The broken window theory in health: Examples of graffiti we can fix

Physician
August 15, 2013

I just left the most unusual conference I have ever attended. First, it was small: 25 invited participants. Second, it was all women. Third, it was all women who have done amazing things …make that “trailblazing things.” They were journalists at major news outlets, retired military officers from the highest ranks, senior leaders (in some cases, the most senior leader) at major federal and state health care agencies, Fortune 500 companies, large …

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C difficile in children: Do probiotics help?

Conditions
August 13, 2013

The intestines, particularly the large intestine, are teeming with bacteria. They are piled on each other as dense as the above photomicrograph shows. The huge majority of them are what we call friendly bacteria: they live inside us, feeding off the rich stew of food we eat, but cause no disease. In fact, their presence is important to our health because they crowd out bacteria that cause disease — the …

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Boston hospitals go Epic: Hear from a holdout

Tech
August 11, 2013

In the Boston marketplace, Partners Healthcare is is replacing 30 years of self developed software with Epic.   Boston Medical Center is replacing Eclipsys (Allscripts) with Epic.   Lahey Clinic is replacing Meditech/Allscripts with Epic.  Cambridge Health Alliance and Atrius already run Epic.   Rumors abound that others are in Eastern Massachusetts are considering Epic.  Why has Epic gained such momentum over the past few years?

Watching the implementations around me, …

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The demand apathy that doctors increasingly face

Physician
August 10, 2013

Monday afternoons are always the same.  I pick up the kids from their grandparents.  We drive home with their backpacks and a carton of home made food.  We park in the garage, and carry all the contents of the car into the house.  As the kids unload, I push the recycle container to the front for street pickup the next day.

Occasionally, I stop and socialize.  Yesterday, I waited at the edge …

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The very best physicians do not judge their patients

Physician
August 10, 2013

It occurs to me there are several keys to being an excellent physician.  One must love science, enjoy hard work, have the courage to make tough decisions, carry a modicum of intelligence and suffer angst at receiving 94% on an organic chemistry test.  In addition, the very best physicians, those we admire and to whom we flock, have a secret weapon.  They do not care.

I do not mean that they …

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Why family physicians are a threat to themselves

Physician
August 8, 2013

In recent months, AAFP President Reid Blackwelder has been editorializing and debating what they see as the encroachment of nurse practitioners (NPs) and other “mid-level providers” (physicians are, presumably, “upper-level”) on the practice territory of family physicians (FPs). Dr. Blackwelder has repeatedly said that NP and physician roles are “not interchangeable.” The AAFP’s position on this issue seems to be resistance to the increasingly common decisions by state legislatures to …

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What happens to all the miscarriages?

Physician
August 6, 2013

Last week a woman told me that she had a miscarriage in her bathroom. She was terrified. She didn’t know what to do. So she flushed it down the toilet.

A miscarriage is the spontaneous expulsion of a fetus from the womb before it is able to survive on its own. One in five pregnancies ends in miscarriage. Many women don’t know they are miscarrying. Those who know usually suffer grief …

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Our patients pay for dumbed down American medicine

Policy
August 4, 2013

I guess what is so utterly frustrating is that the guys up there don’t see what is going on down here. The march of health care reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non-clinician “doctors,” ivory towered administrators, and the business …

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It’s time primary care doctors diagnose autism

Conditions
August 1, 2013

I remember how my son’s autism diagnosis was delivered.  He was three years old.  It wasn’t a surprise really, merely a confirmation of something that I expected and feared.  He was already enrolled in speech and occupational therapy making very little progress.  He saw a developmental specialist at age two and two and half who initially believed that he was not autistic but merely delayed with sensory issues.  After we …

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The medical school interview: Strategies from an admissions officer

Education
July 31, 2013

As a member of the medical school admissions committee, I’ve interviewed many amazing applicants. Here’s what I wish I could say to them:

1. Your interview performance is critical. As interviewers, we’re amazed by the quality of today’s applicants. In fact, many of us wonder if we would get into med school today. “I can’t believe how much she’s done,” is something I hear time and time again from my colleagues. The sad …

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What doctors wear: Do we care too much?

Physician
July 30, 2013

shutterstock_125691797

What would you prefer your doctor to be wearing when examining and treating you or your loved ones? Most would likely reply with something along the lines of “it doesn’t really matter, as long as they are competent and do a good job.“

Except it does matter, apparently. So much so that there have been hospital/nation-wide policies surrounding the issue, and a recent surge in …

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Why you should never order a herpes IgM blood test

Conditions
July 27, 2013

Routine screening blood tests for herpes are not recommended by the Centers for Disease Control. When I say routine screening I mean a scenario such as, “I want to get checked for everything, ok?”

Blood tests for herpes do have a place in specific clinical situations, but that’s for another post.

But say you did get a herpes blood test (even though it’s not recommended many people seem to get it done) …

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Cockpit culture and using the two challenge rule in the OR

Physician
July 25, 2013

cockpit_B777

With the crash of the Asiana 777, we’re hearing a lot about cockpit culture and how communication across a hierarchy sometimes fails, even when the very lives of the folks communicating (or failing to do so) are on the line.  This isn’t a new concept, and isn’t unique to aviation.  Many parallels have been drawn between aviation communication and healthcare team communications, …

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Separating work from home life makes for happier doctors

Physician
July 24, 2013

One tired early morning, during my residency, I had been up all night in the ICU with a sick patient.  Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn’t leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: “The sign of a good doctor is when you can’t go to sleep at night worrying about …

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A guide to giving bad news to patients

Physician
July 22, 2013

The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex.  Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped.  Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling.  The lung cancer has spread, metastasized.  Really bad news.

A …

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Beware of that new car smell when shopping for a new car

Conditions
July 22, 2013

As I shopped for a new car last year, I realized that my priorities were considered odd by most car salesmen. The three most important characteristics I desired in a new car were good gas mileage, good crash safety, and relatively low concentrations of “new car smells.” The often celebrated (but particularly noxious) new car smell is actually a synthetic blend of respiratory irritants and potential carcinogens off-gassing from the …

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Determining the prognosis of patients with pulmonary fibrosis

Conditions
July 20, 2013

Sometimes it’s the simplest things that can make all the difference. Unfortunately, when it comes to informing patients with a new diagnosis of pulmonary fibrosis what to expect, things are anything but simple.

For years, pulmonologists have dreaded the moment when we inform patients of a diagnosis of pulmonary fibrosis. The discussion invariably involves informing them that this disease (which they have probably never heard of) may either kill them or …

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The 3 biggest HIPAA myths debunked

Physician
July 17, 2013

As a healthcare consultant, it is not unusual to be asked about HIPAA regulations on a weekly basis. Three questions come up regularly and seem to cause the most confusion when discussing HIPAA. I call them the Three Big HIPAA Myths – you can’t place medical charts on exam room doors, you can’t use sign-in sheets, and you can’t leave messages on patients’ voice mail or answering machines.

Here, then are …

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Are physicians still responsible for mistakes in health care?

Physician
July 14, 2013

Who is responsible for mistakes in health care?  Who should take credit for success or blame for failure?   Most families, patients and obviously the courts, hold the doctor responsible.  It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect.  However, is this changing because of the Internet and big data?

In 2013, most patients have spent hours on the Internet …

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An ovary removed instead of an inflamed appendix: What happened?

Physician
July 13, 2013

On June 10, 2013 a 32-year-old pregnant woman was reported to have died after having an ovary removed instead of her inflamed appendix. As the infected appendix festered, she became septic and succumbed to multiple organ failure. This tragedy occurred in the UK in late 2011, but has just come to light.

How could this have happened?

Let me count the ways.

The surgery was performed by two trainee surgeons. Their …

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