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Why are so many people opposed to epidurals?

Conditions

October 10, 2014

To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger.

The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In …

It’s time to talk trade-offs in health care

Dr. Saurabh Jha

Policy

October 10, 2014

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An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking …

The problem with primary care residency programs

Susan Putnins

Education

October 8, 2014

“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.”

I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with …

From PA to MD: An appreciation for physician education

Christin M. Giordano, PA

Education

October 6, 2014

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My journey in medicine began as a young child: I was the typical kid who knew I wanted to a be a doctor since I was a child and was thrilled when I was accepted into an 8-year college program which culminated in a medical degree. However, by the end of my undergraduate program, medicine was changing: doctors were spending less …

How to give feedback to medical students

Alex Lickerman, MD

Education

October 5, 2014

My student’s voice trembled as she answered my question. “How do you think you’ve done so far?” I’d asked her. We’d been together on the general medicine inpatient ward for two weeks — the midpoint of the rotation — and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance …

3 ways to improve primary care access

Richard Migliori, MD and Grace Terrell, MD

Policy

October 4, 2014

Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits.

Unfortunately, too many Americans lack easy access to primary care. Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. …

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3 ways to improve primary care access

MKSAP: 59-year-old woman with pain of the right foot

mksap

Conditions

October 4, 2014

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

A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications …

7 common reasons for refusing vaccines

Claire McCarthy, MD

Meds

October 3, 2014

The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S..

We have got to get more people immunized.

Essentially all of the cases were linked to “importations,” cases brought in from other countries …

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7 common reasons for refusing vaccines

There is something very special about being a physician

Arshya Vahabzadeh, MD

Physician

October 2, 2014

Pretty much on a weekly basis I come across an article about how awful life is as a practicing physician. Articles focus on how unhappy physicians are with their jobs, with their hours, with their pay or with health care reform.

After almost a decade of practice, the fact is that I like my job.

Is it perfect? Absolutely not: quite far from it, in fact. There are certainly many times when …

Joan Rivers’ death: What went wrong?

Karen S. Sibert, MD

Physician

September 29, 2014

The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews.

With a physician who is an expert in airway anatomy at her side, and all the technologic advantages …

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Joan Rivers’ death: What went wrong?

When your child doesn’t poop: Solving the constipation death spiral

Roy Benaroch, MD

Conditions

September 27, 2014

Michelle wrote in: “We trained my 3-year-old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there …

Emergency room doctors can safely use bedside ultrasound

Janice Boughton, MD

Physician

September 27, 2014

I have been following the progress of bedside ultrasound (using ultrasound as a diagnostic tool during my physical exam of patients) as it gets a foothold in standard medical practice since I first started learning to do it about 3 years ago. Every so often a study comes out which warms my heart as it proves that less (radiation, expense) is more in treating patients.

An article came out in the …

Vulnerability is a virtue in medicine

Michael Metzner

Education

September 26, 2014

Medical students are repeatedly taught the importance of the physician-patient relationship. We are told that to be a good doctor we must strive to exhibit compassion, empathy, respect, professionalism and confidence all while applying our medical knowledge to figure out a diagnosis and treatment plan. If you add in the pressure of doing this within a 15-minute visit, all while answering questions faster than an Internet search, it can get …

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Vulnerability is a virtue in medicine

How hospitals discourage doctors: A step by step guide

Richard Gunderman, MD, PhD

Physician

September 26, 2014

Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.

Within a minute, an administrative secretary came out and …

An insider guide to reading your radiology report

Rourke Stay, MD

Conditions

September 26, 2014

The simple truth is that radiology reports can be hard to read, especially for those without a medical background. The combination of advanced medical technology and the wonderful subtle intricacies of the human body often result in a final document that more closely resembles a William Faulkner novel (translation: difficult to understand!) than Dr. Seuss. The goal is to try to …

Health care fails to adopt technology. Here are 5 reasons why.

Robert Pearl, MD

Tech

September 25, 2014

Why do so many seemingly great technologies fail to penetrate the health care system?

I hope the following five answers shed some light on the realities of technology adoption in health care.

1. Many new technologies don’t address the real problem

Tech entrepreneurs often take a backward approach to invention. They start by discovering a nifty technology. Later, they figure out how people can use it.

This technique often teaches entrepreneurs a tough lesson: Technology …

A twisted argument against end-of-life care

James C. Salwitz, MD

Physician

September 25, 2014

“All your patients will die. Maybe not today, but someday. The defining fact of life is that it ends. Only a fool would dedicate their career to fighting something that can never be beaten. Therefore, a doctor’s task cannot be to fight death. A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to …

Don’t spank your children. Do these 5 things instead.

Wendy Sue Swanson, MD

Conditions

September 24, 2014

In my mind it’s no wonder the American Academy of Pediatrics has a statement against spanking. Spanking, in the simplest form, is the act of hitting a child, using physical force to try to get a different outcome. Thing is, spanking is an ineffective discipline tool in the long run and research shows it’s damaging to a child’s mental health. …

“I want to give up my son”: Is that child abuse?

Alberto Hazan, MD

Physician

September 24, 2014

The case

A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: “I want to give up custody of my son.”

The patient is well dressed — and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone.

According to the patient, she is a single mother with no support system. Her son’s father deserted …