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Patients are often intimidated and confused by the medical experience

Patient

June 29, 2011

As a recently minted physician, I am often on the receiving end of the gripes and grouses about the medical profession.

Often I get complaints of office visits that are too short, doctors who seem too preoccupied to hear their patients’ complaints, medical bills that are too high and medications that do nothing but cause adverse effects. On the other hand, I can’t count the number of times I have …

Examining medicine through the lens of women’s rights

Emily Lu

Medical Education

June 28, 2011

I’ve always had a hard time identifying myself as a feminist.

I work for healthcare equality and human rights. Women’s rights seemed to me a part of human rights work (and as Hilary Clinton and others have said, woman’s rights are human rights). Tying myself to the feminist movement then seemed to be looking backwards – clinging to a term that was anachronistic, divisive and too narrowly defined in what activism …

How ordering tests sometimes have consequences for patients

Stewart Segal, MD

Physician

June 28, 2011

Sometimes, you just can’t win! In medicine, sometimes is way too often. “Doc, do I need that test?” reviewed the issues surrounding screening colonoscopy exams. The dilemma is always the same. Do I order a test or don’t I?

If I order a test, there are consequences. Some are obvious; some are not. Tests cost money and money is in short supply. One consequence of ordering a test …

Why doctors shouldn’t leave their emotions behind

Michael A. Zadeh, MD

Physician

June 28, 2011

Part of the reason I became a physician was because I got tired of watching those close to me as they suffered through illness and eventually died, while I stood helplessly by, unable to do a thing.

Throughout my training I watched as my mentors interacted with their patients, displaying a political correctness matched with just enough outward emotion so that there was no telling the difference between the good news and the bad.

“Don’t …

Avoiding confrontations and the difficulty of standing up for yourself

Susan Biali Haas, MD

Patient

June 28, 2011

When I was 8, my mom went to a parent-teacher night at school. When she sat down with my teacher, the teacher smiled and said: “So how are Susan’s swimming lessons going?”

My mom frowned, confused. “Susan isn’t taking swimming lessons – perhaps you’ve confused her with someone else?”

“No, I’m sure,” my teacher insisted. “Susan told me that she has to leave at 3 o’clock every afternoon, right when the bell …

How to review the performance of your office staff

Rosemarie Nelson

Physician

June 28, 2011

Your staff members are your most important (and costliest) resource. Have you invested in them? Do they know what is expected of them? Have you asked them if they have what they need to do their jobs?

Optimizing staff performance is a process. It starts with a plan, not the formal performance review.

You can’t do a successful performance evaluation without establishing accurate standards against which the employee’s performance can be …

How positive thinking affects patients with serious illnesses

Dr. Martin Young

Patient

June 28, 2011

I was sick the other day. A bout of gastroenteritis that had me vomiting with diarrhea for 24 hours and feeling weak for another 48. I felt rough for a while, but got over it pretty quickly. My family gave me just the right amount of care, and avoided me appropriately because I get grumpy when I am sick.

Had they dared approach me with the suggestion that my state of …

Surgeons with depression and suicidal thoughts don’t get the care they need

Brian Goldman, MD

Physician

June 28, 2011

When you think of surgeons, you likely picture heroes deftly using scalpels to pull patients back from the brink. But sometimes, as much as surgeons want to save someone, they simply can’t. A new survey finds that some of the men and women doing amazing feats of medicine in the OR don’t think quite so highly of themselves.

Suicidal thoughts could be the result of depression and job burnout. …

The challenge of pre-authorization for an elective procedure

Kevin

Health Policy

June 27, 2011

by Grayson Wheatley, MD

It was supposed to be a routine office visit for my patient.

Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …

A transparent process to allocate resources based on evidence

Bob Doherty

Health Policy

June 27, 2011

The New York Times reports on Washington state’s efforts to “to determine which medical devices and procedures Washington will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all.”

An expert panel, appointed by the state, is getting national attention, writes the Times, “in part because its process is public and open. . . [and] provides a living laboratory of the complexities of applying evidence-based …

Should doctors be scared of government mystery shoppers?

Kevin Pho, MD

KevinMD

June 27, 2011

The government is going to find out about the primary care physician shortage for themselves.

They’re resorting to “mystery shoppers,” used frequently in other industries, to see what the wait times really are for a new primary care doctor. As mentioned before, come 2014, there will be over 30 million newly insured patients looking for a doctor. This will further stress a system short of primary care resources.

Doctors, as …

One more thing: Works for Apple, but killed Google Health

Kevin Pho, MD

KevinMD

June 27, 2011

Google Health is dead.

There have been plenty of post-mortems as to why, ranging from the fact that it’s not social enough (uh … no), to the realization that only a minority of practices have electronic medical records, yet alone a patient portal that can incorporate PHRs like Google Health.

I’ll chip in with my own reason — it suffered from “one more thing” syndrome.

PHRs today aren’t seamlessly incorporated into …

Closing the communication gap between patients and physicians

Howard Luks, MD

Patient

June 27, 2011

I lived in Japan in 1991. When I was having a conversation with someone, they would always nod their head as if they completely understood the message I was trying to convey.

It turns out that was not the case. The nodding was a sign of respect. When I began to inquire if they understood what I was trying to say — it became clear that the answer was usually no.

Many …

Reasons why medical students burn out and become depressed

James Haddad

Medical Education

June 27, 2011

As I finished my 24-hour call recently, I was reminded of a 2009 study revealing a decline in empathy as medical students transition from their mostly-didactic second year to third year, which is essentially an apprenticeship in the hospital with lecture as an afterthought. I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences …

How doctors can shape the health reform narrative

Maggie Kozel, MD

Health Policy

June 27, 2011

With the roll out of the Affordable Care Act and perhaps more significantly the approach of the 2012 elections, public discussions of healthcare reform has been drowning in an alphabet soup of ACOs (not to be confused with the above ACA), CMS, SCHIP, and RUVs, just to name a few.

The challenge is twofold. Most of these plans/systems/agencies deal with how to better pay for a seriously flawed system. …

ACS: The breast cancer screening debate continues

J. Leonard Lichtenfeld, MD

Conditions and Diseases

June 27, 2011

I am sitting here wringing my hands that so much has been made of some studies reported recently at a major radiology conference which suggest that the impact of the breast cancer screening guidelines released by the United States Preventive Services Task Force (USPSTF) in November 2009 has either been good or bad on doctor and patient …

MKSAP: 75-year-old man with a draining chronic ulcer on the foot

mksap

Conditions and Diseases

June 26, 2011

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

A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide.

On physical examination, he is not ill appearing. Temperature …

Differences between obstructive and central sleep apnea

Steven Y. Park, MD

Conditions and Diseases

June 26, 2011

In sleep disorders, obstructive sleep apnea is the most common condition that’s seen, but a significant number of people with obstructive sleep apnea will also have central sleep apnea.

Central sleep apnea is thought to be a condition that’s associated with a number of different neurologic problems, as well as heart or kidney failure. During the night, people with central sleep apnea stop breathing when signals in the brain that …

How a day in the emergency department is a microcosm of real life

StorytellERdoc, MD

Physician

June 25, 2011

I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies–hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.

If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that …

Team based care in health reform needs patient involvement

Kevin Pho, MD

KevinMD

June 25, 2011

The following op-ed was published on June 7, 2011 in USA Today.

More than ever, I find myself fielding questions from patients about the health care reform law. The most common one is, “How will reform affect me?” It’s a complicated question, with a different answer for each patient. But as the law’s full effects unfold, one of the more significant changes will be in how patients interact with their …

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