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Health related anxiety in patients with complex problems

Conditions and Diseases

May 10, 2011

As an academic gastroenterologist at a tertiary care university medical center, I often see patients who have failed traditional therapies that many of my colleagues in the community have tried.

Over the past several years my practice has evolved, from dealing with predominantly the medical aspects of my patients’ diseases to embracing the biopsychosocial model of illness. One of my colleagues has been the world leader in patient care and research in the …

Excited about the future of healthcare in the emergency department

Kevin

Health Policy

May 10, 2011

by William Schumacher, MD

Am I the only one excited about the future of healthcare?

With all the prevailing pessimism about America’s “dysfunctional” health” system, optimists (and I am one) sometimes feel stranded on our own lonely islands.

It’s not that we don’t know what the challenges are. I have been practicing emergency medicine for over 30 years, and there …

How to use an iPad in the OR during surgery

Kevin

Health Technology

May 9, 2011

by Felasfa Wodajo, MD

The iPad has received a significant amount of attention in the health care arena since its introduction last year.

The attraction is fairly obvious; it is a portable, lightweight, powerful computing device with an intui-tive interface and a large library of built-in applications. In fact, major medical schools such as Read more…

How to use an iPad in the OR during surgery

Implementation of a rational system of medical care

Joel Sherman, MD

Health Policy

May 9, 2011

The patient entered her private solo physician’s office and handed her medical ID card to the doctor. He put the card in his desktop reader and reviewed her medical history. All of her visits, vaccinations, medications, tests, x-rays etc from all providers were inscribed on the data chip in the card. The card also included insurance and billing information. At the end of the visit, he updated her information on …

Our personal commitment and social engagement as physicians

Kevin

Physician

May 9, 2011

by Synphen H. Wu, PhD

Mr. C is a 46-year-old Chinese immigrant restaurant worker who came to Bellevue Hospital after two weeks of fatigue, malaise, right upper quadrant (RUQ) abdominal pain, and progressive jaundice.

He was referred from a Chinatown clinic, where his blood tests showed hepatitis B surface antigen, a hepatitis B viral load of 133 million copies, and elevated liver transaminases and bilirubin levels, …

Doctor bashing and confronting physicians in the media

Kevin Pho, MD

KevinMD

May 9, 2011

It’s certainly been fascinating monitoring the response to Theresa Brown’s New York Times’ op-ed on physician bullying.

Predictably, most physicians were outraged, while the rest of the population generally supported Brown. As alluded to in a comment, whenever you have an aggrieved party accusing another one in a national forum, controversy is what you’re going to get. The piece was the …

Health care coordination under the rules of an ACO

Donald Tex Bryant

Health Policy

May 9, 2011

On March 31, 2011 CMS issued its proposed rules for Accountable Care Organizations (over 400 pages).

There is now a 60-day comment period. Shortly thereafter, the final rules will be issued. I am sure there will be changes in the proposed rules as there were changes in the “meaningful use” rules for electronic health records (EHR’s). Yet, much of the intent of …

Why medical students should go through a psychiatry rotation

Maria Yang, MD

Medical Education

May 9, 2011

“Psychiatry consult, returning a page,” she said, cradling the phone between her left ear and left shoulder. Digging around in her pockets, she eventually pulled out a half-sheet of paper that wasn’t already covered in barely legible writing and boxes marked with Xs. Her right hand clicked the pen and prepared to write.

“Hi, this is Cardiology,” the male voice on the phone said. Doctors tend to lose their names when they …

Honored to care for many priests and nuns in my practice

Michael Kirsch, MD

Physician

May 8, 2011

Our society thrives on tension and competition.

GOP vs Democrats
Civil Libertarians vs Eavesdroppers
Ohio State vs Michigan
Creationists vs Darwinists

Ideas, like sports teams, compete to win. We are the referees of these contests. Many of these competitions in the public square are ongoing. Some of these duels are locked in a dead heat. Others are in overtime. Some are ‘challenge matches’ when a vanquished idea wants another shot to change the original outcome. …

Bereavement related depression and consoling a new widow

MomTFH, DO

Patient

May 8, 2011

I am really enjoying my geriatrics rotation.

Although my attending preceptor is primarily a geriatrician, and practices deep in the heart of retiree central in southeast Florida, he also sees some patients who are younger. I took a history on a patient who was younger than me today, in her early thirties.

She started off complaining about insomnia and headaches, and then said …

Theresa Brown unfairly blames doctors for hospital bullying

Kevin Pho, MD

KevinMD

May 7, 2011

Bullying is a problem within health care.

Stung by a physician’s rebuke, Theresa Brown, an oncology nurse, takes to the op-ed pages of the New York Times to address the issue.

In it, she cites several vignettes that paint doctors poorly:

But while most doctors clearly respect their colleagues on the nursing staff, every nurse knows at least one, if not …

Read more…

Theresa Brown unfairly blames doctors for hospital bullying

Where do we draw the line on criminalizing mistakes?

Jeffrey Knuppel, MD

Physician

May 7, 2011

Eric Cropp was a pharmacist who was sent to prison for a mistake that resulted in the death of a child.

This was a high profile case, but it was just one of many examples of a disturbing trend I’ve seen in the U.S. in recent years: a person commits a mistake–with no malicious intent and without being under the …

Be like a circus ring master when seeing a patient in the clinic

Jill of All Trades, MD

Physician

May 7, 2011

When I was a little girl, attending the circus was the highlight event of the year. I remember looking forward to it each year – perhaps because it was something fun, and each year something new. Never the same show twice. Very busy behind the scenes, yet at the same time, quite organized and appearing smooth on the surface.

In the same way, the clinic can be a truly hectic scene. …

MKSAP: 67-year-old man with an abdominal aortic aneurysm

mksap

Conditions and Diseases

May 7, 2011

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

A 67-year-old businessman is evaluated during a routine health examination. He has a 30 pack-year history of smoking, but quit 5 years ago. He consumes two or more alcoholic beverages on most days. He is asymptomatic, but performs no regular physical exercise. He takes no medications.

On …

Fewer choices for patients with health care consolidation

John Mandrola, MD

Health Policy

May 6, 2011

As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.

A decade-or-so ago when I started private practice it was obvious that referrals came to me because of my association with an established …

National Quality Strategy and Partnership for Patients to improve care

David B. Nash, MD, MBA

Health Policy

May 6, 2011

One year after passage of the Affordable Care Act, the Department of Health and Human Services (HHS) has unveiled two programs that will most certainly be transformative for U.S. healthcare, affecting both quality and safety.

With the announcement of the first-ever National Quality Strategy in March, HHS signaled a strong commitment to improving the quality of healthcare.

In essence, …

3 ways to deal with serious illness and engage the health care system

Peter J. Weiss, MD

Patient

May 6, 2011

I am deeply conflicted about how we as a society have come to use physicians, medical science and advanced technology in our lives.

Everything has its place in life, but we have given modern medicine with its focus on the chemistry and physics of illness too prominent of a place. We’ve forgotten that we are not treating diseases; we are helping people with diseases.

Many readers, especially those with lifestyle diseases, can …

Be a boring patient, not an interesting patient

Dr. Martin Young

Patient

May 6, 2011

“She’s a really interesting patient!”

The doctor visiting the lady in question at home is correct. Nothing about her illness either has been routine. The progression of her disease has confounded her regular doctors for months. Nothing about her condition is normal. Medications have not worked as expected. The original diagnosis — Parkinson’s — is in question. All my training and expertise is inadequate, for I am an ENT surgeon, not …

Recovery may be predicted with a perception of the inner pulse

Kevin

Physician

May 6, 2011

An excerpt from The Inner Pulse: Unlocking the Secret Code of Sickness and Health.

by Marc Siegel, MD

The Pulse of Recovery

People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in their true beauty is revealed only if there is light from within.
–Elisabeth Kübler-Ross

The inner pulse can keep beating—loudly—long after doctors, researchers, and their monitors …