A recent survey in the American Journal of Bioethics, indicates that 80 percent of patients expect to see a physician when they come to the emergency department.
Parents were more insistent about their child see a physician or resident for even a minor condition such as a sprained ankle.
Patients indicated a preference for seeing a resident alone for non-urgent conditions (60%) and compared to a physician …
How PAs and NPs impact emergency room care
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated during a routine examination. He has a 5 pack-year cigarette smoking history but stopped 12 years ago. He has no history of hypertension, diabetes mellitus, stroke, or transient ischemic attack. He has no claudication. He is being treated for hyperlipidemia. There …
MKSAP: Healthy 68-year-old man with a cigarette smoking history
My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic.
We were sitting in an area called “the Park” rehashing what her doctor had said when a mother and her daughter sat down at our table. There were lots of empty seats in area but for some reason they decided to sit with us. Call it serendipity. …
Benefits of chance meetings with other cancer patients
by Greg Smith, MD
As a psychiatrist, part of my job is to listen as you tell me about symptoms that bother you every day.
If I can help you put these symptoms into a framework such as a syndrome or a disease, then we can work together on trying to figure out how to treat them. Often times in Read more…
Why cookbook medicine detracts from compassionate care
If you have been at your nursing job for a while, you’ve probably almost forgotten.
Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for you to learn and adhere by as a nurse. After years of routine, you now go about your day as if you actually have some choice in the way you give …
How protocols are taking the decisions away from nurses
Stem cells will usher in the era of regenerative medicine, allowing the creation of cells, tissues and organs to treat or cure diseases and injuries. This will be a fundamental alteration in our approach to medical care and a transformational medical megatrend. And it will be very “personalized medicine” to provide the specific individual with custom tailored new cells and tissues for organ repair or …
How stem cells will impact medical care
Sixty five years ago my maternal grandmother, having experiencing months of fatigue, abdominal discomfort and weight loss, underwent exploratory abdominal surgery, the only truly diagnostic tool available at the time.
One brief look by the surgeon told him everything he needed to know: her liver and omentum were riddled with tumor, clearly advanced, with the primary source unknown and ultimately unimportant. He quickly closed her up and went to speak with …
The patient is a partner in their illness management and health maintenance
I love to pick up my two year old from daycare. Her language is becoming increasingly complex with small sentences, lots of gesturing and expression. When I ask how school was, she says, “Miss you. I crying.” Or, “I running fast with friends.” Or sometimes a confident, “good,” with a head nod.
Yesterday, she said, “friend, bite me.”
Her very kind teacher confirmed the event, and asked my daughter to show me …
Biting in children is a sign of normal social experimentation
I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came …
Why doctors can’t screen patients for every disease
An elderly woman sent home from the hospital develops a life-threatening infection because she doesn’t understand the warning signs listed in the discharge instructions.
A man confused by an intake form in a doctor’s office reflexively writes “no” to every question because he doesn’t understand what is being asked.
A young mother pours a drug that is supposed to be taken by mouth into her baby’s ear, perforating the eardrum.
And a man in …
Poor health literacy linked with unnecessary health complications
The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward.
Two recent headlines focus the problem:
New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone Care
And, CNN Money, May 11, 2011 reports “Your family’s healthcare costs $19,393.” That is for a family of four, which has a median income of $75,700 — before taxes.
Opportunity …
Can ACOs reinvent the American health care system?
I’m all for the values of social media, as evidenced by my frequent use of Twitter, Facebook, Youtube and LinkedIn.
Recently, I realized again the value of a telephone conversation. I was on the phone with someone who I consider a mentor, someone who has fiercely guided me through my journey into social media without knowing the power of what was being done. It was the best 20 minutes of …
Meaningful offline dialogue creates online inspiration
Here are the three most useful words for a doctor: “I don’t know.”
A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.
Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical …
The three most useful words for a doctor
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According to one of the the guidelines set forth by the AMA about professionalism in social media, “When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions.”
With that in mind, Bryan Vartabedian, who …
How doctors should professionally behave on Twitter
Armed with tools I have never used or seen before I entered a physical exam practice room for the first day of learning.
Having finished history-taking practices last semester, we were now beginning a new chapter, learning to take a head-to-toe physical exam. Before class began, we were told to read a book and …
Doing the physical exam for the first time as a medical student
I’m a big game theory guy.
I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the “players” almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is …
Medical malpractice tort reform equals healthcare reform
by Alex Smith, MD
I used to get Sports Illustrated, and my favorite column was titled, “This week’s sign that the apocalypse Is upon us.” Well, JAMA recently published the medical equivalent.
Sima and colleagues at Memorial Sloan Kettering used a population based dataset of patients with cancer to compare rates of cancer screening (mammography, PAP smears, PSA …
Cancer screening on autopilot in patients with advanced cancer
Doctors who do not successfully e-prescribe 10 times for Medicare patients in the first six months of 2011 using claims-based reporting may be hit with a 1% penalty on their Medicare Part B payments for covered professional services in 2012.
The penalty will increase to 1.5% in 2013 for those who don’t e-prescribe for 25 Medicare patients during 2011.
Not yet e-prescribing?
Maybe your Read more…
E-prescribe now, or risk a Medicare penalty
Omega-3 fatty acids (more properly called “n-3 fatty acids”) are a group of naturally occurring fat molecules.
They are found mainly in fish and other marine-derived oils, but some can also be extracted from plants. Omega-3′s are currently very popular, but the evidence for their usefulness isn’t so clear. A recent study failed to show any benefit in preventing dementia. A new study out …
Omega 3 fatty acids and the prevention of heart disease
Herpes zoster (or shingles) is caused by the same virus that causes chicken pox.
Zoster increases in incidence with advancing age. It is estimated that over 1 million Americans get shingles annually with the resulting acute discomfort and often chronic pain thereafter. A vaccine was introduced by Merck in 2006; the initial studies of 38,546 patients indicated …
Almost everyone over the age of 60 should receive the zoster vaccine
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