans do all of the relatively “simple” things they should to stay healthy – i.e., exercise for 20 minutes 3 times a week, don’t smoke, eat fruits and vegetables regularly, wear seat belts regularly, and remain at their appropriate BMI.

FACT: According to the …

Compassion fatigue is an early warning sign of physician burnout

Dike Drummond, MD

Physician

May 28, 2012

For anyone in the helping professions, compassion fatigue is a common occurrence and a clear signal to take better care of your own needs.

Compassion fatigue is when you find yourself challenged to care about your patients in the way you know is proper and expected in your position. One of the key components of quality healthcare is the ability for you to connect with your patients and for them to …

How we treat sexual assault matters more than we will ever know

Natalie

Medical Education

May 28, 2012

My psych final was this morning, which I am 90% confident I did well enough on to pass the class (which is all I need to be satisfied). Considering I counted watching “Girl, Interrupted” as studying, I say that’s not too bad.

I felt like there were many necessary topics left out of our behavioral medicine and psychiatry course. One of the many: sexual assault.

For the past eight years I have …

MKSAP: 59-year-old man with tachycardia and hypertension

mksap

Conditions and Diseases

May 28, 2012

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

A 59-year-old man is evaluated for tachycardia and hypertension six hours after undergoing an uncomplicated open cholecystectomy under general anesthesia. The patient had intraoperative high blood pressure and was treated postoperatively with metoprolol, 5 mg every 4 hours by intravenous bolus. The patient underwent repair of …

Men’s health is a joke on television

Joel Sherman, MD

Physician

May 27, 2012

The mass media has a long history of covering medical dramas and rarely doing so with any realism. We’ve gone from Marcus Welby, MD to a host of shows dedicated to portraying medical personnel in the most salacious ways possible. But at least with all these dramas it is understood that they are fictional. There are now though a host of shows which pretend to show real life medical stories …

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Men’s health is a joke on television

How placebo treatment may be helpful

Brian D. Clark

Medications

May 27, 2012

The ability to critically assess the validity of a clinical trial is one of many important skills that a physician strives to develop. This skill helps guide clinical decision-making, and there are a number of things that we are trained to look for to help determine the validity of any given study. Right at the top of the list of factors that go into this appraisal is that of study …

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How placebo treatment may be helpful

Patients are more than multiple choice questions

Rick Pescatore, DO

Medical Education

May 27, 2012

It felt good to stuff the stethoscope back into my pocket and slip into the emergency department last night. The constant ringing of phones, beeping of cardiac monitors, and distant wail of inbound EMS units was a welcome cacophony compared to the isolated silence of the library study rooms. Sweeping the curtain back as we stepped into the first patient room, the hours of frustration with biochemical pathways and embryological derivatives …

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