Happy residents do much more for their patients

Medical Education
December 23, 2011

The resident’s training can be compared to the one received by Navy Seals or U.S. Marines in many ways. Physical endurance, psychological warfare towards the trainee, long service hours and quick life or death decisions are all aspects of both types of preparation. In most cases, this turns out to be a great burden on the resident’s life, especially on the interns, whose lives have dramatically changed from one day …

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Happy residents do much more for their patients

Abbreviate your med list with caution

Medications
December 23, 2011

People who regularly take medicine should know what we’re taking.  To me, this seems obvious, but there are always those who need everything stated explicitly.  People taking prescriptions, vitamins, herbs, and any other treatments should know what’s being taken and why.

It’s pretty easy to make yourself a list and stick it in your wallet so that it’s always available.  If you need medical assistance (for instance, if you’re in a …

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Abbreviate your med list with caution

How companies try to curb health care costs

Health Policy
December 23, 2011

How do companies curb health care costs?

Do healthier employees lead to increased productivity?  Several progressive companies believe so and have committed to providing employees with programs to help engage them in a healthier lifestyle.

As part of the incentives to lead a healthier lifestyle some employers have instituted a penalty and reward system tied to the companies’ benefits.  For example, smokers may incur a significant surcharge to the cost of their …

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How companies try to curb health care costs

Dropping out of Medicare will break my heart

Health Policy
December 22, 2011

I met with my staff yesterday to discuss the effect of a 27% cut in Medicare reimbursement on our patients and our office.  I had a really lousy day, explaining to my elders what would happen if Congress fails to act.  One of my patients aptly pointed out that Congress has not acted responsibly in the last 20 years and that it would take a miracle for them to get their …

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Dropping out of Medicare will break my heart

Creating a practical, uniform policy on vein treatment

Conditions and Diseases
December 22, 2011

The general public, and much of the medical profession, has unfortunately little understanding of the connection between varicose veins and more serious manifestations of chronic venous disease, represented by higher CEAP classes. This is a fact that keeps many with vein disease from obtaining, or even considering, treatment. Fortunately, public education concerning venous disease and its potential complications, including chronic venous insufficiency and deep venous thrombosis, is growing.

Organizations such as …

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Creating a practical, uniform policy on vein treatment

A good attitude is necessary when transitioning away from medicine

Physician
December 22, 2011

Do you feel like you have nothing to show for the efforts you’ve put into your career change?

It’s easy to feel frustrated and lose motivation when nothing seems to be coming from all the work you put into things like LinkedIn, calling recruiters, revising your resume or networking.

There are two possible reasons why things might not be working for you.  Maybe you are doing the right things but you …

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A good attitude is necessary when transitioning away from medicine

My audacious goal for family medicine

Physician
December 21, 2011

I have a BHAG (Big Hairy Audacious Goal).

I want people to hear “family medicine” and know that it refers to a medical specialty dedicated to providing relationship-based, patient-centered health care.

I want people to know that family docs take care of a lot of complicated, challenging diseases – and not usually in isolation.  Our patients have high blood pressure, complications from type 2 diabetes, congestive heart failure, depression, chronic kidney disease, …

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My audacious goal for family medicine

Autism is but one part of my son’s soul

Conditions and Diseases
December 21, 2011

Conversation with my lovable eight year old boy with autism.

Me: Do you have autism?

David: Yeah. (Pause.) I want some milk.

Me: What do you like to play with?

David: Calvin

Me: Calvin is coming over today. He comes to see your sister. (David never plays with Calvin but does say hi to him).

Me: Do you like school?

David: Yeah

What do you do at school?

No answer

Me: Do you like to run marathons?

David: Yeah (Pretty sure …

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Autism is but one part of my son’s soul

Why I vaccinated my sons against HPV

Medications
December 21, 2011

I knew it was more than a tragic coincidence when two of my friends, middle-aged men without the usual risk factors of tobacco and alcohol use, developed late stage (IV) tongue cancer, reportedly the identical condition with which actor Michael Douglas was diagnosed last year. Cancers of the mouth and throat are growing so quickly that experts in the medical and scientific community are calling this an “epidemic,” for which …

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Why I vaccinated my sons against HPV

Isn’t it time for a patient rating system for doctors?

Physician
December 21, 2011

Here’s a devil’s advocate position.

Historically doctors have held power over patients as compensation for the responsibility of that position, and the epatient and other patient advocacy movements seek to address that imbalance with good reason, arguing that the doctor-patient relationship should be equal.  I don’t mind that. But let’s be truly equal partners then.

The patient’s right to choose a doctor and be informed of the best ones via doctor rating …

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Isn’t it time for a patient rating system for doctors?

The primary care doc fix is in 

Health Policy
December 20, 2011

Matthew Mintz, MD recently shared how primary care doctors are set to lose more than half of their salary. It’s well documented how primary care has faced a number of challenges with half of primary care physicians saying they’d leave medicine if they could as was mentioned in an earlier piece. There’s talk of a “doc fix” as physicians believe the debt ceiling deal is …

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The primary care doc fix is in 

Vaccines, preventable disease, and the nature of risk

Medications
December 20, 2011

Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.

My mother, as a girl, was bitten by …

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Vaccines, preventable disease, and the nature of risk

The fifties woman has many reasons to get better

Physician
December 20, 2011

“51-year old female presents today with …”

Funny, the vast majority of my clinical notes last week began with that phrase, give or take a year or two. Women in their fifties who saw me in the clinic, who I spoke to via television in my telepsychiatry practice, or who I interacted with in some other way. It struck me as odd that so many women of similar age came to …

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The fifties woman has many reasons to get better

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Show doctors the value when it comes to social media and EMRs

KevinMD
December 20, 2011

The common perception is that older doctors are more adverse to technology, especially when it comes to electronic medical records.

Recent data, however, says that isn’t true.

According to a study cited in American Medical News, “physicians more than 10 years out of medical school and those with higher patient volumes were more likely than younger and less busy physicians to …

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Show doctors the value when it comes to social media and EMRs

Reduce sedation in critically ill patients

Physician
December 20, 2011

I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking …

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Reduce sedation in critically ill patients

Quality indicators can harm the elderly

Physician
December 19, 2011

Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.

The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve …

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Quality indicators can harm the elderly

A culture of fear permeates the healthcare system

Physician
December 19, 2011

The culture of fear that led to dozens of fatal plane crashes in Korea, the molestation of young boys at Penn State University, and the tens of thousands of deaths of patients in our health care system are all a consequence of unresolved organizational conflict arising from a culture a fear. Unless, we replace fear with trust, conflict won’t be resolved.

In Korean culture, questioning authority is unacceptable and led to …

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A culture of fear permeates the healthcare system

Conflict between physician and nurse

Physician
December 19, 2011

When it comes to doctor- nurse interactions, when is enough, enough?

Recently, I dealt with an upsetting situation involving a physician and nurse. A little background: The nurse has been working on our unit for years (since it first opened). She is very smart and savvy when it comes to nursing. She constantly gets feedback from the patients as being one of the kindest, most thorough nurses. I look up to …

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Conflict between physician and nurse

Let physician assistants be part of the primary care answer

Physician
December 19, 2011

There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem.   To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future …

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Let physician assistants be part of the primary care answer

Advance planning should be a public health issue

Physician
December 18, 2011

“Medical training rarely deals with helping the dying patient find peace and comfort. In fact, most physicians are uncomfortable with the entire subject. I believe it is one of the most neglected aspects of medical care. I have spent my career as a pulmonary and critical care physician, and I have cared for thousands of dying patients. In many cases, both the patients and I knew that they were dying. …

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Advance planning should be a public health issue

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