The professional status of physicians is at risk

Physician
July 12, 2011

According to Wikipedia, up to the beginning of the 19th century there had been only 3 occupations that were considered to be professions, Divinity, Medicine and Law.

A profession is considered a trade or occupation that transforms itself through “the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit, discipline members, and enforce adherence to an ethical code of practice.”

Professionals are …

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Sometimes the treatment is worse than the disease

Conditions
June 30, 2011

To do nothing is sometimes a good remedy.
-Hippocrates

Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence.

Edna has been my …

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Pharmacies selling prescription information to data mining companies

Meds
June 30, 2011

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant.  To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal …

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The decision point psychiatrists faced with psychotherapy

Physician
June 29, 2011

There’s been plenty of buzz about a recent New York Times story, “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” by Gardiner Harris. The story is essentially a profile of Dr. Donald Levin, a 68 year old psychiatrist who has a private practice in Doylestown, Pa.

It is a poignant example of a common situation in psychiatry. Older psychiatrists were trained during a time when there …

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Why doctors shouldn’t leave their emotions behind

Physician
June 28, 2011

Part of the reason I became a physician was because I got tired of watching those close to me as they suffered through illness and eventually died, while I stood helplessly by, unable to do a thing.

Throughout my training I watched as my mentors interacted with their patients, displaying a political correctness matched with just enough outward emotion so that there was no telling the difference between the good news and the bad.

“Don’t …

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Reasons why medical students burn out and become depressed

Education
June 27, 2011

As I finished my 24-hour call recently, I was reminded of a 2009 study revealing a decline in empathy as medical students transition from their mostly-didactic second year to third year, which is essentially an apprenticeship in the hospital with lecture as an afterthought.  I began my third year with what most would argue is the most difficult rotation, surgery, and my experiences over …

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New fields in general surgery and the rise of the surgical hospitalist

Physician
June 24, 2011

As medicine adapts to the 21st century, new specialties arise.

General surgery is seeing two new fields emerge. One is “Acute Care Surgery,” which encompasses three facets of general surgery — emergency surgery, critical care and trauma care. The other is the concept of a surgical hospitalist. That is, a surgeon works only in a hospital and has no office or private practice. The idea is similar to the medical …

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Reasons why your doctor is running late

Physician
June 24, 2011

It may not be rabbit season or duck season but it definitely seems to be doctor season.

Physicians are lined up squarely in the gun sights of the media,  government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim.   It’s not enough any more to wear a bullet proof white coat.  …

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Difficult testing decisions for parents with premature babies

Physician
June 22, 2011

Many people think that tests (blood work, x-rays, scans, etc.) mean their doctor is doing something constructive and working hard to figure out what is wrong. But tests are a double-edged sword.

When I trained most diagnoses were derived from careful history and a physical exam. Perhaps because our province did not have funds to have enough CT scanners and we didn’t have an MRI, those tests were on a …

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Hospitalists should limit the number of patients they see

Physician
June 21, 2011

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a …

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Explaining how an EKG works

Conditions
June 21, 2011

What is an EKG?

EKG stands for electrocardiogram.  It should probably and sometimes is abreviated ECG, but EKG seems to have stuck as more popular.

Scientists have known for over 120 years that the heart gives off electrical currents when it beats, but it was the Dutch scientist Willem Einthoven in the early 20th century who discovered the nature of this phenomenon and who developed the electrocardiogram as a tool to …

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Why the AMA is in decline, and should doctors care?

KevinMD
June 20, 2011

The American Medical Association recently released its membership numbers, and they’re declining.

According to MedPage Today, the AMA “saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.”

It’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%.  But it seems many physicians have little …

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Before getting a CT scan, ask your doctor if its really needed

Conditions
June 15, 2011

How and when do new medical technologies become the standard of care?

A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.

Looks a bit like a medieval torture doughnut.

The only thing that surprises me about this is that it’s not more.

Way more.

I remember the first time I actually ordered a CT scan on a patient all by myself, in …

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A history of smallpox in America

Conditions
June 14, 2011

This past Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.

In 1751, when George …

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MRI overuse is widespread, and dangerous to patients

Physician
June 13, 2011

MRI overuse and misuse really make me angry.

Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing a full examination. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows.

MRI is unnecessarily overused. In …

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Doctors don’t take snow days

Physician
June 12, 2011

Editor’s note: This post was originally written this past winter.

Boston had another blizzard today. I was really worried about this one. It was supposed to snow hard, about three inches an hour from 3 a.m. to 12 p.m. with poor visibility, impassable roads, etc. I’ve driven home in snow like that, and I find it terrifying. Your car won’t do what you want it to, and worse, other people can’t …

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The Golden Moment in medical malpractice

Physician
June 12, 2011

As Kevin Pho pointed out in his piece, “How malpractice hurts doctors and their future patients,” physicians who have been through trial are often never quite the same.

Physicians who have been sued in medical malpractice case are often referred to as the “Second Victim,” a term that says it all.   When a mistake is made and a patient is injured, the physician also suffers, often in silence and …

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