As a mom and first-time parent, I marveled at my tiny daughter’s curiosity about and interest in the world. Her quest for knowledge was insatiable and her ability to sit absorbed in what she was doing and the moment enviable. Now that she’s 8 (“8 and a quarter, mom!”, said with a sigh and an attitude), she seems to have morphed into a smart, verging-on-sassy pre-tween who’s beginning to think …
Use a beginner’s mind in your medical practice
The recycling container was already full. But I had two more bags to stow before lugging the bin through the gate and into the front yard for pick up. My button down shirt untidy and bulging out from the waist. My long khaki pants felt like a fur coat in the ninety plus Chicago humidity. It was 4pm and I had just arrived home from work, dropped my computer in …
I concentrated to distill all that I had learned about death
Patricia Daly, FACP, of Warren Memorial Hospital in Front Royal, Va., told us about the case of a 49-year-old man who presented with marked weight loss. A year prior, the patient had weighed about 220 pounds and intentionally put himself on a diet, but after losing 45 pounds, he developed poor appetite and early satiety.
He continued to lose weight to a nadir of 143 pounds. He found it increasingly difficult …
The decision to pursue a rare illness
As a patient care provider and someone who is occasionally a patient myself, I am going provide some suggestions on ways to know when it is time to consider seeking a second opinion or time to seek a new health care provider. This top 10 list is taken from personal experience.
10 reasons why you need to change doctors
Doctors order too many tests.
That’s not a surprise for regular readers of this site, but even the physicians themselves think so.
A recent survey reported that, “42% of the 627 respondents believed the patients in their own practice were getting too much care. Just 6% of doctors believed their patients were getting too little care … And 28% of the …
Progressive health reformers need doctors to change the health system
A friend of mine recently took an exotic trip. While shopping in a market, she picked up an appealing item and asked the seller what it cost. She was given a price that seemed high, and paused to consider whether the impulse seemed justified. The shopkeeper grew confused in the silence. Finally he asked my friend, “Don’t you want to know if I can do better?”
Clearly this person was outside …
Health care consumers require a crash course on bargaining
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old woman is evaluated for a sudden loss of vision in the left eye that began 30 minutes ago. She has a 2-week history of fatigue; malaise; and pain in the shoulders, neck, hips, and lower back. She also has a 5-day history of mild …
MKSAP: 75-year-old woman with a sudden loss of vision
I have a confession to make. Lately I’ve been doing some soul-searching regarding the future of my social media presence. It started at a lecture I attended a few weeks ago, where students and residents were cautioned to avoid public social media profiles and blogging. It came up again one morning while I was discussing some current events with other students, and was mentioned most recently at a professionalism …
A social media background is an asset in medicine
Patients may soon be universally able to view their lab results thanks to a new rule proposed by the Department of Health and Human Services. This means patients may access without permission or release by their providers. This is a victory toward patient empowerment and a step in the right direction.
Classically patients do not see their lab results. The busy primary doctors are often left with nothing more than …
The empowered patient is a relief for physician practice
At every turn, we in health care are being told we must fundamentally change the way we deliver care to the patients who come to us for assistance, advice, and decisions as to how they can, if not maintain health, at least survive in an increasingly burdensome world. Whether referenced as medical home, health care home, advanced primary care, patient-centered approaches, or accountable care organizations, it all sounds the same …
Physicians lack harmony in this age of health reform
So I missed out on the whole CME outrage that came up earlier this year in a Archives of Internal Medicine study, but I do have a theory about it that I’d like to try out.
I’m not interested in getting into the “perceived potential bias” vs “actual bias” argument – which is a good one and one Tom Sullivan wrote about extensively – but would rather take a look …
Bias in CME due to the presence of commercial support is overrated
Physicians recommend different treatments for patients than they would choose for themselves. The preceding statement is true according to a similarly titled article recently published in the Archives of Internal Medicine, and has, I will argue, important implications for how we view the doctor-patient relationship.
In the study, one group of physicians was asked to choose between two hypothetical treatment alternatives for either avian flu or colon cancer as …
Doctors should not treat every patient like their mother
In an earlier post, DrRich offered several potential strategies for doctors and patients to consider should healthcare reformers ultimately succeed in their efforts to make it illegal for Americans to seek medical care outside the auspices of Obamacare. To those readers who persist in thinking that DrRich is particularly paranoid in worrying about such a thing, he refers you to his prior work carefully documenting the efforts the Central Authority has already made …
Is medical tourism a dire threat to American surgeons?
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Though there will always be times when an emergency disrupts your schedule, there is usually little reason for patients to wait more than 20 minutes for their visit. You will also find that continually double booking, arriving late, or having general mayhem in your office will inevitably result in everyone having to stay later than expected. Rather than experiencing all of these problems, you will be well served by isolating …
How to isolate problems in your scheduling system
His blood pressure disappeared. The arterial tracing, a red line on the monitor reassuringly undulating with every beat of his heart, falling from 122/83, 99/64, 80/50, 67/42, then a flat line at 48.
I had just come off the elevator, ushered in by the surgery resident who found me in the hallway searching for the right room.
Epinephrine. Get the code cart. Check for a pulse. The nurse screwed the two halves …
The only anesthesiologist in this vast hospital
I once asked a man in his 30’s why he was on disability. He had fallen attempting to ford a swift stream while fishing. He replied: “Well, the judge said I have a bad attitude, I don’t like people and I can’t hold a job.” Shocking as it sounds, it wasn’t very different from other reasons I’ve heard. “I don’t remember, my Dad put me on it.” “I have anxiety.” …
America’s broken disability system
Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.
Generative thinking is …
A hospital board needs to understand generative thinking
Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.
Lethal injections involve delivering a fatal dose …
Lethal injections are not good medicine
“Doc, my back is killing me! I think I need an MRI.”
I don’t know if you’ve ever uttered those words, but I can tell you I’ve sure heard them … more times than I can count. And believe me, I get it. When you’re in pain, all you care about is finding out what’s causing it as soon as possible so you can get rid of it as soon as possible. It’s quite tempting to …
An MRI for back pain may only confuse the diagnosis
Like you, I receive a whole bunch of breaking medical news every day, from television, radio, newspapers, direct mail, email alerts, press releases, and multiple websites.
Is any of it worth my time, my attention, or even a change in my knowledge, attitude, behavior, or medical practice? How can I quickly tell?
A medical journalist from Minnesota named Gary Schwitzer recognized this problem many years ago and created a service that …
It is a rare medical news story that gets high marks
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