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The surprising reason behind an early refill of alprazolam

Physician

October 2, 2015

Theresa arrived in a cloud of noise and commotion.

She had called after four o’clock the day before, but I hadn’t noticed the new message in my electronic inbox before I left the clinic.

Her almost brand new alprazolam bottle and her pain pills were missing, and Theresa was reeling. As she walked down the hall to the exam room, I heard her explain to Autumn how she had been to Walmart …

Bundled payments means the death of quality medical care

David Mokotoff, MD

Policy

September 30, 2015

A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested

For those who are unaware, “bundled payments” means that …

It’s time to remove EHR gag orders. For patient safety’s sake.

David Mann, MD

Tech

September 29, 2015

I recently read an article in Politico entitled “Doctors barred from discussing safety glitches in U.S.-funded software.” The article states that, despite massive public funding of electronic health records (EHR), the EHR corporations (including Epic Systems, Cerner, Siemens, Allscripts, eClinicalWorks and Meditech) routinely attach gag clauses to contracts with the hospitals and medical groups who purchase their systems. We are talking about gag clauses that prevent criticism by …

Medical Jeopardy is a terrible way to learn. Here’s why.

Jennifer Middleton, MD

Education

September 28, 2015

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.

Not that I don’t think games can have an important role in education — far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with …

Health inspectors should be trained to do what doctors do

Rocky Bilhartz, MD

Physician

September 28, 2015

This story is a great one.

It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.

Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.

Step, step, hitch. Step, step, hitch.

One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. …

How call rooms reflect the personality of residency programs

Katie Lockwood, MD

Physician

September 27, 2015

An intern pushed open the call room door so that twelve medical students could crowd their eager faces together to see where we might sleep for the next three years. Only a few months away from medical school herself, the intern acted as if sleeping in such quarters were second nature. She gestured to the fluffy quilts the residents had brought from home to adorn their beds and giggled about …

Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash

mksap

Conditions

September 26, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 27-year-old woman is evaluated for a 1-week history of an intensely pruritic rash on her eyelids. She applied a new brand of eye makeup just prior to the onset of the rash. She immediately discontinued its use and has been applying a moisturizing lotion to both eyelids since then without improvement in her symptoms. …

Osteoporosis: A silent assailant turned me from physician to patient

Karen S. Sibert, MD

Conditions

September 25, 2015

It’s amazing how quickly my role changed from physician to patient, thanks to a silent assailant: osteoporosis.

I went to the gym in the morning before work 12 days ago, as I often do now that my children are all grown up and out of the house. First, a couple of light sets of leg exercises served as a warm-up, and then I started a set with a barbell on my …

Do patients contribute to the God complex in surgeons?

Dr. Henry Woo

Physician

September 23, 2015

Medical oncologist, Dr. Ranjana Srivastava wrote on the subject on how doctors treat doctors may be medicine’s secret shame in the Guardian back in February 2015.

About a month later, vascular surgeon Dr. Gabrielle McMullin used a book launch speech to expose the problems of sexual harassment in the surgical profession. She highlighted a story of where a neurosurgical trainee had refused sexual advances and subsequent to launching a formal complaint, …

It is time for an honest conversation about money and cancer

James C. Salwitz, MD

Physician

September 22, 2015

There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer will be rich beyond anyone’s wildest dreams. In addition, I have personally known several thousand …

When patient-centered care becomes patient-dictated care

Elaine Khoong, MD

Physician

September 21, 2015

“I’d like an MRI for my leg pain. I haven’t had an MRI for many years, and I’m worried.”

These were some of the first words I heard from a patient I was seeing for a new patient visit. Based on this patient’s story and physical exam, her pain was most consistent with a muscle strain. My preferred approach to manage this complaint was to ask the patient to rest her …

How good of a clinician are you?

Sandeep Palakodeti, MD, MPH

Physician

September 21, 2015

In psychology, the Lake Wobegon effect refers to a mythical town where “all the women are strong, all the men are good-looking, and all the children are above average.” In other words, humans have a tendency to overestimate their capabilities, particularly in relation to others.

As a physician, I have yet to meet a fellow doc who didn’t think that their patients loved them or that they weren’t great clinicians. And …

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How good of a clinician are you?

Pain tolerance: A story of two patients

Christopher Stookey, MD

Physician

September 21, 2015

One thing I learned early on as a doctor is different people have different tolerances for pain. At one end of the spectrum, for example, I recall a woman who came to the emergency department with a small splinter in her foot. She arrived wailing in pain, and we had to take her back to a treatment room ahead of other patients because her howling was scaring the people in …

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Pain tolerance: A story of two patients

The story of the pot-smoking neurosurgeon is more complicated than you think

Vamsi Aribindi, MD

Meds

September 20, 2015

A brief article recently posted the name and picture of a neurosurgery resident accused of smoking marijuana on the job. Dr. Gunjan Goel, MD is a neurosurgery resident at University of California, San Diego, and the list of her awards and publications alone is almost as long as my entire CV. The article is brief, and rather uninformative. The only facts that are known are this: The …

Caring for the dying patient is a rewarding challenge

Earl Stewart, Jr., MD

Physician

September 17, 2015

I walked silently into the pristinely decorated room of the hospice facility and was greeted by her family. She lay there, not particularly responsive to her surroundings under the pressure and influences of metastatic stomach cancer. The warmness and smiles on the faces of her family told me that at some point and somehow, in the midst of actively witnessing the transition of their mother, aunt, sister, and grandmother, they …

Treating cancer: Doing nothing is also a choice

James C. Salwitz, MD

Physician

September 14, 2015

Dear doctor:

Attached please find the medical records of Mr. Ron C., who is transferring medical care to your office. Ron is a 63-year-old gentleman with recurrent lung cancer, which has spread to his opposite lung and bones. There are multiple treatment choices for his disease, which we have discussed in detail. However, Ron is leaving my care, because he does not trust me.

As you are well aware, metastatic lung cancer …

The cafeteria can tell you a lot about the hospital. Here’s how.

Suneel Dhand, MD

Physician

September 14, 2015

Hospital cafeterias are important places. Great progress has been made over the last few years in raising the standard of the food served (to both patients and staff!), with much more emphasis too on making the options healthier and nutritious.

Speaking as someone who has worked in several different hospitals, and with my own general interest in health care quality and improving the patient experience, it’s always very interesting to look …

Can you fake empathy until it becomes real?

Rebekah Bernard, MD

Physician

September 13, 2015

Studies show over and over again that empathy is the key to physician-patient communication and is directly related to patient satisfaction, adherence to medical treatment, lawsuits, and clinical outcomes. Yet despite its importance, many doctors still struggle with showing empathy.

The reality is that while most medical students start school with high levels of empathy, it doesn’t take long before that empathy is beaten out of us. Studies show …

How anatomy lab changed this medical student forever

Anonymous

Education

September 13, 2015

I’m supposed to speak at the body donor memorial in September. I told the organizers my speech was written. “Don’t worry,” I assured them. “I have it all in my head, just need to get it down on paper. I’m a writer; it’s my process.” But the truth is that I am struggling with what to say. I’ve tried to write it, but I just end up drinking a pot …

The day I saw the humanity in medicine

Robert G. Dorfman

Education

September 13, 2015

At the heart of American medicine is the concept of bedside manner, and with it the concern that doctors are cold and unemotional. Indeed, doctors are exposed to disease and misfortune on a daily basis. A patient who presents with stage IV metastatic stomach cancer is just one of the many hundreds or thousands of such patients that will walk through the hospital doors in the coming years. Quotidian exposure …

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The day I saw the humanity in medicine

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