Stop blaming patients for not doing enough to stay healthy

Physician
February 20, 2013

“Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying” argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington Post.

“Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their …

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Make patients more accountable for their own health

Physician
February 20, 2013

Let’s talk a little about health accountability.  Two news items have provoked the following rant: why is it always someone else’s responsibility?

The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller.  Such a drug would be a gold-mine for that pharma company because it could …

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Teaching children how to behave: 5 essential principles

Physician
February 19, 2013

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Young children are naturally petulant, noisy, and self-centered. We’re all born with ourselves in the center of the universe, an impression reinforced by parents who must cater constantly to their young babies. But babies become toddlers, and toddlers become children. Sometime during this transition, parents have to teach their children that they are part of a family. For a family to function …

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Advice for parents in medical school or residency

Physician
February 19, 2013

Being a single mother in medical school and residency isn’t a piece of cake. But, being a single parent in this world isn’t a piece of cake, either, and being a medical student and / or resident isn’t a piece of cake. Foregoing medical school isn’t necessarily the answer to any of that.

Here is some general advice I will share with parents, single or otherwise, who are facing decisions about …

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My first year as a locum tenens physician

Physician
February 18, 2013

Locum tenens (literally “place holder”) is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.

When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that …

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Is the history and physical examination worth performing anymore?

Physician
February 17, 2013

Would it be silly to ask, “Is the history and physical examination worth performing anymore?” especially in this era of high-technology medicine? Does it matter if the diagnosis is made by the bedside in contrast to CT or echocardiography? Someone did ask, and the answer is intriguing and was debated. Let’s look at the data.

Four hundred and forty-two consecutive patients were admitted from the emergency department to an …

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5 ways to adapt to an evolving healthcare workforce

Physician
February 15, 2013

Once upon a time a doctor first attended 3 or 4 years of college, then finished 3 or 4 years of medical school, trudged through 1 to 8 years of residency training to hang out “a shingle,” and finally begin to practice medicine, usually in solo practice.  Those days are long gone.  Time has expanded—schooling and training are longer.

Breaks are taken between and during this once but no longer traditional …

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6 tips for getting your doctor to listen to you

Physician
February 13, 2013

Have you ever gone to the doctor and felt like he wasn’t listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place?

Studies show that Read more…

You’re still a doctor, even if you’re not on call

Physician
February 13, 2013

Christmas morning at 1:30 am the phone chimes away. What the … I’m not on call.

“Please call Dr. Dred for patient Selma, perforated colon at local ER,” read the text message.

Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him.

So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, …

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Doctors are the canaries in the coal mine of medicine

Physician
February 12, 2013

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Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.

When there is bad air in the mine, the canary’s sensitive lungs will cause …

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A virtual office visit for your cold is not a good idea

KevinMD
February 10, 2013

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A version of this column was published on January 13, 2013 in USA Today.

Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.

I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an …

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How to know whether your cough is serious

Conditions
February 7, 2013

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I saw 17 patients in my primary care practice yesterday. Six of them were coughing.

One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …

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What is observation care? Clearing up common misperceptions

Policy
February 4, 2013

To treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.

Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, …

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Behind the fetish of vitamin B12 shots

Conditions
February 3, 2013

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Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.

It doesn’t matter who’s doing the quacking. A quack is a quack, even if …

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We can learn a lot by comparing guns to cars

Physician
February 1, 2013

A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch.

And I agree. Comparing guns and cars is fair, after all they kill about …

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From Mom: Here’s what it takes to be a great doctor

Education
January 31, 2013

My mom wrote me the following letter during my first semester in medical school. She has been a patient, and a mother/wife/sister/daughter of patients. She has been around countless doctors. Here is her take on what makes a great one.

Dear Son,

I am so very proud that you are becoming a physician and that you chose this profession, not for the prestige or the financial advantages, but because you want to …

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Do doctors take advantage of desperate couples with infertility loans?

Physician
January 30, 2013

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Somewhere near where you live, a couple will discover this week that they are infertile and that if they want biological children of their own, they are going to need in vitro fertilization (or IVF).  According to treatment protocol, the woman will need to take powerful medicines to ramp up her production of fertilizable eggs.  One monthly cycle of this treatment will run …

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Countertransference is a reality that must be grappled with

Education
January 29, 2013

“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”

***

“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”

“Hello? Hello?”

I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.

“I’m sorry, I can come back…” I start to say. …

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