How motivational interviewing can relieve patients’ suffering

Physician
July 27, 2015

The acronym “MI” has traditionally meant myocardial infarct, or heart attack. Recently it’s taken on a new, more salubrious meaning: motivational interviewing.

A growing number of docs are practicing this technique, which amounts to listening to patients to help them recognize their internal sources of behavior. Boston’s NPR affiliate, WBUR, describes typical MI interventions in which doctors, instead of demanding that patients stop smoking or drinking or overeating, gently …

Read more…

Analyzing the deficit of African-Americans in academic medicine

Education
July 25, 2015

shutterstock_256955077

The number of African-American physicians in academic medicine is dismal, and this leads to an abundance of problems.  Academic hospitals (teaching hospitals associated with universities) generally do not have a proportionate representation of underrepresented minority faculty as compared to the surrounding population. According to a U.S. News & World Report article, the number of African-American faculty increased by 0.2 percent in ten …

Read more…

A patient fails a drug test, but stays in this doctor’s practice. Here’s why.

Physician
July 23, 2015

shutterstock_157734158

The drug test came back abnormal.  There was THC present.  I walked back to Mrs. Johnson and raised my eyebrows.

“What’s wrong?” she asked, not used to whatever kind of look I was giving her.

“Uh, you forgot to mention to me that you smoke weed.”

She blushed and then smirked.  “Well, yes, I guess I forgot to put that down on the sheet.  I don’t …

Read more…

10 things you might not know about the emergency department

Physician
July 22, 2015

shutterstock_139886491

1.  Wait times in most emergency departments are ridiculous. But, if you have a real emergency, you won’t have to wait. If you have abnormal vital signs, a worrisome ECG, or concerning chief complaint, you will be seen long before the person who checked in with a sore throat to get a work excuse.

Patients with chief complaints like “GSW abdomen” and “found down/unresponsive” don’t wait to …

Read more…

Why the Surgeon Scorecard is a journalistic low point for ProPublica

Physician
July 22, 2015

shutterstock_153098018

With much hype and fanfare, the independent investigative journalism outfit, ProPublica recently released their Surgeon Scorecard, assessing individual specialist surgeons who perform elective knee and hip replacements, spinal surgery, prostate surgery, and gallbladder removal surgery.

I had blogged about the impending release.  My trepidation about the idea of a non-medical, non-scientific organization analyzing complex surgical data concerned issues such as …

Read more…

A patient is angry with her emergency care bill. But here’s what she really got.

Physician
July 17, 2015

shutterstock_126678482

Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside.
Their physician neighbor wasn’t available to look at the child. …

Read more…

Comfort may be the most important thing that physicians can provide

Physician
July 13, 2015

A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good.

The answer to discomfort for those who are very ill is comfort care, …

Read more…

The physician is the ultimate patient advocate

Physician
July 13, 2015

“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.”
– Dr. Martin H. Fischer, German-American Physician and Author

“A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”
– Principles of Medical Ethics, American Medical Association

“I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of …

Read more…

ADVERTISEMENT

A quiet day in the doctor’s office: And that’s the way it’s supposed to be

Physician
July 10, 2015

shutterstock_143614549

It’s been a very slow week in my office.  Today we almost pitched a no-hitter, having only one patient come in toward the end of the day.  Overall, we’ve been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages.

What’s wrong?

That was a trick question.  This is exactly what should be happening when things are going …

Read more…

A neurosurgery case that this medical student won’t forget

Education
July 10, 2015

shutterstock_280855511

After the last elective case of the day, the neurosurgeon I was shadowing told me that he was on overnight call that evening, and that I could stick around to observe more surgeries if I wanted to. “Yes,” I responded. “Absolutely yes.”

My fascination with surgery stems from its ability to provide immediate results to a patient by cutting out, repairing, reshaping, or …

Read more…

10 thoughts on the transition to a third-year med student

Education
July 10, 2015

The transition between the basic science years and the clinical years in medical school are jarring, mystifying, exhilarating and thought-provoking. Recently, I did an hour conference with approximately 30 medical students. About half started their clinical year five weeks ago, while the remainder have only three weeks left before they finish the year. They gave me permission to share our discussion. We focused on their (and my) observations about the …

Read more…

ADVERTISEMENT

There are only 3 ways to allocate health care resources

Policy
July 8, 2015

shutterstock_207548383

Manny Alvarez is a 23-year-old college student with the misfortune of having not just a devastating cancer — but the wrong devastating cancer. The chemotherapeutic agents shown to be highly active against his specific tumor cells are FDA approved for the treatment of leukemia, but not for the stunningly rare kind of sarcoma with which Manny has been diagnosed. Nothing is …

Read more…

ADVERTISEMENT

Poker face: The complex psychology of the patient-doctor interaction

Physician
July 6, 2015

shutterstock_125243891

Patient-doctor communication often has many facets, wrinkles, and twists.  Medical school prepares a doctor minimally for the ups and downs of these patient interactions.  There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient.  On the job training is sine qua non.

During and after medical school, it took …

Read more…

542
pages