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Waste at hospitals in developing countries

Physician

December 3, 2010

Year: 1993

Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea
Position: Chief medical officer for Chevron

Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to …

Appendicitis in children and radiation exposure from CT scans

Skeptical Scalpel, MD

Conditions and Diseases

December 3, 2010

Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.

For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular …

How the pharmaceutical industry changed psychiatry

Jan Henderson, PhD

Medications

December 3, 2010

What’s happened to psychiatry over the last 15 to 20 years? That’s a big subject, discussed in many recent and excellent books. One of those books is by Daniel Carlat, author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis.

One of the problems Carlat readily acknowledges is that psychiatry is excessively focused on psychopharmaceuticals at the …

Educate the patient about their disease and discharge plan

Lyle Fettig, MD

Physician

December 3, 2010

Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?

Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I’m guessing that you already knew this) and that you are not alone.

The …

A better system is needed to migrate to electronic health records

Steven Reznick, MD

Health Technology

December 2, 2010

Five years ago my associate and I invested sixty thousand dollars to purchase and set up an electronic health record system and eliminate extensive paper use.

We researched all available systems and decided upon MediNotes because it was a large company with an excellent record of service and their system met all the national requirements for certification. We worked through our local computer vendor’s family …

Learning from the Massachusetts experiment in universal coverage

Joseph Paduda

Health Policy

December 2, 2010

We’re learning a lot from Massachusetts’ experiment in universal coverage – and some of the lessons are rather enlightening.

According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of “That’s the problem with the new U.S. health care reform law … it offers millions of uninsured Americans access to health insurance but doesn’t address underlying medical costs, which are contributing to costly …

Integration and virtual accountable care organizations in health reform

Joe Flower

Health Policy

December 2, 2010

They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing …

Lifestyle matters for specialties that want to survive

Kevin Pho, MD

KevinMD

December 2, 2010

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work …

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Lifestyle matters for specialties that want to survive

Creativity and ADHD may share some common genetic vulnerabilities

Kevin

Conditions and Diseases

December 2, 2010

by Shelley Carson, PhD

Both highly creative individuals and ADHD-diagnosed individuals often report feeling out of place, like a square peg in a round hole.

(In fact, in my creativity research questionnaires I actually ask the question “Do you often feel like a square peg in a round hole?” Participants who score high on the Creative …

MKSAP: 70-year-old woman with hypothyroidism and a fractured hip

mksap

Conditions and Diseases

December 2, 2010

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

A 70-year-old woman with hypothyroidism fell and fractured her hip. During preoperative evaluation for hip fracture repair, she mentions recent mild fatigue, which has not significantly limited performance of her daily activities, and ongoing right upper-quadrant abdominal pain after eating. She takes levothyroxine, 0.075 …

A neurosurgical resident’s typical day

Colin Son, MD

Medical Education

December 1, 2010

I’ve made some fairly outrageous claims about the workload of a neurosurgical resident recently. Seems like a reasonable time to lay out exactly what a day on call can be like for me and my fellow residents.

To be fair an average experience may be hard to articulate. Different rotations and different days yield different … adventures. Right now I’m on a service that could hardly be called grueling, but I …

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A neurosurgical resident’s typical day

Conspiracies against vaccines: Blame the media

Jennifer Gunter, MD

Conditions and Diseases

December 1, 2010

How did the idea that vaccines are dangerous, toxin-filled CDC experiments metastasize so quickly from the fringe to the mainstream?

Keep in mind that not only have vaccines been scientifically proven to be safe, but that some of the arguments against vaccines are so scientifically incredulous they are the equivalent of saying there is a UFO sitting in Central Park right now.

So let’s begin at the beginning. In 1998 Andrew Wakefield …

A community of healthy seniors inspires this physician

Melanie Lane, MD

Patient

December 1, 2010

I have been genuinely blessed by my career in medicine.

When I started medical school, I was living through a very rocky time, dealing with severe, at times suicidal depression. I was working through an outpatient alcohol and drug rehabilitation program, and I was about 40 pounds overweight. I had grown up with a very negative and fatalistic attitude toward life which resulted in chronic misery and a number of personal …

Energy drinks are unregulated and can be dangerous

Linda Pourmassina, MD

Medications

December 1, 2010

With the darker days upon us, it may be tempting to try to fight fatigue with energy drinks.

Ever wonder what’s really in them and what they might be doing to you? I just came across an article in the November issue of the Mayo Clinic Proceedings that broke it down nicely.

Here’s the summary.

Caffeine. No brainer. Interestingly, it is on the list of substances banned by the International Olympic Committee (which is …

How a plumber charges more than a neurosurgeon

S. Irfan Ali, MD

Health Policy

November 30, 2010

So there was a neurosurgeon who called a plumber for a house visit.

The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery.” The plumber stood up, gave him a sly look and said, “well that is why I am a plumber now; I used to be a neurosurgeon.”

I mention this …

Suspicious withdrawal of a publication from an academic journal

Larry Husten, PhD

Physician

November 30, 2010

The official ESC journal Europace publishes an online case report by Dr. Martin Hudec about the extremely rare and spectacular failure of a recently implanted Biotronik 340 VR-T ICD in a 46-year-old man. The battery of the device apparently overheated, causing the device to malfunction and leading to severe internal burning.

On Wednesday, October 6, US electrophysiologist Westby Fisher summarizes the Europace article on his blog and reprints several extremely gruesome …

Travelers with medical conditions fear increased TSA security procedures

Kevin

Patient

November 30, 2010

by Brian Loew

Travelers with medical conditions hope that the TSA pat-down incidents involving bladder cancer survivor Thomas “Tom” Sawyer, at Detroit Metro Airport, and to breast cancer survivor Cathy Bossi, at Dulles Airport, are isolated incidents. But these reports are already creating a chilling effect on air travel for people with medical conditions and disabilities.

This group of travelers could benefit the most from holiday …

Living with cancer is different from living after cancer

Edward Pullen, MD

Conditions and Diseases

November 30, 2010

This is a topic close to home.

My wife was diagnosed with stage 3C cancer of the ovary a bit over a year ago. She was a chemotherapy superstar, had few complications, and has been in remission since her treatment finished last October. Still we know her chances of a cure are fairly low.

Understanding statistics is a mixed blessing. Even though her chances of this cancer never recurring are pretty low, …

Bedside manner may need to include cost of care discussions

Dennis Grace

Patient

November 29, 2010

by Dennis Grace

For years, if you asked for a recommendation for a physician, the answer included some mention of bedside manner.

I mean, we’re human beings first and patients second, so we think it’s great that she’s a brilliant doctor, but is she pleasant? Is she respectful and patient? Nobody wants to work with a know-it-all, especially one who gets to hear about our bowel movements …

The malpractice system doesn’t improve patient safety

Kevin Pho, MD

KevinMD

November 29, 2010

There has been significant media attention on a New England Journal of Medicine case report where a surgeon, Massachusetts General Hospital’s David Ring, described how he operated on the wrong hand of a patient.

Here’s a summary of the case:

Ring, along with colleagues at Massachusetts General and Harvard Medical School, detailed the series of missteps that led to the wrong operation in the patient whose ring finger on her …

Read more…

The malpractice system doesn’t improve patient safety

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