When science ceases to be value-neutral, science ceases to be science

Physician
May 22, 2017

Recently, the Harvard Chan School of Public Health reported on the effect of surgical checklists in South Carolina. The press release was titled, “South Carolina hospitals see major drop in post-surgical deaths with nation’s first proven statewide Surgical Safety Checklist Program.”

The Health News Review, for which I review, grades coverage of research in the media. Based on their objective criteria, the Harvard press release would not score highly.

The title exudes …

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5 ways to tell if a practice has integrity

Conditions
May 22, 2017

I stood in line behind a physician, slightly balding and in a long, starched lab coat at the coffee shop in our hospital. As he paid and took his coffee, I noticed that he smiled and called the clerk by name, “Thank you, Terri.” He went on about his day, and I was left to wonder about the man, his practice and what type of person he was.

My friend has …

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A medical student fails USMLE Step 1. Can he ever be a surgeon?

Physician
May 20, 2017

I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity.

I’m a third-year medical student at an allopathic state medical school. I’ve always wanted to do surgery. My problem is I failed USMLE Step 1 the first time and got a 207 on my second attempt. I hadn’t failed anything else throughout first …

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This physician won’t tell his alcoholic patients to stop drinking. Here’s why.

Physician
May 19, 2017

When I am facing an alcoholic in the office, I do not advise him to stop drinking.

Other physicians may advocate a different approach.  We live in a free society and individuals are free to make their own choices.  I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that …

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Let’s get rid of the review of systems

Physician
May 19, 2017

When it comes to the review of systems, I’ve been a natural, a savant — a prodigy you might say.

During my first few weeks of medical school, I remember doing mock interviews with fake patients. This was long before I learned anything about “HPI,” “ROS,” physical exams, billing or anything medically relevant for that matter. As other students stuttered, trying to figure out what to ask a lady pretending to …

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The hands tell us the most about a cadaver

Physician
May 18, 2017

“OK, it is time to move on,” my professor claps his hands together and yells above the chatter.  We all look up from our Netter’s anatomy books and our cadavers.  The smell of formaldehyde burns my nose as the fluorescent lights flicker above.

“We have explored the chest cavity and the abdominal cavity.  It is now time to move onto the extremities, starting with the arms.  I want you to unwrap …

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What surgeons do is a violent act

Physician
May 18, 2017

“I like good strong words that mean something.”
– Louisa May Alcott

My resident and I are removing a large, recurrent cancer from the neck. Dense scar tissue is everywhere from prior surgery and radiation therapy. The going is slow. Each move is arduous, and bleeding obscures the view of the anatomy.

“Watch out,” I tell her. “The jugular vein is nearby, probably buried in that scar.”

“Yeah,” she responds. “Look at this nerve! …

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No, I’m not settling for family medicine

Physician
May 16, 2017

During a recent internal medicine rotation, a senior resident expressed disappointment that I’ve chosen a career in family medicine. He was concerned that my talents would be wasted, because — in his words — I wouldn’t get to care for the “more complex patients” he sees in internal medicine. Although I appreciated his confidence in my abilities, I felt my heart sink, as it does each time I am faced …

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Why medical professionals have potty mouths

Physician
May 15, 2017

While Muzak plays (think Kenny G covering John Mayer) and courteous expressions like “excuse me” and “thank you” are exchanged in hospital waiting rooms, behind the front desk, angry patients are firing curse words into the hallway like their mouths are assault rifles with an endless supply of ammunition. Nurses are being cussed out by patients who sound like characters in “Platoon.” And medical professionals are dropping f-bombs. All of …

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MKSAP: 28-year-old man is evaluated for recurrent nephrolithiasis

Conditions
May 13, 2017

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

A 28-year-old man is evaluated for recurrent nephrolithiasis. Medical history is significant for Crohn disease complicated by multiple small bowel strictures requiring resection. He began developing kidney stones 3 years ago following his last bowel surgery. Analysis of the stones has consistently shown calcium oxalate, and he has been adherent to a …

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This is the hypocrisy of American health care

Policy
May 11, 2017

Physicians and patients are fighting a growing hypocrisy in American medicine. Examples abound, such as criticism that doctors are overprescribing antibiotics and contributing to resistance, while insurance companies simultaneously incentivize their members to use telemedicine programs or urgent cares instead of visiting their primary care physician.

My own insurance company, Cigna, recently sent me a letter notifying me that I will have a reduced co-pay if I …

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It’s bad luck to say that in a hospital

Physician
May 10, 2017

Doctors and nurses like facts. After all, we’re evidence-based thinkers — rational scientists. Yet, we can be surprisingly superstitious.

Many of us believe in a thing called “call karma,” which is when certain doctors attract sick patients while working on call (these people are said to have bad call karma). Other doctors attract less sick patients, meaning they have good call karma.

As a medical student, I quickly learned that I fell …

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The elderly need hired professionals to administer their medications

Meds
May 9, 2017

One of the most challenging and difficult parts of my professional day is trying to determine if my patients are actually taking their as prescribed.

I ask my patients to bring their medications to each visit in the original pill bottles, and we count pills. I ask them to bring their medication lists as well, and we go through the time-consuming practice of reviewing each medication against the prescribing date and …

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3 communication mistakes doctors make. And how to fix them.

Physician
May 8, 2017

It is not something that is taught enough in medical school, but practicing physicians quickly realize that in this business: Communication is everything. The reality of health care is that you can be the worst physician in the world clinically (not that it’s something desirable to be), display great interpersonal skills, communicating well with your patients — and they will do absolutely anything you say and put you up on …

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An ode to the nurse who saved Jimmy Kimmel’s baby

Conditions
May 8, 2017

Recently, a nurse at Children’s Hospital Los Angeles noticed that comedian Jimmy Kimmel’s newborn baby had a murmur and was cyanotic and brought it to the newborn intensive care unit for further evaluation. That triggered a rush of activity that led to a diagnosis of a congenital heart defect and heart valve problem and surgery to save the baby’s life.

Here’s what the public doesn’t understand: Nurses do this every day. …

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What’s the difference between health care in the U.S. and Haiti? Not much.

Physician
May 8, 2017

“How long have you had the bleeding?”

“About seven years,” my patient replies stoically.

Ange’s angular face no longer retains the beauty of her youth. The sharp lines around her mouth speak of a long life packed into a brief 42 years. She is well dressed, but her manner of speaking betrays the poverty in which she exists.

Ange has advanced cervical cancer — a completely preventable disease. In fact, cervical cancer can …

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The vaccine study you’ll never see

Physician
May 7, 2017

I’ve seen a lot of social media posts or comment threads that say we don’t have any studies to prove that the CDC’s vaccine schedule is safe or effective.|

As a pediatrician, the first time I read that, I was surprised. But now, I think I know what they mean.

I think they mean that we haven’t done the best study. Those of us in the scientific and medical fields frequently demand …

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5 things doctors should know about compassion fatigue

Physician
May 5, 2017

For many physicians, the term “compassion fatigue” may imply, as the words describe, that fatigue leads to the loss of ability to feel compassion for others.

After all, what physician doesn’t have a day when s/he is too tired, running on too little reserve, and feeling some degree of emotional numbness?

Many physicians may not realize, however, that compassion fatigue can go much deeper.  According to the Compassion …

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This gynecological issue is misdiagnosed over 50 percent of the time

Conditions
May 4, 2017

As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses …

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