I see my oncologist for my twice-yearly checkup tomorrow, and while my visits have been blissfully mundane over the last three years, this time I actually have a list of questions and a couple of concerns over the lab results from my latest physical. It’s probably nothing, but once you’ve had cancer you can’t help but wonder which “nothing” is actually the edge of trouble’s long shadow. My family doctor sees no cause for …
No act of kindness is ever wasted
During my time at PPOH, I spent one day a week working at a geriatric adult home.
An adult home is a residence that generally houses people with psychiatric conditions. They can be run by either public or private agencies. At best, they provide services and supports for the residents so they can live independently. At worst, they provide very little other than shelter; they just take people’s money. (The latter has …
Learning from patients at a geriatric adult home
Medicare is beginning to tie financial bonuses to hospital patient satisfaction scores.
Although patient satisfaction is important, I’ve voiced concern in the past about giving hospitals a financial incentive to cater to patient surveys.
In a previous USA Today column, I wrote, “already, more than 80% of doctors … said patient pressure influenced their medical decisions. And in primary care, linking …
How patient satisfaction scores reward rich hospitals
How long ago was it that we were all content with having the physician have a MD or DO title after their name, the clinic or hospital floor nurse having a RN after her name, the pharmacist having RPh after their name?
Now unless the pharmacist has PharmD after their name they can’t be a pharmacist. And for the nurse, unless they have RN, BSN or RN, MSN after their name …
Let’s stop degree creep in health care
In March 2010 President Barack Obama and the Democratic-led Congress passed the single largest change in the American health care industry since the introduction of Medicare and Medicaid in 1965. The Patient Protection and Affordable Care Act (PPACA) aims to drastically change the way that health care is delivered and financed. It partially draws upon the idea of personal responsibility and its role in promoting individual health. Some states, notably …
Personal responsibility in promoting individual health
It is well known that men see doctors much less frequently than women. The reasons are multifactorial and not all that well studied. It’s certainly not because men are healthier than women as they die on the average seven years before women. Clearly women are accustomed to seeing doctors at an earlier age than men for reasons relating to childbirth and birth control. Most accept the recommendations to get an …
Embarrassment is one reason why men don’t see the doctor
The following op-ed was published on September 18, 2011 in USA Today.
A fellow physician recently shared a frustrating clinic visit with me, in which a patient had left by saying, “You doctors need to wake up and realize that patients (who are) in pain are in a no-win situation.”
The patient was absolutely right. This summer, the Institute of Medicine released …
Doctors and patients cannot win when it comes to chronic pain
Several years ago, during an annual mammogram, my wife, who is in her 40s, was told a mass had been found in one of her breasts. Anxious and uncertain, she had a biopsy, and we braced for the worst.
My father-in-law, when in his 50s, went through a similarly harrowing experience when a prostate specific antigen (PSA) test given during a routine physical exam came out positive, and he underwent a …
The fallacies of screening tests extend beyond false positives
Before going any further, the title to a Los Angeles Times story was “Adele to have surgery to treat vocal cord hemorrhage. What is it?”
I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason …
Treating Adele’s vocal cord hemorrhage
What is an essential health benefit? I suppose that is a health or medical action, product, or process that should be paid for by someone other than the patient, in a society that provides so-called “third party coverage.”
Many very smart people and strong organizations have struggled with this issue for many decades.
Prior answers, such as they are, have come from staff model HMOs like Kaiser Permanente, the Veterans Health Administration, …
Is it possible to implement a list of essential health benefits?
I don’t know when I lost my sentimentality.
Whaaap.
With a thud the fish stops flopping up and down. It lays still on the floor of the boat. My camp counselor, a tanned college student, carefully places the paddle on the seat and cuts the fishing line. The hook remains dangling from the lifeless mouth.
He grabs the fish with his bare hand and throws it back into the water. He talks slightly …
Recently, the media has reported that the American Academy of Pediatrics (AAP) has broadened its 2000-2001 guidelines for the diagnosis of and treatment of ADHD. While the prior guidelines focused on children from ages 6 to 12, the new guidelines cover ages 4 to 18. The story is being covered by the media with lead-ins such as saying that AAP is “expanding the age range for diagnosis and treatment.”
This is …
Neuropsychologists in the evaluation of ADHD
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession.
Loni Hildebrandt was a 29-year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and …
When doctors have to be reminded how to act like human beings
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The public gets much of its health-related news from lay-oriented synopses of scientific papers published in refereed medical journals or presentations at major medical conventions. Longer, more detailed commentary is published in the print media, but the majority are short pieces posted on many websites or blogs. I try to familiarize myself with information pertaining to cardiovascular disease as well as predisposing conditions such as diabetes and hyperlipidemia with the …
The ability to quantify empathy
The voice on the phone is demanding, quavering, pleading; “Dr. deMaine you are going to be the attending critical care doctor when our mother is transferred to your hospital today. She needs to be taken off the respirator and allowed to die. We have been pleading with the doctors at the burn center, but they keep doing more procedures. We want her off life support as soon as she gets …
Medicine is slowly facing the issue of futile care
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he had one or two bowel movements of well-formed stool …
MKSAP: 32-year-old man with abdominal pain
One recent morning, my grandma awoke with abdominal pain. She was taken to a good, local community hospital and diagnosed with acute ischemic bowel. There are various causes of ischemic bowel, but regardless of cause, getting the right care quickly determines whether such patients live or die.
After speaking with her physicians, I called some friends. A quick discussion with colleagues in radiology, surgery, and gastroenterology helped me know that the …
Would patients benefit from experts who never meet them?
We heard from a patient during our dermatology week, who worked as a medical laboratory technician, running hundreds of blood samples every day, and frequently using her own blood as the negative control. Then she began to notice that the numbers stopped making sense. Her ANA had shot through the roof and her white blood cells started dropping.
“I couldn’t use my blood as the negative control anymore,” she said, shrugging …
The unspoken assumption that doctors are well
Technology adoption is iterative. Here are some suggestions that can help you adopt and morph EHR techniques and processes to fit into your own practice’s workflow.
When it comes right down to it, some are basic learning techniques that can apply to any new situation in the office.
And remember, everyone has something to learn.
Don’t get stuck in your own routine, if a physician finds a work-around that improves a system function …
Tips for a seamless EHR transition
Harvard University’s Edmond J. Safra Foundation Center for Ethics has conducted a lecture series focused on Institutional Corruption. In December, Marcia Angell-Relman, M.D., the first woman to serve as acting editor-in-chief of the New England Journal of Medicine (NEJM), gave an hour lecture which focused on conflicts of interest (COI) in academic medical centers (AMCs), and continuing medical education (CME). After the lecture, …
The benefits of academia-industry relationships
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