Is medicine a profession or a commodity?

Physician
May 9, 2013

Over the past twenty years, Wall Street business has covertly taken over the medical profession while doctors have been distracted by a deluge of procedural, financial, and legal paperwork. A strategic plan was launched to extract exorbitant profit benefiting business, and is now mainstream without challenge from our profession nor the public.

Legal boardrooms were abuzz in the 1990s as a blueprint assault was made against organized medicine, redirecting a profession into a …

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The big impact of small changes for DSM-5 ADHD diagnosis

Conditions
May 8, 2013

As chairman of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Work Group on Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorders, I read the article on ADHD that appeared on the front page of The New York Times on April 1, 2013, with interest and also dismay, which was shared by my colleagues in the work group. We recognize the effort involved …

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A radiologist reflects on indeterminate findings

Physician
May 7, 2013

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Radiologists care about their patients, even though most diagnostic radiologists don’t meet and greet their patients the same way direct-care clinicians do.

Some people have the erroneous perspective that radiologists and pathologists don’t care about the welfare of their patients. It is possible for us to understand that view if we look at radiologists and pathologists as isolated workers who work …

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5 critical elements of patient-centric care

Tech
May 7, 2013

I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.

1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category.  While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say …

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The problem with leaping into a gluten-free diet

Conditions
May 5, 2013

In recent times, it seems as though every newspaper or magazine with a dedicated health section has a focus on the perils of gluten and the benefits that come along with adhering to a gluten-free diet. Or better yet, each week brings a new celebrity touting the dangers of gluten, and how it is an unhealthy ingredient that should be avoided religiously. Is this truly sound advice?

As a practicing academic …

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Azithromycin and long QT syndrome: Facts from a cardiologist

Meds
May 4, 2013

Text message: “John, This cough and congestion is killing me. It’s turning thick and green. Can you write me a Z-pak? It always works for me.”

If you write a blog on medical decision-making and heart rhythm matters, it seems an incredible omission not to opine on the FDA warning concerning the commonly used antibiotic azithromycin (the drug in a Z-pak). Quoting directly from the FDA warning:

[Azithromycin] can cause …

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Watching my grandfather pass away changed my life

Education
May 4, 2013

Watching my grandfather pass away changed my life. It wasn’t sudden and it shouldn’t have been unexpected. Yet it seemed unnatural, mysterious, and incredibly uncomfortable. I can still remember receiving the phone call from the hospital, my mother letting out a distraught cry that my grandfather was no more. My initial reaction was shock and confusion: I just couldn’t understand what had happened. Looking back, he had been under intensive …

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Why family medicine was the best choice for me

Education
May 3, 2013

When I came to medical school, I was certain I wanted to do primary care.  Despite the forces that steer many of us off the path – how many times have we heard, “but you’re too smart to do primary care!”? – after three years of medical school, I was still committed to primary care.

But I struggled with which type of program would be best for me. I applied to both …

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That slippery bowel wants to be everywhere

Physician
April 29, 2013

Next in a continuing series.

Inside the belly, everything is slippery. The peritoneum is a glistening layer of self-moistening plastic wrap, enveloping the surfaces of all the organs, and the inner aspect of the abdominal wall. Undisturbed, the intestines coil and slither, reptilian. Watching waves of peristalsis makes me smile: there’s something always entertaining about those moving contractions, following one upon another, gurgling, surprisingly tight bands of tension moving …

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The ethical shortcomings of selling supplements

Meds
April 28, 2013

A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”.

As I read her screed against  the ND who conducted a cursory history and exam before checking off $750 worth …

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Practical advice for the parent of a pre-med

Education
April 27, 2013

For over a decade, I have advised pre-meds on how to maximize their chances of getting into medical school. During this time, as I witnessed thousands of anxiety-ridden pre-meds wade doggedly through the murky waters of medical school admissions, I have noticed pre-med difficulties often pale in comparison to those of pre-meds parents. It’s often much easier to be the athlete on the field than the coach on the sidelines. …

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Treating the enemy still requires respect and professionalism

Physician
April 26, 2013

A city is free. A town is celebrating.

I sat and watched the local news station announce that the second suspect in the 2013 Boston Marathon bombings had been taken into custody and was being transported to a nearby hospital.

I am relieved. And thankful.

Then I wonder. I wonder about the hospital that this suspect is being transferred to, and I wonder about my colleagues. What are the nurses, the doctors, and …

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How my geriatric practice works

Physician
April 22, 2013

A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.

I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our …

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As an oncologist, I hate running late

Physician
April 22, 2013

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day.  However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve.  I really hate it when patients are late.

Now, I have to admit this is a unique …

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Radiation therapy: Don’t let me talk you into it

Physician
April 20, 2013

When I was young and foolish and just starting out in my career, I found it very hard to take “no” for an answer.  If a patient needed radiation therapy, and he or she didn’t want to have it, I did my very best to talk that patient into it.   I have always been a very persuasive person—if I didn’t get the go ahead on the first formal consultation, there …

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The locked inpatient psychiatry unit: What’s it really like?

Physician
April 19, 2013

As I walk onto any one of the locked psychiatric units at our hospital I am immediately struck by the hum of intense activity. It’s like the startling feeling of stepping out of an air-conditioned apartment into the steamy height of a New Haven summer. Across from the nurses’ station, a psychologist interviews a patient retelling the story of constant childhood molestation as rivulets of mascara run down her cheeks. …

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Anesthesiologists are victims of their own success

Physician
April 18, 2013

New research just out in the journal Psychology and Aging says pessimists live longer and healthier lives. If this is true, then contemplating the future of anesthesiology ought to make us immortal, because our professional prospects don’t look bright.  As we teach residents to do what we’ve always done, shouldn’t we ask ourselves honestly if we’re training them for a future that doesn’t exist?

Especially here in California, it seems …

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So your partner wants to remove your pubic hair

Physician
April 16, 2013

A divorced friend of mine who recently started dating was shocked to find that the complete absence of female pubic hair seemed to be an expectation among her potential partners. I’m not surprised, when I was in the dating pool a couple of years back there were men who actually listed full clamscaping required among the personal attributes they were seeking in a girlfriend (and here I was looking for …

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