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Black boxes: health warning or profit warning?

Meds

February 1, 2020

“Boxed warnings” or “black boxes” are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks.

The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes “confuse” and “unnecessarily alarm” patients).

So it was no surprise that when the Read more…

Black boxes: health warning or profit warning?

Doctors, a tech revolution is coming

Osmund Agbo, MD

Tech

January 31, 2020

What if I told you just a few years ago that Amazon — a budding e-commerce startup — would come to disrupt the multi-billion dollar retail industry.

I seriously doubt that anyone could have given it a serious thought. At least not in the magnitude that will force a slew of big-box retailers to shut their doors for good.

I am sure the same response would have been elicited about Uber and …

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Doctors, a tech revolution is coming

Nurses are sick of being treated like hotel workers

Rachel Basham, RN, CCRN

Conditions

January 31, 2020

“Compassion fatigue” is a phrase thrown around easily when talking about the health care professions. It is often spoken in the same breath as “burnout” and “turnover” while discussing the crisis of a diminishing workforce and increasing demand in health care.

The phrase brings to mind the burnt-out nurse who doesn’t have the emotional energy to care anymore. I can see her: deep frown lines, flat facial expression, dimmed eyes.

The light …

There is no such thing as medical swag

Nina Shapiro, MD

Physician

January 30, 2020

A recent excellent piece by Dr. Karen Sibert, an experienced anesthesiologist at my institution, raised some critical issues regarding how physicians are thought of by non-physicians, and how misguided that thought process is. Indeed, our stress levels associated with the moves we make and the decisions we contemplate, some of which are made and done in milliseconds, do not come with a price tag, but do …

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There is no such thing as medical swag

Here are the common ways that doctors can practice medicine

Smart Money, MD

Physician

January 29, 2020

When I finished my training, I wish that I had known all of the options I could practice medicine. Most of us categorized our options as either “academic” practice or “private practice,” but in reality, these two options only cover the tip of the iceberg. Was my limited understanding a shortcoming of my medical training? Perhaps. I doubt that many medical schools back then actually had seminars on practicing medicine. …

Are you happy with your decision to go into medicine?

Erin O'Laughlin, DO

Physician

January 28, 2020

On a rare Sunday morning, I woke and had the time to make breakfast for my kids and their cousin, who’d stayed the night. My nephew said, “Thanks, Aunt Erin, I feel like I never see you.”

To which my oldest (10) stated very matter-of-factly, with no ill-intent: “That’s because she’s never home.”

Being a full time, private practice physician and mom to 5 kids, with a healthy social life, it’s extremely …

How do you know if you have hypertension and need medication?

Peter Ubel, MD

Conditions

January 27, 2020

High blood pressure is the silent killer. It puts people at risk for heart attacks, strokes, vascular disease, kidney failure. It is basically really bad to have longstanding, undertreated high blood pressure.

But it is also harmful to be told you have high blood pressure when you don’t, and to be treated for high blood pressure when that treatment won’t benefit you. So when your doctor diagnoses you with high blood …

Physicians are not incentivzed to talk with patients on the phone

Hans Duvefelt, MD

Physician

January 25, 2020

Talking to patients on the phone can be very efficient and quite rewarding, like when I called a worried patient today and told her that her chest CT showed an improving pneumonia and almost certainly no cancer, but a repeat scan some months down the road would still be a good idea. She told me she was feeling better, but still quite weak and that her sputum was still dark …

24 reasons to not vaccinate your kid

Rada Jones, MD

Physician

January 25, 2020

An excerpt from Stay Away From My ER, and other fun bits of wisdom.

1. You don’t like to be told what to do. Especially not by arrogant doctors, who act as if they know better, just because they’ve been through a few decades of training!

2. Your …

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24 reasons to not vaccinate your kid

Making humanism in medicine more humanistic

Ajay Khilanani, MD

Physician

January 23, 2020

Kahlil Gibran writes, “In friendship or in love, the two side by side raise hands together to find what one cannot reach alone.” What types of outcomes can physicians and patients achieve in healing, living, and life when Gibran’s message is incorporated into the physician-patient relationship? Can humanism in medicine become even more humanistic?

“Humanism in medicine” is characterized by the Arnold P. Gold Foundation as respectful …

Beyond red flags: Beware of black butterfly warnings

Raj Waghmare, MD

Conditions

January 23, 2020

I’ve just discharged a kid with a cough, and there are no patients waiting to be seen. “I’ll be back,” I tell the nurse, as I slip away to the hospital kitchen and unlock the door. I steal two frozen grilled cheese sandwiches from the freezer and throw them into the microwave. Minutes later, I’m in the call room.

I take a couple of bites and can already feel acid rising …

Does socialized medical care provide higher quality than private care?

Peter Ubel, MD

Policy

January 22, 2020

Americans are not fans of socialized medicine. Sure, some people want socialized health care payment, including many people who are fans of Medicare for all. But even most Bernie Sanders supporters probably aren’t in favor of socializing the entire U.S. health care system, thereby making hospitals and medical clinics into government property. Americans are proud of the high quality of care offered by non-government providers, from their local community …

A quick CT scan for the frail and elderly

Mary Braun, MD

Physician

January 22, 2020

First, you have to call up your daughter to pick you up and take you to the lab. It’s hard for the nurse to find your vein. The pain from his fishing around in your arm is not nearly as bad as the pain you always have in your hip, and back, and shoulders, but it’s the straw that breaks the camel’s back, and you cry a little bit. The …

This is a real problem in our ER. This is a real problem nationwide.

StorytellERdoc, MD

Physician

January 21, 2020

One of the largest problems in our ER, it seems, is that there is a subset of patients who visit us on a routine basis. Commonly known as “the regulars,” these familiar faces are sprinkled throughout our day between all our other patient visits. Whether it be for chronic pain, for chronic illness, for companionship, simply to have a place to hang out for a few hours, or to get …

Is obesity self-inflicted?

Anonymous

Physician

January 21, 2020

“Aren’t you happy for me?” asks the patient smiling from the exam chair in my office. I say yes, but that’s not entirely true.

Happiness isn’t the right word. Conflicted might be it. How do I reconcile my feelings when this patient, who I am not sure is deserving, reports that he was awarded Social Security disability?

Sure, he has severe arthritis, wildly uncontrolled diabetes, and a massive skin breakdown of his …

Read more…

Is obesity self-inflicted?

What to do if your doctor is excessively egotistical

Christopher Johnson, MD

Physician

January 20, 2020

Egotism is a common trait among doctors, although most of us keep it under adequate control when dealing with patients. The ideal doctor-parent encounter has been described as a collaboration among equals, each of which brings expertise to the exchange; the doctor knows medicine, the parent knows the child. This is the ideal, although sometimes the reality falls short of it. The way our medical system is now structured gives …

Stop the war on PAs and NPs

Brent Lacey, MD

Physician

January 18, 2020

I think it’s time for physicians to end the assault on the clinical practices of PAs and NPs.

Are you worried about PAs and NPs taking your job? If you’re a good doctor, you should stop worrying. Great PAs and NPs are everywhere, and I think it’s time physicians embraced them.

PAs and NPs have excellent skills

My first rotation as a third-year medical student was in the emergency department. There was a …

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Stop the war on PAs and NPs

Keep insulting doctors, and good luck finding a physician in 10 years

Karen S. Sibert, MD

Physician

January 17, 2020

If physicians are “muggers” and co-conspirators in “taking money away from the rest of us,” then journalists and economists are pontificating parasites who produce no goods or services of any real value.

I don’t think either is true, but the recent attacks on physicians by economists Anne Case and Angus Deaton, and “media professional” Cynthia Weber Cascio, deserve to be called out. You …

What Karl Marx can teach doctors about burnout

Farid Alsabeh

Conditions

January 17, 2020

Professional burnout is widely identified using the Maslach Burnout Inventory, which defines it along psychological lines: emotional exhaustion, a feeling of depersonalization and cynicism, and a low sense of personal accomplishment.

Accordingly, the phenomenon of physician burnout is often framed as a personal problem to be solved by means of self-care. While this approach is undoubtedly helpful, it doesn’t sufficiently address the structural factors that contribute to burnout in the first …

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