by Timothy Dempsey
Looking in the mirror before heading out the door for my first patient encounter, I slouched. Something looked off. I had on my new, absurdly short white coat complemented nicely by the equally as new black stethoscope draped around my neck; yet the way I looked wasn’t the problem. It was the way I felt. No matter how well I dressed the part …
Confidence in a student’s ability to become a competent physician
by John Mooney
A recent study conducted by Dove Press Patient Intelligence Journal asked this question of patients: “Have you ever asked your physician to prescribe something different than the original recommendation?” Thirty-four percent of the respondents indicated that in fact they had. Perhaps even more interesting: of that 34 percent, 69 percent of the doctors agreed to prescribe the alternative drug when asked. Why is this important? The health …
Why the time is right for collaborative care
by Marianna Rakovitsky, RPh
Recently, I have talked about the concerns with the use of NSAIDs and their effects on the heart. All medications carry a risk of adverse effects. NSAIDs are usually very effective in controlling pain especially muscle and bone pain, but they also carry a potential risk of side effects such as stomach and kidney problems, increased risk of bleeding and adverse effects …
Alternatives to NSAIDs, pros and cons
Everything seems to be pointing toward two years of partisan and ideological confrontations over health reform. The leadership of an emboldened Republican party has made it clear that it will use its newfound House majority to seek to “repeal and replace” the Affordable Care Act (ACA), and if that doesn’t work, to “defund” it. Huge GOP gains in statehouses make it likely that more states will resist implementation. Meanwhile, President …
Can President Obama and the GOP agree on improving health reform?
by Raymond Raad, MD, MPH
There is a remarkable inconsistency between the ethics of medical practice and the discussion about the health care reform law passed this past March, especially the individual mandate.
In medicine, it is considered unethical to force a patient to do something against his will. Patients are allowed to disagree with their doctors and to decide for themselves whether they want to heed their advice. Patients are even …
Ethics of the individual mandate
Doctors have no trouble or compunction giving these good pieces of advice:
These all likely can augment both life quality and expectancy.
Do doctors, then, (in appropriate situations obviously) go the extra mile and tell a patient to get married? There are reasonable reports church-going adds to longevity, but with sensitivity to broaching religious beliefs, doctors may be reluctant to suggest …
Should doctors give marriage advice?
Gentle nudges is a concept termed recently to describe a micro-choice movement that is beginning to carve out a sizable niche in the healthcare start-up space, and is gaining a lot of well deserved national attention. The secret ingredient relates to the power of a gentle nudge; verbal, text or otherwise to accomplish a change in the behavior of the person who receives the nudge. We are just starting to …
Change health behavior with a gentle nudge
An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011).
We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, someone else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave …
The threat of malpractice means doctors cannot acknowledge their fallibility
I recently read a post from Jan Gurley, MD on here on KevinMD.com.
Her opinion is that medical malpractice lawsuits are a “crap-shoot”; she notes that “malpractice lawsuits fail when it comes to medical errors-in both directions. People who’ve suffered from errors both don’t sue, and lose suits, in the same percentages that people who sued have no suffered from errors.”
Assuming that information is correct for purposes of this …
Patient-physician relationships in medical malpractice
I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.
I …
Treating a patient in a small town versus a big city
by Dora Calott Wang, MD
There will be more shooting rampages, like that which targeted Congresswoman Gabrielle Giffords in Tucson recently-as long as it is easier to get a gun than mental health care. Our current epidemic of mass shootings is but a symptom of our nation’s broken health care system. Poor access to medical care jeopardizes an individual’s health. But when the mentally ill or the seriously distressed can’t access …
Mass shootings is a symptom of our nation’s broken health care system
Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.
A 49 year old healthy woman presented to …
Laryngopharyngeal reflux disease and a complex case or chronic cough
In a guest post last year, physician-author Richard Reece commented that the individual mandate may collapse health reform.
Those words came to mind as Judge Vinson not only ruled the individual mandate unconstitutional, but the entire Affordable Care Act, as well.
Nobody likes to be mandated to do anything, least of all purchase health insurance, and this was always the sticking point with the current iteration of health reform.
So, what …
Health reform repeal will lead to single payer, Medicare for all
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Doctors vs. nurses (or doctors vs. nurse practitioners, or doctors vs. physician assistants, or what have you). The debate is old, tired, unimaginative, divisive, and wrong-headed–for reasons that are too obvious even to list. Does it get perpetuated because it garners comments (175 of them, to be exact)? Snarkniess is not appreciated by this reader, at least.
The New York Times recently ran a column by one of its editors, “Read more…
Praise nurses without comparing them to physicians
You are in the middle of a deposition.
Plaintiff’s lawyer asks, “Do you blog or tweet?” Before you answer, consider this. If you blog or tweet and respond in the affirmative, I believe anything you have ever posted would be subject to discovery by the plaintiff. Oh, you post anonymously? Would you then lie under oath and say you do not blog or tweet? For many physicians, admitting that you blog …
Physician blogs, doctors on Twitter and a malpractice trial
In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.
In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed …
Marcus Welby and the relentless growth of specialization
by Drew Rosielle, MD
The Annals of Internal Medicine recently had a timely discussion of advance care planning, trying to focus the discussion away from helping patients specify what they’d want, and more towards laying the groundwork for appropriate decision making by loved ones whenever that time comes. Good one for the teaching file.
That is, instead of thinking of ACP as patients pre-specifying “if X …
Focus advance care planning on outcomes
Earlier this month, at the third annual American Medical Student Association Patient Safety and Quality Leadership Institute, I listened with sympathy — and, frankly, a certain amount of discomfort — to a fourth-year medical student’s account of his grandmother’s recent hospitalization at a well regarded inpatient facility in New York City.
Admitted with an initial diagnosis of pneumonia, Cole Zanetti’s grandmother languished in the hospital for almost four weeks.
As the medically …
Patient safety lapses in the hospital
Last night, I turned on “House,” a TV show about a physician who is in charge of a team of highly specialized diagnosticians. Every week the team solves a difficult to diagnose medical case by working through an exhaustive differential (DD) diagnosis list. While the show is absurd to the extreme (as the team of physicians almost kills the patient each week), eventually the correct …
Help your doctor formulate an accurate differential diagnosis
An active 61 year female, who has been in my practice for 30 years, developed strange aches and pains and abdominal symptoms. My evaluation turned up nothing.
I then asked for help at the University of Miami rheumatology and gastroenterology divisions. With the help of a brilliant local gastroenterologist and rheumatologist, and after a trip to Johns Hopkins Medical Center and the Mayo Clinic, collagenous …
Patient advocacy is essential in health insurance appeals
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