Don’t confuse death with dignity with suicide

Physician
September 9, 2013

In 2008, the state legislature of Washington passed what was called the Death with Dignity Act, a law that legalized physician assisted suicide.  Under the law, terminally ill patients (predicted to have less than six months to live) can request prescriptions for lethal medications from their physicians, under a series of safeguards:  multiple requests for example, determination of competency, and the like.  Then, if the patients so choose, they can ingest …

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A gastroenterologist dishes on unnecessary colonoscopies

Physician
September 9, 2013

We gastroenterologists are regularly summoned to bring light into dark places. We are the enlightened ones who illuminate anatomical shadows. Sure, we have tunnel vision, but we like to believe that we can think broadly and creatively as well.

We are the scope doctors.

We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights. We deliver a …

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Use visual aids to teach patients and improve decision making

Conditions
September 8, 2013

We all know that physician-patient communication is important. Poor communication, not deficient clinical skill, is the primary driver of malpractice suits; conversely, good clinical communication alone can improve patient outcomes. For example, patients of physicians with superior communication skills have been shown to have superior blood pressure control.  Fortunately, physicians generally recognize the significance of good communication, and often take the time to ensure that it happens.  Yet there …

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Urging doctors to take responsibility for their mistakes

Physician
September 8, 2013

In 2007, I published a story in my local paper in which I confessed to having made a medical error years earlier. I’d mistakenly prescribed an antibiotic for a patient whose chart indicated an allergy to the drug.

Thankfully, the story had a happy ending. My patient recovered and took no legal action after I explained to her what had happened. I ended my article vowing to take greater care to prevent errors …

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7 tips to stay away from misery on vacation

Physician
September 7, 2013

This year my wife and I decided to compile a list of all of the holidays we’ve had since we had kids. Its a nice list and we’re lucky to have traveled as well as we have.

I always get excited about going. There’s the anticipation of downtime away from work (and other peoples’ problems), time for relaxation, sleeping, eating, reading, and some quality time with my family. Life is just …

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When should insurance cover body contouring?

Conditions
September 7, 2013

Today in clinic, I interviewed a formerly morbidly obese woman. She has lost almost 300 pounds since undergoing gastric bypass surgery a few years ago, a presentation that has become increasingly common. She was here to see the plastic surgeon for her four week follow up appointment, status post abdominal skin flap removal.

See, after losing a ton of weight, loose skin remains, especially in places like the arms and abdomen.  …

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Don’t waste your time finding the perfect diet

Conditions
September 7, 2013

Nathan Pritikin: 69.  Robert Atkins: 72.  Roy Walford: 79. Adelle Davis: 70.  Aveline Kushi: 78.  Marjorie Shostak: 51. Jack LaLanne: 96.  Ancel Keys:100.

David Murdock is a billionaire who believes that he knows the formula for the perfect diet.  Not only has he built his own research institute to refine his theories, but he is confident that his food choices will keep him alive to the age of 125. This would …

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What health care in the United States can learn from Nepal

Policy
September 5, 2013

Beautiful Nepal Photos (10)

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning …

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Hospitalizing people against their will: 4 questions to ask

Conditions
September 4, 2013

Involuntary commitment refers to hospitalizing people against their will for psychiatric reasons. It is a controversial topic because this is where medicine and civil liberties intersect: Physicians have the ability to take away the rights of fellow citizens. (I suspect that few people who become psychiatrists realize that making recommendations about involuntary commitment is part of the job. I certainly did not know this. I also did not appreciate the …

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What conditions are more amenable to watchful waiting?

Conditions
September 3, 2013

Watchful waiting has become a term often thought of as an alternative to surgery, radiation, or other interventions for early stage prostate cancer. Watchful waiting is actually a viable option for many other conditions too.

Most Mom’s know that tincture of time with watchful waiting lets their children have the opportunity to recover without intervention for many minor injuries and illnesses without exposing them to the risks associated with antibiotics or …

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The hubris of medicine has to end

Physician
September 3, 2013

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

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Your EMR is watching you

Tech
September 2, 2013

A recent article on American Medical News titled “Medical charting errors can drive patient liability suits” led with a case involving a bad outcome after coronary artery bypass surgery. The plaintiff’s attorney alleged that the doctors did not review the patient’s lab results or x-rays because they did not specific say so in the medical record.

The article quoted a defense attorney who said, “By the time [the doctors] are deposed, …

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Why online dating is a bad idea for teens

Physician
August 29, 2013

Online dating is a bad idea for teens — especially young teens.

That’s why it wasn’t particularly responsible of Seventeen Magazine to publish a blog in which “dating blogger” Isabelle Furth floated the idea of using sites like Match.com to find dates. To be fair, she had concerns about the idea, and she’s in college, so theoretically old enough to make these decisions. But college kids don’t read Seventeen. Middle school …

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How long do you continue to fight when death is certain?

Physician
August 28, 2013

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Not long from now, the last cancer will be defeated, and even today most with the dread disease survive.  However, many still fall.  This leaves us with one of the toughest questions of life.  How long do you continue to fight, when death is certain?  When does striving become vain hope which drains quality and creates only suffering?  What makes struggle worth the …

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Does your doctor know ACLS? Does it matter?

Physician
August 26, 2013

acls

Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …

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Calling a consult: Disrespect from specialists hurts patients

Physician
August 26, 2013

A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.

When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …

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I am an orphan: A medical school without a family medicine department

Education
August 24, 2013

I am a fourth year medical student that attends an institution that does not have a department of family medicine.

Currently there are only 10 such allopathic institutions in the country.   When I tell colleagues and friends that I intend to enter family medicine they say, “oh primary care?”  While yes, it is true that family physicians obviously practice primary care, I am disheartened that my colleagues do not know or …

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You have to develop thick skin in medicine

Education
August 23, 2013

An attending once told me, “You can’t please ‘em all.” And it’s true. Sometimes in medicine, you just have to keep your head up and remember the bigger picture of why you are in this field.

A few months ago I did my internal medicine sub-I, which is a rotation medical students take in their fourth year when they are expected to perform on the same level as an intern. I’ve …

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